Healthy Aging in Sociocultural Context edited by Andrew E. Scharlach and Kazumi Hoshino . 2012 : New York , Routledge . ISBN 978‐0415636216

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106145/1/ijsw12069.pd

Socioeconomic status and race/ethnicity independently predict health decline among older diabetics

Abstract Background There are pervasive racial and socioeconomic differences in health status among older adults with type 2 diabetes. The extent to which racial/ethnic and socioeconomic disparities unfold to differential health outcomes has yet to be investigated among older adults with diabetes. This study examines whether or not race/ethnicity and SES are independent predictors of steeper rates of decline in self-rated health among older adults in the U.S. with type 2 diabetes. Methods The study population was a subset of diabetic adults aged 65 and older from the Health and Retirement Study. Respondents were followed up to 16 years. Multilevel cumulative logit regression models were used to examine the contributions of socioeconomic indicators, race/ethnicity, and covariates over time. Health decline was measured as a change in self-reported health status over the follow-up period. Results Relative to whites, blacks had a significantly lower cumulative odds of better health status over time (OR: 0.61, p < .0001). Hispanics reported significantly lower cumulative odds better health over time relative to whites (OR: 0.59, p < .05). Although these disparities narrowed when socioeconomic characteristics were added to the model, significant differences remained. Including socioeconomic status did not remove the health effects of race/ethnicity among blacks and Hispanics. Conclusions The author found that race/ethnicity and some socioeconomic indicators were independent predictors of health decline among older adults with diabetes.http://deepblue.lib.umich.edu/bitstream/2027.42/112891/1/12889_2011_Article_3453.pd

Neighborhood Environment and Falls among Community-Dwelling Older Adults

Falls present a major challenge to active aging, but the relationship between neighborhood factors and falls is poorly understood. This study examined the relationship between fall events and neighborhood factors, including neighborhood social cohesion (sense of belonging, trust, friendliness, and helpfulness) and physical environment (vandalism/graffiti, rubbish, vacant/deserted houses, and perceived safety walking home at night)

Laws and policies to support the wellbeing of children: an international comparative analysis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98363/1/j.1468-2397.2009.00699.x.pd

The Effect of Health Literacy in Low Estimated Glomerular Filtration and Diabetes

Health literacy is widespread, but its potential is not recognized. By not recognizing health literacy, patients have the burden of coping with diabetes with renal complications without full knowledge of their responsibility to their health. The focus of the project was to assess participants with diabetes with low health literacy and low mean glomerular filtration rate (eGFR). The project goal was achieved by the assessment of the participants\u27 health literacy and eGFR before and after education for their diabetes, then assessed to determine if teaching the participants would improve their health literacy, lab values, and overall health. Participants were recruited by being patients of the designated clinic and screened for diabetes and low eGFR, for a total of 30 participants. The Brief Health Literacy Screen was used to measure health literacy. The health of the participants was appraised by the laboratory values of eGFR and fasting glucose. The project methodology was an observational design using correlation and 2-sample t analysis with the variables eGFR, fasting glucose, and health literacy. The variables were compared before and after the participants\u27 education. Results showed health literacy with patient education was associated with greater patient self-efficacy and improved fasting glucose numbers, eGFR flows, and health literacy scores. The current health climate shows value in different types of health providers. Social change was defined by the project launching a nurse practitioner as the leader for advancing the treatment plans of chronic kidney disease. This project impacts social change by showing patients in the process of improved health and empowering the patients to be advocates of their own health

Diabetes Health and Disability Pathways: Racial/Ethnic, Socioeconomic, and Gender Disparities.

This dissertation examines how race/ethnicity, socioeconomic status, and gender relate to longitudinal health outcomes among older adults with type 2 diabetes. Further, this dissertation analyzes the extent to which certain factors, such as social ties and health and illness behaviors, mediate this relationship. The outcomes examined are self-reported health status, adherence, and functional limitations. The hypotheses tested are that individuals with less social support—as well as individuals from socially disadvantaged backgrounds—will report lower health status and greater functional limitations relative to individuals from socially privileged backgrounds and relative to individuals greater amounts of social support. Longitudinal survey data is examined from the Health and Retirement Study (HRS) along with the 2003 HRS Diabetes Supplement. Further, qualitative and quantitative data were collected and analyzed from a small sample (30) of community-dwelling seniors. Multi-level modeling and mixed-method analysis is used to examine individual-level patterns of change. Throughout this series of analyses, race/ethnicity, socioeconomic status, and gender were independent predictors of subsequent health and disability outcomes. However, additional characteristics, such as social support and health characteristics, are important mediators of this relationship. As discussed in the second chapter, diabetic support is not significantly associated with health decline, but it is strongly associated with adherence to health-promoting activities consisting of a diabetic regimen. Therefore, the extent to which one receives illness support for a given regimen component is highly positively associated with adhering to that component, although this adherence does not necessarily translate into protection against perceived decline in health. As discussed in the fourth chapter, however, different forms of social support interact strongly with health behaviors to prevent functional decline. As diabetes and other chronic illnesses are increasingly recognized as social and public health priorities, it will become more critical to identify proximal and distal mechanisms by which chronic illness trajectories differ. No previous studies have adequately addressed this aim as proposed in this research. The identification of divergent pathways (and in particular, the relationship to mechanisms that can be altered in interventions) over the life course can enable more effective and efficient prevention practices and interventions.Ph.D.Sociology and Health Services Organization and PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/78790/1/enicklet_1.pd

Laws and policies to support the wellbeing of children: an international comparative analysis

The international community has raised concerns regarding the extent to which countries have implemented laws and policies to support the rights and wellbeing of children. This study evaluates the progress of least-developed countries (LDCs) and middle-income countries (MICs) in developing such legislation. Surveys were sent to 131 UNICEF country offices. Items included efforts to promote family preservation and family ties, family-based care over institutionalization, and child participation in placement decisions. A total of 68 surveys were returned, reflecting a 52 percent response rate (LDC, n= 25; MIC, n= 43). Legislation that addressed abuse and neglect of children, maternity leave, removal of children from the family, family care, adoption, and guardianship was widespread. Chi-square tests indicated that MICs had a substantially higher number of laws and policies related to child allowances, school feeding programs, maternity leave, and day care.http://deepblue.lib.umich.edu/bitstream/2027.42/78179/1/j.1468-2397.2009.00699.x.pd

Neighborhood Environment and Falls Among Community-Dwelling Older Adults

Background: Falls present a major challenge to active aging, but the relationship between neighborhood factors and falls is poorly understood. This study examined the relationship between fall events and neighborhood factors, including neighborhood social cohesion (sense of belonging, trust, friendliness, and helpfulness) and physical environment (vandalism/graffiti, rubbish, vacant/deserted houses, and perceived safety walking home at night). Methods: Data were analyzed from 9259 participants over four biennial waves (2006–2012) of the Health and Retirement Study (HRS), a nationally representative sample of adults aged 65 and older in the United States. Results: In models adjusting for demographic and health-related covariates, a one-unit increase in neighborhood social cohesion was associated with 4% lower odds of experiencing a single fall (odds ratio (OR): 0.96, 95% confidence interval (CI): 0.93–0.99) and 6% lower odds of experiencing multiple falls (OR: 0.94, 95% CI: 0.90–0.98). A one-unit increase in the physical environment scale was associated with 4% lower odds of experiencing a single fall (OR: 0.96, 95% CI: 0.93–0.99) and with 5% lower odds of experiencing multiple falls (OR: 0.95, 95% CI: 0.91–1.00) in adjusted models. Conclusions: The physical and social neighborhood environment may affect fall risk among community-dwelling older adults. Findings support the ongoing need for evidence-based fall prevention programming in community and clinical settings

Retirement village physical activity and nutrition intervention process evaluation:Informing practice

© 2018 AJA Inc. Objective: This process evaluation aimed to determine participants’ perceptions of the strategies utilised in a six-month intervention that set out to improve physical activity and nutrition in retirement village (RV) residents. Methods: Qualitative and quantitative data were collected from intervention participants residing in 17 RVs located in Perth, Western Australia, via self-report questionnaires (n = 139) and semi-structured interviews (n = 16). Results: Intervention resources were moderately useful and suitable. Program ambassadors were encouraging (86%), but more frequent, and more direct, contact were preferred. The main reason for withdrawing from the program was health-related conditions (aches, pains, injuries). Conclusion: This study provides evidence that the intervention was reasonably appropriate for older adults residing in RVs. Program ambassadors were well accepted, a successful strategy that should be considered for future interventions in RVs. Increased face-to-face engagement was preferred, but such an approach will require greater investment. The findings contribute to a small research base concerned with health behaviour interventions in RVs

Racial Discrimination in Health Care Is Associated with Worse Glycemic Control among Black Men but Not Black Women with Type 2 Diabetes

BackgroundA growing body of research suggests that racial discrimination may affect the health of Black men and Black women differently.AimsThis study examined Black patients with diabetes mellitus (DM) in order to test gender differences in (1) levels of perceived racial discrimination in health care and (2) how perceived discrimination relates to glycemic control.MethodsA total of 163 Black patients with type 2 DM (78 women and 85 men) provided data on demographics (age and gender), socioeconomic status, perceived racial discrimination in health care, self-rated health, and hemoglobin A1c (HbA1c). Data were analyzed using linear regression.ResultsBlack men reported more racial discrimination in health care than Black women. Although racial discrimination in health care was not significantly associated with HbA1c in the pooled sample (b = 0.20, 95% CI = −0.41 −0.80), gender-stratified analysis indicated an association between perceived discrimination and higher HbA1c levels for Black men (b = 0.86, 95% confidence intervals (CI) = 0.01–1.73) but not Black women (b = −0.31, 95% CI = −1.17 to −0.54).ConclusionPerceived racial discrimination in diabetes care may be more salient for glycemic control of Black men than Black women. Scholars and clinicians should take gender into account when considering the impacts of race-related discrimination experiences on health outcomes. Policies should reduce racial discrimination in the health care