Browsing by Author "Kim, Giyeon"
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Item The association between the number of chronic health conditions and advance care planning varies by race/ethnicity(Routledge, 2020) Choi, Shinae; McDonough, Ian M.; Kim, Minjung; Kim, Giyeon; University of Alabama Tuscaloosa; Ohio State University; Chung Ang UniversityObjectives: Although a national consensus exists on the need to increase the rates of advance care planning (ACP) for all adults, racial/ethnic differences in ACP have been consistently observed. This study investigated the intersection of racial/ethnic differences and the number of chronic health conditions on ACP among middle-aged and older adults in the United States. Method: Responses from 8,926 adults from the 2014 wave of the Health and Retirement Study were entered into multilevel hierarchical logistic regression analyses with generalized linear mixed models to predict ACP focused on assigning a durable power of attorney for healthcare (DPOAHC) and having a written living will after adjusting for covariates. Results: We found a significant positive relationship between the number of chronic health conditions and ACP. Non-Hispanic Blacks/African Americans and Hispanics were less likely to engage in ACP than non-Hispanic Whites/Caucasians. Racial/ethnic disparities were even starker for completing a living will. The number of chronic health conditions had a greater effect for Hispanics than non-Hispanic Whites/Caucasians on ACP through assigning a DPOAHC and having a living will. The initial disparity in ACP among Hispanics with no chronic health conditions decreased as the number of chronic health conditions increased. Conclusion: Our findings suggest that more chronic health conditions increase the likelihood that Hispanics will complete ACP documents. These ACP differences should be highlighted to researchers, policymakers, and healthcare professionals to reduce stark racial/ethnic disparities in ACP. A comprehensive and culturally caring decision-making approach should be considered when individuals and families engage in ACP.Item Barriers to mental health service use: variations by age and race/ethnicity(University of Alabama Libraries, 2013) Ford, Katy Lauren; Kim, Giyeon; University of Alabama TuscaloosaThis study examines the variation by age and racial/ethnic minority status in factors affecting misuse of mental health services (MHS) to identify barriers to adequate mental healthcare among racially/ethnically diverse older adults. Drawn from the nationally representative Collaborative Psychiatric Epidemiology Surveys (CPES), a racially/ethnically diverse group of adults who demonstrated either an objective (psychiatric diagnosis) or perceived need for MHS (n=5,545) was selected for analyses. Binary logistic regression analyses were conducted, with a focus on the interaction of older age with racial/ethnic minority status. To further explore the issue, we used chi-squared tests of proportional differences to compare the rates at which varying racial/ethnic groups and age groups encountered various attitudinal and structural barriers to proper MHS use. We found that Asian, Hispanic/Latino, and Black respondents were significantly more likely to misuse MHS than non-Hispanic Whites (ORs [95% CIs]=1.960 [1.471, 2.609], 2.362 [1.955, 2.854], & 2.906 [2.475, 3.412], respectively). Older adults were less likely than younger adults to misuse MHS (OR=0.991; 95%CI=0.986, 0.995). All differences were significant at p<0.001. There were significant age by race/ethnicity interactions on overall misuse of MHS. Post hoc analyses indicate that many attitudinal and structural barriers showed greater disparity between racial/ethnic minorities and whites in older adults than in younger adults. These results suggest that older age and membership in a racial/ethnic minority group interact to predict greater deficits in openness and access to MHS. Efforts to improve MHS underutilization by these groups should take their unique obstacles into account in order to reduce existing disparities.Item Disability as a risk factor for psychological distress among asian-american elders(University of Alabama Libraries, 2012) Huang, Chao-Hui Huang; Crowther, Martha R.; University of Alabama TuscaloosaResearch has shown a strong association between disability and psychological distress (PD) among older adults. However, little is known about how this relation varies among different subgroups of Asian-American elders. The present study aims to examine the relation between disability and PD within five subgroups of Asian Americans age 60 and older (N=1398): Chinese (n = 291), Japanese (n = 175), Koreans (n =383), Filipinos (n = 149), and Vietnamese (n = 400). Data were drawn from the 2009 California Health Interview Survey (CHIS). A generalized linear model (GzLM) analysis was conducted to assess the overall relations of disability with PD, as well as how these effects were moderated by ethnicity. The three types of disabilities being examined (vision/hearing, cognitive, and ADL functional disabilities) were all associated with increased PD. It was also found that the effects of having cognitive or ADL functional disabilities depended on the elder's ethnicity. Having a cognitive or an ADL functional disability led to notably more distress among Filipinos than among those from other Asian subgroups. In addition, the effect of having an ADL functional disability was not significant for Japanese, even though it was significant for all of the other ethnicities. This current study sheds light on understanding disability as a risk factor for poor mental health among the five subgroups of Asian-American elders. The findings can be applied to enhance the psychological wellbeing of disabled Asian American elders by providing culturally-sensitive mental health services tailored to their specific needs.Item Effects of Nativity, Length of Residence, and County-Level Foreign-Born Density on Mental Health Among Older Adults in the US(Springer, 2016) Choi, Sunha; Kim, Giyeon; Lee, Sungkyu; University of Tennessee Knoxville; University of Alabama Tuscaloosa; Soongsil UniversityUsing the 2004-2007 Medical Expenditure Panel Survey data that are linked to county-level data from the Area Health Resources Files, this study examined whether the healthy immigrant effect applies to mental health of foreign-born older adults. Additionally, testing a protective ethnic density effect on older foreign-born individuals' mental health, this study examined how the percentage of foreign-born population in the county affected the relationship between older adults' immigration status (U.S.-nativity and length of residence in the U.S.) and their mental health status. The sample included 29,011 individuals (level-1) from 920 counties (level-2) across 50 states and D.C. Using the Mental Component Summary of the Short-Form 12, the Kessler Index (K-6), and the Patient Health Questionnaire (PHQ-2), U.S.-born individuals (n = 24,225), earlier immigrants (aeyen15 years in the U.S.; n = 3866), and recent immigrants (< 15 years in the U.S.; n = 920) were compared. The results indicate that recent immigrants showed worse mental health on all three measures compared with U.S.-born individuals and on the K-6 and PHQ-2 compared with earlier immigrants. Higher county-level foreign-born densities were associated with worse mental health status of individuals. However, the significant interactions found in the full conditional multilevel models indicated that the high foreign-born density functioned as a risk factor for worse mental health only among recent immigrants but not among the U.S.-born. In conclusion, the results revealed the vulnerability of older recent immigrants, especially those living in the counties with high foreign-born densities.Item Emergency department utilization among Medicaid beneficiaries with schizophrenia and diabetes: The consequences of increasing medical complexity(Elsevier, 2014) Shim, Ruth S.; Druss, Benjamin G.; Zhang, Shun; Kim, Giyeon; Oderinde, Adesoji; Shoyinka, Sosunmolu; Rust, George; Morehouse School of Medicine; Emory University; Rollins School Public Health; University of Alabama Tuscaloosa; University of Missouri ColumbiaObjective: Individuals with both physical and mental health problems may have elevated levels of emergency department (ED) service utilization either for index conditions or for associated comorbidities. This study examines the use of ED services by Medicaid beneficiaries with comorbid diabetes and schizophrenia, a dyad with particularly high levels of clinical complexity. Methods: Retrospective cohort analysis of claims data for Medicaid beneficiaries with both schizophrenia and diabetes from fourteen Southern states was compared with patients with diabetes only, schizophrenia only, and patients with any diagnosis other than schizophrenia and diabetes. Key outcome variables for individuals with comorbid schizophrenia and diabetes were ED visits for diabetes, mental health-related conditions, and other causes. Results: Medicaid patients with comorbid diabetes and schizophrenia had an average number of 7.5 ED visits per year, compared to the sample Medicaid population with neither diabetes nor schizophrenia (1.9 ED visits per year), diabetes only (4.7 ED visits per year), and schizophrenia only (5.3 ED visits per year). Greater numbers of comorbidities (over and above diabetes and schizophrenia) were associated with substantial increases in diabetes-related, mental health-related and all-cause ED visits. Most ED visits in all patients, but especially in patients with more comorbidities, were for causes other than diabetes or mental health-related conditions. Conclusion: Most ED utilization by individuals with diabetes and schizophrenia is for increasing numbers of comorbidities rather than the index conditions. Improving care in this population will require management of both index conditions as well as comorbid ones. (C) 2013 Elsevier B.V. All rights reserved.Item Factor Structures of Reasons for Immigration Among Older Asian and Latino Immigrants in the United States(Oxford University Press, 2019) Park, Soohyun; Kim, Giyeon; University of Alabama Tuscaloosa; Chung Ang UniversityBackgrounds and Objectives: Although reasons for immigration are significant predictors of immigrants' health, factor structures of reasons for immigration are still unclear among older immigrants. The present study examined the factor structure of reasons for immigration among older Asian and Latino immigrants in the United States. Research Design and Methods: Drawn from the National Latino and Asian American Study, 396 Latino and 298 Asian immigrants over 55 years of age were selected for analysis. Exploratory factor analysis was conducted for nine items concerning reasons for immigration in each immigrant group. Results: Three factors were extracted from both Asian and Latino immigrant elders: (a) "voluntary reasons" to pursue development, (b) "involuntary reasons" due to uncontrollable situations, and (c) "semivoluntary reasons" regarding family/medical duties. While immigration to join family members was located in the "semivoluntary reasons" factor among older Asian immigrants, it was located in the "voluntary reasons" factor among older Latino immigrants. Discussion and Implications: These findings suggest that three underlying factors of reasons for immigration should be understood considering the different characteristics of two racial/ethnic groups of immigrants. In addition, a migratory reason to join the family should be considered differently for elderly Asian and Latino immigrants. This three-factor framework of reasons for immigration can help clinicians provide more culturally sensitive interventions for older minority immigrants.Item Factors predicting intraindividual cognitive variability in older adults with different degrees of cognitive integrity(University of Alabama Libraries, 2016) Shoji, Kristy Douglas; Dautovich, Natalie D.; University of Alabama TuscaloosaGiven the increasing number of older adults in the population, the fact that about 1 in 10 people over the age of 65 will develop mild cognitive impairment, and the substantial individual, familial, and financial burden associated with such disorders, the need for innovative research examining cognitive impairment in older adults is evident. The present study used a microlongitudinal design to assess cognition and contextual factors that may affect cognition for 14 consecutive days using a daily diary method in older adults with varying degrees of cognitive function. This study design enables investigation of concurrent associations between variables, as well as providing unique information not gleaned from the traditional focus on mean values of cognition. The present study had two broad aims: 1) to compare variability in cognition in older adults with varying degrees of cognitive impairment and 2) to investigate relationships between daily cognitive performance, variability in cognitive performance, and contextual factors that may influence daily cognitive performance and variability in older adults with varying degrees of cognitive impairment. Results suggest there was sufficient intraindividual variability in daily cognition to warrant investigation of within-person associations. Furthermore, the contextual factors of pain, stress, and sleep were predictive of cognitive performance, but with significance and directionality of these associations depending on level of measurement (baseline, daily, or mean values). Finally, associations between contextual factors and cognition were frequently conditional upon baseline cognitive status. The findings highlight the need for continued examination of these associations to expand our understanding of cognition in older adults and to discover potential targets for interventions to attenuate cognitive decline.Item Gene by Environment Interactions on Late-Life Cognitive Functioning: Integrative Roles of Polygenic Score, Early Life Trauma, and Psychological Resilience(University of Alabama Libraries, 2021) Park, Soohyun; Allen, Rebecca S.; Kim, Giyeon; University of Alabama TuscaloosaBACKGROUND: Little is known about the integrative roles of genetic, environmental, and psychological factors on late-life cognitive functioning. This study investigated (a) whether early life trauma could moderate the effect of genetic predisposition on late-life cognitive functioning, and (b) whether psychological resilience could moderate the interactive effect of early life trauma and genetic predisposition on late-life cognitive functioning.METHODS: Growth curve modeling was conducted on a nationally representative sample of adults from the European ancestry group aged 50 or older (4,479 females and 3,502 males) from the 2004 – 2016 waves (7 waves) of the Health and Retirement Study. Global cognitive functioning was measured by a total cognition score, composed of fluid and crystallized intelligence. Genetic predisposition for cognitive functioning was measured by polygenic score for general cognition (PGS-gc), and early life trauma was measured by parental alcohol/drug use, physical abuse, and trouble with the police before the age of 18. Psychological resilience was measured as purpose in life and perceived control. RESULTS: After controlling for covariates, PGS-gc, purpose in life, and perceived control, respectively, were significantly and positively associated with global cognitive functioning. Moreover, a significant PGS-gc by early life trauma interaction existed on fluid intelligence. Parental alcohol/substance abuse for older females, and trouble with police for older males, respectively, were significant moderators which decreased the beneficial effect of high PGS-gc on fluid intelligence. Higher perceived control was associated with higher crystallized intelligence (a) among older females with a history of early life trauma and with high PGS-gc; and (b) among males with a history of early life trauma with low PGS-gc, respectively. IMPLICATIONS: The findings demonstrate a gene-by-environment interaction, as early life trauma serves as a significant moderator which attenuates the genetic benefits of PGS-gc on late-life cognitive functioning. Psychological resilience, such as perceived control, has a positive effect on cognitive functioning, and also moderates the interaction effect of PGS-gc and early life trauma on crystallized intelligence. These findings not only provide a clear rationale for trauma-informed care for geriatric populations but also highlight psychological resilience as a modifiable target for effective intervention to promote late-life cognitive health.Item Geographic and Racial-Ethnic Differences in Satisfaction With and Perceived Benefits of Mental Health Services(American Psychiatric Publishing, 2014) Kim, Giyeon; Parton, Jason M.; Ford, Katy-Lauren; Bryant, Ami N.; Shim, Ruth S.; Parmelee, Patricia; University of Alabama Tuscaloosa; Morehouse School of MedicineObjective: This study examined whether racial-ethnic differences in satisfaction with and perceived benefits from mental health services vary by geographic region among U.S. adults. Methods: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), selected samples consisted of 2,160 adults age 18 and older from diverse racial-ethnic groups (Asian, black, Hispanic/Latino, and white) who had used mental health services in the past 12 months. Generalized linear model analysis was conducted for the United States as a whole and separately by geographic region (Northeast, South, Midwest, and West) after adjustment for covariates. Results: In the national sample, no significant main effects of race-ethnicity and geographic region were found in either satisfaction with or perceived benefits from mental health services. In the stratified analyses for geographic regions, however, significant racial-ethnic differences were observed in the West; blacks in the West were significantly more likely to report higher satisfaction and perceived benefits, whereas Hispanics/Latinos in the West were significantly less likely to do so. Conclusions: The findings suggest that there are regional variations of racial-ethnic differences in satisfaction with and perceived benefits from mental health services among U.S. adults and that addressing needs of Hispanics/Latinos in the West may help reduce racial-ethnic disparities in mental health care. Clinical and policy implications are discussed.Item Geographic Disparities in the Relation between English Proficiency and Health Insurance Status among Older Latino and Asian Immigrants(Springer, 2019) Kim, Junghyun; Ford, Katy-Lauren; Kim, Giyeon; University of Alabama Tuscaloosa; Chung Ang UniversityThis study examines whether English proficiency and geographic context explain health insurance status among older Latino and Asian immigrants in the U.S. Drawn from the 2010-2012 ACS PUMS, 57,936 Latino and 47,742 Asian immigrants aged 65 and older were selected. Logistic regression analysis was conducted for the U.S. as a whole and separately by geographic region. In the entire U.S., having limited English proficiency (LEP) and being proficient in English (EP) increased odds of being uninsured among Latino immigrants, whereas LEP and EP decreased odds of being uninsured among Asian immigrants. In the stratified analyses for geographic regions, there were significant ethnic differences in the directionality of the relation between English proficiency and uninsured status. Regional institutions should take care to expand access to information on health care and insurance coverage to racial/ethnic minorities, taking into account the characteristics of these groups at the local level.Item Geographic Region Matters in the Relation Between Perceived Racial Discrimination and Psychiatric Disorders Among Black Older Adults(Oxford University Press, 2017) Kim, Giyeon; Parmelee, Patricia; Bryant, Ami N.; Crowther, Martha R.; Park, Soohyun; Parton, Jason M.; Chae, David H.; University of Alabama Tuscaloosa; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Pittsburgh Healthcare System; Auburn UniversityThis study examined whether the relation between perceived racial discrimination and psychiatric disorders varied by large geographic region among Black older adults in the United States. Black adults aged 55 or older who had experienced racial/ethnic-specific discrimination were drawn from the National Survey of American Life (NSAL). Logistic regression analysis was used to examine main and interaction effects. Results show that there was a significant main effect of perceived racial discrimination, indicating that greater perceived discrimination was significantly associated with increased odds of having any past-year psychiatric disorder. The interaction of region by perceived racial discrimination was significant: The effect of perceived racial discrimination on any past-year psychiatric disorder was stronger among Blacks in the West than those in the South. Findings suggest that whereas, in general, perceived racial discrimination is a risk factor for poor mental health among older Blacks, this association may differ by geographic region. Additional research examining reasons for this variation is needed.Item Geographic variations in alcohol consumption among racially/ethnically diverse older adults(University of Alabama Libraries, 2015) Bryant, Ami; Kim, Giyeon; University of Alabama TuscaloosaThis dissertation sought to examine the role of geographic location, geographic characteristics, and individual level race/ethnicity in alcohol consumption among older adults. Data were obtained from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) and the 2010 US Census. Participants aged 60 and older who were not missing data on any of the main study variables were included (n=185, 190). Data was analyzed for a total of 2,229 counties. Racial/ethnic groups examined included American Indian/Alaska Natives, Asians/Pacific Islanders, Blacks, Hispanics, and Whites. Multilevel modeling was used for main analyses in order to account for the nested structure of the data. Individuals at level 1 were nested within counties at level 2 which were nested within regions at level 3. Alcoholic drinks consumed per month was used as the dependent variable. Significant within and between county variance was found in average alcoholic drinks consumed per month. There were significant main effects of race/ethnicity, county percentage of older adults, county percentage of racial/ethnic minorities, and county median income on average alcoholic drinks consumed per month. Significant interactions were found for individual level race/ethnicity and each of the aforementioned county level variables. These results indicate that geographic location and characteristics are significantly related to the alcohol consumption of older adults. Additionally, results suggest that the role of geographic characteristics in the alcohol consumption of older adults varies by individual level race/ethnicity.Item Health Disparities Grants Funded by National Institute on Aging: Trends Between 2000 and 2010(Oxford University Press, 2012) Kim, Giyeon; DeCoster, Jamie; Huang, Chao-Hui; Parmelee, Patricia; University of Alabama Tuscaloosa; University of VirginiaPurpose of the Study: The present study examined the characteristics of health disparities grants funded by National Institute on Aging (NIA) from 2000 to 2010. Objectives were (a) to examine longitudinal trends in health disparities-related grants funded by NIA and (b) to identify moderators of these trends. Design and Methods: Our primary data source was the National Institutes of Health Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) system. The RePORTER data were merged with data from the Carnegie Classification of Institutions of Higher Education. General linear models were used to examine the longitudinal trends and how these trends were associated with type of grant and institutional characteristics. Results: NIA funded 825 grants on health disparities between 2000 and 2010, expending approximately 330 million dollars. There was an overall linear increase over time in both the total number of grants and amount of funding, with an outlying spike during 2009. These trends were significantly influenced by several moderators including funding mechanism and type of institution. Implications: The findings highlight NIA's current efforts to fund health disparities grants to reduce disparities among older adults. Gerontology researchers may find this information very useful for their future grant submissions.Item Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults(Wiley, 2017) Jimenez, Daniel E.; Schmidt, Andrew C.; Kim, Giyeon; Le Cook, Benjamin; University of Miami; University of Alabama Tuscaloosa; Harvard University; Cambridge Health AllianceObjectiveThe objective is to apply the Institute of Medicine definition of healthcare disparities in order to compare (1) racial/ethnic disparities in general medical care use among older adults with and without comorbid mental health need and (2) racial/ethnic disparities in general medical care use within the group with comorbid mental health need. MethodsData were obtained from the Medical Expenditure Panel Survey (years 2004-2012). The sample included 21,263 participants aged 65+years (14,973 non-Latino Caucasians, 3530 African-Americans, and 2760 Latinos). Physical illness was determined by having one of the 11 priority chronic health illnesses. Comorbid mental health need was defined as having one of the chronic illnesses plus a Kessler-6 Scale >12, or two-item Patient Health Questionnaire >2. General medical care use refers to receipt of non-mental health specialty care. Two-part generalized linear models were used to estimate and compare general medical care use and expenditures among older adults with and without a comorbid mental health need. ResultsRacial/ethnic disparities in general medical care expenditures were greater among those with comorbid mental health need compared with those without. Among those with comorbid mental health need, non-Latino Caucasians had significantly greater expenditures on prescription drug use than African-Americans and Latinos. ConclusionsExpenditure disparities reflect differences in the amount of resources provided to African-Americans and Latinos compared with non-Latino Caucasians. This is not equivalent to disparities in quality of care. Interventions and policies are needed to ensure that racial/ethnic minority older adults receive equitable services that enable them to manage effectively their comorbid mental and physical health needs. Copyright (c) 2016 John Wiley & Sons, Ltd.Item Impact of physical-mental comorbidity on subjective well-being among racially/ethnically diverse elders(University of Alabama Libraries, 2016) Wang, Sylvia Yanlian; Kim, Giyeon; University of Alabama TuscaloosaBackground: Older adults are more likely to be burdened by multiple health conditions, and comorbid physical and mental health conditions adversely affect one’s overall well-being. However, little is known about physical-mental comorbidity as a determinant for subjective well-being among racially/ethnically diverse elders. Objectives: The current study examined racial/ethnic variations in the relationship between types and severity of comorbidity and subjective well-being among diverse elders (White, Black, Hispanic, and Asian). Methods: Data were drawn from the National Health and Aging Trends Study (NHATS) collected in 2011. The current study included 8064 participants who self-identified as White, Black, Hispanic, or Asian in our analyses. In order to examine comorbidity, participants were grouped using sixteen common physical health conditions and two mental disorders. Chi-square analyses were used to compare racially/ethnically diverse participants on demographic variables and types of comorbidity. Analyses of covariance (ANCOVAs) were used to assess the relationship between types and severity of comorbidity and subjective well-being among diverse elders. Results: Significant differences were found on background characteristics and types of comorbidity among racially/ethnically diverse elders. For main analysis results (ANCOVAs), Blacks and Hispanics reported higher subjective well-being than Whites after controlling for covariates. Participants with physical-mental comorbidity reported lower subjective well-being compared to healthy participants. As the severity of physical-mental comorbidity increased, subjective well-being decreased. Conclusion: The current study provided detailed descriptions and comprehensive knowledge of the relationship between physical-mental comorbidity and subjective well-being among diverse elders. Study limitations, clinical implications, and directions for future research are discussed.Item The impact of subjective well-being on longevity among older adults: a detailed examination of the racial/ethnic differences(University of Alabama Libraries, 2019) Wang, Sylvia Yanlian; Kim, Giyeon; Gilpin, Ansley; University of Alabama TuscaloosaLimited studies have investigated the relationship between subjective well-being (SWB) and longevity among older adults. Additionally, no existing research has explored racial/ethnic differences between SWB and longevity in the U.S. Guided by the Main Effect Model, the Stress-Buffering Model, and the Stratification Theory, this study aimed to determine the impact of SWB on longevity. Furthermore, I sought to determine which component(s) of SWB, whether positive affect, negative affect, and/or cognitive evaluation, independently predicted longevity. Lastly, the interaction effect of race/ethnicity and SWB on longevity was assessed. Using the Kaplan-Meier Estimator and the Cox Proportional Hazards (PH) Model, I found that SWB was predictive of longevity among older adults. A higher level of SWB was associated with a lower mortality risk. More importantly, a one-point increase in SWB was associated with a 3% lower mortality risk after adjusting for demographic factors (age, gender, and race/ethnicity), socioeconomic status (SES) covariates (income, education attainment, marital status, and number of health insurances), physical health (number of physical health conditions and self-rated health), and mental health status (depression and anxiety). In addition, positive affect was associated with mortality risk after adjusting for demographic and SES factors, and cognitive evaluation was a significant predictor of longevity after adjusting for all covariates. However, negative affect was not associated with mortality risk. Lastly, the interaction between SWB and race/ethnicity did not predict longevity. These findings highlighted the importance of SWB for longevity among older adults in the U.S. Suggestions for future research and implication for public policy and clinical intervention are discussed.Item The influence of cultural adaptation on depressive symptoms among young Hispanic immigrants(University of Alabama Libraries, 2012) Jaggers, Jeremiah W.; MacNeil, Gordon; University of Alabama TuscaloosaThis study examines how cultural adaptation and family cohesion impact depressive symptoms in Hispanic immigrants that migrated to the U.S. by the age of 17. Using the National Latino and Asian American Study, a recursive regression was conducted on a hypothesized model demonstrating the relationship among the study variables: acculturation, acculturative stress, subjective social status, discrimination, ethnic social identity, dissonant acculturation, family cohesion and depressive symptoms. Psychosocial contextual variables are also included in the analysis and include gender, age, years in the U.S., education, income, and ethnicity. Results revealed two important themes in the data. The first is the importance of family in the adaptation process. As hypothesized, dissonant acculturation leads to the development of depressive symptoms. Additional findings concluded that family cohesion moderated the effect of dissonant acculturation. The second theme revealed in the data was the risk posed by acculturative stress in the adaptation process. Acculturative stress contributes directly to dissonant acculturation and to depressive symptoms.Item Limited English Proficiency and Trajectories of Depressive Symptoms Among Mexican American Older Adults(Oxford University Press, 2019) Kim, Giyeon; Kim, Minjung; Park, Soohyun; Jimenez, Daniel E.; Chiriboga, David A.; Chung Ang University; Ohio State University; University of Alabama Tuscaloosa; University of Miami; University of South FloridaBackground and Objectives: This study examined the effect of limited English proficiency (LEP) on trajectories of depressive symptoms among Mexican American older adults in the United States. Research Design and Methods: The sample was drawn from Waves 1 to 6 (1993-2007) of the Hispanic Established Population for Epidemiological Studies of the Elderly (H-EPESE). A total of 2,945 Mexican American older adults were included in the analyses. A latent growth curve modeling was conducted. Results: After adjusting for covariates, results show that Mexican American older adults with LEP had higher levels of depressive symptoms than those with English proficiency (EP) at baseline as well as over a 14-year period. Differential trajectories were observed between those with LEP and EP over time, indicating that those with LEP had a significantly steeper curve of depressive symptom trajectories over time than those with EP. Discussion and Implications: These results suggest that LEP is a risk factor not merely for greater depressive symptomatology at each time point, but for an accelerated trajectory of depressive symptoms over time among Mexican American older adults. Overall, the findings emphasize the need to assist not only the informal support system of Mexican American older adults with LEP, but also the formal system.Item Longitudinal changes in self-reported expectations for nursing home use in the health and retirement study(University of Alabama Libraries, 2012) Haley, Philip Parker; Allen, Rebecca S.; University of Alabama TuscaloosaThe Behavioral Model of Health Services Use (Andersen, 1968; Andersen & Newman, 1973) is a frequently used framework for examining the factors that bear upon the decision to pursue and utilize health services (Andersen & Newman, 1973; Mui, Choi, & Monk, 1998). According to this model, an individual's predisposing characteristics, their enabling resources, and their degree of need combine to determine whether or not they will pursue health services such as nursing home care. The current study investigated the relations between variables predicted by the Behavioral Model of Health Services Use to influence longitudinal expectations for nursing home use among adults 50 years of age and older. Variables of interest were drawn from the 2002-2008 waves of the Health and Retirement Study (HRS) and included demographics, previous health services use, possession of insurance that pays for nursing home care, social support, cognitive status, emotional health, and functional status. Results suggested that the variables selected based upon the Behavioral Model of Health Services Use exhibited a limited ability to predict changes in nursing home use expectations across time. Limitations of the current study, as well as potential areas for future studies, were discussed.Item Measurement Equivalence of the K6 Scale: The Effects of Race/Ethnicity and Language(Sage, 2016) Kim, Giyeon; DeCoster, Jamie; Bryant, Ami N.; Ford, Katy L.; University of Alabama Tuscaloosa; University of VirginiaThis study examined the measurement equivalence of the K6 across diverse racial/ethnic and linguistic groups in the U.S. differential item functioning analyses using item response theory were conducted among 44,846 U.S. adults drawn from the California Health Interview Survey. Results show that four items (nervous, restless, depressed, and everything an effort) varied significantly across races/ethnicities and four items (nervous, hopeless, restless, and depressed) varied significantly across languages. In additional effect size analyses designed to separate effects of race/ethnicity from language, the structure of the White English group was substantially different from both the Hispanic/Latino English group and Hispanic/Latino Spanish group, whereas the Hispanic/Latino Spanish group was not different from the Hispanic/Latino English group. The findings suggest that there was evident measurement nonequivalence in the K6 among racially/ethnically and linguistically diverse adults and that the observed nonequivalence in the K6 appears to be driven by language rather than race/ethnicity.