Recent Faculty Publications
Sandra Barnes
An Intra-Ethnic Analysis of Social Affiliations among Latinos in the United States
Barnes, S.
Journal of Poverty: Innovations on Social, Political, & Economic Inequalities, 11(1): 107-134, 2007
Studies suggest the importance of social affiliations to acquire such resources and facilitate neighborhood involvement. However, limited research examines these dynamics for Latinos in the U.S. This study considers the relationship between individual-level formal and informal ties (religious, kin, friendship and employment), ethnicity and social affiliations. Findings based on logistic regression analysis using the Multi - City Study of Urban Inequality database for 1,576 Mexicans, Puerto Ricans, Salvadorans, Guatemalans, Nicaraguans, and Dominicans show that, regardless of ethnicity, respondents tend to have educational, cultural, and church-related social affiliations. Persons from Puerto Rico and the Dominican Republic are more likely to have social affiliations. And although education and age engender such affiliations, frequent religious attendance and Catholicism undermine them.
The Cost of Being Poor: A Comparative Study of Life in Poor Urban Neighborhoods in Gary, Indiana
Barnes, S.
SUNY Press, 2005
The book reflects a comparative analysis of the economic and non-economic costs to feed and clothe families for working class and impoverished families. Quantitative and qualitative data are examined based on whether respondents reside in poor or non-poor urban neighborhoods to study the implications of race, class, and space on quality of life and life chances.
*This book is available through the Kelvin Smith Library.
Black Church Culture and Community Action
Barnes, S.
Social Forces, 84(2): 967-994, 2005
Cultural theory posits that social groups possess a cultural repertoire or “tool kit” that reflects beliefs, ritual practices, stories, and symbols that provide meaning and impetus for resource mobilization. This study examines the relationship between longstanding Black Church cultural components – specifically, scripture, song, prayers, and sermons – and activism among Black churches. Based on a national sample of 1,863 Black congregations across seven denominations and logistic regression analysis, cultural theory is tested. Findings support the consistent, direct relationship between prayer groups and gospel music and various forms of community action and less influence by spirituals and the general usage of sacred scripture.
Too Poor to Get Sick? The Implications of Place, Race, and Costs on the Health Care Experiences of Residents in Poor Urban Neighborhoods
Barnes, S.
Research in the Sociology of Health Care, 22:47-64, 2005
Literature suggests that the poor often face a myriad of health care constraints and health problems. This study uses bivariate and multivariate analyses and the 1986 Urban Poverty and Family Life Survey of Chicago (UPFLS) to examine the effects of systemic factors such as the availability of health care providers and neighborhood poverty on individual health decisions for a sample of 2,490 African Americans, Whites, Mexicans, and Puerto Ricans in poor Chicago neighborhoods. Results show that Medicaid usage and having a regular physician increase the number of days home ill and days hospitalized, while frequenting clinics decreases such activity. Additionally, residents in more impoverished urban areas are less likely to stay home ill. Differences in health profiles and providers are also evident based on race/ethnicity. These findings illustrate the important relationship between macro-level factors and specific health choices many residents in poor urban areas make at the micro-level.
Priestly and Prophetic Influences on Black Church Social Services
Barnes, S.
Social Problems, 51(2): 202-221, 2004
This study examines the relationship between priestly and prophetic functions and social services sponsored by the Black Church. A national sample of 1,863 churches across seven denominations is used to study the role of the contemporary Black Church in addressing economic and social problems. Results from negative binomial analyses show varied denominational support of social services. The majority of sponsored programs are economic in nature or youth-oriented, rather than political or civic. Furthermore, financially stable churches with better educated, paid clergy positively influence social service sponsorship. And while variables associated with a prophetic function have a greater influence on social services, variables that reflect a more priestly function, specifically whether churches sponsor religious programs, are also important in motivating churches to provide such services. These findings add to the literature on the nuanced nature of the dialectical model used to describe the Black Church.
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Dale Dannefer
Reciprocal Co-optation: Reflections on the Interface Between Critical Theory and Social Gerontology
Dannefer, D.
In Aging, Globalisation and Inequality: The New Critical Gerontology, edited by Baars, J., Dannefer, D., Phillipson, C. and Walker, A., 2006
The relationship between age and critical theory may be characterized as a relation of reciprocal co-optation. By co-optation I mean that an idea or principle is accepted, but is reframed to fit within the assumptions of one or more preexisting paradigms. Therefore, its power is diluted at the same time that it is heralded as a new contribution. When co-optation is reciprocal, it of course poses a double challenge. This chapter suggests that such a condition of reciprocal co-optation has characterized the relation between age and critical theory. The co-optation of critical theory by the wider discourse in social gerontology has occurred by reducing the scope and meaning of the term; the co-optation of social gerontology by critical theory has occurred by the focus on issues of political economy rather than the more vexing issues of alienation, meaning and mortality.
Missing Persons: Some Problems in the Study of Cognitive Aging
Dannefer, D. (with Patterson, R.)
In International Handbook of Cognitive Aging, edited by S. Hofer and D. Alwin, forthcoming
In this paper, we argue that the challenge posed by cohort analysis has yet to be fully engaged by much of the research on cognitive aging. The problems opened up by cohort analysis demonstrate the social basis for much of the age-related and intracohort variation in cognitive performance, and point to the need for a social-constitutive paradigm that would help identify the multiple levels and types of social influence on cognitive outcomes across the life course. While the discovery of cohort analysis implied a clear need for a paradigmatic change in the understanding of age, the dominant reaction of the field has been “damage control”, attempting to protect as much as possible the ontogenetic view of age-related change. We discuss two forms of damage control, containment and abandonment. We then show how the strong recent interest in the concept of ergodicity also implies the need for paradigm change. In the final section, we point out the lack of attention to distinctly human aspects of cognition (e.g., creativity, imagination, wisdom) in most studies of cognitive aging. Such dimensions of cognitive performance are obviously central important in understanding human aging and may, at least for considerable segment of the life course, have the potential systematically to increase with age.
The Waters We Swim: Everyday Social Processes, Macro-Structural Realities, and Human Aging
In Social Structure and Aging edited by K. Warner Schaie & Ronald P. Abeles, forthcoming
Homo sapiens as a species is distinct in the degree to which individual development and aging are shaped by experience. This is accounted for by specific features of human physical and mental development, including exterogestation and neoteny. It is understandable that we are generally unaware of the profound dependency of human nature on social context, since each of us typically grows up in a local setting of taken-for-granted and largely unreflective routines. Processes of individual development and aging occur gradually over long sweeps of time, and rarely are experienced directly as change. It has been said that “we don't know who discovered water, but we're certain it wasn't a fish.”. The everyday social relations that comprise the invisible and unnoticed “water we swim” shape human development and aging, but are also at the same time themselves constituted through human action. This dialectical interrelation raises the question of the relation of how to conceptualize the relation of individual human beings and the social institutions and practices. Two models for approaching this relationship are presented the accommodationist and constitutionalist models. In studies of aging, the systematic operation of social-structural processes have often been overlooked because of the tendency to link individual-level change and demographic analyses of population change, both of which omit analysis of the everyday operations of social-interactional dynamics and social institutions.
Cumulative Advantage, and the Life Course: Cross-Fertilizing Age and Social Science Knowledge
Dannefer, D.
Journal of Gerontology 58b:S327-S337, 2003
Age and cumulative advantage/disadvantages theory have obvious logical, theoretical, and empirical connections, because both are inherently and irreducibly related to the passage of time. Over the past 15 years, these connections have resulted in the elaboration and application of the cumulative advantage-disadvantage perspective in social gerontology, especially in relation to issues of heterogeneity and inequality. However, its theoretical origins, connections, and implications are not widely understood. This articles reviews the genesis of the cumulative advantage/disadvantage perspective in studies of science, it initial articulation with structural-functionalism, and its expanding importance for gerontology. It discusses its intellectual relevance for several other established theoretical paradigms in sociology, psychology, and economics. On the basis of issues deriving from these perspectives and from the accumulating body of work on cumulative advantage and disadvantage, I identify several promising directions for further research in gerontology.
Toward a Global Geography of the Life Course: Challenges of Late Modernity to the Life Course Perspective
Dannefer, D.
In Handbook of the Life Course, edited by J.T. Mortimer and M.Shanahan, 2003
The life course is a term that refers both to a phenomenon and to a theoretical perspective. As a phenomenon, the life course has often referred to the trajectories and transitions resulting that have come to be associated with the “three boxes of life”, or the institutionalized life course of late modernity. As the destructuring and deinstitutionalizing forces celebrated by postmodernism advance and as awareness of global diversity in life course patterns increases and as the rapid social change associated with globalization develops, the life course as phenomenon becomes increasingly challenging to describe in any unitary or coherent fashion. This circumstance also has implications for life course as a theory or strategy of explanation. A prototypical explanatory strategy of life-course work is the idea that early life experiences predict later life outcomes. Yet this idea has been demonstrated mainly in the context of the relatively stable and prosperous late-20th century economies of the USA and Europe. A global geography of the life course provides the foundation for a fuller examination the life course as phenomenon, as it can illuminate the extent to which the “institutionalization” hypothesis can account for the age-graded sequence of social roles. It also provides a fuller examination of the life course as a strategy of explanation, specifically of the basic hypothesis that early events predict later outcomes under a much wider range of social conditions in adulthood.
When social conditions during one’s adulthood years are less stable, predictable and orderly than has been the case in this relatively stable period, will early life experience continue to have a measurable effect on outcomes?
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Gary Deimling
Functioning and Activity Participation Restrictions among Older Adult, Long-Term Cancer Survivors
Deimling, G.T., Sterns, S., Bowman, K.F. and Kahana, B.
Cancer Investigation, 25: 1-11, 2007
This research examines how cancer and treatment sequelae combine with comorbidities to influence the physical functioning and activity participation restrictions reported by older adult, long-term survivors of breast, prostate and colorectal cancer. The number of current comorbidities was the best predictor of functional difficulties and also a significant predictor of participation restrictions. Cancer stage at diagnosis and continuing cancer symptoms had direct effects on functional difficulties, and indirect effects through functional difficulties on participation restrictions.
Appraisal of the Cancer Experience by Family Members and Survivors in Long-Term Survivorship
Bowman, K.F., Rose, J.H. and Deimling, G.T.
Psycho-Oncology, 15(9): 143-159, 2006
The focus of this research is to discover the dynamics of appraisal of cancer experience in long-term survivorship. Also, it examines the convergence/divergence of this experience between older survivors and family members. Beliefs about the effect of the diagnosis and treatment on family members were important correlates for both family members and survivors in the appraisal process. Cancer characteristics were not related to appraisal for survivors, but stage at diagnosis was associated with a more stressful appraisal for family members.
Cancer-Related Health Worries and Psychological Distress Among Older Adult, Long-Term Cancer Survivors
Deimling, G.T., Bowman, K.F., Sterns, S., Wagner, L.G. and Kahana. B.
Psycho-Oncology, 15(4): 306-320, 2006
This paper examines the cancer-related health worries of older adults and the role that these health worries play in predicting psychological distress, anxiety and depression. About one-third of survivors continue to report worries about recurrence, worries about a second cancer, and worries that symptoms that they experience may be from cancer. The regression analyses show that cancer-related health worries is a significant predictor of both depression and anxiety. Race is s significant predictor; being African American is related to fewer cancer-related health worries. Having more symptoms during treatment is also a predictor of have more cancer-related worries.
Coping Among Older-Adult, Long-Term Cancer Survivors
Deimling, G.T., Wagner, L.G., Bowman, K.F., Sterns, S., Kercher, K. and Boaz Kahana
Psycho-Oncology, 15(2): 143-159, 2006
This research looks into the coping characteristics of older-adult long-term cancer survivors. It examines the effect of personal and illness-treatment characteristics on developing and maintaining coping styles. The most prominent forms of coping used by long-term survivors were planning and acceptance; least used were venting and denial. Increased age was associated with the lower use of all forms of coping, but cancer-type was not. Denial as a form of coping was associated with higher anxiety, depression and cancer-related worries. While race was not found to be a significant predictor of coping style, it was a significant predictor of three dimensions of psychological distress, anxiety, depression and cancer-related worries, with African Americans exhibiting lower levels of distress than Whites. The relevance of these findings for health and social service practitioners is discussed.
The Health of Older-Adult, Long-term Cancer Survivors
Deimling, G.T., Sterns, S., Bowman, K.F. and Kahana, B.
Cancer Nursing, 28(6): 415-424, 2005
This research examines the cancer-related health problems that persist for decades among cancer survivors. Various dimensions such as race and sex as well as type of cancer were incorporated in the analyses. Close to half of survivors in this research continue to have at least one symptom attributed to cancer/treatment and a few reported three for more continuing symptoms. Pain was the most commonly reported symptom attributing it to cancer. Almost half of breast cancer survivors reported experiencing pain, and nearly one third of prostate cancer survivors reported pain. Being African American or female was significantly associated with more current symptoms and greater functional difficulty. Survivors who had the most types of treatment and those who had chemotherapy reported significantly more symptoms both during treatment and currently.
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Brian Gran
Social Policy Puzzles: Reconsidering the Public-Private Dichotomy in Health and Pension Policies
Béland, D. and Gran, B. (Editors)
New York, NY: Palgrave Macmillan, Forthcoming, 2008
In affluent democracies, the welfare state often shares responsibilities with private institutions. Does public-private welfare provision vary across countries and, if so, how? Although scholars have long paid attention to these crucial questions, comparative research can offer unique insights to understanding the changing boundaries between the public and private spheres’ efforts to provide social benefits. Such knowledge is especially important now, as pushes for privatization and market-based social protection are strengthening in a number of advanced industrial societies. This book makes contributes to current debates by offering comprehensive analyses of the public-private dichotomy for social policies across four continents. It innovatively unites systematic quantitative analyses and qualitative, case studies of the public-private dichotomy for health and pension policies. This book underlines the complex nature of the public-private dichotomy for social policy.
The Rights of the Child
Gran, B.
In The Leading Rogue State: The US and Human Rights edited by Judith Blau, J., Moncada, A., Zimmer, C. and Brunsma, D. To be published by Paradigm Publishers
This chapter argues that the United States is a rogue state when it comes to children's rights. The U.S. government is one of only two in the world not to ratify the U.N. Convention on the Rights of the Child. What legal changes would need to take place for the United States to meet this Convention?
A Second Opinion: Rethinking the Public-Private Dichotomy for Health Insurance
Gran, B.
International Journal of Health Services 33(2): 283-313, 2003
Does the public-private dichotomy effectively describe health insurance systems in the advanced industrialized democracies? Is the boundary separating the public and private sectors accurate for studies of social policy formation and cutback? This article has three goals. The first is to discuss reasons for reconsidering the pubic-private dichotomy, as it applies to health insurance systems. The second is to offer a reconceptualization of the public-private demarcation useful for analyses of health insurance systems; the author presents four sectors that may illuminate patters of health insurance for different OECD countries; the social, individual, public, and market sectors. The third goal is to present results using a new methodological approach useful for studying complex social phenomena: the fuzzy-set approach, which allows researchers to treat social phenomena as partially belonging to more than one category. This approach is employed to demonstrate that health insurance provision rarely is solely public or private, but is formed by a combination of sectors. Underlying these three goals is the contention that comparative and historical sociological researchers can offer innovative approaches to the study of health insurance and the interests served by public and nonpublic health insurance programs through reconceiving the public-private dichotomy.
The Office of the Children’s Ombudsperson: Children’s Rights and Social-Policy Innovation
Gran, B. and Aliberti, D.
International Journal of the Sociology of Law 31(2): 89-106, 2003
A potential key to the future of children’s rights is the ombudsperson. In 1981, Norway became the first government to establish an office of a children’s ombudsperson, which has statutory powers to protect children and enforce their rights. This paper represents the first cross-national analysis of the offices of children’s ombudsperson. We employ Qualitative Comparative Analysis, which is based on Boolean algebra, to examine explanations why a national office of children’s ombudsperson has or has not been established in 193 countries up to the year 2000. Our research suggests social policy innovations responds to need and is contingent on country wealth, but is mediated by either strong political rights or subscription to international treaties. This work indicates future research should consider subsequent establishment of offices of children’s ombudsperson and the rights of children an ombudsperson seeks to enforce.
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Susan Hinze
Rapid Clinical Decision-Making in Context: A Theoretical Model to Understand Physicians’ Decision-Making with an Application to Racial/Ethnic Treatment Disparities
Tamayo-Sarver, J. H., Dawson, N.V., Hinze, S.W., Cydulka, R.K., Wigton, R.S., Ibrahim, S.A. and Baker, D.W. Research in the Sociology of Health Care (Health Services, Racial and Ethnic Minorities and Underserved Populations: Patient and Provider Perspectives), 23: 183-213, 2005
The purpose of this paper is to draw on previous work in multiple disciplines to establish a theoretical framework for clinical decision-making that incorporates non-medical factors, such as race/ethnicity, into the way physicians make decisions in the practice of medicine. The proposed Rapid Clinical Decision in Context (RCDC) model attempts to understand the influence of various contextual elements on physicians' decision-making process. The RCDC model provides a basis for future studies to move beyond documentation of areas where disparities exist to understanding the causes of the disparities and designing interventions to address those causes. The paper concludes with a discussion of possible studies to test the proposed model.
‘Am I Being Over-Sensitive?’ Women’s Experience of Sexual Harassment in Medical Training
Hinze, S.W.
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 8(1): 125-151, 2004
Despite larger numbers of women in medicine and strong statements against harassment and gender discrimination in written policies and the medical literature, sexual harassment persists in medical training. This study examines the everyday lives of women and men resident physicians to understand the context within which harassment unfolds. The narratives explored here reveal how attention is deflected from the problem of sexual harassment through a focus on women’s ‘sensitivity.’ Women resist by refusing to name sexual harassment as problematic, and by defining sexual harassment as ‘small stuff’ in the context of a demanding and rigorous training program. Ultimately, both tactics of resistance fail. Following Dorothy Smith (1987), I argue that closer examination of the relations shaping and determining everyday actions is key. The rigid hierarchy of authority and power in medical training should be viewed through a gender lens. I conclude with a discussion of how reforms in medical education must tend to the gendered, everyday realities of women and men in training.
Women, Men, Career and Family in the U.S. Young Physician Labor Force
Hinze, S.W.
Research in the Sociology of Work (Diversity in the Workforce), 14: 185-217, 2004
Drawing upon the 5% Public-Use Microdata Sample (PUMS) from the 1990 and 2000 Censuses (with comparisons to the 1980 Census through the work of Uhlenberg and Cooney, 1990), this paper examines the changing characteristics of the U.S. young physician labor force (age 30-49). Currently, over 45% of medical degrees are earned by women, but gendered work-family patterns persist. Measures examined include income, hourly wages, mean work hours, part-time and overtime work, practice setting, marital status, and children. For a sub-sample of physicians married to physicians, I also examine income and work hour differentials. Close attention is paid to whether a marriage premium and/or a motherhood penalty in wages exists and persists over time. Implications of the documented workforce diversity are discussed for organizations within which physicians are employed.
Racial/Ethnic Disparities in Emergency Department Analgesic Prescription
Sarver, J.H., Hinze, S.W., Cydulka, R.K. and Baker, D.W.
American Journal of Public Health, 93(12): 2067-2073, 2003
The purpose of this paper was to examine racial and ethnic disparities in analgesic prescription among a national sample of emergency department patients. Black, Latino, and White patients in the 1997-1999 National Hospital Ambulatory Medical Care Surveys were analyzed to compare prescription of any analgesics and opioid analgesics by race/ethnicity. For any analgesic, no association was found between race and prescription; opioids, however, were less likely to be prescribed to Blacks than to Whites with migraines and back pain, though race was not significant for patients with long bone fractures. Differences in opioid use between Latinos and Whites with the same conditions were less and nonsignificant. In conclusion, physicians were less likely to prescribe opioids to Blacks; this disparity appears greatest for conditions with fewer objective findings (e.g., migraine).
Inside Medical Marriages: The Effect of Gender on Income
Hinze, S.W.
Work and Occupations, 27(4): 464-499, 2000
Past research on the gender gap in physician incomes suggests that young male physicians outearn young female physicians because they are located in more lucrative specialties and practices and work longer hours. In this paper, I present data on 321 physicians married to physicians and incorporate a range of variables not usually included in studies of income disparities. Besides traditional human capital and structural labor market variables, I include family context measures which prove significant for understanding why women earn less. The findings challenge support for the meritocratic view of the pay gap and call our attention to the importance of the work-family interface in studies of physician income.
Gender and the Body of Medicine or at Least Some Body Parts: (Re)constructing the Prestige Hierarchy of Medical Specialties
Hinze, S.W.
The Sociological Quarterly, 40(2): 217-239, 1999
Understanding the disproportionate location of women physicians in lower status medical specialties necessitates knowing how women and men view the prestige hierarchy of specialties. Previous research on status ranking has been largely quantitative and based upon male respondents. Using narratives from face-to-face interviews with male and female resident physicians, this study finds that, although residents are fairly consistent in their rankings, women were more likely to resist the concept of a prestige hierarchy. In addition to explicit dimensions conferring prestige are implicit justifications grounded in the physician’s body. Specifically, high prestige is associated with active interventionist hands and “balls,” body parts that I argue are not gender neutral. The findings shift the focus from individual-level gender differences toward a gendered examination of the medical specialty hierarchy. The physicians interviewed here give voice to the silent, symbolic, embodied work of gender that shapes the structure of medical specialties into a ladder with a masculine top and a feminine bottom, regardless of whether male or female bodies occupy the rungs.
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Eva Kahana
Institutional constraints on residents in long-term care facilities for the elderly
Sterns, S., & Kahana, E.
In J. Kronenfeld (Ed.), Research in the Sociology of Health Care, Vol. 24: Access, Quality and Satisfaction with Care: Concerns of Patients, Providers and Insurers. 135-154, 2006
For frail older persons, gaining access to care is primarily in the context of long-term care institutions. Based on hypotheses derived from the theory of the total institution (Goffman, 1961) and anticipatory socialization theory (Merton & Kitt, 1950), linkages of intra-institutional and extra-institutional social ties with quality of life outcomes were assessed based on 168 residents’ self-reports of their life and problems experienced in long-term care (Kahana, Kahana, & Young, 1987). Findings reveal that lack of anticipatory socialization was a significant predictor of subsequent wellbeing, whereas the extent of social ties to the outside world did not predict subsequent wellbeing.
Cancer in the Elderly
Berger, N., Savvides, P., Koroukian, S., Kahana, E., Deimling, G., Rose, J., Bowman, K., & Miller, R.
Transactions of the American Clinical and Climatological Association,117, 147-156, 2006
As the population expands, over the period from 2000 to 2050, the number and percentage of Americans over age 65 is expected to double. This population expansion will be accompanied by a marked increase in patients requiring care for disorders with high prevalence in the elderly. Since cancer incidence increases exponentially with advancing age, it is expected that there will be a surge in older cancer patients that will challenge both healthcare institutions and healthcare professionals. In anticipation of this challenge, researchers at the Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio are conducting a series of investigations focused on the intersection of aging and cancer. Studies will be addressed in the high priority research areas of 1) Treatment Efficacy and Tolerance, 2) Effects of Comorbidities, 3) Psychosocial Issues, and 4) Biology of Aging Cancer.
Spirituality and healthy lifestyle behaviors: Stress counter-balancing effects on the well-being of older adults
Boswell, G., Kahana, E., Dilworth-Anderson, P.
Journal of Religion and Health. 45(4), 587-602, 2006
The goal of this study was to examine stress-ameliorating effects of religiosity, spirituality, and healthy lifestyle behaviors on the stressful relationship of chronic illness and the subjective physical well-being of 221 older adults. We also investigated whether the intervening variables functioned as coping behaviors and orientations or as adaptations in late life. Guided by the stress paradigm, path analysis was used to assess these relationships in a stress suppressor model and a distress deterrent model. No suppressor effects were found; however a number of distress deterrent relationships were detected. Spirituality, physical activities, and healthy diet all contributed to higher subjective physical well-being, as counter-balancing effects, in the distress deterrent model. The findings have implications for future research on the role of spirituality, religiosity and the lifestyle behaviors on the well-being of chronically ill older adults. Findings also support the need for studying different dimensions of religiosity and spirituality in an effort to understand coping versus adaptation in behaviors and orientations.
Altruism, Well Being and Mental Health in Late Life
Midlarsky, L. & Kahana, E.
In S. Post (Ed.), Altruism and Health: Perspectives from Empirical Research. New York: Oxford University Press. 81-103, 2007
Blood donors and community service volunteers are recruited with posters announcing that by giving to others, they will receive even more than they give. Is this true? Will those who help others to benefit themselves obtain rewards that they expect? In this chapter, we begin with the background of and theory on altruism. We then focus on our own research on older helpers, emphasizing work on Holocaust heroes, who are now quite elderly. A basic premise of this chapter is that they consequences of altruism, in the form of well-being and mental health, can be viewed through the prism of the altruism paradox.
Meeting challenges of aging among elderly survivors of the Nazi Holocaust
Kahana, B., Kahana, E., King, C., Harel, Z & Seckin, G.
Gerontology: Journal of the Israel Gerontological Society. 47-59, 2007
This paper considers the social and psychological aftermath of one of the most extreme social disasters in recent history, that of the Nazi Holocaust. Focusing on elderly Holocaust survivors, we address broader issues regarding social challenges faced, and adaptations exhibited, by adult trauma survivors. Findings regarding adaptations to aging in the aftermath of early life trauma are presented from interviews with over 300 Holocaust survivors, evenly divided between those living in the U.S. and in Israel. Interviews were also conducted with Jewish elders who did not experience the Holocaust but who immigrated to the U.S., or to Israel just prior to World War II. Survivors of the Holocaust were compared to the immigrant group in terms of physical health, psychiatric symptomatology, and social functioning. Quantitative analyses revealed significant adverse effects of surviving trauma on psychological well-being but did not support anticipated age by survivorship interaction effects. Analyses of qualitative data revealed four notable typologies: (1) the resilient, (2) the unaffected, (3) the conditionally vulnerable, and (4) the generally vulnerable survivors. Within each of these typologies, we note responses illuminating efforts at normalization as survivors interact with society and through this interaction negotiate self-mastery.
Patient proactivity enhancing doctor-patient-family communication in cancer prevention and care among the aged
Kahana, E., & Kahana, B.
In G. Kreps, (Ed.), Handbook of Cancer Care and Communication. New York: Hampton Press, 2007
In attempting to improve communication between doctors and patients related to cancer prevention and care, there have been relatively little patient-driven data, particularly based on elderly patients, to help in developing better communication guidelines (1;2). Present recommendations are largely based on expert (physician) opinions about desirable approaches to communication (3; 4). We present a model that aims to address this gap in knowledge. Our discussion goes beyond the typical focus of the health communication literature on only dyadic interactions, to consideration of interactions among members of a health care triad of physician, patient and Health Significant Other (HSO).
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Jessica Kelley-Moore
Assessing Racial Health Inequality: comparisons from Mixed-Mode Panel Interviews
Kelly-Moore, Jessica A.
Journal of Gerontology: Social Sciences, 61B(4): S212-S220, 2006
Estimates of the extent of health disparities among Black and White older adults are not consistent across studies. The purpose of this study was to systematically compare responses from Black and White older adults in telephone and face-to-face interviews in order to determine whether estimates of racial health inequality vary by survey interview mode. By using data from a mixed-mode panel study, I compared estimates of changing health inequality for Black and White older adults collected from face-to-face and telephone interviews. I calculated trajectories of physical disability by using latent growth models across seven waves of data. Face-to-face interviews yielded consistently higher reports of disability relative to telephone interviews of the same persons. Black adults had significantly greater and increasing disability than did White adults for both interview modes. After adjusting for covariates, I found that Black and White older adults had parallel disability trajectories in face-to-face interviews but a widening gap in disability over time in telephone interviews. Researchers should judiciously consider whether estimates of racial health inequality-and change in disability more broadly-may be misleading because of interview-mode effects.
When Do Older Adults Become “Disabled”? Social and Health Antecedents of Perceived Disability in a Panel Study of the Oldest Old
Kelley-Moore, J., Schumacher, J., Kahana, E., & Kahana, B.
Journal of Health & Social Behavior, 47: 126-141, 2006
Disability carries negative social meaning, and little is known about when (or if ), in the process of health decline, persons identify themselves as "disabled." We examine the social and health criteria that older adults use to subjectively rate their own disability status. Using a panel study of older adults (ages 72+), we estimate ordered probit and growth curve models of perceive disability over time. Total prevalent morbidity, functional limitations, and cognitive impairment are predictors of perceived disability. Cessation of driving and receipt of home health care also influence older adults' perceptions of their own disability. A dense social network slowed the rate of labeling oneself disabled, while health anxiety accelerated the process over time, independent of health status. When considering perceived disability, the oldest old use multidimensional criteria capturing function, recent changes in health status and social networks , and anxiety about their health.
A 3-D Model of Health Decline: Disease, Disability, and Depression Among Black and White Older Adults
Kelley-Moore, J., Ferraro, K.F.
Journal of Health and Social Behavior, 46(4): 376-391, 2005
Much of the research on health decline in older adulthood has specified a single causal direction between two health domains, often measured at the same time point, making it difficult to disentangle the mechanisms of health decline over time. Using three waves of data over seven years from older residents of North Carolina, a 3-D model is used to examine the temporal ordering of general health decline and the pathways of influence across three health domains (disease, disability, and depression). In addition, we test whether the 3-D model of health decline is similar for Black and White older adults. Results indicate that both prevalent and incident disease lead to increases in depression and that prevalent disease leads to greater disability three years later. Depression, in turn, leads to disease, identifying a cycle of health decline that is, for the most part, similar for Black and White older adults. The effect of widowhood is more deleterious to the health of Black older adults than for their White counterparts.
The Black/White Disability Gap: Persistent Inequality in Later Life?
Kelley-Moore, J., Ferraro, K.F.
Journal of Gerontology: Social Sciences, 59B (1): S34-S43, 2004
Moore and Ferraro identify several reasons for the inconsistent results on differences between Black and White older adults and examine these differences in disability trajectories over 6 years. They conclude that a disability gap between Black and White adults exists, but after socioeconomic resources, social integration, and other health indicators are adjusted for, the trajectories of disability by race are not significantly different.
Cumulative Disadvantage and Health: Long Term Consequences of Obesity?
Ferraro, K.F., Kelley-Moore, J.
American Sociological Review, 68: 707-729, 2003
Drawing from cumulative disadvantage theory, the health consequences of obesity are considered in light of the accumulation of risk factors over the life course. Two forms of compensation are also examined to determine if the risk due to obesity is persistent or modifiable. Analyses make use of data from a national survey to examine the consequences of obesity on disability among respondents 45 years of age or older, tracked across 20 years (N = 4,106). Results from tobit models indicate that obesity, especially when experienced early in life, is consistently related to lowerbody disability. The results also show that obesity has long-term health consequences during adulthood, altering the life course in an enduring way. Compensation was not manifest from risk-factor elimination (weight loss), but rather through regular exercise. Although there is evidence for long-term consequences of risk factors on health, the findings suggest that more attention should be given to compensatory mechanisms in the development of cumulative disadvantage theory.
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David Warner
Early Life Origins of the Race Gap in Men’s Mortality
Warner, D. F. and Hayward, M.D.
Journal of Health and Social Behavior, 47(3): 209-226, 2006
A life course framework was used to examine the early life origins of the race gap in men’s all-cause mortality. Data from the National Longitudinal Survey of Older Men (1966–1990) were utilized to evaluate the major social pathways by which early life conditions differentiate the mortality experiences of blacks and whites. The findings indicate that early life socioeconomic conditions, particularly parental occupation and family structure, explain part of the race gap in mortality. However, these effects operate indirectly through adult socioeconomic achievement processes and suggest that policy interventions to eliminate race disparities in mortality and health should address both childhood and adult socioeconomic conditions.
Late Career Transitions among Men and Women in the United States
Warner, D. and Hofmeister, H.
In Globalization, Uncertainty and Late Careers in Society, H.P. Blossfeld, S. Buchholz and D. Hofäcker (Editors): Pp. 141-181, Routledge Advances in Sociology Series. Routledge: London, 2006
Work and retirement transitions were examined as part of an international volume on the effects of globalization on increasing individual uncertainty in late careers in Western industrialized nations. Data from the Health and Retirement Study (1992-2002) and discrete-time hazard models were used to investigate job mobility, unemployment, retirement and disability exits, and reentry to the labor market among older men and women in the United States. Overall, the findings indicate that the uncertainty associated with globalization is unequally experienced, with workers in professional and managerial pressures relatively insulated. Nevertheless, individual characteristics such as financial resources, health and marital status generate considerable heterogeneity in late-career transitions, and do so in different ways for men and women, despite the fact that public and private pension systems tend to uniformly induce early labor force withdrawal.
Does Longer Life Mean Better Health? Not for Native-Born Mexican Americans in the Health and Retirement Study
Hayward, M.D., Warner, D.F. and Crimmins, E.M. 2007.
In The Health of Aging Hispanics: The Mexican-Origin Population. Angel, Jacqueline L. and Keith E. Whitfield (Eds.): Pp. 85-95, Springer: New York.
The Hispanic epidemiological paradox refers to the relative longevity of older Hispanics despite their low socioeconomic resources. This paradox is often construed as only an immigrant story; it is not. Data from the Health and Retirement Study (1992-2002), discrete-time hazard models and multistate life tables were used to demonstrate that it also reflects the relative mortality advantages of older U.S.-born Mexican Americans. That is, U.S.-born Mexican American mortality is similar to that of non-Hispanic whites. Despite low mortality, however, Mexican Americans live more years with disability than Blacks or whites. For older Mexican Americans, longer life is associated with a greater burden of disease –more similar to Black Americans who also lack socioeconomic resources. This is a different twist on the paradox phenomenon.
Demography of Population Health
Hayward, M.D. and Warner, D.F.
In The Handbook of Demography: Chapter 27 (Pp. 809- 825), Dudley L. Poston, Jr. and Michael Micklin (Editors). Springer: New York.
This chapter provides a conceptual overview of the demographic framework used to examine the linkages between the morbidity, mortality and disability processes that define population health. This framework is based on the life table survival model where overall survivorship can be decomposed into the proportion of a cohort surviving without a health condition (i.e., mortality) and without functional limitations (i.e., disability). Various measures of population health based on the life table conceptual framework are reviewed. Measurement and methodological issues in the study of population health are also identified and discussed.
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