scholarly journals Does Sexual Orientation Influence Trajectories of Change in Health? A 20-Year Follow-Up Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 517-517
Author(s):  
Christi Nelson ◽  
Ross Andel
Keyword(s):  
Social Support ◽  
Sexual Orientation ◽  
Health Outcomes ◽  
Chronic Conditions ◽  
Negative Binomial ◽  
Functional Limitations ◽  
Functional Limitation ◽  
The United States ◽  
And Bisexual ◽  
Over Time

Abstract We examined the differences in physical health outcomes over a 20-year period between lesbian, gay, and bisexual (LGB) and heterosexual middle-aged and older adults. We also examined whether the associations were moderated by social support and affect. The analytical sample included 168 LGB adults and 336 propensity-matched heterosexual adults from the Midlife in the United States (MIDUS) study, ranging in age from 25 to 74 years (mean age=42.83) at baseline. Using negative binomial generalized estimating equations and mixed-effects analyses, data from three waves of MIDUS, spanning approximately 20 years from 1995 to 2014, were used to examine the associations between sexual orientation and the health outcomes (number of chronic conditions and functional limitations). Social support and affect were added to the models to test for moderation. The results found that LGB participants reported one more chronic condition at baseline and scored significantly higher for functional limitations. However, LGB participants increased less over time for number of chronic conditions than heterosexual participants, and there were no significant differences in terms of changes in functional limitation over time. Positive affect reduced the strength of the relationship between sexual orientation and functional limitations for LGB participants. No other moderating effects were significant. The results of this study suggest that LGB individuals may become resilient to the negative health effects of minority stressors over time. Interventions should focus on improving the health of LGB individuals when they are younger and more at risk of negative health outcomes.

scholarly journals Health Services Utilization Among Chinese American Older Adults: Moderation of Social Support With Functional Limitation

2018 ◽  
Vol 39 (5) ◽  
pp. 481-489 ◽  
Author(s):  
Jinjiao Wang ◽  
Dexia Kong ◽  
Benjamin C. Sun ◽  
XinQi Dong
Keyword(s):  
Social Support ◽  
Functional Limitations ◽  
Functional Limitation ◽  
Secondary Analysis ◽  
Chinese American ◽  
The United States ◽  
Lower Odds ◽  
Ed Visits ◽  
Older Chinese ◽  
Relationship Of

In this study, we aimed to examine the relationship of social support with hospitalizations and emergency department (ED) visits among older Chinese adults in the United States and its possible mechanism. This was a secondary analysis of data from the Population Study of Chinese Elderly (July 2011-June 2013; N = 3,157). After adjusting for demographic, clinical, and functional covariates in logistic regression analyses, significant interaction between social support from spouse and the number of functional limitations in (instrumental) activities of daily living was related to lower odds of hospitalization (odds ratio [OR] = 0.97 [0.95-0.99]) and ED visits (OR = 0.98 [0.96-0.99]). This finding suggests that among older Chinese American adults with functional limitations, more spousal support was related to lower odds of hospitalizations and ED visits. Future studies should comprehensively measure social support (e.g., content, amount) from other sources and investigate how unnecessary acute health service utilization in this population may be reduced by social support interventions.

scholarly journals Moderation of the Association Between Chronic Medical Conditions and Functional Limitations Over Time by Physical Activity: Effects of Age

2019 ◽  
Vol 75 (1) ◽  
pp. 168-174 ◽  
Author(s):  
Jerrald L Rector ◽  
Kristine Marceau ◽  
Elliot M Friedman
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Chronic Conditions ◽  
Functional Limitations ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Buffering Effect ◽  
Age Related ◽  
Over Time

Abstract Background Age-related accumulation of chronic medical conditions increases disability in older adults. Physical activity potently combats chronic conditions and disability. However, it is unclear whether activity maintenance alleviates the effects of chronic conditions on disability and if this buffering effect differs with age. This study examined whether long-term physical activity can forestall functional limitations in the face of accumulating chronic conditions among middle-aged and older adults. Methods Participants (n = 2,119; 54.7% female) were from the Survey of Midlife Development in the United States. Self-reported physical activity, number of chronic conditions, and functional limitations were obtained across 18–20 years. Functional limitations were regressed against the change in chronic conditions, physical activity, and their interaction over time in a multilevel model of change. Baseline age was added as an additional moderator. Results Faster accumulation of chronic conditions [B(SE) = 2.08(0.32), p < .001] and steeper declines in activity [B(SE) = −2.29(0.41), p < .001] were associated with greater increases in functional limitations over time. Among those with faster-than-average increases in conditions, those who maintained activity had a slower progression of functional limitations, compared to those whose activity declined more rapidly [B(SE) = −11.18(3.96), p = .005]. Baseline age moderated the buffering effect of activity maintenance; older adults were protected against functional limitations only when conditions accumulated slowly [B(SE) = 0.23(0.08), p = .005]. Conclusion This study provides evidence for an age-dependent buffering effect of activity maintenance on the longitudinal relationship between chronic conditions and functional limitations. Intervention strategies using physical activity to forestall disability should target midlife adults and consider the rate of condition accumulation.

scholarly journals The Importance of Studying Health Behavior in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 827-827
Author(s):  
Jaime Hughes ◽  
Susan Hughes ◽  
Mina Raj ◽  
Janet Bettger
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Behavior Change ◽  
Chronic Conditions ◽  
Population Level ◽  
Multiple Chronic Conditions ◽  
Prior Work ◽  
Time Changes ◽  
The Impact ◽  
Over Time

Abstract Behavior change is an inherent aspect of routine geriatric care. However, most research and clinical programs emphasis how to initiate behavior change with less emphasis placed on skills and strategies to maintain behaviors over time, including after an intervention has concluded. This presentation will provide an introduction to the symposium, including a review of prior work and our rationale for studying the critical yet overlooked construct of maintenance in older adults. Several key considerations in our work include the impact of multiple chronic conditions, declines in cognitive and functional capacity over time, changes in environmental context and/or social support, and sustainability of community and population-level programs and services.

scholarly journals THE PROTECTIVE ROLE OF SOCIAL SUPPORT ON DEPRESSIVE SYMPTOMS AMONG AGING SEXUAL MINORITY CANADIANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S303-S304
Author(s):  
Arne Stinchcombe ◽  
Nicole G Hammond ◽  
Kimberley Wilson
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Sexual Orientation ◽  
Sexual Minority ◽  
Large Population ◽  
Population Based ◽  
Protective Role ◽  
Linear Regression Models ◽  
And Bisexual

Abstract Sexual minority older adults face minority stressors that are associated with higher rates of mental illness. The stress buffering effects of social support within majority populations are well documented. Using a large population-based sample of aging Canadians, we sought to examine the relationship between sexual orientation and depressive symptoms, and determine whether this relationship is moderated by social support and sex. Baseline data from the Canadian Longitudinal Study on Aging (CLSA) were used (n = 46147). Participants were between the ages of 45-85 years at time of recruitment (mean age = 62.46, SD = 10.27), and self-reported their sexual orientation as heterosexual or lesbian, gay, or bisexual (LGB) (2.1%). Social support and depressive symptoms were measured using validated instruments. Four functional social support subscales were derived: tangible, positive social interaction, affectionate, and emotional/informational. Multiple linear regression models adjusted for relevant covariates were conducted. LGB identification was associated with greater depressive symptoms when compared to heterosexual participants (p = 0.032). As evidenced by a significant 3-way interaction (p = 0.030), increasing tangible social support was associated with a corresponding decrease in the risk of depressive symptoms; this relationship was most pronounced for lesbian and bisexual women. A significant 2-way interaction (p = 0.040) revealed that as emotional/informational social support increased, depressive symptoms decreased, with greater disparity between LGB and heterosexual participants at lower levels of social support. The results highlight the importance of social support in promoting mental health, especially among sexual minority older adults.

scholarly journals A Changing Landscape of Health Opportunity in the United States: Increases in the Strength of the Association Between Childhood Socioeconomic Disadvantage and Adult Health Between the 1990’s and the 2010’s

2020 ◽  
Author(s):  
Thomas E Fuller-Rowell ◽  
Olivia I. Nichols ◽  
Markus Jokela ◽  
Eric S. Kim ◽  
Elif D. Yildirim ◽  
...  
Keyword(s):  
United States ◽  
Health Outcomes ◽  
Parent Education ◽  
Functional Limitations ◽  
The United States ◽  
Socioeconomic Disadvantage ◽  
Occupational Prestige ◽  
Adult Health ◽  
Important Indicator ◽  
Aggregate Index

The strength of the association between childhood socioeconomic disadvantage (SED) and adult health is an important indicator of health stratification and the degree to which health outcomes are determined early in life. However, changes in the strength of this association over historic time are largely unexamined in the United States. Utilizing data from two independent national samples of adults collected 17 years apart (1995 and 2012), the current study examined changes in the strength of the association between childhood SED and adult health. Childhood SED was scored as an aggregate index from measures of parent occupational prestige, childhood poverty exposure, and parent education. Five measures of adult health were considered: BMI, waist circumference, chronic conditions, functional limitations, and self-rated health. Results indicated that the association between childhood SED and all five health outcomes was significantly stronger in the 2012 sample than the 1995 sample, with the magnitude of the association being more than twice as large in the more recent sample for four out of five outcomes. Findings persisted after adjusting for age, sex, race, marital status, and number of children. Results suggest that the socioeconomic circumstances of childhood have become a stronger predictor of adult health in recent decades. Replication and examination of mechanisms for these effects vis-à-vis changing pathways from childhood SED to adult health through adult status attainments, work environment characteristics, or unfair treatment, is warranted.

scholarly journals Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248702
Author(s):  
Brian Neelon ◽  
Fedelis Mutiso ◽  
Noel T. Mueller ◽  
John L. Pearce ◽  
Sara E. Benjamin-Neelon
Keyword(s):  
Social Vulnerability ◽  
Primary Care Physicians ◽  
Negative Binomial ◽  
Temporal Trends ◽  
The United States ◽  
Social Vulnerability Index ◽  
Crossover Effect ◽  
Death Rates ◽  
The Impact ◽  
Over Time

Background Socially vulnerable communities may be at higher risk for COVID-19 outbreaks in the US. However, no prior studies examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. Therefore, we examined temporal trends among counties with high and low social vulnerability to quantify disparities in trends over time. Methods We conducted a longitudinal analysis examining COVID-19 incidence and death rates from March 15 to December 31, 2020, for each US county using data from USAFacts. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention, with higher values indicating more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles, adjusting for rurality, percentage in poor or fair health, percentage female, percentage of smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, daily temperature and precipitation, and proportion tested for COVID-19. Results At the outset of the pandemic, the most vulnerable counties had, on average, fewer cases per 100,000 than least vulnerable SVI quartile. However, on March 28, we observed a crossover effect in which the most vulnerable counties experienced higher COVID-19 incidence rates compared to the least vulnerable counties (RR = 1.05, 95% PI: 0.98, 1.12). Vulnerable counties had higher death rates starting on May 21 (RR = 1.08, 95% PI: 1.00,1.16). However, by October, this trend reversed and the most vulnerable counties had lower death rates compared to least vulnerable counties. Conclusions The impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties and back again over time.

Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults

2021 ◽  
pp. 5-11
Author(s):  
Caitlin Ryan ◽  
David Huebner ◽  
Rafael M. Diaz ◽  
Jorge Sanchez
Keyword(s):  
Young Adults ◽  
Sexual Orientation ◽  
Health Outcomes ◽  
Health Indicators ◽  
Well Being ◽  
Health Problems ◽  
Self Report ◽  
And Bisexual ◽  
Pencil And Paper ◽  
And Gender

OBJECTIVE We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults. METHODS On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys. RESULTS Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. CONCLUSIONS This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.

A Simulation Framework for Evaluating the Effectiveness of Chronic Disease Management Interventions

2014 ◽  
Vol 6 (4) ◽  
pp. 40-59 ◽  
Author(s):  
Rafael Diaz ◽  
Joshua G. Behr
Keyword(s):  
Health Outcomes ◽  
Chronic Conditions ◽  
The United States ◽  
Dynamics Simulation ◽  
Contributory Factor ◽  
Simulation Framework ◽  
Management Intervention ◽  
Management Interventions ◽  
Intervention Cost ◽  
Financial Consequences

The treatment and management of chronic diseases currently comprise a major fraction of the United States' healthcare expenditures. These expenses are projected to increase as the US population ages. Utilization of the ambulatory healthcare system stemming from chronic conditions has been seen as contributory factor in the rising expenditures. Efforts to better manage chronic conditions ought to result in better health outcomes and, by extension, savings through lower utilization of ambulatory services. The longer-term financial consequences of such interventions, however, are more uncertain. This study offers a System Dynamics simulation framework that identifies and models the critical relationships associated with health outcomes and longer-term financial consequences. This framework is demonstrated through a comparison between groups with a similar generic chronic condition, but one group is subjected to a management intervention and the other group is not. The framework provides constructive insights into how the initial intervention cost estimates, the resulting savings, and the health status may change depending on uncertainties, feedback effects, and cost structures.

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