This article describes the types of complementary therapies used by older adults for health promotion, and delineates the predisposing, enabling, and need factors associated with their use. One-hundred ninety-five African American and White participants (age 65+) completed a baseline interview and up to six sets of three daily follow-up interviews at monthly intervals. Complementary therapies for health promotion included home remedies, specific foods or beverages, herbs, supplements, vitamins, over-the-counter (OTC) medicine, prayer, exercise, and being active. Although gender, ethnicity, education, and trust in doctors were associated with the use of complementary therapies for health promotion, health information seeking was the predisposing factor most often associated. The enabling factors were also associated with their use. Health information seeking, which reflects a wellness lifestyle, had the most consistent associations with complementary therapy use for health promotion. This health self-management for health promotion may have positive effects on future medical expenditures.
health promotion; disease prevention; complementary and alternative medicine; minoirty aging
To document the role job control and schedule control play in shaping women’s physical activity, and how it delineates educational and racial variability in associations of job and social control with physical activity.
Prospective data were obtained from a community-based sample of working women (N = 302). Validated instruments measured job control and schedule control. Steps per day were assessed using New Lifestyles 800 activity monitors.
Greater job control predicted more steps per day, whereas greater schedule control predicted fewer steps. Small indirect associations between ethnicity and physical activity were observed among women with a trade school degree or less but not for women with a college degree.
Low job control created barriers to physical activity among working women with a trade school degree or less. Greater schedule control predicted less physical activity, suggesting women do not use time “created” by schedule flexibility for personal health enhancement.
physical activity; women; work organization; job control
Farm labor housing has been described as among the worst in the nation, oftentimes with poor and unsanitary, indoor living conditions. The objective of this study was to evaluate the association between indoor environmental risk factors and respiratory health among migrant farmworker occupants (N=352) living in employer-provided housing. A cross-sectional sample of adult, Latino male farm laborers were administered a questionnaire to identify the prevalence of major respiratory symptoms. Self-reported and independent observations were made to evaluate environmental respiratory risk factors and indoor housing conditions, including but not limited to, the presence of cockroaches, rodents, pesticides, and visible signs of mold. Spirometry was performed to evaluate lung function using FEV1, FVC and FEV1/FVC ratio. Bivariate analysis was applied to evaluate associations between respiratory symptoms and selected indoor environmental risk factors. Findings for respiratory health included, prevalence of wheeze (11.4%), coughing up phlegm (17.3%), tightness of chest (16.8%) and runny or stuffy nose (34.4%). Respiratory risks identified inside the dwellings included, the use of pesticides or bug sprays for cockroaches (31.5%), rat or mouse poison (19.5%), visible signs of water damage in the bathroom (22.5%) and mold in the sleeping room (11.1%). Spirometry values were normal for most occupants, although statistically significant associations were found between; mold and coughing up phlegm when not having a cold (p=0.0262); presence of mold and asthma (p=0.0084); pesticides used in the home and tightness of chest (p=0.0001) and, use of tobacco and coughing up phlegm (p=0.0131). Although causal inference can be difficult to establish from a cross sectional study, findings from this study represents suggestive evidence that indoor environmental risk factors may be contributory factors for respiratory health problems among this vulnerable population.
Housing; respiratory health; farmworker; environmental health
This study examined the use of self-care strategies to address difficulty sleeping among community-dwelling older adults. Data were collected from a series of 18 questionnaires administered to 195 rural African American and white older adults in North Carolina. Participants reported whether they had experienced difficulty sleeping and strategies used to respond to the symptom. The most widely used strategies included ignoring the symptom, staying in bed or resting, and praying. Herb and supplement use were not reported. Ethnicity, income, and education were associated with use of specific self-care strategies for sleep. This variation suggests that older adults may draw on cultural understandings to interpret the significance of difficulty sleeping and influence their use of self-care strategies, including complementary and alternative medicine use. This information may enable health care providers to communicate with the older patients about sleep difficulty strategies to minimize sleep problems.
older adults; sleep; self-care
This study examines older adults’ fears of diabetes complications and their effects on self-management practices. Existing models of diabetes self-management posit that patients’ actions are grounded in disease beliefs and experience, but there is little supporting evidence. In-depth qualitative interviews were conducted with a community-based sample of 74 African American, American Indian, and white older adults with diabetes. Analysis uses Leventhal’s Common Sense Model of Diabetes to link fears to early experience and current self-management. Sixty-three identified fears focused on complications that could limit carrying out normal activities: amputation, blindness, low blood glucose and coma, and disease progression to insulin use and dialysis. Most focused self-management on actions to prevent specific complications, rather than on managing the disease as a whole. Early experiences focused attention on the inevitability of complications and the limited ability of patients to prevent them. Addressing older adults’ fears about diabetes may improve their diabetes self-management practices.
Rural; qualitative methods; common sense model
To determine if there is an association between flexor digitorum and lumbrical muscle intrusion into the carpal tunnel and carpal tunnel syndrome (CTS).
513 manual laborers (1,026 wrists) were evaluated with ultrasound to determine if those with CTS had more muscle intrusion into the carpal tunnel than those without CTS. 190 of the participants without CTS at baseline (363 wrists) were followed over 1 year to determine if muscle intrusion at baseline predicted the development of CTS.
Participants with CTS had more muscle within the carpal tunnel with the wrist in the neutral (P = 0.026) and flexed positions (P = 0.018) than those without CTS. Baseline muscle intrusion did not predict the development of CTS at 1 year.
Muscle intrusion into the carpal tunnel is associated with CTS, but muscle intrusion alone does not predict the development of CTS over the course of a year.
Carpal tunnel syndrome; incidence; prevalence; ultrasound; EMG
This study examined the use of complementary and medical treatments, both individually and in combination, to address common general and upper respiratory symptoms. Data for the analysis were collected from a series of 18 daily diary questionnaires administered to community-living older African American and white adults living in rural counties in North Carolina. Participants reported symptoms experienced on each diary day and the treatment strategies they used each day in response to the particular symptom(s). Older adults used diverse categories of strategies to treat symptoms; treatment strategies were used inconsistently across symptoms. Use of only complementary strategies, only medical conventional strategies, or both complementary and medical strategies to treat any one symptom rarely corresponded to the use of the same strategy to address other symptoms. Future research would benefit from analyzing how older adults use health care strategies across symptom categories.
aging; complementary medicine; self-care; older adults; rural
To examine the demographic, health and diabetes management correlates of physicians trust in a rural, multi-ethnic population with diabetes.
563 older (≥60 years) African American, American Indian and White adults completed in-home surveys, including the 11-item General Trust in Physicians Scale.
Higher trust scores were seen among: older (≥75) participants (p < .01), those with fewer (<3) chronic health conditions (p < .01), and those who adhered to physical activity (p < .05) and dilated eye exam (p < .01) guidelines; the latter remained significant (eye exam, p = .019) or approached significance (physical activity, p = .051) after adjustment for potential confounders.
Physician trust may influence patient adherence to diabetes management recommendations. Efforts should be made to build trust in the patient-provider relationship to enhance patient outcomes.
physician trust; diabetes self-management; rural older adults; ethnic minority populations
Pesticide safety training is mandated for migrant and seasonal farmworkers. However, none is required for family members, who implement home sanitation to protect against pesticide exposure and need to control pests in substandard housing. Controlled studies have demonstrated the efficacy of pesticide education programs for farmworker families, but no carefully evaluated demonstration projects have shown effectiveness in public health settings. This project evaluates a lay health promoter program to improve pesticide-related knowledge and practices. Promotoras from six agencies recruited families with children to deliver a six-lesson, in-home, culturally and educationally appropriate curriculum. Independently conducted pre- and posttests evaluated changes in knowledge and practices. Adults in 610 families completed the study. Most were from Mexico, with low levels of formal education. Significant improvements in knowledge were observed for all six lessons. Significant improvements were observed in practices related to para-occupational exposure and residential pest control. Lay health promoters with limited training and supervision can have significant impacts on families’ knowledge and practices. They represent a workforce increasingly recognized as a force for reducing health disparities by providing culturally appropriate health education and other services. This study adds to the literature by demonstrating their effectiveness in a public health setting with rigorous evaluation.
community-based participatory research; lay health promoter; demonstration project; migrant and seasonal farmworkers; occupational health and safety; pesticide exposure
To identify the source of behavior change resulting from a health education intervention focused on pesticide safety.
Data were from the La Familia Sana demonstration project, a promotora-delivered pesticide safety education intervention conducted with immigrant Latinos (N = 610).
The La Familia Sana program produced changes in 3 sets of pesticide safety behaviors. Changes in the conceptual targets of the intervention and promotora attributes explained 0.45–6% and 0.5–3% of the changes in pesticide-related behavior, respectively.
The conceptual targets of the La Familia Sana program explained the greatest amount of change in pesticide-related behavior. Promotora attributes also contributed to intervention success
pesticide safety; Latinos; Immigrants; lay health advisors; translational research
Many older adults use complementary therapies in health self-management but do not disclose this use to their physicians. This paper examines factors affecting disclosure of complementary therapy use, and it considers ethnic and gender differences in disclosure. It is based on a systematic qualitative analysis of in-depth interviews conducted with 62 African American and White adults aged 65 and older. Twenty-three of the 39 older adults who acknowledge using complementary therapies disclose this to their physicians. Themes leading to disclosure are believing that physicians are supportive and the importance of sharing information. Themes for not disclosing complementary therapy use include physicians’ negative views, complementary therapy use affecting physicians’ incomes, and the need to protect cultural knowledge. African American women were least likely to disclose use. Disclosure by elders to their physicians is a complex decision process. Medical encounters, including decisions regarding information to disclose, are embedded in broader social structures.
Complementary therapies; patient-provider communication; minority aging
This study analyzes the role of traditional and commercial herbs in older adults’ health self-management based on Leventhal’s Self-Regulatory Model conceptual framework. Sixty-two African American and white adults age 65 and older completed qualitative interviews describing the forms of herbs currently being used, sources of information about them, interpretations of health (acute symptoms or chronic conditions) that lead to their use, and the initiation and suspension of use. Traditional herbs are native to the region or have been traditionally cultivated; usually taken raw or boiled to produce tea; and used for treating mild symptoms. Commercial herbs are prepared as pills, extracts, or teas; they are purchased at local stores or ordered by catalog or internet; and used for health promotion, illness prevention or treatment of chronic conditions. Herbs are widely used among older adults; this analysis differentiates the types of herbs they use and their reasons for herbs use.
Complementary therapies; herbal remedies; rural aging; minority aging
To describe time spent in sedentary and moderate-to-vigorous physical activity (MVPA) by children in Latino farmworker families; and delineate sources of variation in sedentary and MVPA.
Data were from mother-child dyads (N = 248) in Latino farmworker households in North Carolina. Physical activity was assessed using accelerometers; mothers described their children’s characteristics and their physical and social environments.
Children spent 6.2 hours/day sedentary (Median=369 minutes), and 6.0 minutes/day in MVPA. Children in Head Start spent more time sedentary, whereas children living where dogs roam freely were less sedentary. Children whose mothers limited screen time spent 2 more minutes in MVPA.
Preschool-aged Latino children in farmworker families are sedentary, engaging in very little MVPA.
preschool-aged children; Latinos; farmworkers; physical activity
This study describes the nonprescribed therapy use (prayer, over-the-counter medications [OTC's], home remedies, vitamins, herbs and supplements, and exercise) for health promotion among rural elders. It also delineates the association of such therapy use with physical and mental health-related quality of life (HRQoL).
The sample (N = 200) consisted of African American and White elders from south-central North Carolina. Participants completed baseline interviews and repeated measures of nonprescribed therapy use over a 6-month follow-up.
Prayer had the highest percentage (80.7%) of use for health promotion followed by OTC (54.3%); vitamins only (49.3%); herbs and supplements (40.5%); exercise (31.9%); and home remedies (5.2%). Exercise was significantly associated with better physical HRQoL (p < .05). However, elders who used nonprescribed therapies had poorer mental HRQoL than nonusers, adjusting for potential confounders.
This analysis suggests that use of some nonprescribed therapies for health promotion is associated with poorer mental HRQoL.
nonprescribed therapy use; health-related quality of life (HRQoL)
Migrant farmworkers are exposed to pesticides at work. Housing provided to migrant farmworkers may also expose them to pesticides, increasing their health risks. This analysis (1) describes the presence of organophosphorous (OP) and pyrethroid pesticides in North Carolina migrant farmworker houses, and (2) delineates associations of farmworker camp characteristics with pesticide detection and concentration.
In 2010, 186 migrant farmworkers camps in NC were recruited (participation rate of 82.3%); pesticide wipe samples for 176 houses were analyzed. Tobacco is the predominant hand-harvested crop in this region. Two farmworkers per camp completed interviews; a third assisted with a housing inspection. Gas chromatography–mass spectrometry was used to detect OP and pyrethroid pesticides. Covariates of pesticide detection and concentration were determined with ANOVA and Tobit regression.
OPs were found in 166 of 176 houses (average of 2.4/house); pyrethroids were found in 171 houses (average of 4.3/house). The number of different OPs detected in each camp and concentrations of these OPs were not associated with camp and housing characteristics. The number of different pyrethroids detected in each camp and concentrations of these pyrethroids were associated with camps having residents with H2-A visas, a posted North Carolina Department of Labor Certificate of Inspection, no barracks, fewer residents, no bedroom weather protection or floor violations, and no roaches.
Farmworkers are exposed to pesticides where they live. Policy on removing pesticides from farmworker houses is needed. Reducing pesticides in farmworker houses will reduce one health risk confronted by this vulnerable population.
health disparities; vulnerable population; occupational exposures; environmental exposures; agricultural workers; immigrant workers
The purpose of the study was to assess the performance of a short diabetes knowledge instrument (SDKI) in a large multi-ethnic sample of older adults with diabetes and to identify possible modifications to improve its ability to document diabetes knowledge.
Research Design and Methods
A sample of 593 African American, American Indian, and white female and male adults 60 years and older, with diabetes diagnosed at least two years prior, was recruited from eight North Carolina counties. All completed an interview that included a 16-item questionnaire to assess diabetes knowledge. A subsample of 46 completed the questionnaire a second time at a subsequent interview. Item-response analysis was used to refine the instrument to well-performing items. The instrument consisting of the remaining items was subjected to analyses to assess validity and test-retest reliability.
Three items were removed after item-response analysis. Scores for the resulting instrument were lower among minority and older participants, as well as those with lower educational attainment and income. Scores for test-retest were highly correlated.
The SDKI (13 item questionnaire) appears to be a valid and reliable instrument to evaluate knowledge about diabetes. Assessment in a multi-ethnic sample of older adults suggests that this instrument can be used to measure diabetes knowledge in diverse populations. Further evaluation is needed to determine whether or not this instrument can detect changes in knowledge resulting from diabetes education or other interventions.
Environmental and biomedical research often produces data below the limit of detection (LOD), or left-censored data. Imputing explicit values for values < LOD in a multivariate setting, such as with longitudinal data, is difficult using a likelihood-based approach. A Bayesian multiple imputation (MI) method is introduced to handle left-censored multivariate data. A Gibbs sampler, which uses an iterative process, is employed to simulate the target multivariate distribution within a Bayesian framework. Following convergence, multiple plausible data sets are generated for analysis by standard statistical methods outside of a Bayesian framework. With explicit imputed values available variables can be analyzed as outcomes or predictors. We illustrate a practical application using longitudinal data from the Community Participatory Approach to Measuring Farmworker Pesticide Exposure (PACE3) study to evaluate the association between urinary acephate concentrations (indicating pesticide exposure) and self-reported potential pesticide poisoning symptoms. Additionally, a simulation study is used to evaluate the sampling property of the estimators for distributional parameters as well as regression coefficients estimated with the generalized estimating equation (GEE) approach. Results demonstrated that the Bayesian MI estimates performed well in most settings, and we recommend the use of this valid and feasible approach to analyze multivariate data with values < LOD.
Bayesian; Gibbs sampler; Left-censoring; Limit of detection; Longitudinal data; Multiple imputation; Multivariate; Non-detections
Manual laborers are at increased risk for carpal tunnel syndrome (CTS), and a combination of history, physical examination, and nerve conduction studies is often used to screen for CTS in this population. Neuromuscular ultrasound may be a better screening tool, because it is painless. In this study we compare the accuracy of nerve conduction studies and ultrasound for CTS screening.
Five hundred thirteen manual laborers were screened prospectively for CTS using nerve conduction studies and neuromuscular ultrasound, and the accuracy of the 2 techniques was compared using the Katz hand diagram as the diagnostic standard.
The ROC curves for the 2 techniques were not significantly different (P = 0.542), indicating that the approaches had similar diagnostic accuracy.
Neuromuscular ultrasound is a painless technique that has diagnostic accuracy similar to nerve conduction studies and can be used to screen large populations at risk for CTS.
accuracy; carpal tunnel syndrome; clinical neurophysiology; screening test; ultrasound
The prevalence of bifid median nerves and persistent median arteries, their co-occurrence, and their relationship to carpal tunnel syndrome (CTS) are only understood partially.
We screened 1026 wrists of 513 Latino manual laborers in North Carolina for bifid median nerves and persistent median arteries using electrodiagnosis and ultrasound.
A total of 8.6% of wrists had a bifid median nerve, and 3.7% of wrists had a persistent median artery independent of subgroup ethnicity, age, gender, or type of work. An association with definite carpal tunnel syndrome was not found. The presence of either anatomic variant was associated with a high likelihood of co-occurrence of another variant in the same or the contralateral wrist.
The occurrence of median anatomic variants can be determined in field studies using ultrasound. Persistent median arteries and bifid median nerves tend to co-occur but do not put manual laborers at additional risk of developing CTS.
entrapment neuropathy; epidemiology; neuromuscular ultrasound; occupational health; poultry workers
This study documents demographic, health, and complementary therapy (CT) correlates of medical skepticism among rural older adults.
Older (≥65 years) African Americans and Whites in rural North Carolina (N=198) were interviewed. Medical skepticism was assessed using the four items from the Medical Expenditure Survey. Bivariate associations between medical skepticism and demographic and health characteristics and CT use were assessed, and independent effects on CT use.
Positive responses to medical skepticism questions ranged from 19.7% (can overcome illness without help) to 59.6% (believes own behavior determines their health). Medical skepticism indicators were associated with few demographic and health characteristics, and one CT category.
This study shows a high degree of medical skepticism among rural older adults, but limited associations with demographic and health characteristics and CT use. Further research is needed to understand relationships of attitudes towards conventional care and CT use in this population.
Medical skepticism; complementary therapies; rural older adults; African Americans
Studies on complementary therapy use among adults with diabetes are limited by crude use measures and lack of specificity of use for treating diabetes. Data are from a study including baseline and repeated 3-day assessments of complementary therapy use among rural African American and White older (age ≥64) adults (n=71). Most commonly used complementary therapies for diabetes at baseline included prayer (88.7%), food/beverages (50.7%), herbs (11.3%) and home remedies (9.9%). In repeated measures (1131 interviews), prayer was used on 57.2% of days, followed by food/beverages (12.7%), herbs (3.4%) and home remedies (2.7%). 56.3% who reported praying did so on ≥5 reporting periods; other complementary therapy use was sporadic. These data show, with the exception of prayer and food/beverages, limited complementary therapy use for diabetes treatment among rural older adults, and less inconsistent use patterns of most complementary therapies. Further research is needed to understand the motivations and patterns of complementary therapy use for diabetes patients.
Complementary Therapy Use; Diabetes Mellitus; Rural Older Adults
People with diabetes must engage in several self-care activities to manage blood glucose; cognitive function and other affective disorders may affect self-care behaviors. We examined the executive function domain of cognition, depressive symptoms, and symptoms of generalized anxiety disorder (GAD) to determine which common mental conditions that can co-occur with diabetes are associated with blood glucose levels.
We conducted a cross-sectional in-person survey of 563 rural older adults (age 60 years or older) with diabetes that included African Americans, American Indians, and Whites from eight counties in south-central North Carolina. Hemoglobin A1C (A1C) was measured from a finger-stick blood sample to assess blood glucose control. Executive function, depressive symptoms, and symptoms of GAD were assessed using established measures and scoring procedures. Separate multivariate linear regression models were used to examine the association of executive function, depressive symptoms, and symptoms of GAD with A1C.
Adjusting for potential confounders including age, gender, education, ethnicity, marital status, history of stroke, heart disease, hypertension, diabetes knowledge, and duration of diabetes, executive function was significantly associated with A1C levels: every one-unit increase in executive function was associated with a 0.23 lower A1C value (p = 0.02). Symptoms of depression and GAD were not associated with A1C levels.
Low executive function is potentially a barrier to self-care, the cornerstone of managing blood glucose levels. Training aids that compensate for cognitive impairments may be essential for achieving effective glucose control.
A1C; cognitive function; depression; anxiety; aging
This article describes the daily self-management practices of older adults with arthritis and examines the association of symptom experience with the use of self-management behaviors.
197 African American and White participants completed a baseline interview and six sets of three follow-up daily-diary interviews at monthly intervals.
Arthritis was reported by 63.5%. Arthritis self-management reported included complementary therapies, over-the-counter (OTC) and prescription medications, foods or beverages, and home remedies. Odds of implementing these self-care practices were greater on days with joint pain, swelling, and stiffness. Although, 78.0% and 72.4% of all participants reported staying in bed or cutting back on activities in response to joint symptoms, these self-management activities were not associated with having arthritis.
Focusing on daily responses to symptoms demonstrates that older adults actively manage arthritis symptoms using a wide variety of measures, including complementary therapies.
self-care; rural; complementary and alternative medicine; daily diary method
Racial and ethnic disparities in diabetes and subsequent complications are often attributed to culture; however, previous diabetes disparities research is restricted to in-depth ethnic-specific samples or to comparative study designs with limited belief assessment. The goal of this study is to improve understanding of the cultural basis for variation in diabetes beliefs.
Rural North Carolina
Older adults (aged 60+) with diabetes, equally divided by ethnicity (White, African American, American Indian) and gender (N=593).
Guided by Explanatory Models of Illness and Cultural Consensus research traditions, trained interviewers collected data using 38 items in four diabetes belief domains: causes, symptoms, consequences, and medical management. Items were obtained from the Common Sense Model of Diabetes Inventory (CSMDI).
Beliefs about diabetes. Response options for each diabetes belief item were “agree,” “disagree” and “don’t know”. Collected data were analyzed using Anthropac (version 4.98) and Latent Gold (version 4.5) programs.
There is substantial similarity in diabetes beliefs among African Americans, American Indians, and Whites. Diabetes beliefs were most similar in the “symptoms” and “consequences” domains compared to beliefs pertaining to “causes” and “medical management.” Although some discrete beliefs differed by ethnicity, systematic differences by ethnicity were observed for specific educational groups.
Socioeconomic conditions influence diabetes beliefs rather than “ethnicity” per se.
Diabetes Beliefs; Explanatory Models of Illness; Cultural Consensus; Ethnic Differences; Health Disparities
We examined perceptions of Dietary Approaches to Stop Hypertension (DASH) and the food environment among African Americans (AA) with high blood pressure living in two low-income communities and objectively assessed local food outlets.
Focus groups were conducted with 30 AAs; participants discussed DASH and the availability of healthy foods in their community. Sessions were transcribed and themes identified. Fifty-four stores and 114 restaurants were assessed using the Nutrition Environment Measures Survey (NEMS).
Common themes included poor availability, quality, and cost of healthy foods; tension between following DASH and feeding other family members; and lack of congruity between their preferred foods and DASH. Food outlets in majority AA census tracts had lower NEMS scores (stores: −11.7, p=.01, restaurants: −8.3, p=.001) compared with majority White areas.
Interventions promoting DASH among lower income AAs should reflect the food customs, economic concerns, and food available in communities.
Hypertension; diet; food deserts; African American