[show abstract][hide abstract] ABSTRACT: As the Baby-Boom generation enters the ranks of the elderly adults over the next 4 decades, the United States will witness an unprecedented growth in racial/ethnic diversity among the older adult population. Hispanics will comprise 20% of the next generation of older adults, representing the largest minority population aged 65 years and older, with those of Mexican-origin comprising the majority of Hispanics. Little is known about the health status of this population. DATA/METHODS: Data are for Baby Boomers born between 1946 and 1964 (ages 43-61) in the 2007 California Health Interview Survey. Logistic regression estimates the odds of diabetes, hypertension, obesity, fair/poor self-rated health (SRH), and functional difficulties among U.S.-born non-Hispanic Whites (NHW), U.S.-born Mexicans, naturalized Mexican immigrants, and noncitizen Mexican immigrants.
The Mexican-origin populations are disadvantaged relative to NHW for all socioeconomic status (SES) and several health outcomes. The Mexican origin disadvantage in health attenuates when controlling for SES and demographics, but the disadvantage remains for diabetes, obesity, and fair/poor SRH.
Baby Boomers of Mexican origin do not share the advantages of health, income, and educational attainment enjoyed by U.S.-born NHW. As this cohort moves into old age, the cumulative disadvantage of existing disparities are likely to result in continued or worse health disparities. Reductions in federal entitlement programs for the elderly adults that delay eligibility, scale back programs and services, or increase costs to consumers may exacerbate those inequities.
The Gerontologist 03/2012; 52(2):166-76. · 2.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: In 1995, the Veterans Health Administration reorganized its health services structure to emphasize ambulatory care. Successful health care planning and improving access to ambulatory care services now depends upon a better understanding of health care needs and outpatient services. Because the veteran population is heterogeneous, it is important to understand the health, access issues, and utilization of ambulatory care services in order to develop effective strategies and interventions to ensure access to and utilization of ambulatory care. Drawing on a focus group methodology with 86 Native American veterans, representing 34 tribes, this study is a qualitative examination of the health, access, use of the Department of Veterans Affairs Health Care services, barriers to health care, and satisfaction with care experienced by Native American veterans. Results reveal problems in accessing care, receiving appropriate care, and coordinating care within the VA health care system. Policy and program recommendations include increasing outreach and education efforts regarding the availability of benefits and services, improving coordination of services between the Indian Health Service and the VA, and reemphasizing the importance of patient-centered care.
Home Health Care Services Quarterly 10/2010; 29(4):195-215.
[show abstract][hide abstract] ABSTRACT: There is compelling evidence that caring for an elderly individual with functional limitations is physically and psychologically stressful. The purpose of this study is to test a multimodal caregiver intervention of ethnically and racially diverse caregivers. We sought to examine if caregivers (n=199) of older adults with physical and/or cognitive problems experienced improved depression and caregiver outcomes after participating in a community-based Caregiver Support/Training Program (CS/TP). Using a single group pretest--post-test design, caregiver depression decreased significantly. Specifically, caregivers were more likely to report higher positive affect at post-test. Although caregivers reported decreased caregiver burden, the difference was not statistically significant. One-way ANOVAs were also conducted to look at group differences. The findings of this study will help practitioners understand the importance of developing more targeted interventions that take specific ethnic and cultural characteristics of caregivers into consideration.
Home Health Care Services Quarterly 01/2008; 27(4):299-325.
[show abstract][hide abstract] ABSTRACT: We assessed racial/ethnic variations in patterns of ambulatory care use among Department of Veterans Affairs (VA) health care-eligible veterans to determine if racial/ethnic differences in health care use persist in equal-access systems.
We surveyed 3227 male veterans about their health and ambulatory care use.
Thirty-eight percent of respondents had not had a health care visit in the previous 12 months. Black (odds ratio [OR] = 0.5), Hispanic (OR = 0.4), and Asian/Pacific Islander veterans (OR=0.4) were less likely than White veterans to report any ambulatory care use. Alternately, Whites (OR=2.2) were more likely than other groups to report ambulatory care use. Being White was a greater predictor of health care use than was having fair or poor health (OR=1.4) or functional limitations (OR=1.5). In non-VA settings, racial/ethnic minorities were less likely to have a usual provider of health care. There was no VA racial/ethnic variation in this parameter.
Racial/ethnic disparities in health and health care use are present among VA health care-eligible veterans. Although the VA plays an important role in health care delivery to ethnic minority veterans, barriers to VA ambulatory care use and additional facilitators for reducing unmet need still need to be investigated.
American Journal of Public Health 01/2006; 95(12):2231-7. · 3.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: The objectives of this study were to describe the military experiences of Native American veterans and to explore how factors related to veteran identity influence their use of health services. Study participants completed a demographic and health questionnaire, followed by participation in a focus group session. The findings revealed that, despite their negative experiences during military service, most participants had a positive veteran identity. Almost 46% of participants reported having a service-related illness or injury. Almost one-third (28.2%) used the Indian Health Service (IHS) exclusively for their health care, followed by those who used both IHS and Veterans Affairs (VA) services (23.5%), followed by VA-only users (21.2%). We conclude that Native American veterans highly identify with their military service but may turn to IHS for their medical care. The data support the current VA policy of strengthening coordination with the IHS to ensure that the medical needs of Native American veterans are addressed.
Military medicine 10/2005; 170(9):782-6. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: Diverse veteran's perspectives on the accessibility and acceptability of the Department of Veteran Affairs (VA) health services are presented.
The qualitative methodology uses 16 focus groups (N = 178) stratified by war cohort (World War II and Korean Conflict versus Vietnam War and Persian Gulf War) and four ethnic/racial categories (African American, Asian American, European American, Hispanic American).
Five themes emerged regarding veterans' health care expectations: (1) better information regarding available services, (2) sense of deserved benefits, (3) concern about welfare stigma, (4) importance of physician attentiveness, and (5) staff respect for patients as veterans. Although veterans' ethnic/racial backgrounds differentiated their military experiences, it was the informants' veteran identity that framed what they expected of VA health services.
Accessibility and acceptability of VA health care is related to veterans' perspectives of the nature of their entitlement to service. Provider education and customer service strategies should consider the identified factors to increase access to VA as well as improve veterans' acceptance of the care.
Military medicine 04/2004; 169(3):243-50. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: The article describes the El Portal Latino Alzheimer's Project--a dementia-specific outreach and services program targeting Latino caregivers in the Los Angeles County area. The project is an example of an interorganizational community-based collaborative developed to provide an array of coordinated, ethnic-sensitive services to Latino dementia-affected adults and their family caregivers, using culturally specific outreach and services delivery strategies. Results of an evaluation of service utilization indicate a reduction in barriers to care and an increase in services utilization. Los Angeles County provides a natural urban laboratory to study the special needs and circumstances of older Latinos dealing with chronic and debilitating illnesses. Implications for social work practice are discussed.
Social work 05/2003; 48(2):259-71. · 1.15 Impact Factor
[show abstract][hide abstract] ABSTRACT: This qualitative study explored the domains of gender, ethnicity, and military association in a population of women veterans as these domains related to the women's access to and use of health care services and assessed barriers to the use of health services and suggestions for improving them. The study found that a significant proportion of the participants had experienced some form of gender discrimination in the military, through segregation or sexual harassment, and that their perceptions of the Veterans Administration health care system were framed by their military, ethnic/racial, and gender experiences.
[show abstract][hide abstract] ABSTRACT: As the US population is aging, so too is the US veteran population. Chief among the challenges facing the Department of Veterans Affairs (VA) is developing health programs and services that mesh with the needs of an aging veteran population and therefore improve the health status of elderly veterans. Meeting this challenge requires an understanding of the health needs of the older veteran population, including health disparities that exist across racial ethnic populations. This study examines the self-rated health and functioning of a national sample of veterans aged 65+ participating in the National Survey of Veterans. The results show that over one half of elderly veterans report difficulty in functioning and rate their health status as fair or poor. Additionally, elderly African American and Hispanic veterans report worse health than non-Hispanic white veterans across the majority of health indicators. Given the health profile of older veterans found in this study, it would seem necessary that programs serving older veterans be adept at the ongoing medical management of chronic disease and the provision of long-term care services.
American Journal of Medical Quality 01/2003; 18(3):108-16. · 1.47 Impact Factor
[show abstract][hide abstract] ABSTRACT: This analysis examines the self-rated health and functioning of World War II, Vietnam era, Korean Conflict, and Persian Gulf War veterans participating in the Veteran Identity Program Survey 2001. The results indicate that although World War II veterans are more likely to report poor health status and functioning, Vietnam-era veterans report more difficulty with specific activities of daily living and instrumental activities of daily living than any other era of veterans. These relationships remain when controlling for race/ethnicity, socioeconomic status, disease prevalence, and mental health status. These findings suggest that there are characteristics unique to the Vietnam experience that negatively affect this cohort of veterans. We suggest that further analysis examine the specific pathways through which the experience of being a Vietnam veteran affects health. In the meantime, health and social service planning within the Department of Veterans Affairs should explore the services that should be developed and targeted to this cohort of veterans so that they may remain independent in the community.
Military medicine 10/2002; 167(9):783-9. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examines race-specific military service effects on outpatient care utilization in the Department of Veterans Affairs (VA) using data from the 1992 National Survey of Veterans. The study population consisted of 4,791 male veterans. After controlling for predisposing, enabling, and need variables, black veterans were 3.7 times more likely than white veterans to use VA outpatient care. Veterans discharged from the military for medical release were less likely to use VA outpatient care (odds ratio = 0.76) than veterans discharged at the end of their normal terms. Hispanic veterans discharged for medical release were 5.3 times more likely than white veterans discharged for the same reason to use VA outpatient care. Korean conflict and mixed war period veterans were more likely to use VA outpatient care than World War II veterans. Racial/ethnic differences in military service characteristics influence the use of VA outpatient care and should be understood in delivering outpatient care to veterans.
Military medicine 08/2002; 167(7):525-31. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: Minority recruitment is crucial to successful clinical research and associated community-based outreach programs. Reaching and retaining a diverse sample is particularly challenging when research targets not only ethnic or racial minorities but also subcultural groups such as veterans of different war periods. We describe various strategies that address the special challenges of minority recruitment through our experience engaging an ethnically diverse sample of 258 veterans as part of an evaluation of ambulatory care services at Department of Veterans Affairs health care facilities. Most veterans were recruited by liaison with the community center, which accounted for 29% of the total sample. Other strategies included on-site recruitment (21%), word of mouth (21%), mailings to veterans' organizations (12%), and newspaper advertisements (7%). Strategies varied in their effectiveness at reaching specific racial or ethnic groups and veterans from different cohorts of war service.
Military medicine 07/2002; 167(6):501-5. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: Our objective was to describe racial/ethnic variations in Department of Veterans Affairs (VA) ambulatory care use and its association with the presence of unmet health care needs. Using the 1992 National Survey of Veterans, we examined race/ethnicity and unmet health care need for ambulatory care users of VA and non-VA facilities. Black and Hispanic veterans were more likely to report any VA use. In unadjusted analyses, American Indian/Eskimo, Hispanic, and black veterans were 4.4, 2.5, and 1.9 times more likely, respectively, than white veterans to report an inability to get needed care. Adjusting for VA ambulatory care use diminished the disparity in inability to get needed care between American Indian/Eskimo or Hispanic veterans and white veterans and eliminated the disparity between black and white veterans. Our findings support the VA's role as a medical safety net provider and suggest that VA ambulatory care use is effective in mitigating health-related racial disparities for some veterans. Additional facilitators for reducing unmet need should be explored.
Military medicine 04/2002; 167(3):235-41. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: "Veteran identity" is defined as veterans' self-concept that derives from his/her military experience within a sociohistorical context. Veteran identity may vary by race/ethnicity because the sociohistorical context of the military experience varies by race.
To explore veteran identity and how it varies by race/ethnicity, and to identify aspects of veteran identity that significantly influence preferences for, and use of, VA outpatient care.
Focus groups were conducted at community sites to explore concepts related to veteran identity, race/ethnicity, military experience, and health services use. The focus groups informed the development of a telephone survey, which was administered to veterans of four racial/ethnic groups in Southern California and Southern Nevada.
One hundred seventy-eight veterans participated in the focus groups, and 3,227 veterans completed the telephone survey.
Dependent variables include: (1) preference for VA health services, (2) VA-only outpatient use, (3) Any VA outpatient use, and (4) number of outpatient visits within the previous 12 months. Independent variables include veteran identity, sociodemographic, and health-related characteristics.
All veteran identity variables were significantly associated with race/ethnicity. Race/ethnicity, eg, being black or Hispanic, in addition to veteran identity factors, significantly influenced preferences for VA outpatient care. Veteran identity factors, however, had less influence on VA outpatient service utilization than socioeconomic factors.
Minority veterans who highly identify with their veteran status may prefer the VA to other systems of care. Factors associated with veteran identity may be useful for incorporation into interventions to improve access to VA care.
Medical Care 02/2002; 40(1 Suppl):I117-28. · 3.23 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examines veterans' satisfaction with outpatient care within the context of outpatient user type, race/ethnicity, and veteran identity. The sample includes 2652 veterans who participated in the VIP 2001 Survey. After controlling for enabling and need characteristics in logistic regression models, Veterans Administration (VA)-only users were 2 to 8 times more satisfied with their outpatient care than were VA nonusers on 5 out of 10 satisfaction measures. White veterans were 1.5 to 3.4 times more satisfied than nonwhite veterans on 8 out of 10 satisfaction measures. Members of veterans' organizations were less satisfied with their outpatient care than nonmembers on 5 out of 10 satisfaction measures. Factors associated with race/ethnicity and veteran identity may be incorporated into interventions to improve VA outpatient care satisfaction.
American Journal of Medical Quality 01/2002; 17(4):155-64. · 1.47 Impact Factor
[show abstract][hide abstract] ABSTRACT: This article presents a comparative analysis of the level of awareness and utilization of 15 community-based long-term care services by 213 elderly Korean and 201 non-Hispanic White Americans. We found extremely low levels of awareness and utilization of long-term health and social services among Korean Americans, in both absolute and relative terms. This finding challenges the success of the Older Americans Act, an important funding source of those services, in meeting its stated objectives to increase service availability and delivery to minority elders and socioeconomically disadvantaged elders. Strategies for effective outreach and public education efforts are also discussed.
The Gerontologist 07/1998; 38(3):309-16; discussion 317-9. · 2.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the adequacy of training in public health and aging, all accredited schools of public health, as well as other departments offering a Masters in Public Health degree, were surveyed. Results suggest that the current scope and quantity of training in public health and aging is inadequate, except for in a few schools of public health. Barriers and facilitators, such as finances, were similar for all institutions. The lack of appropriately trained faculty was a problem, particularly for institutions with no health and aging courses. A relatively small number of public health graduate students take courses in health and aging. In contrast, there are thousands of public, nonprofit, and private agencies that could use public health professionals with such education. It is concluded that the modest scope of health and aging course work and the small number of students in those courses does not come close to meeting the need for knowledgeable public health and aging practitioners.
[show abstract][hide abstract] ABSTRACT: This article presents a comparative analysis of chronic disease prevalence among older Koreans and non-Hispanic whites residing in Los Angeles County. The authors conducted a multivariate analysis that explores the impact of socioeconomic status, other sociodemographic variables, and social isolation on disease prevalence. The results reveal that while older Koreans have a higher prevalence of chronic kidney disease and diabetes, older non-Hispanic whites are disadvantaged for stroke and cancer. Furthermore, socioeconomic status indicators do not eliminate ethnic differences in disease in any substantial way. Health prevention and promotion intervention should consider the effect that Korean health practices may have on disease, as well as the role that cultural values, beliefs, and attitudes may have on the management of chronic disease and prevention efforts among the Korean population.
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Family & community health 06/1997; 20(2). · 0.99 Impact Factor