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    ABSTRACT: Studies of the early-life origins of adult physical functioning and mortality have found that childhood health and socioeconomic context are important predictors, often irrespective of adult experiences. However, these studies have generally assessed functioning and mortality as distinct processes and used cross-sectional prevalence estimates that neglect the interplay of disability incidence, recovery, and mortality. Here, we examine whether early-life disadvantages both shorten lives and increase the number and fraction of years lived with functional impairment. We also examine the degree to which educational attainment mediates and moderates the health consequences of early-life disadvantages. Using the 1998-2008 Health and Retirement Study, we examine these questions for non-Hispanic whites and blacks aged 50-100 years using multistate life tables. Within levels of educational attainment, adults from disadvantaged childhoods lived fewer total and active years, and spent a greater portion of life impaired compared with adults from advantaged childhoods. Higher levels of education did not ameliorate the health consequences of disadvantaged childhoods. However, because education had a larger impact on health than did childhood socioeconomic context, adults from disadvantaged childhoods who achieved high education levels often had total and active life expectancies that were similar to or better than those of adults from advantaged childhoods who achieved low education levels.
    Demography 11/2013;
  • The Journals of Gerontology Series B Psychological Sciences and Social Sciences 03/2012; 67(2):221-5.
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    ABSTRACT: Using the Proactivity Model of Successful Aging, we examined how internal and external resources contribute to the maintenance of psychological well-being and social activities among older adults who experience normative stressors of aging. Outcome variables in this study are collectively referred to as quality of life (QOL). We also examined the mediating role of proactive adaptations between internal and external resources and QOL indicators. Based on five annual interviews of a sample of 1000 community-dwelling older adults in Florida (effective N = 561), we tested the lagged effects of stressors on two indicators of QOL, four years later. In the full longitudinal model, using structural equations, we estimated the direct effects of internal and external resources on QOL, along with indirect effects through proactive adaptations. Stressors negatively influenced QOL four years later. Internal and external resources led to better QOL four years later, both directly and indirectly through proactive adaptations of marshaling support and planning for the future. These findings lend support to the Proactivity Model of Successful Aging by documenting the value of proactive adaptations (i.e., exercise, planning ahead, and marshaling support) as proximate influences on QOL outcomes (i.e., depressive symptomatology and social activities). Findings suggest that older adults can maintain successful aging even in the face of health-related and social stressors by invoking accumulated resources to deal actively with the challenges of aging.
    Aging and Mental Health 02/2012; 16(4):438-51.
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    ABSTRACT: Race/ethnicity, gender, and socioeconomic status are the three most prominent factors to predict health outcomes. Despite the fact that persistent health inequalities are found between groups, we know little about how the interrelatedness of these social positions influences the health of older adults. In this study, we apply a feminist intersectional approach to the study of health inequalities, treating social variables as multiplicative rather than additive to capture the mutually constitutive dimensions of race/ethnicity, gender, and education. This paper makes use of data from the National Social Life, Health and Aging Project, a nationally representative sample of 3,005 community-dwelling U.S. adults aged 57 to 85 years old, to explore intersections of race, gender, and education. We use a combination of stratified analysis with an interaction term to test multiplicative effects. First, our findings confirm that Black women with less than a high school education have the poorest self-rated health. Second, at the bivariate level, we find highly educated White men are not the converse of lower educated Black women. Third, at the multivariate level, we find being Black and female has an effect on health beyond those already accounted for by race and gender. This research demonstrates the explanatory power of an intersectionality approach to deepen understanding of the overlapping, simultaneous production of health inequalities by race, class, and gender.
    Women s Health Issues 01/2012; 22(1):e91-8.
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    ABSTRACT: Prior research has not adequately considered that disablement occurs within a web of relationships that provides socioemotional resources to and/or places demands on older adults. Drawing on the stress process and life course perspectives, we considered the social context of disablement by examining the influence of marital quality on the association between disability and loneliness among married older adults. Using data from the National Social Life, Health, and Aging Project, we found (1) functional limitations were associated with higher levels of loneliness; (2) neither positive nor negative marital quality mediated this association, contrary to the stress-deterioration hypothesis; and (3) positive (but not negative) marital quality moderated this association, consistent with the stress-buffering hypothesis. These associations were similar for women and men. Our findings indicate the importance of the social context of disablement, as interpersonal resources offer protection from the deleterious socioemotional consequences of disability.
    Journal of Health and Social Behavior 01/2012; 53(1):50-66.
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    ABSTRACT: To examine driving in the context of people with medically intractable epilepsy, a population generally discouraged from driving. This study tested the relationship between a comprehensive set of factors and driving among 190 patients with a currently valid driver's license who were being evaluated for epilepsy surgery. Almost one third (32.6%) of the sample reported currently driving. Distributional comparisons by current driving status revealed driving was significantly more prevalent among patients who were employed full-time and those who had not experienced a seizure-related MVA. The decision not to drive in the context of a chronic medical condition is complex and influenced by a myriad of factors such as perceived illness susceptibility and severity.
    American journal of health behavior 07/2011; 35(4):485-95.
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    ABSTRACT: A number of studies have demonstrated wide disparities in health among racial/ethnic groups and by gender, yet few have examined how race/ethnicity and gender intersect or combine to affect the health of older adults. The tendency of prior research to treat race/ethnicity and gender separately has potentially obscured important differences in how health is produced and maintained, undermining efforts to eliminate health disparities. The current study extends previous research by taking an intersectionality approach (Mullings & Schulz, 2006), grounded in life course theory, conceptualizing and modeling trajectories of functional limitations as dynamic life course processes that are jointly and simultaneously defined by race/ethnicity and gender. Data from the nationally representative 1994-2006 US Health and Retirement Study and growth curve models are utilized to examine racial/ethnic/gender differences in intra-individual change in functional limitations among White, Black and Mexican American Men and Women, and the extent to which differences in life course capital account for group disparities in initial health status and rates of change with age. Results support an intersectionality approach, with all demographic groups exhibiting worse functional limitation trajectories than White Men. Whereas White Men had the lowest disability levels at baseline, White Women and racial/ethnic minority Men had intermediate disability levels and Black and Hispanic Women had the highest disability levels. These health disparities remained stable with age-except among Black Women who experience a trajectory of accelerated disablement. Dissimilar early life social origins, adult socioeconomic status, marital status, and health behaviors explain the racial/ethnic disparities in functional limitations among Men but only partially explain the disparities among Women. Net of controls for life course capital, Women of all racial/ethnic groups have higher levels of functional limitations relative to White Men and Men of the same race/ethnicity. Findings highlight the utility of an intersectionality approach to understanding health disparities.
    Social Science [?] Medicine 03/2011; 72(8):1236-48.
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    ABSTRACT: This paper offers a conceptual framework that focuses on "care-getting", a proactive means of insuring responsive and high quality care that is necessary for maintenance of good quality of life during the final years of life. Unlike traditional formulations and empirical studies that consider end of life issues among the terminally ill, we call for a broader consideration of the final years of life among older adults experiencing different health trajectories. We expect frail older adults' dispositions, proactive adaptations, and responsiveness of their informal and formal social resources, to play key roles in achieving good quality of life close to the end of life. Such positive outcomes near the end of life help preserve the integrity of the person and contribute to a sense of being cared for [1]. The conceptual framework we propose is a necessary next step for social gerontology, in order to incorporate preparation for dying into the life course. This important final life stage has been previously neglected in gerontological life course theory. Cross-cultural considerations in getting responsive care close to the end of life are discussed.
    Current Aging Science 02/2010; 3(1):71-8.
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    ABSTRACT: Children's rights continue to be subject of international debates. Moving past these debates can be facilitated with an international measure of children's rights. This article introduces the Children's Rights Index, an international measure of children's rights for over 190 countries. The Children's Rights Index consists of two civil rights, two political rights, two social rights, and two economic rights. This article presents country scores on the Children's Rights Index, then examines whether children's rights vary by region and other differences, such as country wealth. It is hoped that the Children's Rights Index will provide evidence on children's rights important to the work of governments and nongovernmental organizations, as well as scholars and others concerned about children's welfare.
    The International Journal of Children s Rights 12/2009; 18(1):1-17.
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    ABSTRACT: To examine narratives of personal coping with the cancer experience and compare them with narratives of advice offered to other cancer patients by community-dwelling elderly cancer survivors. Qualitative and quantitative mixed methods. Community. Interviews were conducted with 100 elderly adults who had reported cancer diagnosis from among participants of a panel study of 1,107 community-dwelling elderly adults. Mean age of the sample was 78.7+/-6.8; 62% were female, and 62% were married. Three raters identified consistent themes through content analyses of interviews using a staged content analysis process. Themes reporting personal coping were coded separately from advice respondents would offer to others. Respondents reported themes of personal coping that corresponded well to previously established modes of problem-focused and emotion-focused coping. Themes for personal coping primarily reflected reframing, normalizing, and obtaining social support. Assertive healthcare consumerism and self-care were seldom reported as personal coping strategies but emerged as important coping approaches, along with positive attitude maintenance, in advice offered to others. Length of survivorship was unrelated to coping strategies. Elderly cancer survivors use passive modes of coping and rely on physicians, family, or cognitive acceptance in coping with cancer, but they offer far more proactive advice to other cancer patients. These findings underscore the importance of physician encouragement of older cancer patient initiative and proactivity in expressing views and preferences. Physicians should offer reassurance that elderly patients' questions and initiatives are welcomed.
    Journal of the American Geriatrics Society 11/2009; 57 Suppl 2:S269-71.
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