Ethnic variation in the impact of emotion and emotion regulation on health: a replication and extension

Although emotions and patterns of emotion regulation are central to models linking personality and health, the generalizability of these models to diverse populations of older adults remains untested. In this study, 1,364 community-dwelling women (aged 50-70 years) from six ethnic groups completed self-report measures of trait anger, inhibition, defensiveness, and health. As expected, reports of trait anger and emotion inhibition predicted poorer health (and defensiveness better health), even when demographics and health behaviors were controlled. However, these characteristics related to outcome differently across ethnic groups; greater anger was related to better health in all groups other than U.S-born European Americans, and increased emotion inhibition was associated with better health among immigrant Eastern European women. Results are discussed within a contextualistic model of emotions and health, and directions for future research are given.     

The uncharted waters of emotion: Ethnicity, trait emotion and emotion expression in older adults

Emotions are central to contemporary theories of health, and a growingbody of psychological research has shown emotion and emotion regulatorystyles to be predictive of health outcomes. Yet despite these clear links andthe fact that patterns of emotion and expression are partially a product ofculture, there is a meager literature on the emotional characteristics ofdifferent ethnic groups. Even where ethnicity has been investigated inemotions research, it has typically been operationalized in such a way thatwithin-group differences are obscured with most individuals assigned tobroad ethnic categories, such as non-Hispanic White, or Black. In thepresent study we draw on data from a multi-ethnic sample of 755community-dwelling older adults to parse a picture of the emotionalcharacteristics of three of the largest and most culturally distinct ethnicgroups in the Northeastern United States: African Americans, West Indians (Jamaicans), andEastern Slavs (Russians and Ukrainians) from the former Soviet Republic,as well as a comparison group of US-born European Americans. Aspredicted, there were striking differences in nine of 10 trait emotions aswell as in levels of emotion expressed during conflict. The findings arediscussed in terms of emotion socialization and implications for predictionand intervention in psychosocial models of emotions, emotion regulation,and health in older ethnic populations.     

Identifying older Chinese immigrants at high risk for osteoporosis

BACKGROUND: Data about whether Asian Americans are a high-risk or a low-risk group for osteoporosis are limited and inconsistent. Few previous studies have recognized that the heterogeneity of the Asian American population, with respect to both nativity (foreign- vs U.S.-born) and ethnicity, may be related to osteoporosis risk. OBJECTIVE: To assess whether older foreign-born Chinese Americans living in an urban ethnic enclave are at high risk of osteoporosis and to refer participants at high risk for follow-up care. DESIGN: Cross-sectional survey and osteoporosis screening, undertaken as a collaborative project by the Chinese American Service League and researchers at the University of Chicago. SETTING: Chicago's Chinatown. PARTICIPANTS: Four hundred sixty-nine immigrant Chinese American men and women aged 50 and older. MEASUREMENTS AND MAIN RESULTS: Chinese Americans in this urban setting are generally recent immigrants from south China with limited education and resources: mean age at immigration was 54, 56% had primary only or no education, and 57% reported "fair" or "poor" self-rated health. Eighteen percent are uninsured and 55% receive Medicaid. Bone mineral density (BMD) of the calcaneus was estimated using quantitative ultrasound. Immigrant Chinese women in the study had lower average BMD than reference data for white women or U.S.-born Asian Americans. BMD for immigrant Chinese men in the study was similar to white men at ages 50 to 69, and lower at older ages. Low body mass index, low educational attainment and older age at immigration were all associated with lower BMD. CONCLUSIONS: Foreign-born Chinese Americans may be a high-risk group for osteoporosis.     

Attachment styles in older European American and African American adults

OBJECTIVES: Differential attachment styles have been linked to differential emotion regulation and ability to cope with stress in samples of young adults. There are few data on attachment styles in older adults despite the fact that attachment relationships are said to play a significant role in psychological well-being throughout the life span. The goal of the study was to examine attachment patterns in older adults. METHODS: Participants were 800 community-dwelling older European Americans and African Americans (M = 74 years) living in a large urban community. Attachment measures included the family and friend intimacy subscales from the Network Analysis Profile and the Relationship Scales Questionnaire. RESULTS: In contrast to findings with younger individuals, where the majority of respondents have been found to be secure (i.e., comfortable with closeness and dependency), the majority of the present sample were found to be dismissing/avoidant (i.e., uncomfortable with closeness, compulsively self-reliant). European Americans scored higher than African Americans on attachment security, whereas African Americans scored higher than European Americans on dismissing attachment. However, the assessment of relatedness based on the Network Analysis Profile, where respondents named their closest kin, indicated that African Americans had higher scores than European Americans, though their networks were smaller. DISCUSSION: Age and ethnicity differences appear to reflect cohort effects related to the impact of economic hardship on families earlier this century and racial prejudice. The high rates of dismissing attachment and low rates of secure attachment in this large urban population suggest that these individuals may be at risk for social isolation and poor health as they become older and more frail.     

Country of birth as a risk factor for asthma among Mexican Americans

In the United States, among Hispanics, Mexican Americans have the lowest rate of asthma. However, this population includes Mexican Americans born in the United States and in Mexico, and risk factors that might impact the prevalence of asthma differ between these groups. To determine the prevalence of and risk factors for asthma among U.S.- and Mexican-born Mexican Americans, we analyzed data from two U.S. surveys that included 4,574 persons who self-reported their ethnicity as Mexican American from the Third National Health and Nutrition Examination Survey (NHANES III) 1998-1994 and 12,980 persons who self-reported their ethnicity as Mexican American from National Health Interview Survey (NHIS) 1997-2001. U.S.-born Mexican Americans were more likely than Mexican-born Mexican Americans to report ever having asthma in both the NHANES III (7% [SE 0.5] vs. 3% [SE 0.3], p < 0.001) and NHIS surveys (8.1% [0.4] vs. 2.5% [0.2], p < 0.001). In a multivariate regression model controlling for multiple demographic variables and health care, the risk for asthma was higher among U.S.-born Mexicans in NHANES III (odds ratio 2.1, 95% confidence interval 1.4-3.3) and NHIS (odds ratio 2.7, 95% confidence interval 1.6-5.5). In conclusion, the prevalence of asthma was higher in U.S.-born than in Mexican-born Mexican Americans. This finding highlights the importance of environmental exposures in developing asthma in a migratory population.     

Protective neighborhoods: neighborhood proportion of Mexican Americans and depressive symptoms in very old Mexican Americans

Research indicates that neighborhood context can have a significant effect on the health of older adults. The evidence suggests that there may be physical health benefits afforded to Mexican Americans living in ethnically homogenous neighborhoods, despite the relatively high economic risk in such neighborhoods, but few studies have considered the effect of neighborhood ethnic density on mental health outcomes in older adults. This study evaluated the association between neighborhoods with a high proportion of Mexican Americans and depressive symptoms in very old Mexican Americans. Hierarchical linear modeling was used to examine data from Wave 5 (2004/05) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly. Subjects included 1,875 community-dwelling Mexican Americans aged 75 and older living in 386 neighborhoods in five states in the southwestern United States (Arizona, California, Colorado, New Mexico, Texas). Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (α=0.88). Results showed that, in very old men, there was a significant negative association between percentage of Mexican Americans in the neighborhood and depressive symptoms (P=.01). In women, the direction of the association was the same, but the effect was not significant. These findings suggest that the proportion of Mexican Americans in the neighborhood matter more for very old Mexican American men than women. Further research may inform screening and treatment for depressive symptoms based on differences in neighborhood composition. Recommendations include culturally customized programs that offer older Mexican Americans greater mobility and access to programs and opportunities in culturally identifiable neighborhoods.     

Acculturation and the prevalence of depression in older Mexican Americans: baseline results of the Sacramento Area Latino Study on Aging

OBJECTIVE: To determine the association between acculturation, immigration, and prevalence of depression in older Mexican Americans. DESIGN: Cross-sectional analysis from a cohort study. SETTING: Urban and rural counties of the Central Valley of Northern California. PARTICIPANTS: One thousand seven hundred and eighty-nine Latinos recruited from a population-based sample (85% Mexican Americans) with a mean age of 70.6 (range 60-100; standard deviation (SD) = 7.13); 58.2% were women. MEASUREMENTS: Depressive symptoms were assessed with the Center for Epidemiologic Studies--Depression scale (CES-D). Acculturation was measured with the Acculturation Rating Scale for Mexican Americans--II. Psychosocial, behavioral, and medical histories were also obtained. RESULTS: The prevalence of depression (CES-D > or = 16) was 25.4%. Women were at greater risk (32.0%) than men (16.3%; male/female odds ratio (OR) = 2.43, 95% confidence interval (CI) = 1.90-3.09). The prevalence of depression was higher among immigrants (30.4%, OR = 1.70, 95% CI = 1.36-2.13), bicultural participants (24.2%, OR = 1.66, 95% CI = 1.24-2.24), and less-acculturated participants (36.1%, OR = 2.95, 95% CI = 2.22-3.93) compared with U.S.-born (20.5%) and more-acculturated groups (16.1%). When adjustments for education, income, psychosocial, behavioral, and health-problem factors were made, the least-acculturated participants were at significantly higher risk of depression than highly acculturated Mexican Americans (OR = 1.56, 95% CI = 1.06-2.31). CONCLUSIONS: These findings are consistent with previously reported estimates of a higher prevalence of depression for older Mexican Americans than non-Hispanic Caucasians and African Americans and are the first to report the prevalence and risk of depression for older U.S.-born and immigrant Mexican Americans. The high prevalence of depression of the least acculturated group may be related to cultural barriers encountered by immigrants and less-acculturated older Mexican Americans and to poorer health status.     

Ethnic differences in the prevalence of cryptogenic cirrhosis

OBJECTIVES: Nonalcoholic steatohepatitis (NASH) associated with obesity and type 2 diabetes mellitus (DM) is postulated to be the cause of most cases of cryptogenic cirrhosis (CC). While ethnic differences in the prevalence of obesity and DM in the United States are well documented, there is little information regarding prevalence of CC or NASH among different U.S. ethnic groups. This study was performed to assess the demographic characteristics of patients with CC at a U.S. county hospital with a racially and ethnically diverse patient population. METHODS: Medical records and pathology databases were reviewed to identify patients at Parkland Memorial Hospital, Dallas County, Texas from 1990 to 2001 with CC or cirrhosis attributed to NASH. RESULTS: Forty-one patients (12 men, 29 women) were found to meet these criteria. Of these, 68% were obese (BMI > or = 30) and/or had type 2 DM and 74% of liver biopsies revealed one or more features of NASH. Of patients with CC 68% were Hispanic while only 7% were African American, despite the fact that Hispanics comprised < 26% and African Americans > 40% of adult medicine patients. Prevalence of CC among Hispanic and African American patients was 3.1-fold higher and 3.9-fold lower, respectively, than among European American patients despite similar prevalence of DM among Hispanics and African Americans. CONCLUSION: These findings support the hypothesis that NASH associated with obesity and DM is responsible for the majority of cases of CC among Hispanics and European Americans. However, the current findings also indicate that this form of cirrhosis is unexpectedly rare among African Americans.     

To the Future of Ethnogeriatric Research and Publication

The reinstatement of the Journal of the American Geriatrics Society Section on Ethnogeriatrics coincides with more rapid growth in older populations that are classified as ethnic and racial minorities in the United States than those classified as non‐Hispanic white. By 2060, 40% of older Americans are predicted to belong to a minority. Important needs for ethnogeriatric research and publication include: making sure research populations are meaningful and precise rather than using categories that include many unrelated groups; and increasing research among smaller ethnic populations of older adults. Topics in need of attention include epidemiology of common geriatric illness among the smaller populations, and social determinants for those in which disparities have been established; the extent and effectiveness of use of Culturally and Linguistically Appropriate Services Standards in geriatric care; examination of communication strategies used in provider/patient interaction, especially use of interpreters; ethnic differences in treatment of older patients; and models of use of community health workers from older patients' own cultural communities. Stresses related to caregiving in cultures emphasizing the importance of family care are important to understand acceptable models of long‐term care for diverse families. The new Ethnogeriatric Section opens the opportunity for geriatric researchers, especially those from diverse backgrounds, to explore important issues in cross‐cultural geriatric care; their findings can then form the basis of expanded ethnogeriatric curriculum for training future providers for the growing population of diverse older Americans.     

Predicting Ethnic Variation in Adaptation to Later Life: Styles of Socioemotional Functioning and Constrained Heterotypy

It is an axiom of social gerontology that populations of older individuals become increasingly differentiated as they age. Adaptations to physical and social losses and the increased dependency that typically accompany greater age are likely to be similarly heterogeneous, with different individuals adjusting to the aging process in widely diverse ways. In this paper we consider how individuals with diverse emotional and regulatory profiles, different levels of religiosity, and varied patterns of social relatedness fare as they age. Specifically, we examine the relation between ethnicity and patterns of socioemotional adaptation in a large, ethnically diverse sample (N = 1118) of community-dwelling older adults. Cluster analysis was applied to 11 measures of socioemotional functioning. Ten qualitatively different profiles were extracted and then related to a measure of physical resiliency. Consistent with ethnographic and psychological theory, individuals from different ethnic backgrounds were unevenly distributed across the clusters. Resilient participants of African descent (African Americans, Jamaicans, Trinidadians, Barbadians) were more likely to manifest patterns of adaptation characterized by religious beliefs, while resilient US-born Whites and Immigrant Whites were more likely to be resilient as a result of non-religious social connectedness. Taken together, although these data underscore the diversity of adaptation to later life, we suggest that patterns of successful adaptation vary systematically across ethnic groups. Implications for the continued study of ethnicity in aging and directions for future research are given.     

Advancing the science of recruitment and retention of ethnically diverse populations

We highlight several critical challenges that must be addressed to accelerate the advancement of the science on recruitment and retention of ethnically diverse older adults into health research. These include the relative lack of attention by researchers to methodological issues related to recruitment and retention of ethnically diverse populations and the inadequacy of funding to advance systematically this field. We describe strategies used by the Resource Centers on Minority Aging Research and other National Institute of Aging-funded programs to advance the science of recruitment of ethnically diverse older adults. Finally, we propose a set of broad recommendations designed to generate a body of evidence on successful methods of recruitment and retention of ethnically diverse populations in health research. To eliminate health disparities and better understand aging processes in ethnically diverse populations, much more research is needed on effective strategies for increasing minority enrollment in health research. Comparative effectiveness research on more intensive recruitment and retention methods, which are often needed for including diverse populations, will require dedicated funding and concerted efforts by investigators.     

New Estimates of Racial/Ethnic Differences in Life Expectancy with Chronic Morbidity and Functional Loss: Evidence from the National Health Interview Survey

This study documents the mortality, chronic morbidity and physical functioning experiences of U.S. Hispanics, non-Hispanic whites, and non-Hispanic blacks 50 years of age and older in the United States. Hispanics are classified by nativity to better assess an important source of heterogeneity in population health within that population. Drawing on mortality and morbidity data from the National Health Interview Survey, demographic models of healthy life expectancy are used to derive estimates of life expectancy, life expectancy with and without chronic morbidity conditions, and life expectancy with and without functional limitations. The results not only highlight the mortality advantages of foreign-born Hispanics, but also document their health advantages in terms of morbidity and physical functioning beyond age 50. Nativity is a highly important factor differentiating the health and mortality experiences of Hispanics: U.S.-born Hispanics have a health profile more indicative of their minority status while foreign-born Hispanics have much more favorable mortality and health profiles. Differences in smoking across racial/ethnic/nativity groups is suggested as an important reason behind the apparent health advantages of foreign-born Hispanics relative to whites as well as relative to their U.S.-born counterparts.     

Ethnogeriatric education: Need and content

The population of elders from ethnic minority populations in the U.S. is growing much more rapidly than the exploding older population as a whole, yet few geriatric providers are being educated concerning ethnic elders' diverse health care needs. Examples are given of the diversity of ethnic elders' health risks, health beliefs and expectations of treatment, and utilization patterns of health care services being incorporated into ethnogeriatric curriculum being developed by the Stanford Geriatric Education Center.Supported by a grant from the Bureau of Health Professions for Geriatric Education Centers.     

Heart failure in the elderly: a U.S. perspective

Heart failure (HF) affects 5 million Americans, of whom three-fourths are over age 65 and half are over age 75.1 HF is currently the leading cause of hospitalization among older adults in the U.S., and it is the most costly medical illness by a factor of almost two.……     

Late Life Attachment in Context: Patterns of Relating Among Men and Women from Seven Ethnic Groups

The purpose of the present study was to develop the later life attachment literature by providing data contrasting patterns of attachment among 616 older men and women (aged 50 to 70) from seven ethnic groups in the United States: African Americans, English-speaking Caribbeans, Haitians, Dominicans, Puerto Ricans, Eastern Europeans, and European Americans. A multivariate analysis of the variance with ethnicity, gender, and income as factors predicting four dimensional styles of attachment (secure, dismissive, preoccupied, and fearful avoidant) revealed numerous ethnic differences in attachment styles. Most notably, Haitians reported greater dismissiveness than all other groups, with Eastern Europeans reporting more than Dominicans, Puerto Ricans, European Americans and African Americans. Haitians also reported lower fearful avoidance than all other groups. Dominicans and Puerto Ricans reported greater preoccupation than Haitians, African Americans, and English-speaking Caribbeans. The most notable interactions with gender and income revealed that although preoccupation was lower among African American, English-speaking Caribbean, Haitian, and European American women versus men, it was greater among Dominican, Puerto Rican, and Eastern European women, and that whereas security was generally high among European Americans notwithstanding income, income strongly impacted attachment security in other groups. These differences are interpreted in light of ethnic differences in historical, familial, and religious contexts. This study provides a glimpse into the ethnic and cultural diversity in the ways in which older adults relate to significant others.     

Waist circumference, BMI and the prevalence of self-reported diabetes among the elderly of the United States and six cities of Latin America and the Caribbean

Using data from the Salud Bienestar y Envejecimiento (SABE) project and the U.S. National Health and Nutrition Examination Survey (NHANES 1999-2004), we examined the prevalence of obesity and diagnosed diabetes among older adults in the Americas; we also examined the association of age, sex, level of education, weight status, waist circumference, smoking, and race/ethnicity with diabetes among older adults. The prevalence of diagnosed diabetes was highest in the US Blacks and Mexican Americans, followed by Bridgetown and Mexico City (22% for each) and lowest in Santiago, Montevideo, Havana, and US Whites (13-15%). Diagnosed diabetes was significantly associated with BMI among participants from Bridgetown, Sao Paulo, and the three US ethnic groups, while it was associated with waist circumference in all sites except Mexico City. Our findings suggest major geographical and ethnic variation in the prevalence of diagnosed diabetes among older adults. Waist circumference was more consistently associated with the prevalence of diagnosed diabetes than BMI. Higher prevalences of diabetes are found among the elderly of African or Mexican descent in the United States and in other countries of the Americas when compared to the prevalence among whites in the United States and in other Latin American countries with populations of predominant Western European descent.     

Cultural Equivalence in Depressive Symptoms in Older White, Black, and Mexican-American Adults

OBJECTIVES: To examine cultural equivalence in responses to depressive symptom items of three racial or ethnic elderly groups.
DESIGN: Cross-sectional analyses of two national data sets.
SETTING: The New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) and the five-state Hispanic EPESE (H-EPESE).
PARTICIPANTS: Whites (n=1,876) and blacks (n=464) were drawn from the New Haven EPESE and Mexican Americans (n=2,623) were drawn from the H-EPESE.
MEASUREMENT: The original 20-item version of the Center for Epidemiologic Studies Depression Scale (CES-D).
RESULTS: From differential item functioning analyses, a lack of measurement equivalence was found for 16 depressive symptom items. Mexican Americans were predisposed to endorse 12 depressive symptoms. Blacks were more likely than whites to endorse two interpersonal items (unfriendly and disliked). Mexican Americans were more likely than whites to respond to four positive affect items (good, hopeful, happy, and enjoyed) and more likely than blacks to endorse three positive items (good, happy, and enjoyed).
CONCLUSION: Results suggested response bias to depressive symptom items in racially and ethnically diverse older adults. Mexican Americans were more likely than whites to endorse the large number of depressive symptom items. Blacks were much more likely to respond in patterns similar to those of the whites. Findings from this study provide a foundation for developing culturally appropriate depression measures in health disparities research.     

Racial and ethnic disparities in cancer screening the importance of foreign birth as a barrier to care

CONTEXT: Racial/ethnic groups comprised largely of foreign-born individuals have lower rates of cancer screening than white Americans. Little is known about whether these disparities are related primarily to their race/ethnicity or birthplace. OBJECTIVE: To determine whether foreign birthplace explains some racial/ethnic disparities in cancer screening. DESIGN, SETTING, AND SUBJECTS: Cross-sectional study using 1998 data from the National Health Interview Survey. MAIN OUTCOME MEASURES: Completion of cervical, breast, or colorectal cancer screening. RESULTS: Of respondents, 15% were foreign born. In analyses adjusted for sociodemographic characteristics and illness burden, black respondents were as or more likely to report cancer screening than white respondents; however, Hispanic and Asian-American and Pacific Islander (AAPI) respondents were significantly less likely to report screening for most cancers. When race/ethnicity and birthplace were considered together, U.S.-born Hispanic and AAPI respondents were as likely to report cancer screening as U.S.-born whites; however, foreign-born white (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.41 to 0.82), Hispanic (AOR, 0.65; 95% CI, 0.53 to 0.79), and AAPI respondents (AOR, 0.28; 95% CI, 0.19 to 0.39) were less likely than U.S.-born whites to report Pap smears. Foreign-born Hispanic and AAPI respondents were also less likely to report fecal occult blood testing (FOBT); AORs, 0.72; 95% CI, 0.53 to 0.98; and 0.61; 95% CI, 0.39 to 0.96, respectively); and sigmoidoscopy (AORs, 0.70; 95% CI, 0.51 to 0.97; and 0.63; 95% CI, 0.40 to 0.99, respectively). Furthermore, foreign-born AAPI respondents were less likely to report mammography (AOR, 0.49; 95% CI, 0.28 to 0.86). Adjusting for access to care partially attenuated disparities among foreign-born respondents. CONCLUSION: Foreign birthplace may explain some disparities previously attributed to race or ethnicity, and is an important barrier to cancer screening, even after adjustment for other factors. Increasing access to health care may improve disparities among foreign-born persons to some degree, but further study is needed to understand other barriers to screening among the foreign-born.     

Emotion complexity and emotion regulation across adulthood

This research used data from a study on daily emotional experience in adulthood to examine the associations between age, emotion complexity, and emotion regulation. Data were drawn from a study of daily stress that included 239 participants ranging in age from 18 to 89 from North Central Florida. Two indicators of emotion complexity were considered: emotion differentiation and the co-occurrence of positive and negative affect. Emotion regulation was assessed in terms of individuals’ likelihood of maintaining adaptive emotion states. There were no age differences in adults’ co-occurrence of positive and negative emotions. In contrast to theories suggesting age would be associated with greater emotion complexity, the findings revealed that older adults had lower differentiation scores than younger adults. Age was also associated with more adaptive patterns of emotion regulation. Specifically, older adults persisted in low negative states and moved out of high negative states more readily than younger adults. Finally, neuroticism, self-concept incoherence, mean daily stress, and emotion complexity were associated with emotion regulation. Notably, adults who reported a greater mix of positive and negative affect moved out of high negative affect states more rapidly than adults with lower co-occurrence scores. This finding is in keeping with a growing body of work suggesting that positive affect promotes recovery from negative affect. Overall, the findings suggest that although emotion complexity is associated with emotion regulation, it does not appear to be a key factor underlying age differences in emotion regulation.