Health Literacy and Health Conditions at the Intersections of Gender and Race in Later Life

Abstract The benefits of health literacy are well-documented. Health literacy is a set of skills to locate, understand, and use health-related information to make optimal health decisions. However, relatively less is known about the long-term relationship between health literacy and overall health conditions among older adults. Additionally, health literacy and health at the intersection of gender and race/ethnicity, rather than gender and race separately, are yet to be investigated. This study analyzed sub-samples (n = 1,260 adults age 50+) of the 2010 Health and Retirement Study (HRS) health literacy module data, and the 2012, 2014, and 2016 HRS data to examine the trajectories of health based on eight physical and mental conditions (0-8 points: better-worse) among older adults. Latent growth curve mixture models were used to investigate the changes in health and six groups defined by gender (women and men) and race/ethnicity (White, Black, and Hispanic). Results showed that overall health deteriorated over time (latent-slope = 0.19, p < 0.001) but the trajectories were diverse (latent-slope variance = 0.06, p < 0.001). Greater health literacy (0-5 points: worse-best scaling), which was measured with a validated scale, was associated with better overall health only among White women and men. Notably, White women received the baseline health benefits (b = -0.20, p < 0.05) from health literacy whereas Black women (b = 0.09, p > 0.05) did not [Δb = 0.09 -(-0.20) = 0.29, p < 0.05]. Other detailed comparisons, theoretical explanations, and public health policy implications for diverse older populations were evaluated.

Download Full-text

Parsing out the “Hispanic Effect” in Disaggregated Homicide Trends at the Intersection of Race, Ethnicity, and Gender from 1990 to 2016

Homicide Studies ◽

10.1177/1088767920939312 ◽

2020 ◽

pp. 108876792093931

Author(s):

Shytierra Gaston ◽

CheyOnna Sewell

Keyword(s):

Black Women ◽

White Women ◽

White Men ◽

Policy Implications ◽

Mortality Data ◽

Homicide Victimization ◽

Hispanic Men ◽

Race Ethnicity ◽

And Gender ◽

Ethnicity And Gender

This study contributes to homicide research by parsing out the Hispanic Effect and applying an intersectional approach to examining U.S. homicide victimization trends by race, ethnicity, and gender, jointly. Drawing on mortality data, we document and describe total, firearm, and non-firearm homicide victimization rates from 1990 to 2016 for six subgroups: Black women, Black men, Hispanic women, Hispanic men, White women, and White men. The analysis of within- and between-group homicide trends reveals important subgroup-specific patterns that prior studies using aggregate or confounded data have masked. The findings have important research, theory, and policy implications and advocate for an intersectional approach to studying homicide.

Download Full-text

Homeownership Among Older Adults: Source of Stability or Stress?

Innovation in Aging ◽

10.1093/geroni/igaa057.2417 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 691-691

Author(s):

Jennifer Molinsky ◽

Christopher Herbert

Keyword(s):

Older Adults ◽

Later Life ◽

Housing Affordability ◽

Housing Quality ◽

Policy Implications ◽

Term Care ◽

Housing Stability ◽

Race Ethnicity ◽

Housing Equity

Abstract For older adults, homeownership can be an important source of housing stability and personal wealth that can be tapped in later life, including for long-term care. Nonetheless, owning a home is not without physical and financial challenges for aging households, and many owners are reluctant to take advantage of housing equity later in life. This paper reviews the conditions of older homeowners to assess the degree to which owning a home is—or is not—associated with financial security and housing stability. We review trends in homeowning among older adults, including differences by race/ethnicity and income. We then describe the extent of housing affordability challenges among homeowners, the degree of mortgage indebtedness, and the extent and use of housing equity. Finally, we examine issues related to housing quality and accessibility. The paper concludes with a discussion of policy implications.

Download Full-text

Intersections of Gender and Race among Older Workers during the COVID-19 Pandemic

Innovation in Aging ◽

10.1093/geroni/igab046.3150 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 871-872

Author(s):

Takashi Yamashita ◽

Wonmai Punksungka ◽

Samuel Van Vleet ◽

Abigail Helsinger ◽

Phyllis Cummins

Keyword(s):

Social Support ◽

Older Adults ◽

Older Workers ◽

Odds Ratio ◽

White Women ◽

Social Inequalities ◽

National Level ◽

Local Data ◽

Gender And Race ◽

Race Ethnicity

Abstract The novel coronavirus/COVID-19 pandemic in 2020 has impacted the aging workforce. In addition to local data and case studies that are rapidly increasing, baseline national-level inquiries are needed for investigating relevant social inequalities. Also, the intersections of gender and race/ethnicity among older adults are critical yet understudied areas. For example, older minority women’s experience in the pandemic, compared to older men, are yet to be investigated. We analyzed the nationally representative 2020 Health and Retirement Study (HRS) COVID-19 module data. Based on the sample of 2,086 adults aged 50 years and older, employment during the pandemic as well as psychosocial measures, including social support and attitudes toward work, are examined. We used survey-weighted binary logistic regression models. Results showed that older Black women (Odds-ratio = 0.52, p = 0.02 < 0.05) were less likely to work for pay compared to White women during the pandemic. Also, older Hispanic men (Odds-ratio = 2.82, p = 0.03 < 0.05) were more likely to work for pay than older White men. Older Hispanic women (Odds-ratio = 2.41, p = 0.03 < 0.05) were more likely to worry about getting social support during the pandemic than White women. However, there was no significant differences in the changes in attitudes toward work across gender and racial/ethnic groups during the pandemic. Based on the baseline national data analysis, we discussed possible policy changes and interventions that consider the intersections of gender and race/ethnicity to help older adults re-adjust to post-pandemic work environments and labor markets.

Download Full-text

Racial and Ethnic Disparities in Maternal Outcomes and the Disadvantage of Peripartum Black Women: A Multistate Analysis, 2007–2014

American Journal of Perinatology ◽

10.1055/s-0038-1675207 ◽

2018 ◽

Vol 36 (08) ◽

pp. 835-848 ◽

Cited By ~ 11

Author(s):

Virginia Tangel ◽

Robert S. White ◽

Anna S. Nachamie ◽

Jeremy S. Pick

Keyword(s):

Black Women ◽

Length Of Stay ◽

Cesarean Delivery ◽

White Women ◽

Average Length ◽

Ethnic Disparities ◽

Maternal Outcomes ◽

Racial And Ethnic Disparities ◽

Mortality And Morbidity ◽

Race Ethnicity

Objective Racial and ethnic disparities in obstetric care and delivery outcomes have shown that black women experience high rates of pregnancy-related mortality and morbidity, along with high rates of cesarean delivery, compared with other racial and ethnic groups. We aimed to quantify these disparities and test the effects of race/ethnicity in stratified statistical models by insurance payer and socioeconomic status, adjusting for comorbidities specific to an obstetric population. Study Design We analyzed maternal outcomes in a sample of 6,872,588 delivery records from California, Florida, Kentucky, Maryland, and New York from 2007 to 2014 from the State Inpatient Databases, Healthcare Cost and Utilization Project. We compared present-on-admission characteristics of parturients by race/ethnicity, and estimated logistic regression and generalized linear models to assess outcomes of in-hospital mortality, cesarean delivery, and length of stay. Results Compared with white women, black women were more likely to die in-hospital (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.47–2.45) and have a longer average length of stay (incidence rate ratio: 1.10, 95% CI: 1.09–1.10). Black women also were more likely to have a cesarean delivery (OR: 1.12, 95% CI 1.12–1.13) than white women. These results largely held in stratified analyses. Conclusion In most insurance payers and socioeconomic strata, race/ethnicity alone is a factor that predicts parturient outcomes.

Download Full-text

Abstract MP66: Social Determinants And Co-morbid Conditions In Women Of Child-bearing Age With Hypertension From 2001-2018

Hypertension ◽

10.1161/hyp.78.suppl_1.mp66 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Lara C Kovell ◽

Claire Meyerovitz ◽

Didem Ayturk ◽

Stephen P Juraschek ◽

Tiffany A Moore Simas ◽

...

Keyword(s):

Black Women ◽

Social Determinants ◽

White Women ◽

Hispanic Women ◽

Private Insurance ◽

Anthropometric Measures ◽

Mortality And Morbidity ◽

Child Bearing ◽

Race Ethnicity ◽

Morbid Conditions

Introduction: Hypertension (HTN) is the most important modifiable risk factor of serious maternal mortality and morbidity. Social determinants, including economic stability and access to healthcare, influence HTN outcomes and are critical to understanding and addressing racial and ethnic differences in HTN control. Objective: To assess social determinants and co-morbidities in US women of child-bearing age with HTN by race/ethnicity Methods: We studied women (age 20-50) with HTN in the National Health and Nutrition Examination Surveys 2001-2018. Social determinants and co-morbid conditions were examined in groups categorized by race/ethnicity - Non-Hispanic White (White), Non-Hispanic Black (Black), and Hispanic. Demographics, anthropometric measures, and co-morbid conditions were compared with White women as reference. Results: In all women with HTN, the mean (SE) age was 36.0 (0.3) years and 63% were on BP medication. Compared to white women, Black and Hispanic women had lower food security, poverty income ratio, smoking use, and private insurance (all p<0.0001, Table ). Black women had higher BP medication use, BMI, and BP compared to White women (all p<0.0001). Hispanic women had higher rates of diabetes (p=0.009) and no place to go for healthcare (p=0.005) compared to White women. Food insecurity was present in 34% of Hispanic women. Conclusions: Despite effective diagnostics and therapy, health inequity is common in women of child-bearing age with HTN, with differences by race/ethnicity in social determinants and co-morbid conditions. Each racial/ethnic group with HTN brings social determinants and comorbid conditions important for providers to recognize.

Download Full-text

Racial/Ethnic Disparities in Mammogram Frequency Among Women With Intellectual Disability

Intellectual and Developmental Disabilities ◽

10.1352/1934-9556-57.3.177 ◽

2019 ◽

Vol 57 (3) ◽

pp. 177-187 ◽

Cited By ~ 1

Author(s):

Evelyn Arana ◽

Amy Carroll-Scott ◽

Philip M. Massey ◽

Nora L. Lee ◽

Ann C. Klassen ◽

...

Keyword(s):

Intellectual Disability ◽

Black Women ◽

Medical Record ◽

Ethnic Groups ◽

White Women ◽

Ethnic Disparities ◽

Medical Record Data ◽

Record Data ◽

Race Ethnicity ◽

Racial Ethnic

Abstract Little information exists on the associations between intellectual disability (ID) and race/ethnicity on mammogram frequency. This study collected survey and medical record data to examine this relationship. Results indicated that Hispanic and Black women with ID were more likely than White women with ID to have mammograms every 2 years. Participants who live in a state-funded residence, were aged 50+, and had a mild or moderate level of ID impairment were more likely to undergo mammography compared to participants living with family or alone, were <50, and had severe ID impairment. Further research is needed to understand the mechanisms explaining disparities in mammograms between these racial/ethnic groups.

Download Full-text

New onset of restless legs syndrome in pregnancy in a prospective multiracial cohort

Neurology ◽

10.1212/wnl.0000000000011082 ◽

2020 ◽

Vol 95 (24) ◽

pp. e3438-e3447

Author(s):

Muzi Na ◽

Jing Wu ◽

Mengying Li ◽

Stefanie N. Hinkle ◽

Cuilin Zhang ◽

...

Keyword(s):

Risk Factors ◽

Black Women ◽

Restless Legs Syndrome ◽

White Women ◽

Hispanic Women ◽

Nutritional Factors ◽

Restless Legs ◽

Relative Risks ◽

Race Ethnicity ◽

In Pregnancy

ObjectiveTo determine whether the incidence and risk factors of restless legs syndrome (RLS) in pregnancy differ by race/ethnicity, we estimated relative risks of demographic, socioeconomic, and nutritional factors in association with risk of any incident RLS in pregnancy in a cohort of 2,704 healthy pregnant women without prior RLS.MethodsUsing data from the multicenter, multiracial National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies–Singletons, we examined the incidence of RLS from early pregnancy to near delivery through up to 6 assessments. Multivariable Poisson models with robust variance were applied to estimate relative risks (RRs).ResultsThe cumulative incidence of RLS in pregnancy was 18.1% for all women, 20.3% for White women, 15.4% for Black women, 17.1% for Hispanic women, and 21.1% for Asian women. Among Hispanic women, older age (RR [reference ≤25 years]: 25–35 years, 1.51; 95% confidence interval [CI] 1.05–2.16; ≥35 years, 1.58; 95% CI 0.93–2.68), anemia (RR [reference no]: yes, 2.47; 95% CI 1.31–4.64), and greater total skinfolds of the subscapular and triceps sites, independent of body mass index (RR [reference quartile 1]: quartile 5, 2.54; 95% CI 1.30–4.97; p trend = 0.01) were associated with higher risk of RLS, while multiparity was associated with a lower risk (RR [reference nulliparity]: 0.69; 95% CI 0.50–0.96). In Black women, greater skinfolds and waist circumference were associated with higher risk of pregnancy RLS, although the trends were less clear.ConclusionsThe incidence of RLS in pregnancy was high and differed by race/ethnicity, which is likely accounted for by differences in other risk factors, such as age, parity, and nutritional factors.

Download Full-text

THE ASSOCIATION OF LONELINESS AND CHRONIC CLINICALLY SIGNIFICANT PAIN AMONG AFRICAN AMERICAN AND WHITE OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.2281 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S613-S613

Author(s):

David Camacho ◽

Denise Burnette ◽

Maria P Aranda ◽

Ellen Lukens

Keyword(s):

Older Adults ◽

Chronic Pain ◽

African American ◽

African Americans ◽

African American Women ◽

Social Life ◽

White Women ◽

Later Life ◽

Physical And Mental Health ◽

Biopsychosocial Model Of Pain

Abstract Loneliness and pain are significant public health problems in later life, yet limited research has examined how these factors interact among racially diverse older adults. Guided by the Biopsychosocial Model of Pain, we used data from Waves 2 and 3 of the National Social Life, Health, and Aging Project to investigate the relationship between loneliness and chronic pain among 1,102 African-American and White adults aged 50 and over. Using logistic regression analyses, our final models considered demographics, physical and mental health, functioning, medication, health behaviors and social factors. Approximately 32% of African Americans and 28% of Whites reported chronic loneliness. Compared to Whites African-Americans were 2.5 times more likely to experience chronic pain. Among White participants, loneliness was not associated with chronic pain; however, the interaction of being African-American and lonely was associated with decreased odds of chronic pain in main and gendered analyses. African American women were 4 times more likely than White women to report chronic pain. Our results address the objectives of the National Pain Strategy (2016) to elucidate the experiences of chronic pain among diverse elders in the US. Future work should seek a deeper understanding of loneliness and chronic pain among African Americans elders and how cultural dynamics may help explain our counter intuitive findings (e.g., “Superwoman Schema”).

Download Full-text

Disparities at the Intersection of Race and Ethnicity: Examining Trends and Outcomes in Hispanic Women With Breast Cancer

JCO Oncology Practice ◽

10.1200/op.20.00381 ◽

2020 ◽

pp. OP.20.00381

Author(s):

Cosette D. Champion ◽

Samantha M. Thomas ◽

Jennifer K. Plichta ◽

Edgardo Parrilla Castellar ◽

Laura H. Rosenberger ◽

...

Keyword(s):

Breast Cancer ◽

Black Women ◽

Racial Differences ◽

White Women ◽

Hispanic Women ◽

Hazard Ratio ◽

Tumor Subtype ◽

Hispanic Patients ◽

Race Ethnicity ◽

Hispanic White

PURPOSE: We sought to examine tumor subtype, stage at diagnosis, time to surgery (TTS), and overall survival (OS) among Hispanic patients of different races and among Hispanic and non-Hispanic (NH) women of the same race. METHODS: Women 18 years of age or older who had been diagnosed with stage 0-IV breast cancer and who had undergone lumpectomy or mastectomy were identified in the National Cancer Database (2004-2014). Tumor subtype and stage at diagnosis were compared by race/ethnicity. Multivariable linear regression and Cox proportional hazards modeling were used to estimate associations between race/ethnicity and adjusted TTS and OS, respectively. RESULTS: A total of 44,374 Hispanic (American Indian [AI]: 79 [0.2%]; Black: 1,011 [2.3%]; White: 41,126 [92.7%]; Other: 2,158 [4.9%]) and 858,634 NH women (AI: 2,319 [0.3%]; Black: 97,206 [11.3%]; White: 727,270 [84.7%]; Other: 31,839 [3.7%]) were included. Hispanic Black women had lower rates of triple-negative disease (16.2%) than did NH Black women (23.5%) but higher rates than did Hispanic White women (13.9%; P < .001). Hispanic White women had higher rates of node-positive disease (23.2%) versus NH White women (14.4%) but slightly lower rates than Hispanic (24.6%) and NH Black women (24.5%; P < .001). Hispanic White women had longer TTS versus NH White women regardless of treatment sequence (adjusted means: adjuvant chemotherapy, 42.71 v 38.60 days; neoadjuvant chemotherapy, 208.55 v 201.14 days; both P < .001), but there were no significant racial differences in TTS among Hispanic patients. After adjustment, Hispanic White women (hazard ratio, 0.77 [95% CI, 0.74 to 0.81]) and Black women (hazard ratio, 0.75 [95% CI, 0.58 to 0.96]) had improved OS versus NH White women (reference) and Black women (hazard ratio, 1.15 [95% CI, 1.12 to 1.18]; all P < .05). CONCLUSION: Hispanic women had improved OS versus NH women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.

Download Full-text

Prospective study of pain outcomes associated with contralateral prophylactic mastectomy in women with nonhereditary breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6587 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6587-6587

Author(s):

Demetria Joy Smith-Graziani ◽

Patricia A. Parker ◽

Susan K. Peterson ◽

Isabelle Bedrosian ◽

Yu Shen ◽

...

Keyword(s):

Breast Cancer ◽

Black Women ◽

Repeated Measures ◽

White Women ◽

Prophylactic Mastectomy ◽

Contralateral Prophylactic Mastectomy ◽

Mean Difference ◽

Pain Severity ◽

Pain Outcomes ◽

Race Ethnicity

6587 Background: Women with nonhereditary breast cancer are increasingly undergoing contralateral prophylactic mastectomy (CPM). We examined pain severity and the impact of pain on the lives of women who underwent CPM compared to those who did not. We also examined the associations between age, race/ethnicity, reconstruction and pain outcomes. Methods: Between 2012 and 2015, we recruited women with newly diagnosed nonhereditary breast cancer who were planned for surgery. We assessed pain with the Brief Pain Inventory at initial surgical consultation and at 1, 6, 12, and 18 months after surgery. The repeated measures model was used to assess the association between pain severity or interference and CPM status over different time points adjusting for other covariates. Results: Of 288 women enrolled (mean age 56 years, 58% non-Hispanic White, 17% non-Hispanic Black), 50 underwent CPM, 163 had unilateral mastectomy, and 75 had breast conserving surgery. Mean pain severity was higher at 1 month (2.78 vs 1.9, p = .01) and 6 months (2.79 vs 1.96, p = .03) after surgery in women with CPM versus those without. In the multivariable repeated measures model adjusted for time, age, race/ethnicity and reconstruction status, there was a significant interaction between time and CPM for pain severity (p < .01) but not interference (p = .13). This suggests that CPM patients had higher pain severity in the first 6 months after surgery, but their pain scores decreased by 12 months becoming similar to women without CPM. Black women had higher pain severity (mean difference 1.35, standard error [SE] 0.35; p < .01) and interference (mean difference 0.91, SE 0.32; p < .01) compared to White women with or without CPM. There was no association between age or reconstruction status and pain severity or interference. Conclusions: Pain severity in patients undergoing CPM is highest during the first 6 months after surgery. Women considering CPM should be counseled about this potential outcome. Race/ethnic disparities exist in pain management, pain perceptions and communication of pain. Black women undergoing breast surgery report worse pain outcomes than White women regardless of CPM status.

Download Full-text