UMBC Center for Health, Equity, & Aging (CHEA)

Permanent URI for this collectionhttp://hdl.handle.net/11603/18192

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Erin Roth - Review of Philip B. Stafford, Elderburbia: Aging with a Sense of Place in America
(Indiana University, 2010-09-15) Roth, Erin
‘Successfully’ Aging ‘Alone’?: Unequal Global Opportunities and Rising Risks in Family-Based Models of Care Cross-Nationally
(Oxford University Press, 2024-08-10) Mair, Christine A.
For the first time in human history, older adults will outnumber children and a substantial and growing proportion will live alone and lack one or more nuclear family tie. Such unprecedented shifts require a reevaluation of existing models of “successful aging”, particularly in terms of long-term care policies.This paper draws on country-level data from multiple publicly available sources (e.g., World Bank, Organization for Economic Cooperation and Development, Our World in Data, and the World Values Survey) to examine cross-national patterns of development, health, demography, resources and policies, and cultural values in low-, middle-, and high-income countries.Although there exists substantial heterogeneity across countries, country-level patterns illustrate the economic privilege of living alone and the dominance of “successful aging” opportunities in high income countries. Cultural values about family reflect standard patterns of economic development, yet friendship emerges as a particularly consistent global value. At the country-level, living alone and health are associated in higher income countries with lower within-country inequality.Aging “alone” is a risk factor in some contexts, yet a marker of privilege in others. Models of “successful aging” are largely unobtainable in lower income countries or high inequality countries, and therefore require a thorough incorporation of global realities, or final abandonment in favor of more nuanced structural perspectives. Long-term care policies that assume the presence of family will yield increasing risk over time across all global contexts and represent a key vulnerability in the future of healthy aging policy.
A Look at External Political Efficacy and the Role of Digital Skills in the Adults U.S. Population
(Sage, 2024-07-23) Punksungka, Wonmai; Yamashita, Takashi; Narine, Donnette; Helsinger, Abigail; Cummins, Phyllis A.; Kramer, Jenna W.; Karam, Rita
The ability to effectively use digital technology and problem-solve are critical skills for maintaining democratic health, particularly as civil society and the modern digital landscape continuously evolve. However, information on whether individuals have the critical problem-solving skills to use digital technology and confidently affect change is yet to be further explored. Using data from the 2017 Program for International Assessment of Adult Competencies (n = 2749), we examined the associations between digital problem-solving skills and the three levels (low, neutral, high) of external political efficacy in the U.S. adult population. We used multinomial logistic regression and found a positive association between digital problem-solving skills and external political efficacy, while explanations for the three levels of efficacy are nuanced. Continuous development of digital problem-solving skills through adult education has implications for political efficacy, and ultimately for the promotion of a variety of civic engagement in the adult life stages.
Association between pre-hip fracture depression and days at home after fracture and assessing sex differences
(Wiley, 2024-07-20) Mehta, Rhea; Orwig, Denise L.; Chen, Chixiang; Dong, Yu; Shardell, Michelle D.; Yamashita, Takashi; Falvey, Jason R.
Background Hip fracture and depression are important public health issues among older adults, but how pre-fracture depression impacts recovery after hip fracture is unknown, especially among males who often experience greater depression severity. Days at home (DAH), or the days spent outside a hospital or healthcare facility, is a novel, patient-centered outcome that can capture meaningful aspects of fracture recovery. How pre-fracture depression impacts DAH after fracture, and related sex differences, remains unclear. Methods Participants included 63,618 Medicare fee-for-service beneficiaries aged 65+ years, with a hospitalization claim for hip fracture surgery between 2010 and 2017. The primary exposure was a diagnosis of depression at hospital admission, and the primary outcome was total DAH over 12 months post-discharge. Longitudinal associations between pre-fracture depression and the count of DAH among beneficiaries were estimated using Poisson regression models after adjustment for covariates; sex-by-depression interactions were also assessed. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) reflecting relative differences were estimated from these models. Results Overall, beneficiaries with depression were younger, White females, and spent 11 fewer average DAH compared to counterparts without depression when demographic factors (age and sex) (IRR = 0.91; 95% CI = 0.90, 0.92; p < 0.0001) and social determinants of health (race, Medicaid dual eligibility, and poverty) were adjusted for (IRR = 0.92; 95% CI = 0.91, 0.93; p < 0.0001), but this association attenuated after adjusting for medical complexities (IRR = 0.99; 95% CI = 0.98, 1.01; p = 0.41) and facility and geographical factors (IRR = 1.0037; 95% CI = 0.99, 1.02; p = 0.66). There was no evidence of effect modification by sex. Conclusions The comorbidity burden of preexisting depression may impact DAH among both male and female Medicare beneficiaries with hip fracture. Results suggest a holistic health approach and secondary prevention of depressive symptoms after hip fracture.
”Kinlessness” and Aging w/ Dr. Christine Mair
(UMBC Center for Social Science Research, 2023-10-30) Anson, Ian; Mair, Christine A. ; Yamashita, Takashi
On this episode I speak with Dr. Christine Armstrong Mair, Associate Professor of Sociology and Gerontology and Director of the Center for Health, Equity, and Aging (CHEA) in the Department of Sociology, Anthropology, and Public Health (SAPH) at UMBC. We discuss Dr. Mair’s ongoing research into aging and older adult lifestyles across the world. Dr. Mair mentioned the following resources in our discussion: Gateway to Global Aging Data SMaRT Scholars Program National Academies of Science, Engineering, and Medicine (NASEM), Seminar on Kinlessness and Living Alone at Older Ages (Drs. Margolis, Carr, Taylor, and Mair)
Associations between education, information-processing skills, and job automation risk in the United States
(Sage, 2023-11-07) Narine, Donnette; Yamashita, Takashi; Chidebe, Runcie C. W.; Cummins, Phyllis A.; Kramer, Jenna W.; Karam, Rita
Job automation is a topical issue in a technology-driven labor market. However, greater amounts of human capital (e.g., often measured by education, and information-processing skills, including adult literacy) are linked with job security. A knowledgeable and skilled labor force better resists unemployment and/or rebounds from job disruption brought on by job automation. Therefore, the purpose of this study was to advance understanding of the association between educational attainment and literacy, and job automation risk. Using the 2012/2014/2017 Program for the International Assessment of Adult Competencies (PIAAC) data, survey-weighted linear regression was used to model the risk of job automation as a function of education, and literacy proficiency. Higher educational attainment (college or higher vs. less than high school: b = −18.23, p < .05) and greater literacy proficiency (score 0–500 points: b = −.038, p < .05) were associated with a decrease in job automation risk among the U.S. workforce.
An Intersectional Approach to Examining Breast Cancer Screening among Subpopulations of Black Women in the United States
(Springer Nature, 2023-09-13) Narine, Donnette; Yamashita, Takashi; Mair, Christine A.
This study examines breast cancer screening behavior among subpopulations of Black women in the United States. Binary logistic regression was used to analyze breast cancer screening among a nationally-representative sample (n = 9,783) of Black women—US-born, non-US-born Caribbean, and non-US-born African—from the 2011-2017 National Health Interview Survey dataset. Non-US-born African Black women were less likely to have breast cancer screening, compared to US-born Black women. Among non-US-born Black women, non-US-born Caribbean Black women were more likely to have had breast cancer screening. Differential healthcare access associated with nativity differences among Black women can be informing their breast cancer screening behaviors. Efforts to improve breast cancer outcomes among Black women can benefit from interventions that account for differential access to healthcare and breast cancer screening behaviors among subgroups of Black women.
Less is (Often) More: Number of Children and Health Among Older Adults in 24 Countries
(Oxford University Press, 2023-08-25) Antczak, R; Quashie, N T; Mair, Christine A.; Arpino, B
Objectives Previous evidence about the impact of parenthood on health for older adults is mixed, perhaps due to variation in number of children and context. Higher numbers of children could lead to support or strain, depending on individual and country contexts. Yet, no studies currently exist that examine associations between number of children and several health indicators among older adults across multiple global regions. Methods We analyze cross-sectional data (1992-2017) of 166,739 adults aged 50+ across 24 countries from the Health and Retirement Study family of surveys to document associations between number of children, treated as a categorical variable, and five health outcomes (self-rated health, ADL limitations, IADL limitations, chronic conditions, depression). We perform multivariable analyses by estimating logistic regression models for each country and each outcome. Results Multiple comparisons between categories of number of children revealed at least one significant difference in each country, and a majority of significant differences indicated those with more children had poorer health. The risk of poorer health for parents of multiple children was observed in 15 countries, but in some countries fewer children predict poorer health. The greatest number of differences were identified for depression and chronic conditions, and very few for functional limitations. Discussion We observe a greater probability that more children is associated with poorer health in later life, especially for chronic conditions and depression. However, a universal global or regional pattern could not be identified. These findings raise new questions about how country contexts shape fertility and health.
The UMBC Applied Sociology MA Program
(UMBC Center for Social Science Research, 2023-07-05) Anson, Ian; Mair, Christine A.; Wallace, Brandy H.; Brauer, R.B.; Gray-Thomas, Jayla; Khalid, Fariha; Gilchrist, Perry
This episode features the remarkable UMBC MA in Applied Sociology program. Contact the program for more information at sociologyma@umbc.edu. First we hear from Dr. Christine Armstrong Mair and Dr. Brandy H. Wallace, both UMBC faculty members affiliated with the Applied Sociology program. We also hear from two current MA students working on theses in applied sociology, R.B. Brauer and Jayla Gray-Thomas, and two recent alumni of the program, Fariha Khalid and Perry Gilchrist. Check out the following links for more information on UMBC, CS3, and our host: The UMBC Center for the Social Sciences Scholarship The University of Maryland, Baltimore County Ian G. Anson, Ph.D.
Training for Business Success: Does Diversity Training Improve Productivity, Performance, and Fair Promotions?
Henderson, Loren; Washington, Patrick; Watkins-Butler, Akilah
There is a great deal of pessimism about the impact of diversity. Some critics have declared that diversity training programs do not work. Using data from the 2002 National Organizations Survey, this paper offers an examination of the relationship between the presence of diversity management and training in business organizations and assessments of business performance, business productivity, and fairness in the job promotion processes. The results suggest that, even after taking into account the size of the organization, the age of the organization, the percentage of workers who were minority, the percentage of workers who were female, and whether the organization was a private corporation, companies that have diversity training are more likely than are their counterparts without diversity training programs to report higher productivity than their competitors. Similarly, business organizations with diversity training programs are more likely than are other business organizations to report better business performance than their competitors. Also, companies with diversity training are more likely than are companies without diversity training programs to report that their employees believe procedures for determining promotions are fair. Such results go a long way toward dispelling the notion that diversity training programs do not matter. They show that diversity training programs can lead to positive outcomes.
Credit Where Credit is Due?: Race, Gender, and Discrimination in the Credit Scores of Business Startups
(Sage, 2015-01-01) Henderson, Loren; Herring, Cedric; Horton, Hayward Derrick; Thomas, Melvin
This research seeks to understand the degree to which credit scores of new business startups are influenced by racial or gender considerations. It also examines the degree to which access to business credit lines is influenced by racial and gender-related factors that go beyond would-be borrowers’ credit scores. Using credit data from new startups, the analysis finds that, when controlling for firm and human capital characteristics, Black-owned startups receive lower than expected business credit scores. Moreover, when credit scores, firm characteristics, and human capital characteristics are taken into consideration, startups owned by people of color still receive business credit lines that are substantially lower than those of their Whiteowned counterparts, and startups owned primarily by women receive credit lines that are substantially lower than those owned primarily by men. A Blinder-Oaxaca decomposition suggests that credit lines for Black-owned businesses would more than double, Latino-owned businesses’ lines of credit would nearly triple, Asian-owned businesses’ lines of credit would more than triple, and those where the primary owners are women would be more than twice as large if their business lines of credit were determined in the same way as those for businesses owned primarily by Whites and by men.
Mass incarceration, residential segregation and racial disparities in HIV
(Academic Journals, 2016-12-31) Henderson, Loren
Using a “mass incarceration” framework and county-level national data, this paper examines the relationship between incarceration, ex-offender reentry locations, and HIV rates in counties with different racial compositions. A series of “race-of-county” stratified regression models estimate HIV prevalence rates with incarceration and ex-offender reentry locations when taking into consideration residential segregation (that is, Black isolation and White isolation), region, high school graduation rates, sex ratios, unemployment rates, median income, healthcare professional shortages, percentage of residents without insurance, population density, and income inequality. As predicted, HIV rates are higher in counties with high incarceration rates or with ex-offender reentry facilities. A race-of-county stratified analysis, however, reveals nuanced patterns: In White counties and the highest-percentage Black counties, HIV rates increase as incarceration rates increase. In integrated counties, they do not. In the highest-percentage Black counties, the presence of reentry locations is associated with higher rates of HIV, but this is not true in White and integrated counties. In integrated counties, higher levels of Black isolation are associated with high HIV rates. In counties of all racial compositions, higher levels of White isolation are associated with lower rates of HIV. Implications of these results are discussed.
Undiagnosed Diabetes: Identifying the Community Paths to Type 2 Diabetes Diagnostic Testing
(Oxford University Press, 2020-12-16) Chard, Sarah; Girling, Laura; Henderson, Loren; Eckert, J Kevin
Over seven million U.S. adults are estimated to have undiagnosed diabetes and are at heightened risk of diabetes complications and poorer long-term glycemic control. Key to addressing undiagnosed diabetes is identifying how persons encounter diabetes testing in everyday life and the contextual factors that lead to consulting a health care provider. As part of the NIA-funded Subjective Experience of Diabetes Study we examined the pathways through which community-living African-American and non-Hispanic White older adults with type 2 diabetes (T2D) (N=75) received their T2D diagnosis. Systematic, thematic analyses using ATLAS.ti reveals three primary routes to diabetes diagnosis: diagnosis through continuity of primary care, diagnosis through happenstance testing, and diagnosis following the exacerbation of symptoms. While diagnosis as part of routine care was the least reported (N=13), participants’ accounts suggest diagnosis in primary care validates the patient-provider relationship and provides an occasion to calmly establish a treatment plan. More frequently, however, diagnosis occurs through fortuitous encounters with glucose tests, e.g., through work or community research projects (N=15) or after symptoms become alarming and disrupt daily life (N=47). Participants’ experiences in these latter two categories reveal the critical role of insurance and social prompts in the decision to consult a clinical provider regarding symptoms. At the same time, the abundance of over-the-counter therapies treating conditions commonly found early in the emergence of diabetes can delay clinical follow up. These findings highlight the importance of social prompts and community-based testing in the fight to reduce undiagnosed diabetes.
“Here it was waiting for me:” Diabetes Diagnosis Pathways and Implications for Health Policy
(PSO, 2022) Chard, Sarah; Girling, Laura; Harris-Wallace, Brandy; Henderson, Loren; Roth, Erin G.; Eckert, J. Kevin
Diabetes in older adults is a growing public health concern with nearly 30% of Americans 65 and older having diabetes. This includes 2.6 million older adults with undiagnosed diabetes who are at high risk of microvascular and cardiovascular complications (Centers for Disease Control and Prevention, 2022). The majority of cases are Type-2 diabetes. The past decade has witnessed an expansion in screening recommendations in an effort to reduce rates of undiagnosed older adults. Drawing on the sociology of diagnosis, we suggest further attention to the social factors that shape the diagnosis process is needed. We examine the diabetes diagnosis process from the perspective of older adults with type 2 diabetes. The data derive from diabetes illness narrative interviews with non-Hispanic White and African American older adult men and women (age ≥50) with type 2 diabetes (N=83). Our thematic analysis reveals four pathways to diagnosis: 1. Annual wellness exam, 2. Workplace screening, 3. Community-based opportunities, and 4. Health event or alarm. Diabetes’ early symptoms are often normalized within daily life, with health insurance gaps, providers’ dismissal of symptoms, and nonprescription medications reinforcing efforts to address initial symptoms within the home. Wellness visits, as well as worksite and community-based screening, critically intercede in the unfolding of symptoms. In contrast, diagnosis in connection with a health event or alarm carries an additional toll on social and emotional well-being. These findings have implications for national screening policies and local diabetes control efforts.
Living with Dementia during COVID-19, feat. Dr. Laura Girling
(UMBC Center for Social Science Research, 2021-12-10) Anson, Ian; Girling, Laura; Majid, Tabassum
Person-Centered Care in Nursing Homes: Many Stakeholders, Many Perspectives
(Healio, 2021-01-22) Kusmaul, Nancy; Tucker, Gretchen G.
Nursing home culture change moves facilities towards person-centered care. This study examined how people in different roles experienced choice and autonomy in four areas addressed by culture change: consistent assignment, food choice, waking/bedtime routines, and bathing. This descriptive qualitative study included 32 participants from one continuing care retirement community: 10 residents, eight family members, nine direct care workers, and five managers. Interviews were audiotaped, transcribed verbatim, and coded. Codes were grouped around the practice areas and cross-cutting themes. All groups reported choice in all areas. Challenges arose when patient choice and nursing home functions conflicted. Stakeholders disagreed when care needs should supersede choice. Findings suggest that it is difficult to balance resident choices 1) with the diverse needs/wants of other residents and 2) safety. Leaders, such as nurse managers, should provide ongoing education to residents, family, and staff to help them negotiate these challenges.
The Use of Online Health-Management Tools and Health Care Utilization among Older Americans
(Oxford University Press, 2020-07-07) Liu, Darren; Yamashita, Takashi; Burston, Betty; Keene, Jennifer R
Background and Objectives The digital divide, or differences in access to technology, can have far-reaching consequences. This study identified disparities in access to online health-related technology. It then investigated associations between online health-related technology use and health care utilization among older adults in the United States. Research Design and Methods The study used a cross-sectional data set of 1,497 adults aged 51 and older from the 2014 Health and Retirement Study (HRS)’s supplemental module (Health Behaviors) and the RAND version of the HRS fat file. Results Older age, being a racial/ethnic minority, married, uninsured, and having lower educational attainment, lower income, and reporting poorer health were each associated with lower levels of use of online health-management tools. The use of online health-management tools was associated with a 34% greater mean number of doctor visits (incidence rate ratio = 1.34, SE = 0.10, p < .05) than nonuse. However, such use was not associated with the number or type of hospitalizations. Indeed, only health care needs as measured by self-rated health status (odds ratio [OR] = 0.58, SE = 0.18, p < .05) and the number of chronic conditions were associated with hospitalizations (OR = 1.68, SE = 0.07, p < .05). Discussion and Implications While more research is needed to clarify the purposes (e.g., prevention vs. treatment) and outcomes of health care service utilization as a function of technology use, it may be wise to proactively tackle the digital divide as one upstream strategy for improving various health and health care outcomes among older adults.
COVID-19 and Maryland’s Older Adults
(UMBC Center for Aging Studies, 2020-06-02) Millar, Roberto J.; Sahoo, Shalini; Yamashita, Takashi; Sociology, Anthropology, and Public Health
Older Marylanders (80 + years old), who make a large majority of long-term care residents, have the highest risk of contracting and dying from COVID-19. Complying with the preventive measures suggested by the Maryland Department of Health is critical to protect Maryland’s oldest old, both in communities as well as in long-term care facilities.
Oldest-old Adults Face Higher Risk of COVID-19 Mortality
(2020-04-30) Sahoo, Shalini; Roberto, Millar; Takashi, Yamashita
HEALTH LITERACY AND HEALTH INFORMATION SOURCES AMONG OLDER ADULTS IN THE U.S
(UMBC Center for Aging Studies, 2020-04-25) Yamashita, Takashi; Cummins, Phyllis

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