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Background Aging is often associated with the challenge of navigating daily tasks with a painful chronic medical illness. Yet, there is concern of the number of older adults impacted with more than one chronic condition. Despite the increasing number of adults diagnosed with diabetes and comorbid chronic illnesses, there remains a lack of understanding in how multiple illnesses relate to experiences of pain. To assess the association between multiple chronic conditions and pain, this study aimed to identify clusters of chronic medical conditions and their association with pain among a sample of older Black and White adults diagnosed with diabetes. Methods Two hundred and thirty-six participants responded to a series of questions assessing pain frequency and severity, as well as health and social characteristics. A factor analysis was used to categorize clusters of medical conditions, and multiple regression models were used to examine predictors of pain. Results Seven of the assessed chronic medical conditions loaded on three factors, and accounted for 57.2% of the total variance, with heart disease (factor 1) accounting for 21.9%, musculoskeletal conditions (factor 2) for another 18.4%, and factor 3 (microvascular diseases) accounting for a final 16.9% of the variability among the chronic medical conditions. Covariate-adjusted models showed that fewer years of education and higher scores on the microvascular and musculoskeletal conditions factors were associated with higher pain frequency, with the musculoskeletal conditions factor being the strongest predictor. Conclusions Findings from this study compliment existent literature underscoring the prevalence and importance of comorbid diagnoses in relation to pain. Examining health-related factors beyond a single disease diagnosis also provides an opportunity to explore underlying disease co-occurrences that may persist beyond organ system classifications.

Females are more likely than males to participate in evidence-based health promotion and disease prevention programs targeted for middle-aged and older adults. Despite the availability and benefits of Stanford’s Chronic Disease Self-Management Education (CDSME) programs, male participation remains low. This study identifies personal characteristics of males who attended CDSME program workshops and identifies factors associated with successful intervention completion. Data were analyzed from 45,375 male CDSME program participants nationwide. Logistic regression was performed to examine factors associated with workshop attendance. Males who were aged 65–79 (OR = 1.27, p < .001), Hispanic (OR = 1.22, p < .001), African American (OR = 1.13, p < .001), Asian/Pacific Islander (OR = 1.26, p < .001), Native Hawaiian (OR = 3.14, p < .001), and residing in nonmetro areas (OR = 1.26, p < .001) were more likely to complete the intervention. Participants with 3+ chronic conditions were less likely to complete the intervention (OR = 0.87, p < .001). Compared to health-care organization participants, participants who attended workshops at senior centers (OR = 1.38, p < .001), community/multipurpose facilities (OR = 1.21, p < .001), and faith-based organizations (OR = 1.37, p < .001) were more likely to complete the intervention. Men who participated in workshops with more men were more likely to complete the intervention (OR = 2.14, p < .001). Once enrolled, a large proportion of males obtained an adequate intervention dose. Findings highlight potential strategies to retain men in CDSME programs, which include diversifying workshop locations, incorporating Session Zero before CDSME workshops, and using alternative delivery modalities (e.g., online).

Background Individuals living in lower-income areas face an increased prevalence of chronic disease and, oftentimes, greater barriers to optimal self-management. Disparities in disease management are seen across the lifespan, but are particularly notable among middle-aged adults. Although evidence-based Chronic Disease Self-management Education courses are available to enhance self-management among members of this at-risk population, little information is available to determine the extent to which these courses are reaching those at greatest risk. The purpose of this study is to compare the extent to which middle-aged adults from lower- and higher-income areas have engaged in CDSME courses, and to identify the sociodemographic characteristics of lower-income, middle aged participants. Methods The results of this study were produced through analysis of secondary data collected during the Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative. During this initiative, data was collected from 100,000 CDSME participants across 45 states within the United States, the District of Columbia, and Puerto Rico. Results Of the entire sample included in this analysis (19,365 participants), 55 people lived in the most impoverished counties. While these 55 participants represented just 0.3% of the total study sample, researchers found this group completed courses more frequently than participants from less impoverished counties once enrolled. Conclusion These results signal a need to enhance participation of middle-aged adults from lower-income areas in CDSME courses. The results also provide evidence that can be used to inform future program delivery choices, including decisions regarding recruitment materials, program leaders, and program delivery sites, to better engage this population.

To examine the impact of individual and community socioeconomic status (SES) measures on mental health outcomes in individuals with arthritis, participants with self-reported arthritis completed a telephone survey assessing health status, health attitudes and beliefs, and sociodemographic variables. Regression analyses adjusting for race, gender, BMI, comorbidities, and age were performed to determine the impact of individual and community level SES on mental health outcomes (i.e., Medical Outcomes Study SF-12v2 mental health component, the Centers for Disease Control and Prevention Health-Related Quality of Life Healthy Days Measure, Center for Epidemiological Studies Depression [CES-D] scale). When entered singly, lower education and income, nonmanagerial occupation, non-homeownership, and medium and high community poverty were all significantly associated with poorer mental health outcomes. Income, however, was more strongly associated with the outcomes in comparison to the other SES variables. In a model including all SES measures simultaneously, income was significantly associated with each outcome variable. Lower levels of individual and community SES showed most consistent statistical significance in association with CES-D scores. Results suggest that both individual and community level SES are associated with mental health status in people with arthritis. It is imperative to consider how interventions focused on multilevel SES factors may influence existing disparities.

Arthritis is a common chronic illness that disproportionately affects women and African Americans and is often associated with depression. The mechanisms through which arthritis-related pain are associated with depression remain unclear. This study examined the relationship between arthritis-related pain and depressive symptoms to determine if functional impairment and sense of mastery mediated this relationship. Participants included 77 African-American and 98 white women with arthritis (aged 45–90) who completed structured questionnaires assessing pain, functional impairment, sense of mastery and depressive symptoms. Regression analyses showed that sense of mastery and functional impairment partially mediated the relationship between pain and depressive symptoms for whites such that the previously significant pain-depression relationship (β=0.40, p<0.001) was no longer significant (β=0.05, p=0.62). Only sense of mastery partially mediated between pain and depressive symptoms for African Americans. Again, the previously significant pain-depression relationship (β=0.32, p<0.01) was reduced (β=0.16, p=0.19). Implications of the study suggest that it is important for service providers and healthcare professionals to be aware of different lifetime experiences and perceptions of illness in order to better serve the needs of women from different race groups.

There are a number of factors that influence compliance with prescribed plans of care. However, there remains a need to identify the collective source health, behavioral, and social constructs have on treatment satisfaction. This study aimed to identify indicators of pain treatment satisfaction among older adults receiving outpatient treatment from a comprehensive cancer center in the southeast region of the United States. Data included a sample of 149 Black and White patients diagnosed with cancer, with the majority being White (85%) and female (57%). Patients were surveyed on questions assessing pain treatment satisfaction, pain severity, and additional social characteristics. A series of multivariate models were specified, whereby patients reporting multiple chronic conditions, poor communication, and perceived discrimination were less satisfied with treatment. Positive communication, higher self-efficacy, and fewer perceived discriminatory acts were significant among the female patients only. These findings suggest the need to develop clinical models that assess how these factors influence the degree of treatment satisfaction, while providing a comprehensive mechanism by which to service the long-term needs of older adults.

Abstract African Americans (AA) are 17% less likely to be diagnosed with arthritis compared to Whites, yet disproportionately burdened by arthritis symptoms. AA are overrepresented in the diagnosis and burden of other chronic conditions (diabetes, heart disease), highlighting the need to engage them in evidence-based Chronic Disease Self-Management Education (CDSME) Programs. This study examines how disease profiles may influence program attendance. Using a multinomial logistic regression, data were analyzed from AA with arthritis (N=20,541) who attended CDSME programs in 48 states. Relative to those with only arthritis, participants with more complex disease profiles were less likely to attend an arthritis-specific program (P<0.001) and more likely to attend a diabetes-specific program (P<0.001). Those with more complex disease profiles were more likely to attend programs at healthcare organizations and residential facilities, and less likely to attend in faith-based organizations (P<0.001). Understanding barriers and facilitators to program attendance have policy and public health implications.

Abstract Many older workers balance paid work with care work. Working caregivers face unique challenges that make them more likely to leave the work force. However work environments may be more or less accommodating to their needs, and in addition, they may need to work for financial reasons. Current research on working caregivers has not explored: a) the work environments of older working caregivers; b) whether particular work environments are likely to influence whether caregivers stop working; and c) whether these effects vary by type of care work (spousal versus parental). This study addresses these gaps. Using data drawn from the 2008-2014 waves of the Health and Retirement Study, we used latent class analysis to develop a typology of work environments of individuals 51-75 who are engaged in paid work. Four classes of work environments emerged: A) balanced, supportive work environments (34%); B) average environments with high job lock (30%); C) poor, unsupportive work environments (21%); and D) highly accommodating, stressful jobs (14%). Logistic regression results showed those in group D were less likely than all other groups to leave their jobs. In addition, relative to spousal caregivers, parental caregivers in class A were significantly more likely to leave the labor force. Results suggest that caregivers may be more likely to continue engaging in paid work in supportive work environments, and work environments may be more likely to retain older working caregivers by identifying ways to help them meet their work needs and maintain their caregiving roles.

Osteoarthritis (OA), the most common form of arthritis in older adults, often results in pain, disability and poor psychological well-being. Compared to White adults, Black adults consistently report more pain, more activity limitations, and have different perceptions about OA. Racial disparities also exist in treatments, and prevalence of arthritis. It is imperative to have effective interventions and treatment options for older Blacks. Yet, few arthritis interventions have included Black participants in their samples, and nearly all of those have failed to report separate analyses indicating the effectiveness for Black adults, thus leaving a gap in the literature. The purpose of this study is to begin to identify factors needed to design arthritis interventions that will reduce barriers and increase appeal to Blacks. The present dissertation consists of one study with two related parts. The first part consists of a needs assessment that examined intervention preferences, barriers to healthcare, knowledge about interventions and care, utilization, and health beliefs among Black and White adults with self-reported physician-diagnosed OA. The second part evaluated materials used in an existing arthritis intervention for acceptability. The study was based on the Arthritis Self Management Program (ASMP). Frequencies were examined to determine needs related to arthritis healthcare of Blacks and Whites recruited from the community. Independent samples t-tests and Pearson’s Chi-square analyses were examined to determine group differences between Blacks and Whites. Blacks were more likely to report cost, lack of trust, fear of being the only person of their race, lack of recommendation from their doctor, and lack of recommendation of a family or friends as barriers to participating in arthritis interventions. In addition, Blacks were more likely to prefer the intervention content, structure and delivery, and arthritis resources presented in the needs assessment in comparison to Whites. As for the evaluation of the intervention materials, Blacks and Whites were similar on most sections. Based on our findings we suggest that practical adaptations (e.g., cost) be made to existing arthritis interventions to increase cultural sensitivity. Such adaptations have the potential to minimize barriers and offer a program that would be appealing to Blacks with OA.

Abstract African Americans remain underrepresented in accessing and utilizing evidenced-based health promotion interventions (EBIs). Challenges with dissemination and implementation of EBIs further corroborate existing racial/ethnic health/healthcare disparities. Therefore, there is a need to identify effective ways to increase the widespread adoption of health promotion behaviors among African Americans across the life course. It is plausible that engaging in non-traditional partnerships (i.e., community groups or organizations valued in the community with the capacity and infrastructure) could result in greater adoption and improved utilization of EBIs among African Americans. Although frequently overlooked as a study variable in empirically sound public health research, Black Greek Letter Organizations (BGLO) could be an innovative and practical approach to advancing health in the African American community. It is necessary to gain preliminary evidence of feasibility (e.g., motivation, target population reach, acceptability, ). Therefore, the purpose of this study was to conduct a content analysis to identify the intentions and communication trends of BGLOs as it pertains to public health and the African American community and assess population reach and perceptions by evaluating responses to communication specific to health promotion.We assessed health promotion patterns of four BGLOs in a ten-county metropolitan area. Coded content included communication via the organization's webpage, Facebook, Twitter, YouTube, Instagram, and LinkedIn from a five-year time period. Findings confirm that BLGOs are invested in the health and well-being of the community, place emphasis on mitigating health inequities, and are uniquely positioned to serve as stakeholders for the translation of EBIs to end-users.