Effect of Race on Cultural Justifications
Peggye Dilworth-Anderson,1,2Beverly H. Brummett,3Paula Goodwin,4
Sharon Wallace Williams,1,5Redford B. Williams,3and Ilene C. Siegler3
1Center for Aging and Diversity, University of North Carolina Institute on Aging, Chapel Hill.
2Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill.
3Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
4Department of Child Development and Family Studies, Purdue University, West Lafayette, Indiana.
5Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill.
Objectives. Our objective in this study was to explore the effects of caregiver characteristics on cultural reasons given
for providing care to dependent elderly family members.
Methods. The sample included 48 African American and 121 White caregivers. Using multivariate analyses, we
used caregiver characteristics (e.g., race, gender, education) to predict scores on the Cultural Justifications for Caregiving
Results. Confirmatory factor analysis showed that the CJCS was appropriate for both African American and White
caregivers. African Americans had stronger cultural reasons for providing care than Whites, education levels were
inversely related to CJCS scores, and the influences of gender and age on cultural reasons were moderated by race.
Compared to females, African American males had lower CJCS scores, whereas White males had higher CJCS scores.
Younger as compared to older White caregivers had higher CJCS scores.
Discussion. This study supports the long-standing cultural tradition of African American families providing care to
dependent elders. Cultural reasons for caregiving need to be interpreted within the context of race and gender
socialization. Social roles, such as husband or wife, son or daughter, can also help determine how individuals within
a particular cultural group experience cultural expectations and obligations. Information from this study can inform
culturally appropriate caregiving interventions.
Williams, & Gibson, 2002; Janevic & Connell, 2001; Vitaliano,
Zhang, & Scanlan, 2003) document the growing and stressful
demands of caregiving to older family members, especially
dementia caregiving. These reviews show that a limited amount
of research exists in understanding caregiving in diverse
populations, especially those that address cultural and ethnic
issues. For example, little is known about cultural reasons for
giving care as well as how culture can serve to provide
a network of caregivers, and how and why people give care to
dependent elders in the family. Although numerous steps can
be taken to address these concerns, this article approaches it by
providing information on cultural reasons, which can be
assessed through a cultural justification measure, for giving
care to older dependent relatives among African American and
White caregivers. Informed by the literature on race, culture,
behavior, and aging (see the work of Jackson, Antonucci, &
Brown, 2004) as well as behavioral medicine (Siegler, Bastian,
Steffens, Bosworth, & Costa, 2002; Whitfield, Weidner, Clark,
& Anderson, 2002), this study addresses a major gap in the
literature that speaks to culture, and not just race. It also
expands the work of Dilworth-Anderson, Goodwin, and
Williams (2004) on cultural reasons for giving care by
including White caregivers that are spouses or other relatives.
Two key concepts are critical to this discussion: race and
culture. Although there is, according to Smedley and Smedley
EVERAL comprehensive reviews of the caregiving
literature (Aranda & Knight, 1997; Dilworth-Anderson,
(2005), no recognized or definitive definition of race, they do
note, however, that when race is defined it is generally defined
to include phenotypical and social characteristics. Further, race
is viewed as a socially derived concept that takes history and
politics into account, but does not conform to any anthropo-
logical, biological, or genetic criteria. It reflects a recognized
social definition, that is, people self-identify with being
African American or White. Thus, race is used in this
discussion to provide a context for the life experiences of
people based on their identified racial group classification and,
when coupled with the discussion on culture, to provide
a larger landscape from which to assess and interpret the lives
Culture is defined here as a set of shared symbols, beliefs,
and customs that shapes individual and group behavior
(Goodenough, 1999). It provides guidelines for speaking,
doing, interpreting, and evaluating one’s actions and reactions
in life. One’s culture serves as a platform for cultural reasons,
which are defined in this discussion as the expressions and
meanings, as derived from culture, that direct particular
behaviors, such as why people provide care to older dependent
relatives and their families. However, we do not purport that
cultural reasons are uniform within any particular cultural
group; instead there is likely variability within cultural groups
regarding how they express the cultural reasons for giving care.
With this in mind, the concept of cultural frame is important to
this study. Cultural frame, according to Goodenough (1999),
Journal of Gerontology: SOCIAL SCIENCES
2005, Vol. 60B, No. 5, S257–S262
Copyright 2005 by The Gerontological Society of America
by guest on November 6, 2015
addresses how individual characteristics and experiences, such
as gender and age, can influence cultural beliefs and values
about caregiving. Cultural frame allows us to understand how
an individual’s culture framework is developed through the
incorporation of the sum of one’s experiences, interactions, and
thoughts with the norms and expectations one perceives as
being held by other group members, typically of family
members. Thus, due to differences in individual cultural frames,
people can simultaneously be cultural group members and hold
cultural beliefs that are not shared by some members of the
group (Dilworth-Anderson & Gibson, 2002; Goodenough,
With these definitions in mind, the heuristic logic of the
study is to uncover critical, but previously unstudied, cultural
and personal dimensions of why family members give care to
older relatives, without making assumptions that it is expected
and normal. Additionally, this study reports on only a particular
aspect of culture without viewing culture at its broadest levels.
This study, therefore, addresses the cultural reasons for giving
care, and, as noted above, we suggest that these reasons direct
particular caregiving behaviors found among people who have
different racial identities.
Reasons for giving care that reflect the cultural values and
beliefs of caregivers are assessed in this study, as well as how
such factors as race, gender, age, education, and relationship to
the care recipient may affect their cultural reasons for giving
care. The study addresses three major questions: 1) Are there
differences in how specific groups (e.g., African Americans vs
Whites) differ in the cultural reasons caregivers give for
providing care? 2) What caregiver characteristics (i.e., gender,
age, education, income, work status, and relationship to the care
recipient) predict cultural reasons for caregiving? and 3) Does
race moderate the influence of caregiver characteristics on
cultural reasons for providing care? These questions, as noted
earlier, attempt to address issues of culture but cannot do so
without recognizing that African Americans and Whites are
also within distinct racial categories. As such, culture and race
are interconnected concepts in our society.
We recruited participants as part of a study to examine the
underlying biological and behavioral mechanisms whereby
stressful social and physical environments lead to health
disparities between different socioeconomic and racial groups.
The present sample consisted of 175 middle-aged and older
adults who reported significant caregiving responsibility for
a spouse or parent with Alzheimer’s disease. We recruited
caregivers using flyers, ads in the local media, and outreach
efforts conducted under the auspices of a community outreach
and education program. All subjects gave informed consent
prior to their participation in the study. We collected data in two
venues—during a home visit by a nurse and during a visit to the
General Clinical Research Center (GCRC) at Duke University
Medical Center. We gave a questionnaire battery containing the
information used in the present study to participants during
the home visit, which they then returned upon their visit to
the GCRC, at which point study personnel went over the ques-
tionnaires to check with the participant regarding any queries or
unanswered items. The present study consisted of 169 partic-
ipants (48 African Americans, 121 Whites) who had complete
data for all independent and dependent variables of interest
(6 participants had missing data on one or more of these
Independent variables.—Caregiver characteristics examined
included race, age, gender, education, income, work status, and
relationship to the care recipient. Race was coded 1 for African
American and 2 for White. Age was measured in years,
rounded to the nearest year. Gender was coded 1 for male and
2 for female. Education was measured in years of education
completed. Income was measured in 20 categories, beginning
with less than $10,000 and increasing by increments of $4,000
ending at $100,000 or more. Work status was coded as 1 for
participants who worked full time and 0 for those who were not
employed full time. Finally, type of caregiver was coded as 1
for spousal caregivers and 2 for nonspouse caregivers. Ninety-
five percent of the nonspouse caregivers were adult children;
the remaining 5% included other relatives (siblings, grand-
children, cousins, and fictive kin).
Dependent variable.—The Cultural Justifications for Care-
giving Scale (CJCS; Dilworth-Anderson et al., 2004) is a 10-
item measure designed to assess caregivers’ cultural reasons
and expectations in providing care (See Table 1 for scale
items). Responses are coded as follows: 4¼strongly agree, 3¼
somewhat agree, 2 ¼ somewhat disagree, and 1 ¼ strongly
disagree. Items are summed, and scores may range from 10 to
40, with higher scores indicating stronger cultural reasons for
giving care. The Cronbach alpha was .86 in the present sample
of 169 caregivers. Additionally, we compared the factor
structure of the CJCS across race using a two-group
confirmatory factor analysis as available in the M-Plus software
package (Muthe ´n & Muthe ´n, 1998–2004). Specifically, we
compared the fit of a one-factor model in which the loadings
were constrained to be equivalent across racial groups to the fit
of the same model in which no such constraints were made. The
chi-square difference test comparing the models indicated that
the corresponding loadings were not significantly different
across racial groups (v2¼ 9.382, 9df, p ¼ .402).
Table 1. Cultural Justifications for Caregiving Scale
I give care because:
a. It is my duty to provide care to elderly dependent family members.
b. It is important to set an example for the children in the family.
c. I was taught by my parents to take care of elderly dependent family
d. Of my religious and spiritual beliefs.
e. By giving care to elderly dependent family members, I am giving back
what has been given to me.
f. It strengthens the bonds between me and them.
g. I was raised to believe care should be provided in the family.
h. It is what my people have always done.
i. I feel as though I am being useful and making a family contribution.
j. My family expects me to provide care.
DILWORTH-ANDERSON ET AL.
by guest on November 6, 2015
We used bivariate analyses (t tests or chi-square tests) to
examine the effects of race on the following sample character-
istics: age, gender, education, income, work status, and type of
caregiver (spouse vs nonspouse). We conducted multivariate
analyses to address the effects of race and sample character-
istics on cultural justifications for caregiving. Specifically, we
used ordinary least squares (OLS) regression equations to
examine main effects and interaction models. Main effects
models included race, age, gender, education, income, work
status, and relationship to the care recipient as predictors of
cultural justifications for caregiving. Interaction models added
race by sample characteristics product terms (e.g., Race3Age)
to our main effects model. Interaction analyses addressed
whether the effects of caregiver characteristics on CJCS scores
differed between African American and White caregivers. We
evaluated these interactions of interest simultaneously using the
pooled test, as recommended by Harrell (2001). This test
controls for Type 1 error when conducting multiple tests of
interactions. If the test is nonsignificant, interactions cannot be
interpreted even if one or two of them are significant; however,
if the pooled test is significant, individual significant interaction
terms can be interpreted with some confidence that they were
not just ‘‘chance’’ effects.
We used SAS Version 8 statistical software (SAS Institute,
2000) to conduct all analyses. Prior to entry into regression
analyses, we scaled nondichotomous variables (age, income,
education) to their interquartile range. This yielded a regression
coefficient that compares a typical participant in the upper half
of the distribution of the predictor to a typical participant in the
Table 2 presents the characteristics of the sample and the
results of the bivariate analyses comparing African American to
White caregivers. African American caregivers in this study
were younger, had lower incomes, were more likely to work
full time, and were less likely to be spousal caregivers than
were White caregivers. However, African American caregivers
did not differ from White caregivers in terms of gender and
education. Bivariate analyses also revealed that African
American caregivers had significantly higher CJCS scores
than their White counterparts (African Americans M ¼ 34.9
[5.5]; Whites M ¼ 32.9 [5.9]), suggesting that African
American caregivers adhered more strongly to cultural reasons
for providing care than did White caregivers.
We provide results of the main effects regression model
predicting CJCS scores in caregivers in Table 3. As with
bivariate analysis, results of the multivariate model that
controlled for other caregiver characteristics showed that race
was significantly related to the CJCS, with African American
caregivers scoring significantly higher on the scale, as
compared to White caregivers (b ¼ 2.3, p , .03). In addition
to race, education was also significantly related to CJCS scores,
such that caregivers who had higher levels of educational
attainment scored lower on the CJCS (b ¼ ?1.7, p , .05).
Although the results for gender did not reach conventional
levels of statistical significance, they suggested a trend for
males to score higher on the CJCS (b ¼ 1.9, p , .09). Age,
income, work status, and type of caregiver were not
significantly related to CJCS scores.
The pooled test for the six interaction terms (race interacting
with gender, age, education, income, work status, and relation-
ship to the care recipient) was significant (p , .047). Further
examination revealed that both gender (p¼.013) and age (p¼
.029) interacted with race. The form of the interaction for
gender was such that among African Americans, males had
lower CJCS scores, as compared to females, whereas White
males had higher CJCS scores, as compared to females (see
Figure 1). Regarding the Race 3 Age interaction, within the
African American group there was little difference between
CJCS scores for younger versus older caregivers; however,
within the group of younger White caregivers, their CJCS
scores were higher as compared to older caregivers (see
Figure 1). The four interaction terms of race by education,
income, work status, and type of caregiver were nonsignificant
(p . .150).
DISCUSSION AND CONCLUSIONS
The purposes of the present study were to examine whether
or not there were racial differences in the cultural reasons
caregivers give for providing care, to examine which caregiver
characteristics predict the cultural reasons for caregiving, and to
ascertain whether race moderated the effects of caregiver
characteristics on cultural justifications for caregiving. The
newly developed CJCS (Dilworth-Anderson et al., 2004) was
developed to assess a relatively homogenous construct of
reasons for caregiving. As noted earlier, the family plays an
important role in the perpetuation of cultural values and beliefs
Table 2. Sample Characteristics and Cultural Justification for
Caregiving by Race
(n ¼ 48)
$40,000–$44,999 $55,000–$59,999 , .03
(n ¼ 121)
Age, M (SD)
Gender, n (% male)
Education, n (% . 12 years)
Income, median range
Work status, n (% full time)
Type of caregiver, n (% spouse)
CJCS scores, M (SD)
Notes: CJCS ¼ Cultural Justification for Caregiving Scale. For the table,
N ¼ 169. Statistical significance was determined by t tests for nondichotomous
variables and by chi-square tests for dichotomous variables.
Table 3. Main Effects Model: Predictors of CJCS Scores
Race (African American)
Work status (not full time)
Type of caregiver (spouse)
Notes: CJCS¼Cultural Justification for Caregiving Scale. Age, income, and
education were scaled to their interquartile range.
CULTURAL JUSTIFICATIONS FOR CAREGIVING
by guest on November 6, 2015
through the generations; therefore, the CJCS reflects the
influence of the family on the development of cultural reasons.
In this study, the CJCS was used to measure caregivers’
adherence to cultural reasons for providing care, of which we
report several major findings.
First, the factor structure of the CJCS across race using
a two-group confirmatory factor analysis showed that the
corresponding loadings were not significantly different across
racial groups. In other words, the scale assesses cultural
justifications equally well in African American and White
caregivers in this study. Second, both bivariate and multivariate
analyses revealed that African Americans scored significantly
higher on the CJCS as compared to Whites. The implications of
African Americans scoring significantly higher on the scale, as
compared to Whites, suggest they differ from Whites regarding
why they give care to older relatives. Evidence suggests that
these differences may be rooted in sociohistorical explanations
on the formation of interdependence of family and community
members and expected reciprocity between family members
seen in African American families unlike in White families
(Franklin, 1997). Historically, African American informal
family networks have served as social service systems, welfare
systems, and community-based intervention systems (Burton &
Dilworth-Anderson, 1991; Franklin; Katz, 1993). As such,
cultural socialization in the African American community helps
create beliefs and attitudes about caring for dependent others in
the family. For example, Lawton, Rajagopal, Brody, and
Kleban (1992) found that African American caregivers, as
opposed to White caregivers, more strongly identify with
traditional values that encourage providing care to older
dependent people in the family. Additionally, the literature
suggests that, unlike White families, African American families
are more likely to provide care in collectivist versus in-
dividualistic caregiving systems (Keith, 1995; Pyke &
Bengtson, 1996). Again, African Americans scoring higher
on the CJCS in this study may reflect collectivist ways of
thinking about caregiving as indicated by items on the scale that
address interdependence and expected reciprocity. Another
interpretation of this finding is that financial pressures and the
lack of resources were barriers to providing formal care from an
institution, hence family expectations deemed that care should
be provided by the family.
Figure 1. Race 3 Gender and Race 3 Age interactions as predictors of CJCS scores. Age groups are based on medium split; means are
adjusted for education, income, work status, type of caregiver, gender (top graph) and age (bottom graph).
DILWORTH-ANDERSON ET AL.
by guest on November 6, 2015
A third finding in this study was the influence of caregiver
characteristics on CJCS scores. Results of the regression
analyses show that caregivers’ educational level was the only
caregiver characteristic variable that significantly predicted
CJCS scores. Specifically, there was an inverse relationship
between education and CJCS scores; caregivers with higher
levels of education scored lower on the CJCS. It is possible that
caregivers with higher levels of education will have more
mainstream ideologies that lessen their cultural connection to
their identified group. This finding also speaks to the lack of
homogeneity in racial and cultural groups in their beliefs and
attitudes about family roles, expectations, and obligations. It
also addresses Goodenough’s (1981) concept of cultural frame
whereby individual characteristics and experiences help shape
how people experience their culture, sometimes collectively
and sometimes individually. It could also be surmised that
education modified cultural justifications for caregiving in that
education may have changed the way that people think about
what their roles are in the caregiving process. In addition,
education may provide an economic advantage in that the
caregivers were in a position to use alternative ways of
To address whether there were differences in the effects of
caregiver characteristics on CJCS scores attributed to race, we
examined interaction terms with race and each of the caregiver
characteristics. Our fourth finding showed that there were
significant interactions found between race and both gender and
age. Regarding gender, it was revealed that among African
American caregivers, males had significantly lower CJCS
scores than females, whereas White male caregivers had higher
CJCS scores than females. We speculate that selection effects
may partly explain this Race3Gender interaction. In particular,
we believe that White male caregivers in this study represent
a select group of caregivers. The majority of White male
caregivers in this study were husbands as opposed to adult sons
among African American male caregivers. According to
Cantor’s (1979) hierarchical-compensatory model, husbands,
when available, will assume the caregiving role to wives.
Caring for dependent wives may be perceived as a role that is
an extension of the husband role and culturally justified.
However, caring for a dependent mother is not a role for which
men have been socialized. Instead, their roles have been
primarily to provide financial support as opposed to direct
social and emotional support when adult daughters are available
to address these issues. As noted in the gerontological literature,
caregiving is a ‘‘gendered’’ experience whereby American
cultural values, as well as those in specific cultural groups,
socialize male and female children into defined roles that
prevail today and are evident in who cares for elders in this
society (Finley, 1989; Neal, Ingersoll-Dayton, & Starrels,
1997). Women in the caregiving role, as compared to men,
perform more tasks, spend more hours in providing care, and
have a higher level of responsibility in the caregiving role (Neal
et al.). Further, sons tend to provide care at a ‘‘distance’’ and
typically serve as a primary caregiver when there are no adult
daughters available. We purport that it is more likely that adult
sons in these situations are providing care by default rather than
for cultural reasons.
Race also interacted with age in predicting CJCS scores.
Younger White caregivers reported higher CJCS scores than
older caregivers. These findings may suggest that younger
White caregivers, especially among husbands, may have
egalitarian marital relationships similar to those found among
African Americans that include providing as well as receiving
care. However, no significant differences were found with
respect to age for African Americans. This may be due to the
fact that African American families have traditionally been
perceived as more egalitarian and flexible in family roles than
are White families (Dillaway & Broman, 2001; McAdoo,
1993). Thus, African Americans—young and old, male and
female—have been socialized to provide care.
In conclusion, the findings from this study highlight the ef-
fect of race on caregivers’ cultural reasons for providing care to
dependent elderly family members. These findings, we believe,
moves the discussion beyond using race as a proxy for under-
standing cultural influences in caregiving research (Gallagher-
Thompson et al., 2000; Haley et al., 1995). As expected, African
American caregivers in this study expressed stronger cultural
reasons for providing care than White caregivers, as measured
by the CJCS. However, we believe that the cultural values that
once served to foster strong caregiving networks may now be a
source of stress for some caregivers. For example, Dilworth-
Anderson and colleagues (2004) found that very strong cultural
justifications for giving care to dependent family members pre-
dicted less positive evaluations of health for African American
caregivers. Very weak cultural justifications for caregiving were
predictive of poor evaluations of health as well. Instead, African
American caregivers with moderate levels of cultural justifica-
tions for providing care evaluated their health the most
African Americans scoring higher on the CJCS given the
emerging literature that points out that older African Americans
have smaller social networks and fewer social resources as
compared to Whites (Ajrouch, Antonucci, & Janevic, 2001;
suggests that these smaller networks, although denser in family
connections as compared to Whites, may not have the ability to
provide support over time, especially in networks where socio-
economic resources are limited. Therefore, we believe the
findings from this study provide additional information to the
emerging literature that examines social networks and resources
in later life by showing that culture can be viewed as a social
resource for understanding who gives careand whoreceives it in
African American and White families.
Given the importance of culture for African Americans in
providing care to dependent family members and the effect
cultural beliefs have on their health, future studies are needed to
examine the processes whereby caregivers are socialized to
provide care to elders. Furthermore, significant race interactions
show that not all African American or White caregivers adhere
to cultural values for caregiving universally. Thus, within-
group analyses are needed to further explain the cultural
socialization processes among these specific racial groups,
especially about gender and age.
Several limitations are noted in the study. Statistical analysis
of the CJCS found that it could detect cultural differences in
reasons for providing care with equal reliability among White
and African American caregivers. Yet, as noted earlier, because
culture provides a framework for behavior, there is a need to
engage in more refined and in-depth ethnographic investigations
CULTURAL JUSTIFICATIONS FOR CAREGIVING
by guest on November 6, 2015
in the future that may illuminate differences in caregiving
between racial subgroups, and perhaps between genders, that
will enhance our knowledge about the role of culture in
understanding caregiver behavior and health outcomes.
Another limitation is that, similar to other studies, caregivers
with higher levels of education and incomes are more likely to
participate than the general population. For example, the
income level of the African American sample indicates a higher
level of income than those in the general population ($40,000–
$44,999 vs $38,096 median income; U.S. Census Bureau,
2004). Finally, the lack of longitudinal data did not allow for
assessing changes in the status of caregivers and care recipients
on cultural justifications for caregiving.
This work was supported by a grant from the National Institute on Aging
(Grant R01 AG19605), with cofunding from the National Institute of
Mental Health and National Institute of Environmental Health Sciences to
Redford B. Williams, MD, as principal investigator. We would like to thank
Michael Babyak for his statistical consultation.
Address correspondence to Peggye Dilworth-Anderson, Center for
Aging and Diversity, UNC Institute on Aging, 720 Airport Road, Suite 100,
CB 1030, Chapel Hill, NC 27599-1030. E-mail: email@example.com
Ajrouch, K. J., Antonucci, T. C., & Janevic, M. R. (2001). Social networks
among Blacks and Whites: The interaction between race and age.
Journal of Gerontology: Social Sciences, 56B, S112–S118.
Aranda, M. P., & Knight, B. G. (1997). The influences of ethnicity and
culture on the caregiver stress and coping process: A sociocultural
review and analysis. The Gerontologist, 37, 342–354.
Barnes, L. L., Mendes de Leon, C. F., Bienias, J. L., & Evans, D. A. (2004).
A longitudinal study of Black–White differences in social resources.
Journal of Gerontology: Social Sciences, 59B, S146–S153.
Burton, L. M., & Dilworth-Anderson, P. (1991). The intergenerational roles
of aged Black Americans. Marriage and Family Review, 16, 311–322.
Cantor, M. H. (1979). Neighbors and friends: An overlooked resource in
the informal support system. Research on Aging, 1, 434–463.
Dillaway, H., & Broman, C. (2001). Race, class, and gender in marital
satisfaction and divisions of household labor among dual-earner
couples. Journal of Family Issues, 22, 309–327.
Dilworth-Anderson, P., & Gibson, B. E. (2002). The cultural influence of
values, norms, meanings, and perceptions in understanding dementia in
ethnic minorities. Alzheimer Disease and Associated Disorders, 16,
Dilworth-Anderson, P., Goodwin, P. Y., & Williams, S. W. (2004). Can
culture help explain the physical health effects of caregiving over time
among African American caregivers? Journal of Gerontology: Social
Sciences, 59B, S138–S145.
Dilworth-Anderson, P., Williams, I. C., & Gibson, B. E. (2002). Issues of
race, ethnicity, and culture in caregiving research: A twenty-year review
(1980–2000). The Gerontologist, 42, 327–272.
Finley, N. J. (1989). Theories of family labor as applied to gender
differences in caregiving for elderly parents. Journal of Marriage and
the Family, 51, 79–86.
Franklin, D. (1997). Ensuring inequality: The structural transformation of
the African-American family. New York, NY: Oxford University Press.
Gallagher-Thompson, D., Arean, P., Coon, D., Menendez, A., Takagi, K.,
Haley, W. E., et al. (2000). Development and implementation of
intervention strategies for culturally diverse caregiving populations.
In R. Schulz (Ed.), Handbook of dementia caregiving: Evidence-
based interventions for family caregivers (pp. 151–185). New York:
Goodenough. W. H. (1981). Culture, language, and society. Menlo Park,
CA: Benjamin/Cummings Publication Co.
Goodenough, W. H. (1999). Outline of a framework for a theory of cultural
evolution. Cross-Cultural Research, 33, 84–107.
Haley, W. E., West, C. A., Wadley, V. G., Ford, G. R., White, F. A.,
Barrett, J. J., et al. (1995). Psychological, social, and health impact of
caregiving: A comparison of black and white dementia family
caregivers and noncaregivers. Psychology and Aging, 10, 540–552.
Harrell, F. E. (2001). Regression modeling strategies: With applications to
linear models, logistic regression, and survival analysis. New York:
Jackson, J. S., Antonucci, T. C., & Brown, E. (2004). A cultural lens on
biopsychosocial models of aging. Advances in Cell Aging and
Gerontology, 15, 221–241.
Janevic, M. R., & Connell, C. M. (2001). Racial, ethnic, and cultural
differences in the dementia caregiving experience: Recent findings. The
Gerontologist, 41, 334–347.
Katz, M. B. (1993). The ‘‘Underclass’’ debate: Views from history.
Princeton, NJ: Princeton University Press.
Keith, C. (1995). Family caregiving systems: Models, resources, and
values. Journal of Marriage and the Family, 57, 179–190.
Lawton, M. P., Rajagopal, D., Brody, E., & Kleban, M. H. (1992). The
dynamics of caregiving for demented elders among Black and White
families. Journal of Gerontology: Social Sciences, 47, S156–S164.
McAdoo, J. L. (1993). Decision making and marital satisfaction in African
American families. In H. P. McAdoo (Ed.), Family ethnicity: Strength
in diversity (pp. 109–119). Newbury Park, CA: Sage.
Muthe ´n, B., & Muthe ´n, L. (1998–2004). MPlus Manual (3rd Ed.). LA:
Neal, M. B., Ingersoll-Dayton, B., & Starrels, M. E. (1997). Gender and
relationship differences in caregiving patterns and consequences among
employed caregivers. The Gerontologist, 37, 804–816.
Pyke, K. D., & Bengston, V. L. (1996). Caring more or less: Individualistic
and collectivist systems of family eldercare. Journal of Marriage and
the Family, 58, 379–392.
SAS Institute. (2000). SAS/STAT software changes and enhancements,
Release 8.1. Cary, NC: Author.
Siegler, I. C., Bastian, L. A., Steffens, D. C., Bosworth, H. B., & Costa, P. T.
(2002). Behavioral medicine and aging. Journal of Consulting and
Clinical Psychology, 70, 843–851.
Smedley, A., & Smedley, B. D. (2005). Race as biology is fiction, racism
as a social problem is real: Anthropological and historical perspectives
on the social construction of race. American Psychologist, 60, 16–26.
U.S. Census Bureau. Income 2003 (August 27, 2004). Retrieved September
20, 2004, from http://www.census.gov/hhes/income/income03/
Vitaliano, P. P., Zhang, J., & Scanlan, J. M. (2003). Is caregiving hazardous
to one’s physical health? A meta-analysis. Psychological Bulletin, 129,
Whitfield, K. E., Weidner, G., Clark, R., & Anderson, N. B. (2002).
Sociodemographic diversity and behavioral medicine. Journal of
Consulting and Clinical Psychology, 70, 463–481.
Received September 28, 2004
Accepted April 26, 2005
Decision Editor: Charles F. Longino, Jr., PhD
DILWORTH-ANDERSON ET AL.
by guest on November 6, 2015