S. Melinda Spencer

Racial Differences in Self-Rated Health at Similar Levels of Physical Functioning: An Examination of Health Pessimism in the Health, Aging, and Body Composition Study

BACKGROUND The health pessimism hypothesis suggests that Black elders are more pessimistic about health than Whites and therefore tend to report lower self-rated health (SRH) at comparable health status. The current analysis examined the factors associated with SRH and tested the health pessimism hypothesis among older adults at similar levels of physical functioning. METHODS The study example included 2,729 Health, Aging, and Body Composition study participants aged 70-79 years. We used hierarchical logistic regression to examine the association between race and SRH while adjusting for demographic, physical health, and psychosocial factors. The analyses were repeated for participants at similar levels of objective functioning to test the health pessimism hypothesis. RESULTS The association between race and SRH remained independent of physical and psychosocial health variables, with Whites being 3.7 times more likely than Black elders to report favorable SRH. This association was significant at each level of physical functioning and greater at the higher (odds ratio [OR] = 5.5) versus lower (OR = 2.2) levels of functioning. CONCLUSIONS The results suggest greater health pessimism among Black elders and expand previous work by including objective functioning in multidimensional models to deconstruct race variations in the SRH of older adults.

Effect of obesity on health-related quality of life among appalachian elderly

Background There is a paucity of research on health behaviors, health status, and overall health-related quality of life among Appalachian elderly. Identifying factors among older adults that place them at risk for low health-related quality of life is important for targeting unmet health needs and guiding community efforts to help improve population health. Methods For this study, we examined the relationship between obesity and health-related quality of life among Appalachians aged 65 years or older using the 2000 Behavioral Risk Factor Surveillance Survey data. Results Our results showed that obese elderly Appalachians report poorer self-rated health and more days of poor physical health compared with their nonobese counterparts. Conclusion The goals put forward in Healthy People 2010 include the reduction of obesity and enhancement of quality of life. If such health disparities are to be eliminated and quality of life enhanced, a sustained effort to identify their determinants among Appalachian elderly is needed.

Research on Rural Caregiving: A Literature Review

The goals of this article are to present a systematic review of rural caregiving research and provide suggestions for future research efforts. The review, conducted through a search of databases, was limited to original research articles published between 1990 and 2007. The articles focused on informal caregiving of dependent older adults in rural settings. Thirty-one articles met the inclusion criteria, with 11 being rural/urban comparative studies and 20 being rural only studies. The majority of the studies were quantitative and cross-sectional. Areas for improvement in future research include incorporating theory, defining key terms, using probability sampling, examining data longitudinally, including objective measures, recruiting more racially/ethnically diverse samples, and using a mixed-method approach. Currently, it is difficult to know the extent to which the rural environment influences informal caregiving. Additional research is needed to develop a more thorough understanding of caregiving in the rural context.

Adult Caregiving Among American Indians: The Role of Cultural Factors

PURPOSE With a sample of American Indian adults, we estimated the prevalence of adult caregiving, assessed the demographic and cultural profile of caregivers, and examined the association between cultural factors and being a caregiver. This is the first such study conducted with American Indians. DESIGN AND METHODS Data came from a cross-sectional study of 5,207 American Indian adults residing on 2 closely related Lakota Sioux reservations in the Northern Plains and one American Indian community in the Southwest. Cultural factors included measures of cultural identity and traditional healing practices. RESULTS Seventeen percent of our sample reported being caregivers. In both the Northern Plains and Southwest, caregiving was positively correlated with younger age, being a woman, larger household size, attending and participating in Native events, and endorsement of traditional healing practices. In both regions, attendance and participation in Native events and engagement in traditional healing practices were associated with increased odds of caregiving after adjusting for covariates. Only in the Northern Plains did we find that speaking some Native language at home was associated with increased odds of being a caregiver. Examination of interaction terms indicated some sex differences in the association between cultural factors and caregiving in the Northern Plains but not in the Southwest. IMPLICATIONS Our findings indicate that greater cultural identity and engagement in traditional healing practices are related to caregiving in American Indian populations. Caregiving research, intervention efforts, and caregiving programs and services in Native communities should pay special attention to the dynamics of culture and caregiving.

Differences in Caregiving: Does Residence Matter?

Many rural residents require care as they age, but the stress associated with providing care to dependent elders may be exacerbated in nonmetropolitan areas due to the lack of formal services. To better understand residential variation in caregiver outcomes, a random-digit telephone survey was conducted in 2004 with 219 metropolitan, 77 micropolitan, and 104 nonmetropolitan West Virginia caregivers. Residential differences were not detected for caregiver well-being outcomes of burden and depressive symptomatology. However, nonmetropolitan caregivers reported more medical conditions than caregivers in other residential categories. Taken together, findings of this study do not support the notion that rural residence always places caregivers at risk for negative outcomes.

Influence of caregiving on health-related quality of life among American Indians.

Caregiving can have a profound effect on the health of the caregiver, yet research on caregiving among American Indians is limited. The purpose of this study was to examine the influence of caregiving on the health‐related quality of life (HRQoL) of American Indians enrolled in the Education And Research Towards Health (EARTH) study. Participants in the EARTH study represented three different tribes in the Northern Plains and Southwestern regions of the United States who completed self‐administered, computer‐assisted questionnaires between 2003 and 2006. Participants were classified as caregivers if at least one adult relied on them for personal care or as non‐caregivers (n = 3,736). Caregivers were further classified according to type; those caring for an adult with unspecified needs (CAU, n = 482) and those caring for an adult with mental or physical difficulties (CAD, n = 295). HRQoL was measured using the mental and physical health component scores of the Medical Outcomes Study 12‐item Short‐Form Health Survey. Regional differences emerged with regard to caregiver type. Across both regions, non‐caregivers reported significantly better mental and physical health than CAD, and the health of participants classified as CAU did not differ from that of non‐caregivers. The health of American Indian caregivers depends on the kind of care provided, but detailed measures of caregiving are necessary to understand how caregiving influences health. This has implications for the design of effective interventions in tribal communities.

Examining the Relationships Between Religiosity, Spirituality, Internalized Homonegativity, and Condom Use Among African American Men Who Have Sex With Men in the Deep South.

The Sexual Health in Faith Traditions Study evaluated the relationships between religiosity, spirituality, internalized homonegativity, and sexual risk behaviors among a sample of African American men who have sex with men living in the Deep South. Participants were recruited primarily from Black Gay Pride celebrations to complete a self-administered, paper-and-pencil survey. Structural equation modeling was used to determine relationships between key constructs and condom use for insertive (n = 285) and receptive (n = 263) anal intercourse in the past 3 months. Almost half of respondents reported using condoms “every time” when engaging in insertive (48.3%) or receptive (45.1%) anal intercourse. Religiosity and spirituality were differentially associated with dimensions of internalized homonegativity. While no significant direct relationships were reported between either religiosity or spirituality and condom use, dimensions of internalized homonegativity mediated significant indirect relationships. Findings suggest that religiosity and spirituality influence African American men who have sex with men’s internalized homonegativity and, subsequently, engagement in safer sex behaviors.

Health Information-Seeking Practices of African American Young Men Who Have Sex with Men: A Qualitative Study.

The current study used a qualitative, phenomenological approach to investigate the health information–seeking practices of African American young men who have sex with men (AAYMSM). Forty-two self-identified AAYMSM, aged 18 to 21, residing in a Southeastern U.S. city participated in a qualitative focus group or face-to-face interview to examine their access to health information, current and preferred sources and types of health information, and recommendations for improving the delivery of health information to AAYMSM. Participants reported accessing health information from a complex network of sources, including peers, health care professionals, parents, and the Internet. Most consulted these sources to access information about the prevention of sexually transmitted infections (STIs) and HIV/AIDS. In addition, participants provided recommendations to improve delivery of health information and identified parents and the Internet as preferred sources of health information. This research highlights the importance of developing health information, specifically for AAYMSM.

Health Communication Practices among Parents and Sexual Minority Youth.

Positive perceptions of parent–child communication can influence behavioral outcomes such as sexual behavior and substance use among young people. Parent–child communication has been effective in modifying adverse health outcomes among heterosexual youth; however, limited research has examined the perceptions of parent–child communication among sexual minority youth, specifically African American young men who have sex with men (AAYMSM). Understanding AAYMSMs and parents’ health communication perceptions and practices is critical for improving delivery of health information for this population and communication about sensitive health issues. Using mixed-methods research, the authors conducted focus groups and interviews and administered a cross-sectional survey to 42 AAYMSM and 10 parents of AAYMSM. Descriptive statistics were used to examine survey responses. Thematic analysis revealed that sexual orientation and HIV/AIDS were the most reported topics discussed among both parent and youth participants. Barriers to parent–child communication included fear, embarrassment, lack of time, and the limited availability of AAYMSM-specific health information. Recommended strategies for improving parent–child communication are discussed. Findings will assist in the development of targeted interventions to improve parent–child communication about health among AAYMSM and parents.

Assistive technology use of older American Indians in a southeastern tribe: the native elder care study.

The objectives of this study were to examine the prevalence of assistive technology (AT) use, type of assistance used for each activity of daily living (ADL) limitation, and correlates of AT use among Native Indian aged 55 and older. Data were collected as part of a cross‐sectional study of disability with 505 members of a federally recognized tribe using in‐person interviewer administered surveys. Participants who reported difficulty with ADLs, including bathing, dressing, eating, transferring, walking, toileting, grooming, and getting outside, were asked about AT use. Other measures were demographics, living arrangements, receipt of personal care, Medicare and Medicaid beneficiary status, number of chronic conditions, lower body function, and personal mastery. Results indicated that 22.3% of participants aged 55 and older and 26.0% aged 65 and older reported AT use. Toileting had the largest percentage of participants who relied on AT only and getting outside had the largest percentage of participants relying on a combination of AT and personal care. Multiple variable logistic regression analysis identified receipt of personal care, having more chronic conditions, and poorer lower body function as significantly associated with higher odds of AT use. The results suggest that there is greater AT use in this sample than in same‐aged adults in national samples. This greater use may be reflective of a combination of higher disability rates, cultural factors, and greater access to AT. Clinicians can use this information to identify the activities with which their patients are experiencing the most difficulty and which ones can be addressed with AT versus personal care.