Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

Background. Although psychosocial and health factors impact insomnia symptoms, less is known about these effects in economically disadvantaged African-American older adults. Aims. This study investigated social and health determinants of insomnia symptoms among economically disadvantaged African-American older adults. Methods. This survey enrolled 398 African-American older adults (age ≥ 65 years) from economically disadvantaged areas of South Los Angeles. Gender, age, educational attainment, financial difficulty, number of chronic diseases, self-rated health, pain intensity, and depression were covariates. Total insomnia, insomnia symptoms, and insomnia impact were our outcomes. Linear regression was applied for data analysis. Results. Based on linear regression, higher financial difficulty (B = 0.48, 95% CI = 0.35–0.61), smoking status (B = 1.64, 95% CI = 0.13–3.16), higher pain intensity (B = 0.39, 95% CI = 0.11–0.67), higher number of chronic diseases (B = 0.34, 95% CI = 0.05–0.64), and more depressive symptoms (B = 0.35, 95% CI = 0.12–0.57) were associated with a higher frequency of insomnia symptoms. Based on a logistic regression model, lower age (B = 0.91, 95% CI = 0.91–1.00) and high financial difficulty (OR = 1.15, 95% CI = 1.08–1.24), pain (OR = 2.08, 95% CI = 1.14–3.80), chronic disease (OR = 1.27, 95% CI = 1.07–1.51) and depression (OR = 2.38, 95% CI = 1.22–4.65) were associated with higher odds of possible clinical insomnia. We also found specific predictors for insomnia symptoms and insomnia impact. Conclusions. Among African-American older adults in economically disadvantaged areas of South Los Angeles, insomnia symptoms co-occur with other economic, physical, and mental health challenges such as financial difficulty, smoking, multimorbidity, pain, and depression. There is a need to address sleep as a component of care of economically disadvantaged African-American older adults who have multiple social and health challenges.

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Depressive Symptoms among Economically Disadvantaged African American Older Adults in South Los Angeles

Brain Sciences ◽

10.3390/brainsci9100246 ◽

2019 ◽

Vol 9 (10) ◽

pp. 246 ◽

Cited By ~ 3

Author(s):

Meghan C. Evans ◽

Sharon Cobb ◽

James Smith ◽

Mohsen Bazargan ◽

Shervin Assari

Keyword(s):

Older Adults ◽

African American ◽

Depressive Symptoms ◽

Los Angeles ◽

Educational Attainment ◽

Marital Status ◽

Pain Intensity ◽

Economically Disadvantaged ◽

South Los Angeles ◽

Financial Difficulties

Background: Although social, behavioral, and health factors correlate with depressive symptoms, less is known about these links among economically disadvantaged African American (AA) older adults. Objective: To study social, behavioral, and health correlates of depressive symptoms among economically disadvantaged AA older adults. Methods: This survey was conducted in South Los Angeles between 2015 and 2018. A total number of 740 AA older adults (age ≥55 years) were entered to this study. Independent variables were gender, age, educational attainment, financial difficulties, living alone, marital status, smoking, drinking, chronic medical conditions (CMCs), and pain intensity. The dependent variable was depressive symptoms. Linear regression model was used to analyze the data. Results: Age, financial difficulties, smoking, CMCs, and pain intensity were associated with depressive symptoms. Gender, educational attainment, living arrangement, marital status, and drinking were not associated with depressive symptoms. Conclusion: Factors such as age, financial difficulties, smoking, CMCs, and pain may inform programs that wish to screen high risk economically disadvantaged AA older adults for depressive symptoms.

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Binge Drinking among Economically Disadvantaged African American Older Adults with Diabetes

Behavioral Sciences ◽

10.3390/bs9090097 ◽

2019 ◽

Vol 9 (9) ◽

pp. 97 ◽

Cited By ~ 3

Author(s):

Shervin Assari ◽

James L. Smith ◽

Mohammed Saqib ◽

Mohsen Bazargan

Keyword(s):

Older Adults ◽

African American ◽

African Americans ◽

Los Angeles ◽

Binge Drinking ◽

Economically Disadvantaged ◽

Living Arrangement ◽

Urban Environments ◽

Health Determinants ◽

African American Older Adults

Purpose. This study investigated the effect of demographic, socioeconomic, and psychological factors as well as the role of health determinants on alcohol consumption and binge drinking among economically disadvantaged African American older adults with type 2 diabetes mellites (T2DM). Methods. This survey recruited 231 African Americans who were older adults (age 65+ years) and had T2DM. Participants were selected from economically disadvantaged areas of South Los Angeles. A structured face-to-face interview was conducted to collect data on demographic factors, objective and subjective socioeconomic status (SES) including education and financial difficulty, living arrangement, marital status, health, and drinking behaviors (drinking and binge drinking). Results. Age, gender, living alone, pain, comorbid conditions, and smoking were associated with drinking/binge drinking. Male gender, pain, and being a smoker were associated with higher odds of drinking/binge drinking, while individuals with more comorbid medical conditions had lower odds of binge drinking. Conclusion. In economically constrained urban environments, gender, pain, and smoking but not age, SES, depression, and health may predict binge drinking for African American older adults with T2DM. African Americans older adult men with T2DM with comorbid pain should be screened for binge drinking.

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Medication Complexity among Disadvantaged African American Seniors in Los Angeles

Pharmacy ◽

10.3390/pharmacy8020086 ◽

2020 ◽

Vol 8 (2) ◽

pp. 86

Author(s):

Edward Adinkrah ◽

Mohsen Bazargan ◽

Cheryl Wisseh ◽

Shervin Assari

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Low Income ◽

Living Arrangements ◽

Healthcare Providers ◽

Multiple Chronic Conditions ◽

Health Maintenance ◽

South Los Angeles ◽

African American Older Adults

Background. Several publications highlight data concerning multiple chronic conditions and the medication regimen complexity (MRC) used in managing these conditions as well as MRCs’ association with polypharmacy and medication non-adherence. However, there is a paucity of literature that specifically details the correlates of MRC with multimorbidity, socioeconomic, physical and mental health factors in disadvantaged (medically underserved, low income) African American (AA) seniors. Aims. In a local sample in South Los Angeles, we investigated correlates of MRC in African American older adults with chronic disease(s). Methods. This was a community-based survey in South Los Angeles with 709 African American senior participants (55 years and older). Age, gender, continuity of care, educational attainment, multimorbidity, financial constraints, marital status, and MRC (outcome) were measured. Data were analyzed using linear regression. Results. Higher MRC correlated with female gender, a higher number of healthcare providers, hospitalization events and multimorbidity. However, there were no associations between MRC and age, level of education, financial constraint, living arrangements or health maintenance organization (HMO) membership. Conclusions. Disadvantaged African Americans, particularly female older adults with multimorbidity, who also have multiple healthcare providers and medications, use the most complex medication regimens. It is imperative that MRC is reduced particularly in African American older adults with multimorbidity.

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Chronic Respiratory Disease and Health-Related Quality of Life of African American Older Adults in an Economically Disadvantaged Area of Los Angeles

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101756 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1756 ◽

Cited By ~ 4

Author(s):

Mohsen Bazargan ◽

James L. Smith ◽

Paul Robinson ◽

John Uyanne ◽

Ruqayyah Abdulrahoof ◽

...

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Urban Areas ◽

Economically Disadvantaged ◽

Disadvantaged Area ◽

Related Quality ◽

Health Related ◽

African American Older Adults

Background. Most of the attention of policy makers, program planners, clinicians, and researchers in the area of physical health disparities among African American older adults has been traditionally focused on cardiometabolic disease and cancer. Among a long list of chronic medical conditions, chronic respiratory conditions (CRCs), such as asthma, chronic bronchitis, and emphysema, have received less attention. Purpose. This study investigated whether CRCs contribute to physical and mental health-related quality of life (HRQoL) of African American older adults who live in economically disadvantaged urban areas, and whether these effects are due to demographic factors, socioeconomic status (SES), health behaviors, and comorbid medical and mental conditions. Methods. This community-based study recruited 617 African American older adults (age ≥ 65 years) from Service Planning Areas (SPA) 6, an economically disadvantaged area in South Los Angeles. Structured face-to-face interviews were used to collect data on demographic factors (age and gender), SES (educational attainment and financial difficulty), living arrangements, marital status, health behaviors (cigarette smoking and alcohol drinking), health (CRC, number of comorbid medical conditions, depressive symptoms, and pain intensity), and physical and mental HRQoL (Physical and Mental Component Summary Scores; PCS and MCS; SF-12). Linear regressions were used to analyze the data. Results. The presence of CRCs was associated with lower PCS and MCS in bivariate analysis. The association between CRCs and PCS remained significant above and beyond all confounders. However, the association between CRCs and MCS disappeared after controlling for confounders. Conclusion. For African American older adults living in economically disadvantaged urban areas, CRCs contribute to poor physical HRQoL. Evaluation and treatment of CRCs in African American older adults may be a strategy for reduction of disparities in HRQoL in this population. As smoking is the major modifiable risk factor for CRCs, there is a need to increase accessibility of smoking cessation programs in economically disadvantaged urban areas. More research is needed on the types, management, and prognosis of CRCs such as asthma, chronic bronchitis, and emphysema in African American older adults who reside in low-income and resource limited urban areas.

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Influenza Vaccination among Underserved African-American Older Adults

BioMed Research International ◽

10.1155/2020/2160894 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Mohsen Bazargan ◽

Cheryl Wisseh ◽

Edward Adinkrah ◽

Hoorolnesa Ameli ◽

Delia Santana ◽

...

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Influenza Vaccination ◽

Vaccine Uptake ◽

Depression Symptoms ◽

South Los Angeles ◽

Flu Vaccination ◽

African American Older Adults

Background. Racial disparities in influenza vaccination among underserved minority older adults are a public health problem. Understanding the factors that impact influenza vaccination behaviors among underserved older African-Americans could lead to more effective communication and delivery strategies. Aims. We aimed to investigate rate and factors associated with seasonal influenza vaccination among underserved African-American older adults. We were particularly interested in the roles of demographic factors, socioeconomic status, and continuity and patient satisfaction with medical care, as well as physical and mental health status. Methods. This community-based cross-sectional study recruited 620 African-American older adults residing in South Los Angeles, one of the most under-resources areas within Los Angeles County, with a population of over one million. Bivariate and multiple regression analyses were performed to document independent correlates of influenza vaccination. Results. One out of three underserved African-American older adults aged 65 years and older residing in South Los Angeles had never been vaccinated against the influenza. Only 49% of participants reported being vaccinated within the 12 months prior to the interview. One out of five participants admitted that their health care provider recommended influenza vaccination. However, only 45% followed their provider’s recommendations. Multivariate logistic regression shows that old-old (≥75 years), participants who lived alone, those with a lower level of continuity of care and satisfaction with the accessibility, availability, and quality of care, and participants with a higher number of depression symptoms were less likely to be vaccinated. As expected, participants who indicated that their physician had advised them to obtain a flu vaccination were more likely to be vaccinated. Our data shows that only gender was associated with self-report of being advised to have a flu shot. Discussion. One of the most striking aspects of this study is that no association between influenza vaccination and being diagnosed with chronic obstructive pulmonary disease or other major chronic condition was detected. Our study confirmed that both continuity of care and satisfaction with access, availability, and quality of medical care are strongly associated with current influenza vaccinations. We documented that participants with a higher number of depression symptoms were less likely to be vaccinated. Conclusion. These findings highlight the role that culturally acceptable and accessible usual source of care van play as a gatekeeper to facilitate and implement flu vaccination among underserved minority older adults. Consistent disparities in influenza vaccine uptake among underserved African-American older adults, coupled with a disproportionate burden of chronic diseases, places them at high risk for undesired outcomes associated with influenza. As depression is more chronic/disabling and is less likely to be treated in African-Americans, there is a need to screen and treat depression as a strategy to enhance preventive care management such as vaccination of underserved African-American older adults. Quantification of associations between lower vaccine uptake and both depression symptoms as well as living alone should enable health professionals target underserved African-American older adults who are isolated and suffer from depression to reduce vaccine-related inequalities.

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Eye Examination Recency among African American Older Adults with Chronic Medical Conditions

Healthcare ◽

10.3390/healthcare8020094 ◽

2020 ◽

Vol 8 (2) ◽

pp. 94

Author(s):

Mohsen Bazargan ◽

Tavonia Ekwegh ◽

Sharon Cobb ◽

Edward Adinkrah ◽

Shervin Assari

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Medical Care ◽

Care Providers ◽

Middle Aged ◽

South Los Angeles ◽

Self Rated Health ◽

Eye Examination ◽

African American Older Adults

Background: Pervasive racial and economic inequalities have a disproportionate impact on health care utilization among African Americans. One area where we see such disparities is in the recency of eye examinations among the economically disadvantaged. However, our current understanding of the barriers and facilitators of eye examinations in underserved African-American older adults is limited. Aims: Building on Andersen’s model of health service use and using an exploratory approach; we tested various demographic, social, and health factors that were associated with eye examination among underserved middle-aged and older adults in South Los Angeles. We examined predisposing characteristics, enabling factors, and need-for-care characteristics. Methods: With a cross-sectional design, we conducted this survey on a convenience sample of (n = 740) non-institutionalized African-American older adults who were 55+ years old and residing in South Los Angeles, CA, USA. Data were collected on demographic factors, continuity of care, access to care, self-rated health, chronic medical conditions, and depressive symptoms. The outcome was recency of eye examination. Multivariate regression was used for data analysis. Results: 59% of the participants had received at least one eye examination during the last 12 months. A total of 17% had an eye examination within the last two years. Notably, 26% of diabetic participants did not have an eye examination within the last two years. One out of four participants indicated that, within the last two years, no provider ever recommended that they receive an eye examination. Age, education, continuity of medical care, accessibility of medical care, satisfaction with medical care, providers’ recommendation for eye examination, self-rated health, and a diagnosis of hypertension and diabetes mellitus were predictors of eye examination recency. Overall, our analysis indicates that these enabling factors accounted for most of the variance in the recency of eye examinations. Conclusion: A large proportion of underserved African-American middle-aged and older adults in South Los Angeles do not comply with the recommended annual eye examination. This is, in part, because about one-third of them have not received an eye exam recommendation from their health care providers. However, a wide range of factors such as age, education, continuity of care, satisfaction with access, self-rated health, and a diagnosis of hypertension and diabetes mellitus, also influence whether or not African-American middle-aged and older adults receive an eye examination. Programs should address a wide range of multi-level factors to tackle this health inequality.

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Marijuana Use among African American Older Adults in Economically Challenged Areas of South Los Angeles

Brain Sciences ◽

10.3390/brainsci9070166 ◽

2019 ◽

Vol 9 (7) ◽

pp. 166 ◽

Cited By ~ 4

Author(s):

Sharon Cobb ◽

Mohsen Bazargan ◽

James Smith ◽

Homero E. del Pino ◽

Kimberly Dorrah ◽

...

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Cigarette Smoking ◽

Alcohol Drinking ◽

Living Alone ◽

Financial Strain ◽

Chronic Medical Conditions ◽

South Los Angeles ◽

African American Older Adults

Purpose: This study explored demographic, social, behavioral, and health factors associated with current marijuana use (MU) among African American older adults who were residing in economically challenged areas of south Los Angeles. Methods: This community-based study recruited a consecutive sample of African American older adults (n = 340), age ≥ 55 years, residing in economically challenged areas of South Los Angeles. Interviews were conducted to collect data. Demographics (age and gender), socioeconomic status (educational attainment, income, and financial strain), marital status, living alone, health behaviors (alcohol drinking and cigarette smoking), health status (number of chronic medical conditions, body mass index, depression, and chronic pain), and current MU were collected. Logistic regression was used to analyze the data. Results: Thirty (9.1%) participants reported current MU. Age, educational attainment, chronic medical conditions, and obesity were negatively associated with current MU. Gender, income, financial strain, living alone, marital status, smoking cigarettes, drinking alcohol, depression, and pain did not correlate with MU. Conclusion: Current MU is more common in younger, healthier, less obese, less educated African American older adults. It does not seem that African American older adults use marijuana for the self-medication of chronic disease, pain, or depression. For African American older adults, MU also does not co-occur with cigarette smoking and alcohol drinking. These results may help clinicians who provide services for older African Americans in economically challenged urban areas.

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Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16071175 ◽

2019 ◽

Vol 16 (7) ◽

pp. 1175 ◽

Cited By ~ 7

Author(s):

Mohsen Bazargan ◽

James Smith ◽

Sharon Cobb ◽

Lisa Barkley ◽

Cheryl Wisseh ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

African American ◽

Los Angeles ◽

Continuity Of Care ◽

Chronic Conditions ◽

Male Gender ◽

Multiple Chronic Conditions ◽

South Los Angeles ◽

Ed Visits

Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.

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Substance Use among Economically Disadvantaged African American Older Adults; Objective and Subjective Socioeconomic Status

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101826 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1826 ◽

Cited By ~ 16

Author(s):

Shervin Assari ◽

James Smith ◽

Ritesh Mistry ◽

Mehdi Farokhnia ◽

Mohsen Bazargan

Keyword(s):

Older Adults ◽

African American ◽

Cigarette Smoking ◽

Educational Attainment ◽

Alcohol Drinking ◽

Economically Disadvantaged ◽

Health Risk Behaviors ◽

Subjective Socioeconomic Status ◽

Financial Difficulties ◽

African American Older Adults

Purpose. This study investigated the effects of objective and subjective socioeconomic status (SES) indicators on two health behaviors, cigarette smoking and alcohol drinking, among African American older adults. Methods. This community-based study recruited 619 economically disadvantaged African American older adults (age ≥ 65 years) residing in South Los Angeles. Structured face-to-face interviews were conducted to collect data. Data on demographic factors (age and gender), subjective SES (financial difficulties), objective SES (educational attainment), living arrangement, marital status, healthcare access (insurance), and health (number of chronic medical conditions, self-rated health, sick days, depression, and chronic pain) and health behaviors (cigarette smoking and alcohol drinking) were collected from participants. Logistic regressions were used to analyze the data. Results. High financial difficulties were associated with higher odds of smoking cigarettes and drinking alcohol, independent of covariates. Educational attainment did not correlate with our outcomes. Similar patterns emerged for cigarette smoking and alcohol drinking. Conclusion. Subjective SES indicators such as financial difficulties may be more relevant than objective SES indicators such as educational attainment to health risk behaviors such as cigarette smoking and alcohol drinking among African American older adults in economically constrain urban environments. Smoking and drinking may serve as coping mechanisms with financial difficulty, especially among African American older adults. In line with the minorities’ diminished returns (MDR) theory, and probably due to discrimination against racial minorities, educational attainment has a smaller protective effect among economically disadvantaged African American individuals against health risk behaviors.

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Depression Treatment Status of Economically Disadvantaged African American Older Adults

Brain Sciences ◽

10.3390/brainsci10030154 ◽

2020 ◽

Vol 10 (3) ◽

pp. 154

Author(s):

Sharon Cobb ◽

Mohsen Bazargan ◽

Jessica Castro Sandoval ◽

Cheryl Wisseh ◽

Meghan C. Evans ◽

...

Keyword(s):

Older Adults ◽

African American ◽

High Risk ◽

Educational Attainment ◽

Pain Intensity ◽

Economically Disadvantaged ◽

Polynomial Regression ◽

Chronic Medical Conditions ◽

Medical Conditions ◽

Treatment Status

Background: It is known that depression remains largely untreated in underserved communities. Hence, it is desirable to gain more knowledge on the prevalence and correlates of untreated depression among African-American (AA) older adults in economically disadvantaged areas. This knowledge may have the public health benefit of improving detection of AA older adults with depression who are at high risk of not receiving treatment, thereby reducing this health disparity. Objective: To study health and social correlates of untreated depression among AA older adults in economically disadvantaged areas. Methods: Between 2015 and 2018, this cross-sectional survey was conducted in South Los Angeles. Overall, 740 AA older adults who were 55+ years old entered this study. Independent variables were age, gender, living arrangement, insurance type, educational attainment, financial strain, chronic medical conditions, and pain intensity. Untreated depression was the dependent variable. Logistic and polynomial regression models were used to analyze these data. Results: According to the polynomial regression model, factors such as number of chronic medical conditions and pain intensity were higher in individuals with depression, regardless of treatment status. As our binary logistic regression showed, age, education, and number of providers were predictive of receiving treatment for depression. Conclusion: Age, educational attainment, number of providers (as a proxy of access to and use of care) may be useful to detect AA older adults with depression who are at high risk of not receiving treatment. Future research may focus on decomposition of the role of individual-level characteristics and health system-level characteristics that operate as barriers and facilitators to AA older adults receiving treatment for depression.

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