Susan L. Ivey

Lower-Body Function, Neighborhoods, and Walking in an Older Population

BACKGROUND Poor lower-body capacity is associated with reduced mobility in older populations. PURPOSE This study sought to determine whether neighborhood environments (e.g., land-use patterns and safety) moderate that association. METHODS The study is based on a cross-sectional sample of 884 people aged > or =65 years identified through service organizations in Alameda County CA, Cook County IL, Allegheny County PA, and Wake and Durham counties NC. In-person interviews focused on neighborhood characteristics, physical and cognitive function, and physical activity and walking. Functional capacity was tested using measures of lower-body strength, balance, and walking speed. The main outcome was time spent walking in a typical week (<150 vs > or =150 minutes per week). Objective environmental measures were also included. Estimates of main and interaction effects were derived from regression models. RESULTS Living in a residential area, compared to a mixed-use or commercial area, was associated with less time spent walking (<150 minutes per week; OR=1.57, 95% CI=1.04, 2.38). Living in a less-compact area (greater median block length) is also significantly associated with less walking for seniors, but only among those with excellent lower-body strength. CONCLUSIONS Neighborhood type is associated with walking among older people, as it is among the general adult population. In individuals with poor lower-body function, no association was found between residence in a less-compact area and walking. For those people, the relationship between neighborhood characteristics and walking requires further study.

From Hospital to Home: Assessing the Transitional Care Needs of Vulnerable Seniors

PURPOSE This qualitative study assessed the needs of patients and caregivers during the transition from hospital to home. We specifically identified unmet needs of ethnic minorities, recent immigrants, and seniors with limited English proficiency (LEP). Findings are translated into recommendations for improving services to these groups during health care transitions. DESIGN AND METHODS This needs assessment included extensive analysis of qualitative data collected from 20 language-, culture-, and ethnic-specific focus groups with caregivers who recently assisted a senior after a hospital discharge. Findings from these focus groups were supplemented by 5 in-depth, longitudinal case studies of recently hospitalized seniors and their caregivers. RESULTS Inadequate information and training at discharge were themes that spanned all groups, despite ethnicity or language. Additional unmet needs were identified for ethnic minorities, those with LEP, and recent immigrants, including lower levels of social support than might be expected, lack of linguistically appropriate information and services, and cultural and financial barriers to using long-term care services. IMPLICATIONS As ethnic diversity increases among older Americans, it will become increasingly important to design health care services to meet the needs of diverse groups. Recommendations include assessments of informal care, bilingual information and services, partnerships with community agencies providing culturally competent services, and expansion of home- and community-based services to near-poor seniors.

Collection of data on patients' race and ethnic group by physician practices.

The authors argue that physician practices should routinely collect data on the race and ethnic group of their patients. They caution against the use of these data to infer information about health-related values or beliefs, and they discuss the benefit of using these data at the population level to detect disparities in care and to improve the quality of care.

Alarming trends in pediatric overweight in the United States

SummaryObjectives:A comprehensive review of the pediatric overweight literature was undertaken to examine secular changes in the prevalence of pediatric overweight, the current magnitude and scope of pediatric overweight, and the identity of high-risk groups in the U.S.Methods:Articles published in the last two decades and studies of nationally representative numbers of children were highlighted.Results:An unprecedented three-fold increase in the prevalence of pediatric overweight has occurred in recent decades in the U.S. and evidence suggests that this trend is continuing unabated. While no sociodemographic or racial group has escaped this trend, particularly at risk are African American girls, Hispanic girls and boys, and children from low-income households.Conclusions:The rising prevalence of pediatric overweight in the U.S. is a harbinger of increases in diabetes, cardiovascular disease and numerous other health problems. Furthermore, disparities in pediatric overweight along ethnic and socio-economic lines are expected to further exacerbate current disparities in rates of chronic disease. Strategies and programs to prevent overweight among children are urgently needed.ZusammenfassungAlarmierende Trends in der Verbreitung von Übergewicht im Kindesalter in den USAZielsetzung:Eine umfassende Prüfung der Literatur zu Übergewicht im Kindesalter wurde vorgenommen, um langfristige Veränderungen im Vorkommen, das gegenwärtige Ausmass und die Reichweite von Übergewicht im Kindesalter zu untersuchen und um Gruppen mit besonders hohem Risiko in den USA zu identifizieren.Methoden:Spezifisch berücksichtigt wurden Artikel, die während der letzten 20 Jahre publiziert wurden und Studien mit national repräsentativen Teilnehmerzahlen.Ergebnisse:Eine noch nie da gewesene Verdoppelung der Prävalenz für Übergewicht im Kindesalter war in den letzten Jahrzehnten zu verzeichnen und die Datenlage deutet darauf hin, dass sich dieser Trend unvermindert fortsetzt. Keine sozio-ökonomische oder ethnische Untergruppe konnte sich diesem Trend entziehen. Afroamerikanische Mädchen und lateinamerikanische Mädchen und Knaben sowie Kinder aus Haushalten mit niedrigem Einkommen sind besonders gefährdet.Schlussfolgerungen:Die steigende Prävalenz für Übergewicht im Kindesalter in den USA ist ein Vorbote für eine Zunahme von Diabetes, Herzkreislauferkrankungen und zahlreichen anderen Gesundheitsproblemen. Weiterhin ist zu erwarten, dass die ethnischen und sozio-ökonomischen Ungleichheiten bei Übergewicht im Kindesalter die bereits bestehenden Ungleichheiten im Vorkommen von Krankheiten noch verstärken. Es bedarf dringend Strategien und Programme zur Vorbeugung von Übergewicht bei Kindern.RésuméTendance alarmante du surpoids pédiatrique aux Etats-UnisObjectifs:Une revue exhaustive de la littérature sur le surpoids pédiatrique a été effectuée pour examiner les changements au cours du siècle de la prévalence du surpoids, son importance actuelle et son extension, ainsi que pour identifier les groupes à haut risque aux Etats-Unis.Méthodes:Etude des articles publiés au cours des 20 dernières années et des études portant sur des échantillons d’enfants représentatifs au niveau national.Résultats:Un doublement sans précédant de la prévalence du surpoids pédiatrique s’est produit au cours des récentes décennies aux Etats-Unis et les données suggèrent que cette tendance se poursuit inexorablement. Bien que cette tendance touche tous les groupes socio-démographiques et ethniques, les filles africaines-américaines, les garçons et les filles hispaniques et les enfants de familles ayant un bas revenu sont particulièrement à risque.Conclusions:La prévalence croissante du surpoids pédiatrique aux Etats-Unis est une source d’accroissement du diabète, de maladies cardio-vasculaires et de nombreux autres problèmes de santé. De plus, les disparités de surpoids pédiatriques selon l’ethnie ou le niveau socio-économique ont probablement exacerbé les inégalités actuelles concernant les taux de maladies chroniques. Il est urgent de développer des stratégies et des programmes destinés à prévenir le surpoids chez les enfants.

Walking and the Preservation of Cognitive Function in Older Populations

PURPOSE This cross-sectional study takes a unique look at the association between patterns of walking and cognitive functioning by examining whether older adults with mild cognitive impairment differ in terms of the community settings where they walk and the frequency, intensity, or duration of walking. DESIGN AND METHODS The sample was based on interviews with 884 adults aged 65 years and older, residing in 4 locations across the United States: Alameda County, California; Cook County, Illinois; Allegheny County, Pennsylvania; and Durham/Wake Counties, North Carolina. Cognitive function was assessed using a modified Mini-Mental State Examination (MMSE) and the Mental Alternation Test (MAT). Multiple linear regressions were conducted between self-reported walking activities and cognitive measures, controlling for psychosocial, demographic, health status, functional performance, and neighborhood characteristics. RESULTS The community setting where people walk and the intensity of walking in their neighborhood were significantly associated with cognitive status. After controlling for individual and neighborhood characteristics, better MAT scores were significantly associated with brisk walking and walking fewer times per week. Compared with the MMSE, the MAT was more likely to be associated with patterns of walking among older adults. Older adults with lower MAT scores were more likely to walk in indoor shopping malls and less in parks, whereas those with higher cognitive function scores on the MMSE were less likely to walk in indoor gyms. IMPLICATIONS This investigation provides insight into the extent to which walking is associated with preservation of cognitive health, setting the stage for future longitudinal studies and community-based interventions.

Promoting Cognitive Health: A Formative Research Collaboration of the Healthy Aging Research Network

PURPOSE Evidence suggests that healthy lifestyles may help maintain cognitive health. The Prevention Research Centers Healthy Aging Research Network, 9 universities collaborating with their communities and the Centers for Disease Control and Prevention, is conducting a multiyear research project, begun in 2005, to understand how to translate this knowledge into public health interventions. DESIGN AND METHODS This article provides an overview of the study purpose, design, methods, and processes. We examined the literature on promoting cognitive health, convened a meeting of experts in cognitive health and public health interventions, identified research questions, developed a common focus group protocol and survey, established quality control and quality assurance processes, conducted focus groups, and analyzed the resulting data. RESULTS We conducted 55 focus groups with 450 participants in 2005-2007, and an additional 20 focus groups and in-depth interviews in 2007-2008. Focus groups were in English, Spanish, Mandarin, Cantonese, and Vietnamese, with African Americans, American Indians, Asian Americans, Hispanics, non-Hispanic Whites, physicians and other health practitioners, rural and urban residents, individuals caring for family or friends with cognitive impairment, and cognitively impaired individuals. IMPLICATIONS The data provide a wealth of opportunities for designing public health interventions to promote cognitive health in diverse populations.

Participatory Design of Mass Health Communication in Three Languages for Seniors and People With Disabilities on Medicaid

OBJECTIVES We used participatory design methods to develop and test guidebooks about health care choices intended for 600 000 English-, Spanish-, and Chinese-speaking seniors and people with disabilities receiving Medicaid in California. METHODS Design and testing processes were conducted with consumers and professionals; they included 24 advisory group interviews, 36 usability tests, 18 focus groups (105 participants), 51 key informant interviews, guidebook readability and suitability testing, linguistic adaptation, and iterative revisions of 4 prototypes. RESULTS Participatory design processes identified preferences of intended audiences for guidebook content, linguistic adaptation, and format; guidebook readability was scored at the sixth- to eighth-grade level and suitability at 95%. These findings informed the design of a separate efficacy study that showed high guidebook usage and satisfaction, and better gains in knowledge, confidence, and intended behaviors among intervention participants than among control participants. CONCLUSIONS Participatory design can be used effectively in mass communication to inform vulnerable audiences of health care choices. The techniques described can be adapted for a broad range of health communication interventions.

Social and cultural influences on tobacco-related health disparities among South Asians in the USA

Objective To explore and understand key cultural contexts of tobacco use among South Asian communities in the USA. Design Focus groups, with homogeneous compositions of gender, generational status and length of time in the USA, were conducted in two distinct South Asian ethnic enclaves. Focus group findings were triangulated with observational data regarding the availability of culturally specific tobacco from commercial ethnic outlets and cultural events. Subjects Respondents included 88 men and women of South Asian descent, aged 18–65 years, immigrant and native born, representing diversity of religion, socioeconomic status and region of origin, with the use of at least one culturally specific tobacco product in previous 24 months. Results A large number of culturally specific products were commonly used by community members. Knowledge of product-specific health risks was lacking or inaccurate. Many culturally specific tobacco products were considered to have beneficial properties. South Asian tobacco items were used to preserve cultural traditions and express ethnic identity in a new dominant culture. The social and cultural values ascribed to use helped distinguish community members from mainstream society and from other minority populations. Conclusions Many cultural factors govern tobacco use among diverse global populations. Especially for migrants with a common regional origin, the role of ethnic identity may strongly influence culturally specific tobacco patterns. Qualitative inquiry helps elucidate such culturally framed behaviour in culturally diverse populations. These cultural contexts should be integrated into research and practice. Understanding multidimensional factors influencing non-traditional tobacco use is essential to ensure that comprehensive tobacco control strategies address tobacco-related disparities.

Knowledge, attitudes, and practice toward epilepsy (KAPE): A survey of Chinese and Vietnamese adults in the United States

We conducted, in four languages, the first national cross-sectional survey of the knowledge, attitudes, and practice with respect to epilepsy of Chinese- and Vietnamese-American adults. We used a convenience sampling method to recruit 2831 adults in seven states. Eighty-four percent had heard or read of epilepsy and 58% had seen a seizure, whereas only 34% knew someone with epilepsy. Forty-two percent would object to their children marrying a person with epilepsy, and 43% would not knowingly hire someone with epilepsy. We examined bivariate associations for questions of knowledge, attitudes, and practice with age, gender, ethnicity, nativity, language, and education. chi(2) analyses showed differences in knowledge of and attitudes toward epilepsy by age group, gender, ethnicity, and education. Although misconceptions and negative views about epilepsy are held by Chinese and Vietnamese populations living in the United States, our results show noteworthy differences in attitudes and practice in relation to previous studies in Asian countries.

Changing supply and earning patterns of the mental health workforce.

The authors examine recent trends in the supply and earnings of various mental health providers from 1989 to 1995. The makeup of the mental health workforce is fundamentally different now than a decade ago. The number and earnings of psychiatrists have been relatively flat. The number of psychologists increased by 24%, with their earnings rising rapidly in the 1980s, and remaining level since 1990. The number of clinically trained social workers increased by 87% over the same period, and the number of advanced practice nurses certified in mental health specialties almost doubled, with the earnings of these masters-level providers increasing steadily over the period described. These trends are discussed in the context of major changes in the financing and delivery of mental health care.