Sandra A. Black

University of Maryland, Baltimore, Baltimore, Maryland, United States

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Publications (48)140.61 Total impact

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    ABSTRACT: Prison inmates present with higher rates of disease morbidity and mortality than the general population. The rates of certain infectious diseases such as hepatitis C, HIV/AIDS, and tuberculosis are reported to be particularly elevated in prison systems. Scarce information, however, exists on the overall infectious disease profile of inmate populations. The present study examined the prevalence of major infectious diseases in one of the nation's largest prison populations. The study population consisted of 336,668 Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated for any duration between January 1, 1999 and December 31, 2001. Information on medical conditions, sentencing factors, and sociodemographic factors was obtained from an institution-wide medical information system. Latent tuberculosis infection constituted the most prevalent infectious disease reported among inmates. This was followed in frequency by hepatitis C, HIV/AIDS, and syphilis. Prevalence estimates for most of the infectious diseases under study exhibited substantial differences across gender, age, and ethnicity. The present study shows that the prison population had prevalence rates that were substantially higher for latent TB, HIV/AIDS, and hepatitis C than those reported for the general population and some incarcerated populations. The rate of active TB among TDCJ inmates, however, was comparable to that of the general population and other incarcerated populations.
    Preventive Medicine 06/2004; 38(5):607-12. DOI:10.1016/j.ypmed.2003.11.020 · 3.09 Impact Factor
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    Sandra A Black · Kyriakos S Markides · Laura A Ray ·
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    ABSTRACT: To examine the separate and combined effects of depression and diabetes on the incidence of adverse health outcomes among older Mexican Americans. Longitudinal data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) survey were used to examine the main effects and interaction effects of diabetes and depressive symptoms (measured with the Center for Epidemiologic Study of Depression) or clinical diagnostic criteria (measured with the Composite International Diagnostic Interview Depression Module) on the development of macrovascular complications (including cardiovascular disease, stroke, and kidney disease), microvascular complications (including nephropathy, neuropathy, retinopathy, and amputations), functional disability, and mortality over 7 years in a sample of 2,830 Mexican Americans aged >or=65 years. The interaction of diabetes and depression was found to be synergistic, predicting greater mortality, greater incidence of both macro- and microvascular complications, and greater incidence of disability in activities of daily living, even when controlling for sociodemographic characteristics such as sex, age, education, acculturation, and marital status. Importantly, this interaction was found to predict not only greater incidence but also earlier incidence of adverse events in older adults. Whether a marker for underlying disease severity, an indicator of diminished self-care motivation, or the result of physiologic changes, the interaction of depression and diabetes has a synergistic effect on the health of older Mexican Americans, increasing the risk for poor outcomes. This is of particular clinical importance because although depression is often underrecognized in older adults, effective treatment is available and can result in improved medical outcomes.
    Diabetes Care 10/2003; 26(10):2822-8. DOI:10.2337/diacare.26.10.2822 · 8.42 Impact Factor
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    Kushang V Patel · Sandra A Black · Kyriakos S Markides ·

    American Journal of Public Health 04/2003; 93(3):433-5. DOI:10.2105/AJPH.93.3.433 · 4.55 Impact Factor
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    ABSTRACT: To examine the extent to which cognitive status and decline in cognitive status predict mortality in older Mexican Americans. Longitudinal cohort. Older Mexican Americans residing in five southwestern states in the United States. Two thousand six hundred twenty-five persons aged 65 and older living in Texas, New Mexico, Colorado, Arizona, and California. The cognitive function of participants was assessed using the Mini-Mental State Examination (MMSE) in 1993-94 and again in 1995-96. Cognitive decline was defined using two sets of criteria: a drop to 17 or less (moderate-severe cognitive impairment) on the MMSE at 2-year follow-up and a decrease of at least four points, a threshold change in scores that was used to predict mortality in this sample. Cox proportional hazards models were conducted to examine the association between the MMSE and increased risk for mortality, after controlling for sociodemographic characteristics, medical conditions, and depressive symptoms. Five-year mortality risk was significantly associated with persons in the moderately-severely cognitively impaired category (hazard ratio (HR) = 2.35, P <.001). Moreover, mild cognitive impairment was also predictive of mortality in older Mexicans (HR = 1.45, P <.001). Two-year declines in cognitive functioning, particularly in persons who had declined to the moderate-severe impairment category (HR = 2.23, P <.001) and those who dropped at least four points on the MMSE (HR = 1.30, P <.001), were predictive of mortality 3 years later, after controlling for important variables. Baseline moderate-severe and mild cognitive status and 2-year decline in cognitive functioning independently predict mortality in older Mexican Americans. Although age and selected medical conditions have been reported as the more salient predictors of mortality, cognitive functioning should be considered part of identifying older persons at high risk for underlying medical conditions and mortality.
    Journal of the American Geriatrics Society 03/2003; 51(2):178-83. DOI:10.1046/j.1532-5415.2003.51055.x · 4.57 Impact Factor
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    ABSTRACT: This study was designed to determine the incidence and prevalence of amputations in diabetic Mexican American elders and to identify correlates of lower extremity amputations. Data for this study came from baseline and two follow-up interviews of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE) conducted in five southwestern states (Texas, California, New Mexico, Colorado and Arizona) in 1993-1994. Of the 3050 subjects aged 65 and older, 690 reported diabetes, and from these, 60 (8%) reported having at least one lower extremity amputation. Losing a leg was the most common type of amputation (53%). Twelve percent of respondents reported a new amputation and 40% of amputees reported a second amputation during follow-up. Mortality among amputees was 46% during a 5-year follow-up. Multiple logistic regression analysis showed that being male and having eye problems, hip fracture and diabetes for 10 or more years were significantly associated with lower extremity amputations at baseline, whereas obesity, stroke and 10 or more years with diabetes were significantly associated with new amputations at 5-year follow-up. Gender and disease history were associated with lower extremity amputations at baseline and follow-up. These variables may be useful in developing patient education and intervention programs.
    Journal of Diabetes and its Complications 03/2003; 17(2):59-65. DOI:10.1016/S1056-8727(02)00175-7 · 3.01 Impact Factor
  • Sandra A Black · Ronald D Rush ·
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    ABSTRACT: To simultaneously examine the influence of functional disability on the development of cognitive impairment and the influence of cognitive status on the development of functional disability over time and compare findings across ethnic groups. A population-based longitudinal study. Galveston County, Texas. Three hundred sixty-five community-dwelling Hispanic Americans, African Americans, and non-Hispanic whites, aged 75 and older. Baseline measures included demographics, self-reported chronic medical conditions, functional disability, and cognitive status. Longitudinal measures included functional decline and cognitive decline. Substantial functional decline was associated with each additional error on the mental status measure; substantial cognitive decline was associated with each additional antecedent disability. These findings were evident across all three ethnic groups, even when taking into account the effects of demographic factors and chronic health conditions, although the specific chronic health conditions that influenced cognitive and functional decline were found to vary across the three ethnic groups. Our findings suggest that, rather than simply being correlated markers of increasing frailty, cognitive and functional decline appear to influence the development of one another. Clinicians need to be aware of these associations, which may affect the direction of preventive care and rehabilitation in the oldest old. Appropriate intervention may result in the prevention or delay of functional disability and cognitive decline. Awareness of the specific chronic health conditions that increase the risk for cognitive or functional decline in various ethnic groups, and the effect of comorbid disease, may also help efforts to prevent decline in older adults.
    Journal of the American Geriatrics Society 01/2003; 50(12):1978-86. DOI:10.1046/j.1532-5415.2002.50609.x · 4.57 Impact Factor
  • David A Chiriboga · Sandra A Black · Maria Aranda · Kyriakos Markides ·
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    ABSTRACT: Although social stressors have successfully predicted depressive symptomatology in a number of populations, few studies have examined the relevance of stressors for Mexican American elders. Results are reported here from a multistage probability sample of 3,050 Mexican Americans aged 65 and older drawn from a 5-state region. Participants reported low levels of education and income, and most reported difficulty in reading or writing in English. Deaths, illness of close other, and financial problems were the three most frequent life events, and many reported financial strains. Depressive symptoms were then regressed on demographic indicators, cognitive status, linguistic acculturation, social supports, and three types of stressors. Being a woman, lower income, decreased income, chronic financial strain, and several health stressors were associated with greater symptomatology. Results identified a cluster of economic stressors and conditions that may play a critical role in the etiology of depressive symptoms in this minority population.
    The Journals of Gerontology Series B Psychological Sciences and Social Sciences 12/2002; 57(6):P559-68. DOI:10.1093/geronb/57.6.P559 · 3.21 Impact Factor
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    Sandra A Black ·
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    ABSTRACT: The US Department of Health and Human Services has developed an initiative called "Eliminating Racial and Ethnic Disparities in Health," which parallels Healthy People 2010, the nation's health goals for the next decade. The initiative focuses on areas of health disparity that are known to affect racially and ethnically diverse groups of the population yet hold the promise of improvement. The first step to addressing such health inequities is to understand the scope and nature of the diseases that contribute to such disparities. This commentary reviews the epidemiology and consequences of type 2 diabetes, particularly as it is manifested in socially and culturally diverse groups, and offers recommendations for actions to address the disparities resulting from diabetes.
    American Journal of Public Health 05/2002; 92(4):543-8. DOI:10.2105/AJPH.92.4.543 · 4.55 Impact Factor
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    ABSTRACT: The purpose of this analysis was to examine the association of sociodemographic variables and health-related conditions with 5-year declines in cognitive function among Mexican American elderly persons. The cognitive function of 1759 participants was assessed by using the Mini-Mental State Examination (MMSE) in 1993/1994 and again in 1998/1999. Cognitive decline was defined by two sets of criteria: (1) a drop to 17 or below on the MMSE at follow-up, and (2) a decline of at least three points, the mean change in MMSE scores among respondents who obtained scores at or above the 5th percentile distribution at baseline. Cognitive decline was significantly associated with sociodemographic variables including age, education, marital status, and household composition. In addition, respondents with reported vision impairment, stroke, and diabetes were at increased risk for cognitive decline after controlling for multiple potential confounders. Although age and education have been reported as the more salient predictors of cognitive deterioration, other sociodemographic and several medical conditions including stroke and diabetes should be considered as part of cognitive aging studies among Mexican American elders.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 04/2002; 57(3):M181-5. DOI:10.1093/gerona/57.3.M181 · 5.42 Impact Factor
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    ABSTRACT: This study was designed to examine the association of sociodemographic and health-related factors with the development of diabetic complications in older Mexican Americans. Data came from the baseline interview of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE), conducted in 1993-1994, a population-based study of 3,050 Mexican Americans aged 65 and older from 5 southwestern states. A total of 690 subjects (23%) reported having been diagnosed with diabetes. Of these, 412 (60%) reported having one or more diabetic complications. Multiple logistic regression analysis found that respondents with less than 12 years of education were more likely to report diabetic complications than those with higher school education. Having diabetes for over 15 years, and having had a stroke or a heart attack were also associated with elevated rates of complications. Circulation problems were the most common complication reported by 280 (40%) respondents, followed by eye problems (38%), kidney problems (14%) and amputations (8%). Special attention should be given to sociodemographic and health-related factors influencing the health of older Mexican Americans. Identification of these factors will help physicians better control the disease to prevent complications.
    Ethnicity & disease 02/2002; 12(2):252-8. · 1.00 Impact Factor
  • J A Loera · S A Black · K S Markides · D V Espino · J S Goodwin ·
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    ABSTRACT: Little is known about use of herbal medicines by older Mexican Americans. The objective of this study was to determine the characteristics among older Mexican Americans that correlate with use of herbal medicines. We administered a cross-sectional regional sample survey, the 1993-1994 Hispanic Established Populations for the Epidemiologic Study of the Elderly of Mexican Americans, by in-home interviews of noninstitutionalized older Mexican Americans age 65 and over living in Texas, New Mexico, Colorado, Arizona, and California. The use of herbal medicine in the 2 weeks prior to the interview was reported by 9.8% of the sample. Chamomile and mint were the two most commonly used herbs. Users of herbal medicines were more likely to be women, born in Mexico, over age 75, living alone, and experiencing some financial strain. Having arthritis, urinary incontinence, asthma, and hip fracture were also associated with an elevated use of herbal medicines, whereas heart attacks were not. We found that herbal medicine use was substantially higher among individuals reporting any disability in activities of daily living, poor self-reported health, and depressive symptoms. Herbal medicine use was associated with the use of over-the-counter medications but not with prescription medications. Herbal medicine use was particularly high among respondents who had over 24 physician visits during the year prior to interview. Herbal medication use is common among older Mexican Americans, particularly among those with chronic medical conditions, those who experience financial strain, and those who are very frequent users of formal health care services.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 12/2001; 56(11):M714-8. DOI:10.1093/gerona/56.11.M714 · 5.42 Impact Factor
  • Z.Helen Wu · Sandra A. Black · Kyriakos S. Markides ·
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    ABSTRACT: The aim of this study was to identify patterns of mammogram and Papanicolaou (Pap) screenings among Mexican American women ages 67 and over. Data on 1,403 Mexican American women from the Hispanic Established Population for the Epidemiological Study of the Elderly, a cohort study of community-dwelling Mexican Americans ages 65 years or over from the southwestern United States, were analyzed. Mexican American women age 75 or older were less likely to ever have had breast or cervical screening than women ages 67 to 74, even controlling for sociodemographic, cultural, and selected health factors. Overall, fewer medical conditions and never having had a hysterectomy were found to be associated with a decreased chance of ever having had a mammogram or a Pap test. Women who lacked insurance coverage and had fewer doctor visits were less likely to ever have had a mammogram, whereas women with low education, low acculturation, and lower cognitive status scores were less likely to ever have had a Pap test. If these results withstand more detailed studies (e.g., with the addition of important variables such as awareness), better communication with health professional doctors and improvement of access to heath care services should increase rates of both mammogram and Pap screenings.
    Preventive Medicine 11/2001; 33(4):268-73. DOI:10.1006/pmed.2001.0880 · 3.09 Impact Factor
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    ABSTRACT: This report describes the prevalence and correlates of functional blindness and visual impairment among older Mexican Americans, using data on 2800 respondents from the Hispanic Established Populations for the Epidemiological Study of the Elderly. Bivariate and multivariate logistic regression analyses were used to examine the associations between corrected bilateral distant vision and sociodemographic characteristics, selected health conditions, self-reported health status, health care utilization, and functional dependence on the basis of assistance needed for basic and instrumental activities of daily living (ADLs). Using a modified Snellen test for distance visual acuity, 5% of older Mexican Americans were found to be functionally blind, and 13.5% were found to be visually impaired. Vision loss was significantly associated with older age, lower education, hypertension, diabetes, poor self-rated health, and hospitalization during the year prior to the interview. Over 50% of functionally blind subjects required assistance with at least one basic ADL, compared with 15% of those who were visually impaired and 8% of those who were not visually impaired. The prevalence of functional blindness in this sample of elderly Mexican Americans was higher than reported for the general elderly population, yet they also have higher rates of adequate vision because of the low prevalence of visual impairment. The results suggest a need for more research on the prevalence and impact of functional blindness and visual impairment on the health of older Mexican Americans.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 10/2001; 56(9):M548-51. DOI:10.1093/gerona/56.9.M548 · 5.42 Impact Factor
  • Z.Helen Wu · Jacques Baillargeon · James J Grady · Sandra A Black · Kim Dunn ·
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    ABSTRACT: The seroprevalence of HIV infection was examined among a sample of incoming inmates in the Texas Department of Criminal Justice prison system. Rates were compared across sociodemographic factors and three types of prison facilities: substance abuse felony punishment units (SAFPs), state jails, and prisons. The study sample consisted of 4386 incoming inmates incarcerated for any duration, dating from November 1, 1998, to May 31, 1999. Among males, inmates entering state jails had a higher HIV infection rate (3.7%) than either inmates entering prisons (1.9%) or those entering SAFPs (0.5%). Among females, inmates entering prisons had a higher rate of infection (9.3%) than those entering state jails (2.5%) or SAFPs (4.5%). Although a number of blinded HIV seroprevalence studies have been conducted in U.S. prison systems, scarce information is currently available on HIV infection rates in alternative correctional facilities. The present study shows that HIV seropositivity varied substantially according to race, gender, and prison facility type. Given the shorter incarceration periods for inmates held in alternative facilities, understanding how infection rates vary according to type of incarceration facility holds particular public health relevance.
    Annals of Epidemiology 08/2001; 11(5):342-6. DOI:10.1016/S1047-2797(01)00210-1 · 2.00 Impact Factor
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    ABSTRACT: The purpose of this analysis was to examine the differential impact of performance-based and self-reported lower body measures on 2-year mortality in Mexican American elderly persons. Data employed are from the Hispanic Established Population for Epidemiological Studies of the Elderly, a probability survey of 3050 community-dwelling Mexican Americans aged 65 and older from the five Southwestern states interviewed in 1993 and 1994. Of the baseline sample with complete data, 198 persons were confirmed deceased 2 years later. A three-task, performance-based, lower body function measure consisting of a short walk, balance, and repeated chair stands tests was used. Self-reported lower body function was measured by a 4-item Activities of Daily Living (ADL) measure involving the lower body. The three-task, lower body function measure was a significant predictor of 2-year mortality. The short walk alone was as predictive as the summary measure. The predictive ability of both measures was minimally reduced by the inclusion of the self-reported ADL measure and life-threatening medical conditions. Finally, the ADL measure was not a significant predictor of mortality with all the other variables in the analysis. Objective measures of lower body function were significant predicators of mortality in Mexican American elderly persons, as found in the general population. Unlike previous studies, the ADL measure was not an independent predictor of mortality after controlling for the objective measure and other risk factors. Additional research is needed to address why objective measures of function are such strong predictors of death.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 05/2001; 56(4):M243-7. DOI:10.1093/gerona/56.4.M243 · 5.42 Impact Factor
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    ABSTRACT: Diabetes is one of the most common and costly medical conditions among prison inmates. Scarce information, however, currently exists about the management of this condition in the correctional setting. The purpose of this study was to describe antidiabetic agent prescribing patterns and adherence among diabetic prison inmates. The study population consisted of 4,061 Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between December 1, 1998, and March 31, 1999, and who were diagnosed with either Type 1 or Type 2 diabetes mellitus. Approximately one-third (33%) of the study subjects were prescribed insulin only, 38% were prescribed oral hypoglycemic agents (OHA) only, 13% were prescribed both insulin and OHA, and 13% received no medication. The median adherence rates with drug therapy were 61% for insulin only, and 66% for OHA only. For combination therapy, the median adherence rate was 56% for insulin and 66% for OHA. The authors noted that the rate of insulin-only therapy and OHA and insulin combination therapy among TDCJ inmates was higher than that reported among previous studies of nonincarcerated samples. Alternatively, it was reported that the rate of OHA-only therapy and no therapy was lower among inmates than among their free-world counterparts. It is likely, however, that these differences were driven, in large part, by the underlying differences in the demographic composition of the study samples. It will be important for investigators to examine whether future studies of inmate populations exhibit similar pharmacotherapy and compliance rates, and moreover to assess whether such rates differ substantially from nonincarcerated samples, even after adjusting for sociodemographic factors.
    Journal of Correctional Health Care 04/2001; 8(1):37-53. DOI:10.1177/107834580100800103
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    ABSTRACT: Although prison inmates are reported to exhibit elevated rates of depressive disorders, little is known about anti-depressant prescribing patterns in correctional institutions. The study population consisted of 5305 Texas Department of Criminal Justice (TDCJ) inmates who were diagnosed with one of three depressive disorders: major depression, dysthymia, and bipolar disorder (excluding those with manic episodes only). Information on medical conditions, sociodemographic factors, and pharmacotherapy was obtained from an institution-wide medical information system. In 1998, 78.2% of all inmates diagnosed with depressive disorders were treated with antidepressant medication. Of these, 47.3% were treated exclusively with tricyclic anti-depressants (TCA); 30.9% were treated with selective serotonin re-uptake inhibitors (SSRI); and 21.8% were not treated with any form of anti-depressant medication. Prescribing patterns varied substantially according to a number of sociodemographic factors under study. Because the present study relied on retrospective, clinical data, the investigators had limited ability to assess: specific symptomatology for each diagnosed depressive condition under study; socio-economic status, pre-incarceration access to health care; and the overall reliability and validity of the data. The proportion of prison inmates with depressive disorders who receive appropriate medication management is substantially higher than that reported among similarly diagnosed nonincarcerated samples. It will be important, however, for future investigators to examine the sources of sociodemographic variation in treatment patterns found in the present study.
    Journal of Affective Disorders 04/2001; 63(1-3):225-31. DOI:10.1016/S0165-0327(00)00188-9 · 3.38 Impact Factor
  • Z H Wu · S A Black · J L Freeman · K S Markides ·
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    ABSTRACT: Published information about cancer screening in older Mexican-American women is scarce. This study reported the patterns of mammogram and Pap test use among older Mexican-American women. The patterns and associated factors were examined and compared with Healthy People 2000 targets. Data were obtained from the Hispanic Established Population for the Epidemiological Study of the Elderly, the largest representative survey of community-dwelling Mexican Americans aged 67 years or over, from the southwestern United States. Among older Mexican-American women, 68.3% reported ever having a mammogram, and 41.2% reported having a mammogram in the last two years; 64.0% reported ever having a Pap test, with 43.6% reported having a Pap test in the last three years. The data for older Mexican-American women demonstrated that they approached the targets for breast cancer screening, but not for Pap test use.
    Ethnicity & disease 02/2001; 11(4):645-51. · 1.00 Impact Factor
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    ABSTRACT: This study assessed correlates of antidepressant medication compliance among 5,305 inmates of the Texas Department of Criminal Justice prison system who were diagnosed as having a depressive disorder. Use of tricyclic antidepressants, male gender, and higher age were all positively associated with medication compliance scores. This investigation provided no evidence that broader use of selective serotonin reuptake inhibitors would improve adherence to pharmacologic treatment in this population. The results also suggest that correctional administrators may wish to target younger inmates and women with interventions to improve medication compliance.
    Psychiatric Services 12/2000; 51(11):1444-6. DOI:10.1176/ · 2.41 Impact Factor
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    ABSTRACT: To determine whether positive affect has an independent effect on functional status, mobility, and survival in an older Mexican American sample. A 2-year prospective cohort study. Five Southwestern states: Texas, California, Arizona, New Mexico, and Colorado. A population-based sample of 2282 Mexican Americans aged 65 to 99 who reported no functional limitations at baseline interview. In-home interviews in 1993-1994 and again in 1995-1996 assessed demographic variables, health conditions, activities of daily living, performance-based mobility, survival, and a rating of positive and negative affect. In multivariate analyses, there was a direct relationship between positive affect scores at baseline and mobility, functional status, and survival 2 years later, controlling for functional status, sociodemographic variables, major chronic conditions, body mass index (BMI), smoking status, drinking status, and negative affect at baseline. Subjects with high positive affect were half as likely (odds ratio (OR) = 0.48; 95% confidence interval (CI) 0.29, 0.93) to become disabled in activities of daily living (ADLs), two-thirds as likely (OR = 0.64; 95% CI 0.51, 0.79) to have a slow walking speed, and half as likely (OR 0.53; 95% CI 0.30, 0.93) to have died during the 2-year follow-up compared to those with lower positive affect scores. Our results support the concept that positive affect, or emotional well-being, is different from the absence of depression or negative affect. Positive affect seems to protect individuals against physical declines in old age.
    Journal of the American Geriatrics Society 06/2000; 48(5):473-8. DOI:10.1111/j.1532-5415.2000.tb04991.x · 4.57 Impact Factor

Publication Stats

2k Citations
140.61 Total Impact Points


  • 2002-2004
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
    • University of South Florida
      Tampa, Florida, United States
  • 1993-2001
    • University of Texas Medical Branch at Galveston
      • • School of Medicine
      • • Department of Preventive Medicine & Community Health
      • • Department of Internal Medicine
      Galveston, Texas, United States
  • 1999
    • Texas A&M University - Galveston
      Galveston, Texas, United States