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1.  PREDICTORS OF COMPUTER USE IN COMMUNITY-DWELLING ETHNICALLY DIVERSE OLDER ADULTS 
Human factors  2011;53(5):431-447.
Objective
In this study we analyzed self-reported computer use, demographic variables, psychosocial variables, and health and well-being variables collected from 460 ethnically diverse, community-dwelling elders in order to investigate the relationship computer use has with demographics, well-being and other key psychosocial variables in older adults.
Background
Although younger elders with more education, those who employ active coping strategies, or those who are low in anxiety levels are thought to use computers at higher rates than others, previous research has produced mixed or inconclusive results regarding ethnic, gender, and psychological factors, or has concentrated on computer-specific psychological factors only (e.g., computer anxiety). Few such studies have employed large sample sizes or have focused on ethnically diverse populations of community-dwelling elders.
Method
With a large number of overlapping predictors, zero-order analysis alone is poorly equipped to identify variables that are independently associated with computer use. Accordingly, both zero-order and stepwise logistic regression analyses were conducted to determine the correlates of two types of computer use: email and general computer use.
Results
Results indicate that younger age, greater level of education, non-Hispanic ethnicity, behaviorally active coping style, general physical health, and role-related emotional health each independently predicted computer usage.
Conclusion
Study findings highlight differences in computer usage, especially in regard to Hispanic ethnicity and specific health and well-being factors.
Application
Potential applications of this research include future intervention studies, individualized computer-based activity programming, or customizable software and user interface design for older adults responsive to a variety of personal characteristics and capabilities.
PMCID: PMC3211095  PMID: 22046718
2.  Circadian activity rhythms and risk of incident dementia and MCI in older women 
Annals of neurology  2011;70(5):722-732.
Objective
Previous cross-sectional studies have observed alterations in activity rhythms in dementia patients but the direction of causation is unclear. We determined whether circadian activity rhythms measured in community-dwelling older women are prospectively associated with incident dementia or mild cognitive impairment (MCI).
Method
Activity rhythm data were collected from 1,282 healthy community-dwelling women from the Study of Osteoporotic Fractures cohort (mean age 83 years) with wrist actigraphy for a minimum of three 24-hour periods. Each participant completed a neuropsychological test battery and had clinical cognitive status (dementia, MCI, normal) adjudicated by an expert panel approximately 5 years later. All analyses were adjusted for demographics, BMI, functional status, depression, medications, alcohol, caffeine, smoking, health status, and co-morbidities.
Results
After 4.9 years of follow-up, 195 (15%) women had developed dementia and 302 (24%) had developed MCI. Older women with decreased activity rhythms had a higher likelihood of developing dementia or MCI when comparing those in the lowest quartiles of amplitude (Odds ratio[OR]=1.57,95% CI,1.09–2.25) or rhythm robustness (OR=1.57,95%CI,1.10–2.26) to women in the highest quartiles. An increased risk of dementia or MCI (OR=1.83,95% CI,1.29–2.61) was found for women whose timing of peak activity occurred later in the day (after 3:51PM) when compared to those with average timing (1:34PM–3:51PM).
Interpretation
Older, healthy women with decreased circadian activity rhythm amplitude and robustness, and delayed rhythms have increased odds of developing dementia and MCI. If confirmed, future studies should examine whether interventions (physical activity, bright light exposure) that influence activity rhythms will reduce the risk of cognitive deterioration in the elderly.
doi:10.1002/ana.22468
PMCID: PMC3244839  PMID: 22162057
3.  The validation of a new measure quantifying the social quality of life of ethnically diverse older women: two cross-sectional studies 
BMC Geriatrics  2011;11:60.
Background
To our knowledge, the available psychometric literature does not include an instrument for the quantification of social quality of life among older women from diverse ethnic backgrounds. To address the need for a tool of this kind, we conducted two studies to assess the initial reliability and validity of a new instrument. The latter was created specifically to quantify the contribution of a) social networks and resources (e.g., family, friends, and community) as well as b) one's perceived power and respect within family and community to subjective well-being in non-clinical, ethnically diverse populations of older women.
Methods
In Study 1, we recruited a cross-sectional sample of primarily non-European-American older women (N = 220) at a variety of community locations. Participants were administered the following: a short screener for dementia; a demographic list; an initial pool of 50 items from which the final items of the new Older Women's Social Quality of Life Inventory (OWSQLI) were to be chosen (based on a statistical criterion to apply to the factor analysis findings); the Single Item Measure of Social Support (SIMSS); and the Medical Outcome Study 36-item Short-Form Health Survey (MOS SF-36). Study 2 was conducted on a second independent sample of ethnically diverse older women. The same recruitment strategies, procedures, and instruments as those of Study 1 were utilized in Study 2, whose sample was comprised of 241 older women with mostly non-European-American ethnic status.
Results
In Study 1, exploratory factor analysis of the OWSQLI obtained robust findings: the total variance explained by one single factor with the final selection of 22 items was over 44%. The OWSQLI demonstrated strong internal consistency (α = .92, p < .001), adequate criterion validity with the SIMSS (r = .33; p < .01), and (as expected) moderate concurrent validity with the MOS SF-36 for both physical (r = .21; p < .01) and mental (r = .26; p < .01) quality of life. In order to confirm the validity of the 22-item OWSQLI scale that emerged from Study 1 analyses, we replicated those analyses in Study 2, although using confirmatory factor analysis. The total variance accounted for by one factor was about 42%, again quite high and indicative of a strong single-factor solution. Study 2 data analyses yielded the same strong reliability findings (i.e., α = .92, p < .001). The 22-item OWSQLI was correlated with the SIMSS (r = .27, p < .001) in the expected direction. Finally, correlations with the MOS SF- 36 demonstrated moderate concurrent validity for physical (r = .14; p < .01) and mental (r = .18; p < .01) quality of life, as expected.
Conclusions
The findings of these two studies highlight the potential for our new tool to provide a valid measure of older women's social quality of life, yet they require duplication in longitudinal research. Interested clinicians should consider using the OWSQLI in their assessment battery to identify older women's areas of lower versus higher social quality of life, and should establish the maximization of patients' social quality of life as an important therapeutic goal, as this variable is significantly related to both physical and mental health.
doi:10.1186/1471-2318-11-60
PMCID: PMC3221620  PMID: 21982161
4.  Feasibility and Validity of Dementia Assessment by Trained Community Health Workers Based on Clinical Dementia Rating 
Background/Objectives
Ethnic minority elders, particularly recent Asian immigrants, have a heightened prevalence of dementia but lack timely diagnosis and treatment. This study was designed to determine the level of agreement between dementia rating by trained community health workers (CHWs) based on the Clinical Dementia Rating (CDR) and the gold standard, physician diagnosis.
Design
Cross-sectional validation study.
Settings
Key community gathering places such as ethnic churches, senior centers, low-income elderly apartments, and ethnic groceries in the Baltimore-Washington metropolitan area.
Participants
Ninety community-dwelling Korean American elderly (aged 60 years or older).
Measurements
The CDR is a standardized clinical dementia staging instrument to assess a patient’s cognitive and functional performance after a semi-structured interview protocol. A total of six CHWs who were trained and certified as CDR raters interviewed and rated study participants. A bilingual geriatric psychiatrist evaluated the participants independently for dementia status.
Results
61.1% of the participants were rated as having either mild cognitive impairment (CDR=0.5) or dementia (CDR=1 or higher) by CHWs, as compared to 56.7% diagnosed by the clinician. A receiver operating characteristic (ROC) curve analysis demonstrated a good predictive capability for CDR rating by trained CHWs (ROC area under the curve=0.86 [95% confidence interval=0.78–0.93], with sensitivity=85.5% and specificity=88.6%) in detecting mild cognitive impairment and dementia.
Conclusion
The findings provide preliminary evidence that trained CHWs can effectively identify community-dwelling Korean elderly with mild cognitive impairment and dementia for early follow-up assessment and care in the resource scarce community.
doi:10.1111/jgs.12309
PMCID: PMC3714359  PMID: 23730928
dementia; Clinical Dementia Rating; community health worker; Korean; elders
5.  The Importance of Family to Youth Living in Violent Communities 
The purpose of this study was to investigate family functioning in the relationship between community violence exposure and 1) self-esteem and 2) confrontational coping in a sample of urban youth. Adhering to the tenets of community based participatory research, academic and community partners collaborated on a cross-sectional study with 110 community dwelling urban youth, ages 10–16 living in a city located in the Northeastern United States. As part of a larger survey, this analysis included selected items on lifetime community violence exposure, family functioning, self-esteem and use of confrontational coping strategies in response to community violence. Over 90% of the youth reported some type of lifetime community violence exposure. Controlling for age and gender, older youth and those with healthier family functioning had higher self-esteem; community violence exposure was not associated with self-esteem. Healthier family functioning was associated with decreased use of confrontational coping, though increasing amounts of community violence exposure was still associated with increased confrontational coping. Family can be protective in violent environments. Results from this study directly informed an intervention aimed at youth violence prevention. This study highlights how psychiatric and mental health nurses may be able to address the complex interplay of factors for youth living in violent environments.
doi:10.1111/j.1365-2850.2011.01774.x
PMCID: PMC3158488  PMID: 21848601
Community violence; coping; family; self-esteem; youth
6.  Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults 
Background
Sleep disturbance is a complex health problem in ageing global populations decreasing quality of life among many older people. Geographic, cultural, and ethnic differences in sleep patterns have been documented within and between Western and Asian populations. The aim of this study was to explore sleep problems among Hong Kong seniors by examining the prevalence of poor sleep quality, the relationship between sleep quality and health-related quality of life, and associated factors of good sleepers in different age groups.
Methods
This cross-sectional study used convenience sampling and gathered data during face-to-face interviews. Older community-dwelling individuals (n = 301) were recruited in community centres in 2010. The Pittsburgh Sleep Quality Index and Medical Outcomes Study Short Form-36 were used to measure sleep quality and health-related quality of life. The Medical Outcomes Study Short Form-36 domain scores were compared between good and bad sleepers and between long and short sleepers using Hotelling’s T-Square test. SF-36 domain scores were placed into a logistic regression model that controlled for significant demographic variables (gender, educational level, perceived health).
Results
Most (77.7%) participants were poor sleepers. Participants who had global Pittsburgh Sleep Quality Index scores <5 and slept ≥5.5 h/night had better health-related quality of life. Vitality, emotional role, physical functioning, and bodily pain domain scores were associated factors of good sleepers in different age groups.
Conclusions
This study found a strong negative association between sleep deprivation (poor quality, short duration) and health-related quality of life. Associated factors for good sleep quality in later life differ among age groups in relation to universal age-related changes, and should be addressed by social policies and health-care programmes.
doi:10.1186/1477-7525-10-72
PMCID: PMC3445836  PMID: 22709334
Sleep; Older Chinese; Quality of life; Nursing
7.  Oral Health Self-Care Behaviors of Rural Older Adults 
Objectives
This analysis describes the dental self-care behaviors used by a multi-ethnic sample of older adults, and it delineates the associations of self-care behaviors with personal characteristics and oral health problems.
Methods
A cross-sectional comprehensive oral health survey conducted with a random, multi-ethnic (African American, American Indian, white) sample of 635 community-dwelling rural adults aged 60 years and older was completed in two rural southern counties.
Results
Rural older adults engage in a variety of self-care behaviors, including the use of Over-the-Counter (OTC) Medicine (12.1%), OTC Dental Products (84.3%), Salt (51.0%), Prayer (6.1%), and Complementary Therapies (18.2%). Some gender and ethnic class differences are apparent, with greater use by women of OTC Medicine and Salt, and greater use by African Americans and American Indians of OTC Medicine and OTC Dental Products. Use of dental self-care behaviors appears to be driven by need. Those reporting oral pain, bleeding gums, and dry mouth have a greater odds of engaging in most of the dental self-care behaviors, including use of complementary therapies.
Conclusions
The major factor leading to the use of self-care behaviors is need. Although oral pain does increase the use of self-care behaviors, so do bleeding gums and dry mouth. Research and practice should address self-care behaviors used for oral health problems in addition to pain. Investigators should expand analysis of dental self-care behavior and the relationship of self-care behavior to the use of professional services. Further research also should explore the use of complementary therapies in dental self-care.
doi:10.1111/j.1752-7325.2009.00121.x
PMCID: PMC2784128  PMID: 19486460
Self-care; health self-management; complementary therapies; aging; gerontology; rural health; minority health
8.  Urinary Incontinence: Its Assessment and Relationship to Depression among Community-Dwelling Multiethnic Older Women 
The Scientific World Journal  2014;2014:708564.
Urinary Incontinence (UI) affects many older adults. Some of its deleterious consequences include stress, major depression, diminished quality of life, sexual dysfunction, and familial discord. Of the various mental health problems identified in the literature as being comorbid with UI, the most notable one continues to be depression. Despite a wealth of research contributions on this topic, the available literature is underrepresentative of ethnic minority older women. Culture has been shown to have a significant impact on a woman's perception of her own UI symptoms; this demonstrates the necessity for the recruitment of ethnically and culturally diverse samples when studying UI. In the present study, we determined the prevalence of UI among 140 community-dwelling, ethnically diverse older women (28.2%), discovered that our new UI screener is reliable, and did not find the UI-depression link to be significant. The clinical and research implications of our findings are discussed.
doi:10.1155/2014/708564
PMCID: PMC3984862  PMID: 24982981
9.  Disparities in Oral Health Status Among Older Adults in a Multi-Ethnic Rural Community: The Rural Nutrition and Oral Health Study 
Objectives
To compare oral health status by ethnicity and socioeconomic status among African American (AA), American Indian (AI), and white dentate and edentulous community-dwelling older adults.
Design
Cross-sectional study; data from self-reports and oral examinations.
Participants
A multi-stage cluster sampling design was used to recruit 635 participants aged 60+ from rural North Carolina counties with substantial AA and AI populations.
Measurements
Participants completed in-home interviews and oral examinations. Self-reported data included socio-demographic indicators, self-rated oral health status, and presence/absence of periodontal disease, bleeding gums, oral pain, dry mouth, and fit of prostheses. Oral examination data included number of teeth and numbers of anterior and posterior functional occlusal units.
Results
Compared to whites, AAs and AIs had significantly lower incomes and educational attainment. Self-rated oral health was significantly higher in whites, compared to both AAs and AIs. Prevalence of self-reported periodontal disease and bleeding gums was lower in whites. Among dentate participants, AAs were significantly more likely than whites to have moderately reduced numbers of teeth (11–20 teeth) and posterior occlusal contacts. Oral health deficits remained associated with ethnicity when adjusted for socioeconomic variables.
Conclusions
Oral health disparities in older adults in a multi-ethnic rural area are largely associated with ethnicity and not socioeconomic status. Clinicians should be aware of these health disparities in oral health status and their possible role in disparities in chronic disease. Further research is necessary to understand whether these oral health disparities reflect current or lifetime access to care, diet, or attitudes toward oral health care.
doi:10.1111/j.1532-5415.2009.02367.x
PMCID: PMC3400086  PMID: 19563519
10.  The Association of Health and Functional Status with Private and Public Religious Practice among Rural, Ethnically Diverse Older Adults with Diabetes 
Purpose
This analysis describes the association of health and functional status with private and public religious practice among ethnically diverse (African American, Native American, white) rural older adults with diabetes.
Methods
Data were collected using a population-based, cross-sectional, stratified, random sample survey of 701 community-dwelling elders with diabetes in two rural North Carolina counties. Outcome measures were private religious practice, church attendance, religious support provided, and religious support received. Correlates included religiosity, health and functional status, and personal characteristics. Statistical significance was assessed using multiple linear regression and logistic regression models.
Findings
These rural elders had high levels of religious belief, and private and public religious practice. Religiosity was associated with private and public religious practice. Health and functional status were not associated with private religious practice, but they were associated with public religious practice, such that those with limited functional status participated less in public religious practice. Ethnicity was associated with private religious practice: African Americans had higher levels of private religious practice than Native Americans or whites, while Native Americans had higher levels than whites.
Conclusions
Variation in private religious practice among rural older adults is related to personal characteristics and religiosity, while public religious practice is related to physical health, functional status and religiosity. Declining health may affect the social integration of rural older adults by limiting their ability to participate in a dominant social institution.
doi:10.1111/j.1748-0361.2007.00097.x
PMCID: PMC3653177  PMID: 17565525
rural aging; minority aging; chronic disease; diabetes; religious participation; religiosity; social integration
11.  Coping and Participation in Youth With Spinal Cord Injury 
Background:
Coping and participation are important adjustment outcomes of youth with spinal cord injury (SCI). Research addressing how these outcomes are related is limited.
Objective:
This cross-sectional study examined relationships between coping and participation in youth with SCI.
Method:
Youth ages 7 to 18 years were recruited from 3 hospitals specializing in rehabilitation of youth with SCI. The Kidcope assessed coping strategies, and the Children’s Assessment of Participation and Enjoyment (CAPE) examined participation patterns. Point biserial and Pearson correlations assessed relationships among variables, and hierarchical multiple regression analyses examined whether coping significantly contributed to participation above and beyond significant demographic and injury-related factors.
Results:
The sample included 294 participants: 45% female, 65% Caucasian, 67% with paraplegia. Mean age was 13.71 years (SD = 3.46), and mean duration of injury was 5.39 years (SD = 4.49). Results indicated that higher levels of social support and lower levels of self-criticism predicted higher participation in informal activities, lower levels of social withdrawal predicted participation in informal activities with a greater diversity of individuals, lower levels of blaming others predicted higher enjoyment of informal activities, and higher levels of cognitive restructuring predicted participation in formal activities with a greater diversity of individuals and in settings further from home.
Conclusion:
Results suggest higher levels of social support and cognitive restructuring and lower levels of self-criticism, social withdrawal, and blaming others predicted favorable participation outcomes. Interventions for youth with SCI that encourage higher levels of positive coping strategies and lower levels of negative and avoidant strategies may promote positive participation outcomes.
doi:10.1310/sci1803-220
PMCID: PMC3584773  PMID: 23459106
coping; participation; spinal cord injury (SCI); youth
12.  Relationship Between Ways of Coping and Quality of Life in Married Women: Toward Mental Health Promotion 
Background
Adaptive ways of coping with stress are as a major component of mental health and also this is considered as a key element in quality of life.
Objectives
The aim of this study was to investigate the relationship between quality of life and coping mechanisms in married women ages between 18-65 years in order to develop appropriate intervention programs to promote mental health.
Patients and Methods
This study was a part of interventional project to mental health promotion in married women that completed through a cross sectional studies using two standard questionnaires: Ways of Coping (WOC) and Quality of Life questionnaire (WHO, QOL-BREF).
Results
The most and the least used ways in coping with stress were Planful Problem Solving and Confronting Coping. Considering the quality of life, the most and the least scores were related to social dimension and mental health. Also women who have higher quality of life used more Positive Reappraisal way and less Escape-Avoidance way to deal with stress (P < 0.05).
Conclusions
It seems that implementation of an appropriate interventional program related to adaptive ways of coping in order to deal with stress is effective in mental health and quality of life promotion.
doi:10.5812/ircmj.12728
PMCID: PMC3918203  PMID: 24578846
Quality of Life, Women; Mental Health
13.  Association of Socioeconomic Status and Life-style Factors with Coping Strategies in Isfahan Healthy Heart Program, Iran 
Croatian Medical Journal  2009;50(4):380-386.
Aim
To investigate the association between life-style and socioeconomic factors and coping strategies in a community sample in Iran.
Method
As part of a community-based study called Isfahan Healthy Heart Program, we studied 17 593 individuals older than 19 living in the central part of Iran. Demographic and socioeconomic factors (age, sex, occupation status, marital status, and educational level) and lifestyle variables (smoking status, leisure time physical activity, and psychological distress), and coping strategy were recorded. Data were analyzed by Pearson correlation and multiple linear regression.
Results
Not smoking (women β = -11.293, P < 0.001; men β = -3.418, P = 0.007), having leisure time physical activity (women β = 0.017, P = 0.046; men β = 0.005, P = 0.043), and higher educational level (women β = 0.344, P = 0.015; men β = 0.406, P = 0.008) were predictors of adaptive coping strategies, while smoking (women β = 11.849, P < 0.001; men β = 9.336, P < 0.001), high stress level (women β = 1.588, P = 0.000; men β = 1.358, P < 0.001), and lower educational level (women β = -0.443, P = 0.013; men β = -0.427, P = 0.013) were predictors of maladaptive coping strategies in both sexes. Non-manual work was a positive predictor of adaptive (β = 4.983, P < 0.001) and negative predictor of maladaptive (β = -3.355, P = 0.023) coping skills in men.
Conclusion
Coping strategies of the population in central Iran were highly influenced by socioeconomic status and life-style factors. Programs aimed at improving healthy life-styles and increasing the socioeconomic status could increase adaptive coping skills and decrease maladaptive ones and consequently lead to a more healthy society.
doi:10.3325/cmj.2009.50.380
PMCID: PMC2728387  PMID: 19673038
14.  Sleeping Well, Aging Well: A Descriptive and Cross-Sectional Study of Sleep in “Successful Agers” 75 and Older 
Objectives
To examine diary-based, laboratory-based, and actigraphic measures of sleep in a group of healthy older women and men (≥75 years of age) without sleep/wake complaints and to describe sleep characteristics which may be correlates of health-related quality of life in old age.
Design
Cross-sectional, descriptive study.
Setting
University-based sleep and chronobiology program.
Intervention
None.
Participants
Sixty-four older adults (30 women, 34 men; mean age 79)
Measurements
We used diary-, actigraphic-, and laboratory-based measures of sleep, health-related quality of life, mental health, social support, and coping strategies. We used two-group t-tests to compare baseline demographic and clinical measures between men and women, followed by ANOVA on selected EEG measures to examine first-night effects as evidence of physiological adaptability. Finally, we examined correlations between measure of sleep and health-related quality of life.
Results
We observed that healthy men and women aged 75 and older can experience satisfactory nocturnal sleep quality and daytime alertness, especially as reflected in self-report and diary-based measures. Polysomnography (psg) suggested the presence of a first-night effect, especially in men, consistent with continued normal adaptability in this cohort of healthy older adults. Continuity and depth of sleep in older women were superior to that of men. Diary-based measures of sleep quality (but not psg measures) correlated positively (small to moderate effect sizes) with physical and mental health-related quality of life.
Conclusions
Sleep quality and daytime alertness in late life may be more important aspects of successful aging than previously appreciated. Good sleep may be a marker of good functioning across a variety of domains in old age. Our observations suggest the need to study interventions which protect sleep quality in older adults to determine if doing so fosters continued successful aging.
doi:10.1097/JGP.0b013e3181557b69
PMCID: PMC2772651  PMID: 18070833
sleep; successful aging; aging; health-related quality of life
15.  Prevalence and Predictors of Mild Cognitive Impairment in Xi’an: A Community-Based Study among the Elders 
PLoS ONE  2014;9(1):e83217.
Mild cognitive impairment (MCI) is an intermediate stage between normal cognitive function and dementia among aging individuals. This study was designed to estimate the prevalence of MCI and explore the possible risk factors including gender disparities among community-dwelling older individuals. The study was conducted in Xi’an, China. This is a cross-sectional study. A total of 815 individuals, 60 years and older were selected by stratified random cluster sampling. Cognitive function was measured using the mini-mental status examination (MMSE), the Chinese version of the Dementia Rating Scales (CDRS) was used to apply the diagnostic of non-dementia, and activities of daily living (ADL) and instrumental activities of daily living (IADL) systems were used to functional status. The association between sociodemographic characteristics, lifestyle, history of chronic diseases and MCI were evaluated separately for men and women using the Pearson χ2- test and binary logistic regression. Of the 815 community-dwelling individuals, 145 were found to have MCI. Overall, the prevalence of MCI was 18.5%, with a prevalence of 19.6% in women (105/535), and 15.3% (40/261) in men. The results of the binary logistical regression analysis indicated that age and history of stroke were associated with MCI in men. For women, the risk factors were lower level of educational and lack of religious attendance. Results suggested that the factors capable of influencing MCI differed profoundly between older men and older women. For this reason, different preventative measures should be adopted to delay or reverse cognitive impairment among community-dwelling older men and women.
doi:10.1371/journal.pone.0083217
PMCID: PMC3885430  PMID: 24421876
16.  Disability and health status: ethnic differences among women in the United States 
STUDY OBJECTIVES—There are few data describing disability and health status for ethnic groups. The disablement process involves social influences, which may include minority status. Cross sectional data were examined to investigate the relation of ethnicity to disability.
DESIGN—A stratified random digit dialled sample of women aged 40 and older. Disability and health status were measured as functional and activity limitations, work disability, and days of poor physical and mental health.
SETTING—United States.
PARTICIPANTS—Women interviewed by telephone included 774 white, 749 African-American, 660 Hispanic, and 739 Native American women.
MAIN RESULTS—The prevalence of disability was higher among minority women when classified by general health status, and the need for personal care assistance. There was a striking excess of work disability: 3.5% of white women compared with 7.1% to 10.3% for minority women. The differences were reduced when adjusted for other risk factors and socioeconomic status. White and minority women reported more similar disability when it was defined by poor mental and physical health days.
CONCLUSIONS—Disability is correlated with social and demographic characteristics as well as medical diagnoses. Ethnicity also is associated with disability and may be part of a social context for disablement. Future research should concentrate on the temporal sequence of disability. Consistent definitions of disability will facilitate this research.


Keywords: women's health; health status; disability; minority groups
doi:10.1136/jech.54.3.200
PMCID: PMC1731647  PMID: 10746114
17.  Measurement Invariance of Neuropsychological Tests in Diverse Older Persons 
Neuropsychology  2011;25(2):260-269.
Objective
Comparability of meaning of neuropsychological test results across ethnic, linguistic, and cultural groups is important for clinicians challenged with assessing increasing numbers of older ethnic minorities. We examined the dimensional structure of a neuropsychological test battery in linguistically and demographically diverse older adults.
Method
The Spanish and English Neuropsychological Assessment Scales (SENAS), developed to provide psychometrically sound measures of cognition for multi-ethnic and multilingual applications, was administered to a community dwelling sample of 760 Caucasians, 443 African Americans, 451 English-speaking Hispanics, and 882 Spanish-speaking Hispanics. Cognitive function spanned a broad range from normal to mildly impaired to demented. Multiple group confirmatory factor analysis (CFA) was used to examine equivalence of the dimensional structure for the SENAS across the groups defined by language and ethnicity.
Results
Covariance among 16 SENAS tests was best explained by five cognitive dimensions corresponding to episodic memory, semantic memory/language, spatial ability, attention/working memory, and verbal fluency. Multiple group CFA supported a common dimensional structure in the diverse groups. Measures of episodic memory showed the most compelling evidence of measurement equivalence across groups. Measurement equivalence was observed for most but not all measures of semantic memory/language and spatial ability. Measures of attention/working memory defined a common dimension in the different groups, but results suggest that scores are not strictly comparable across groups.
Conclusions
These results support the applicability of the SENAS for use with multi-ethnic and bilingual older adults, and more broadly, provide evidence of similar dimensions of cognition in the groups represented in the study.
doi:10.1037/a0021090
PMCID: PMC3058248  PMID: 21381830
Neuropsychological Assessment; Measurement Equivalence; Ethnicity; English; Spanish
18.  Belief in Divine Control, Coping, and Race/Ethnicity among Older Women with Breast Cancer 
Background
Belief in divine control is often assumed to be fatalistic. However, the assumption has rarely been investigated in racial/ethnic minorities.
Objectives
This study aims to examine the association between belief in divine control and coping and how the association was moderated by ethnicity/acculturation in a multi-ethnic sample of breast cancer patients.
Methods
Latina, African American, and non-Hispanic White older women with newly diagnosed breast cancer (N=257) from a population-based survey completed the scale of Belief in Divine Control and the Brief COPE.
Results
Belief in divine control was positively related to approach coping (i.e., positive reframing, active coping, and planning) in all ethnic groups. Belief in divine control was positively related to acceptance and negatively related to avoidance coping (i.e., denial and behavioral disengagement) among low-acculturated Latinas.
Conclusions
Negative presumptions about fatalistic implications of belief in divine control should be critically reappraised, especially when such skepticism is applied to racial/ethnic minority patients.
doi:10.1007/s12160-012-9358-5
PMCID: PMC3873338  PMID: 22529040
Religiosity and belief in divine control; Coping; Cancer fatalism; Race/ethnicity; Acculturation; Aged
19.  The influence of active coping and perceived stress on health disparities in a multi-ethnic low income sample 
BMC Public Health  2008;8:41.
Background
Extensive research has shown that ethnic health disparities are prevalent and many psychological and social factors influence health disparities. Understanding what factors influence health disparities and how to eliminate health disparities has become a major research objective. The purpose of this study was to examine the impact of coping style, stress, socioeconomic status (SES), and discrimination on health disparities in a large urban multi-ethnic sample.
Methods
Data from 894 participants were collected via telephone interviews. Independent variables included: coping style, SES, sex, perceived stress, and perceived discrimination. Dependent variables included self-rated general and oral health status. Data analysis included multiple linear regression modeling.
Results
Coping style was related to oral health for Blacks (B = .23, p < .05) and for Whites there was a significant interaction (B = -.59, p < .05) between coping style and SES for oral health. For Blacks, active coping was associated with better self-reported health. For Whites, low active coping coupled with low SES was significantly associated with worse oral health. Coping style was not significantly related to general health. Higher perceived stress was a significant correlate of poorer general health for all ethnoracial groups and poorer oral health for Hispanics and Blacks. SES was directly related to general health for Hispanics (.B = .27, p < .05) and Whites (B = .23, p < .05) but this relationship was mediated by perceived stress.
Conclusion
Our results indicate that perceived stress is a critical component in understanding health outcomes for all ethnoracial groups. While SES related significantly to general health for Whites and Hispanics, this relationship was mediated by perceived stress. Active coping was associated only with oral health.
doi:10.1186/1471-2458-8-41
PMCID: PMC2268682  PMID: 18230164
20.  Glutathione Peroxidase Enzyme Activity in Aging 
Background
It is hypothesized that free radical damage contributes to aging. Age-related decline in activity of the antioxidant enzyme glutathione peroxidase (GPx) may contribute to increased free radicals. We hypothesized that GPx activity decreases with age in a population of older women with disability.
Methods
Whole blood GPx activity was measured in baseline stored samples from participants in the Women's Health and Aging Study I, a cohort of disabled community-dwelling older women. Linear regression was used to determine cross-sectional associations between GPx activity and age, adjusting for hemoglobin, coronary disease, diabetes, selenium, and body mass index.
Results
Six hundred one participants had complete demographic, disease, and laboratory information. An inverse association was observed between GPx and age (regression coefficient = −2.9, p < .001), indicating that for each 1-year increase in age, GPx activity decreased by 2.9 μmol/min/L. This finding remained significant after adjustment for hemoglobin, coronary disease, diabetes, and selenium, but not after adjustment for body mass index and weight loss.
Conclusion
This is the first study to examine the association between age and GPx activity in an older adult cohort with disability and chronic disease. These findings suggest that, after age 65, GPx activity declines with age in older women with disability. This decline does not appear to be related to diseases that have been previously reported to alter GPx activity. Longitudinal examination of GPx activity and other antioxidant enzymes in diverse populations of older adults will provide additional insight into age- and disease-related changes in these systems.
PMCID: PMC2964084  PMID: 18511755
Glutathione peroxidase; Oxidative stress; Aging; Older adult
21.  Cardiovascular risk factors in ethnic populations within Canada: results from national cross-sectional surveys  
Open Medicine  2010;4(3):e143-e153.
Background
Differences in the prevalence of cardiovascular disease and associated risk factors have been noted across ethnic groups both within and between countries. The Canadian population is becoming increasingly diverse because of immigration. Understanding ethnic differences in cardiovascular risk factors is critically important in planning appropriate prevention strategies for the country’s rapidly changing population. We sought to examine the prevalence of cardiovascular risk factors in various Canadian ethnic groups.
Methods
We analyzed 3 cross-sectional cycles (for 2000, 2003 and 2005) of the Canadian Community Health Survey of people aged 12 years and older. The surveys were conducted by means of self-reported questionnaires. We used stratified analysis to evaluate the relation between risk factors and ethnicity. The effect of participants’ ethnicity on the prevalence of risk factors was estimated by means of logistic regression, with adjustment for differences in age, sex, marital status, education, household income, language spoken, immigration status, residency type (urban or rural), household size, region (province or territory) and chronic diseases (heart disease, stroke, cancer, bronchitis, chronic obstructive pulmonary disease, bowel disease, arthritis, epilepsy, ulcers, thyroid disease and diabetes mellitus).
Results
We included 371 154 individuals in the analysis. Compared with white people, people from visible minorities (i.e., neither white nor Aboriginal) had a lower prevalence of diabetes mellitus (4.5% v. 4.0%), hypertension (14.7% v. 10.8%), smoking (20.4% v. 9.7%) and obesity (defined as body mass index ≥ 30; 14.8% v. 9.7%) but a higher prevalence of physical inactivity (50.3% v. 58.1%). More specifically, after adjustment for sociodemographic characteristics, people from most visible minorities, in comparison with the white population, were less likely to smoke; were more likely to be physically inactive, with the exception of people of Korean, Japanese and Latin ethnicity; and were less likely to be obese, with the exception of people of black, Latin, Arab or West Asian ethnicity. However, relative to white people, hypertension was more prevalent among those of Filipino or South East Asian background (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.23–1.93) and those of black ancestry (OR 1.69, 95% CI 1.43–2.00).
Interpretation
Cardiovascular risk factors vary dramatically by ethnic group. Health professionals should increase their promotion of physical activity among visible minorities and should prioritize the detection and control of diabetes and hypertension during routine contact with patients of visible minorities, particularly those of South Asian, Filipino and black ethnicity.
PMCID: PMC3090103  PMID: 21687334
22.  Ethnic Variation in Oral Health and Social Integration among Older Rural Adults 
This analysis examines the associations of oral health with social integration among ethnically diverse (African American, American Indian, white) rural older adults. Data are from a cross-sectional survey of 635 randomly selected community-dwelling adults aged 60+. Measures include self-rated oral health, number of teeth, number of oral health problems, social engagement, and social network size. Minority elders have poorer oral health than do white older adults. Most rural elders have substantial social engagement and social networks. Better oral health (greater number of teeth) is directly associated with social engagement, while the relationship of oral health to social network size is complex. The association of oral health with social engagement does not differ by ethnicity. Poorer oral health is associated with less social integration among African American, American Indian and white elders. More research on the ways oral health affects the lives of older adults is warranted.
doi:10.1177/0733464811420428
PMCID: PMC3685432  PMID: 23788829
Oral health disparities; social engagement; social network; rural aging
23.  Smoking Status, Physical Health–Related Quality of Life, and Mortality in Middle-Aged and Older Women 
Nicotine & Tobacco Research  2012;15(3):662-669.
Introduction:
Women who smoke, particularly older women, have been relatively neglected in smoking research. There is a lack of knowledge concerning the relation of level of smoking to quality of life and mortality among middle-aged and older women smokers.
Methods:
This study examined the relation of smoking status to physical health–related quality of life (PHRQL) and total mortality in women in the Women’s Health Initiative (WHI) Observational Study. Participants were 90,849 postmenopausal women, who were an average age of 63.6 years at baseline. Analyses used multiple linear and Cox proportional hazards regression and controlled for age, educational level, and ethnicity. Never-smokers were the reference group.
Results:
We found that smoking status was significantly related to PHRQL cross-sectionally at baseline and prospectively at a 3-year follow-up, with those who smoked having lower PHRQL. Heavier smokers showed large, clinically meaningful associations with PHRQL and light smokers showed small associations. In addition, we found that the smoking status at baseline was significantly related to 10-year total mortality. Both light and heavier smoking at baseline significantly correlated with higher mortality risk; however, the relationship of smoking to mortality was dose dependent. Among former smokers, those who had smoked longer showed significantly lower PHRQL and significantly increased mortality risk.
Conclusions:
Findings suggest that the risks of smoking may not be evident to light smokers and that educational interventions targeted to middle-aged and older women stressing the consequences of light smoking may be particularly beneficial.
doi:10.1093/ntr/nts182
PMCID: PMC3611990  PMID: 22965789
24.  Gait speed correlates in a multiracial population of community-dwelling older adults living in Brazil: a cross-sectional population-based study 
BMC Public Health  2013;13:182.
Background
Gait speed is a strong predictor of a wide range of adverse health outcomes in older adults. Mean values for gait speed in community-dwelling older adults vary substantially depending on population characteristics, suggesting that social, biological, or health factors might explain why certain groups tend to self-select their gait speed in different patterns. The vast majority of studies reported in the literature present data from North American and European populations. There are few population-based studies from other regions with a different ethnicity and/or social and health conditions. To address this, the present study identified the mean usual and fast gait speeds in a representative multiracial population of community-dwelling older adults living in a developing country, and explored their association with sociodemographic, mental and physical health characteristics.
Methods
This was a cross-sectional population-based study of a sample of 137 men and 248 women, aged 65 years and over. Usual gait speed and fast gait speed were measured on a 4.6 m path. Participants were classified into slow, intermediate, and faster groups by cluster analysis. Logistic regression analysis was used to estimate the independent effect of each factor on the odds of presenting with a slower usual and slower fast gait speeds.
Results
Participants had a mean (SD) usual gait speed of 1.11 (0.27) m/s and a mean fast gait speed of 1.39 (0.34) m/s. We did not observe an independent association between gait speed and race/ethnicity, educational level, or income. The main contributors to present a slower usual gait speed were low physical activity level, stroke, diabetes, urinary incontinence, high concern about falling, and old age. A slower fast gait speed was associated with old age, low physical activity, urinary incontinence and high concern about falling.
Conclusion
A multiracial population of older adults living in a developing country showed a similar mean gait speed to that observed in previously studied populations. The results suggest that low physical activity, urinary incontinence and high concern about falling should not be neglected and may help identify those who might benefit from early intervention.
doi:10.1186/1471-2458-13-182
PMCID: PMC3598989  PMID: 23448191
Gait speed; Aged; Aged health; Urinary incontinence; Physical performance; Cross-sectional studies
25.  Psychosocial Factors and Adjustment to Pain in Individuals with Postpolio Syndrome 
Objective
The purpose of the current study was to examine the associations among measures of psychosocial factors, pain, and adjustment in persons with postpoliomyelitis syndrome.
Design
A cross-sectional survey design was used. Sixty-three community-dwelling individuals with postpoliomyelitis syndrome returned completed questionnaires (71% response rate) that included measures of pain intensity and interference, psychological functioning, pain catastrophizing, social support, and pain-related beliefs and coping.
Results
After controlling for demographic variables, the group of psychosocial variables accounted for an additional 23% of the variance in pain intensity. These variables explained an additional 35% and 50% of the variance in pain interference and psychological functioning, respectively, after accounting for demographic variables and pain intensity. Social support was associated with both psychological functioning and pain interference, whereas catastrophizing was most closely related to psychological functioning. Individual pain beliefs and coping strategies were variably related to the three criterion measures.
Conclusions
The overall results of the current study are consistent with a biopsychosocial framework for understanding pain and functioning in individuals with postpoliomyelitis syndrome. Although additional research is needed to clarify the nature of the relationships between individual psychosocial variables and functional indices, the findings suggest the need for a multidisciplinary approach to pain management in individuals with postpoliomyelitis syndrome.
doi:10.1097/PHM.0b013e3181c9f9a1
PMCID: PMC3157697  PMID: 20068433
Postpolio Syndrome; Pain; Biopsychosocial; Adjustment

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