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This cross-sectional study aims to examine the associations between engagement in cognitive, social, and religious activity and cognitive function (i.e., global cognition, cognitive performance, episodic memory, working memory, and executive function) and to explore the moderation effect of acculturation on the associations. Data were drawn from the Population-Based Study of Chinese Elderly (PINE) Wave I. Multivariate regression analyses showed that participation in more cognitive and social activities were associated with better cognitive function indicated by all five measures. Also, more frequent attendance in religious services is related to better working memory only. Compared with those more acculturated peers, the less acculturated community-dwelling Chinese older adults benefited more from high levels of activity engagement, especially in global cognition, cognitive performance, and episodic memory. Findings illustrate the importance of increasing older adults’ exposure to cognitively stimulating and socially integrated activities or environments, which may help to preserve the cognitive function of older adults.

This study examined the relationships of psychological sense of community (PSOC) with self-rated health and depressive symptoms among older Chinese Americans. The sample was taken from the Population Study of Chinese Elderly in Chicago (PINE), a population-based survey of 3,159 community-dwelling seniors. PSOC was measured through the Sense of Community Index (SCI). Factor analysis indicated a four-dimensional structure within the SCI; however, the SCI lacked dimensional consistency and items that composed four underlying factors were different than the proposed ones. After controlling for sociodemographics, binary and multinomial logistic regression analyses showed that a higher level of PSOC was related to a lower likelihood of self-reporting poor or fair health and of developing more depressive symptoms. The identified factors of influence and emotional connection were also significantly related to self-rated health and depressive symptoms. Future research need aim at improving the conceptualization process of the PSOC and cultural relevance in minority populations.

Objective: Loneliness has been associated with cognitive functioning in the general older adult population. Previous studies further indicate that loneliness has a strong association with depressive symptoms and the two constructs can reinforce each other to diminish well-being. However, such relationships have not been examined in U.S. Chinese older adults. This study attempts to bridge this knowledge gap. Method: Data were drawn from a population-based study of 3,159 U.S. Chinese older adults in the Greater Chicago area. Stepwise multivariate regression analyses were conducted to examine the relationship between loneliness, depressive symptoms, and global cognitive functioning. Results: Loneliness was associated with poor global cognitive functioning in U.S. Chinese older adults, though the relationship became nonsignificant after adjustment for depressive symptoms. The interaction term between loneliness and cognitive functioning was statistically significant ( p < .01). The findings further highlight the importance of age, education, number of children, number of people in household, and length of residence in the U.S. in cognitive functioning among U.S. Chinese older adults. Discussion: The study findings indicate that loneliness and depressive symptoms act together to influence cognitive functioning in U.S. Chinese older adults. Research and clinical implications of the findings are discussed.

Research about Asian Americans and Asian health equity issues have significant gaps, in part, due to lack of funding and support for minority investigators and examinations of health in this population. This special issue is designed to further our understanding of Asian health equity, especially within the context of global Chinese populations to examine how sociocultural contexts impact aging and health. Through the findings reported in this special issue, we call for increased funding and support to minority research scholars to conduct research toward improving Asian health equity, with an emphasis on nuanced cultural contexts of this population.

Using data from the Population Study of Chinese Elderly in Chicago (PINE) conducted from 2011 to 2013, this study aims to examine the role of acculturation in engagement in cognitive, social, and religious activities among older Chinese Americans. Activity engagement and acculturation levels were relatively low in the study sample. Multivariate regression analyses showed that high levels of acculturation in general, and particularly media use (e.g., TV and radio) and ethnic social relations (i.e., preferred ethnicity of those with whom one interacts) were associated with more engagement in cognitive and social activities, respectively. High levels of acculturation in general and ethnic social relation in particular increased the likelihood of engaging in religious activities. Language use was not related to engagement in any activity, probably because only 2% of the PINE participants preferred to speak English. Findings indicate that acculturation can promote activity engagement probably through media use and social relations, whereby older adults may acquire information about opportunities for various activities. Active participation with life may improve older adults’ well-being and help address the widening health disparities among minority older populations in American society.

Older adults disproportionately experience musculoskeletal symptoms, which are associated with morbidity and mortality. Traditional Chinese medicine (TCM) is an important part of Chinese culture and for millennia have been used to maintain health. This article aims to examine the association between musculoskeletal symptoms and different subtypes of TCM usage. Data were collected through the Population Study of Chinese Elderly in Chicago (PINE) study, a community-engaged, epidemiological study of a U.S. Chinese population. Review of systems was used to measure musculoskeletal symptoms. TCM use was measured by using a 5-point scale. Logistic regression analyses were conducted to control for potential confounding factors. Of 3,157 Chinese, older adults aged 60 and older, the mean age was 72.8 ( SD = 8.3) and 58.9% were female. Older adults with any musculoskeletal symptoms had greater utilization of overall TCM use (odds ratio [OR] = 2.10, 95% confidence interval [CI] = [1.76, 2.52]), especially massage therapy (OR = 3.41, 95% CI = [2.51, 4.63]), herbal (OR = 2.68, 95% CI = [2.28, 3.14]), and acupuncture (OR = 2.49, 95% CI = [1.87, 3.32]). However, there was no statistically significant association between the presence of musculoskeletal symptoms and Tai-Chi (OR = 1.18, 95% CI = [0.93, 1.50]). This study demonstrated that musculoskeletal symptoms among Chinese older adults were strongly associated with the use of TCM. Future research is needed to examine the effectiveness of TCM in treating musculoskeletal symptoms.

The experience of loneliness is prevalent and detrimental. Personality may influence individual perceptions of loneliness, but the relationship has not been adequately examined among minority aging populations. In a representative sample of 3,157 Chinese older adults in Chicago, we examined the associations between two personality traits and loneliness. Independent variables were neuroticism and conscientiousness, and dependent variable was perceived loneliness. Logistic regressions were used to adjust for confounding factors. Both traits were significantly associated with loneliness. One unit increase in neuroticism was associated with a 1.15 times higher likelihood of feeling lonely (odds ratio [OR]: 1.15, 1.12-1.18), whereas a unit increase in conscientiousness was associated with 3% decrease in risk of loneliness (OR: 0.97, 0.96-0.99). Compared with a low level of neuroticism, individuals with middle and high levels were 1.51 and 3.59 times more likely to feel lonely (OR: 1.51, 1.17-1.95; OR: 3.59, 2.84-4.54). Participants with high conscientiousness had a 24% decreased risk of loneliness relative to those with a low level (OR: 0.76, 0.60-0.96). This study provides evidence supporting the close relationships between personality and loneliness among U.S. Chinese older adults. Rigorously designed longitudinal studies are needed to clarify different trajectories of loneliness over time and its associated factors.

Objective: To examine U.S. Chinese older women and the association between their cancer screening behaviors and self-reported cancers with Traditional Chinese Medicine (TCM) use across sociodemographic characteristics. Method: Through the Population Study of Chinese Elderly in Chicago (PINE), 1,830 Chinese older women self-reported history of cancer screening, presence of women’s cancers, and TCM use according to type. Analyses were performed using multivariate regression models. Results: Chinese older women who underwent breast cancer screening are more likely to use herbal TCM (rate ratio [RR] = 1.15, 95% confidence interval [CI] = [1.03, 1.29]), acupuncture (RR = 1.62, CI = [1.21, 2.15]), massage therapy (RR = 2.05, CI = [1.46, 2.88]), and tai chi (RR = 1.86, CI = [1.28, 2.69]). Those who had cervical cancer screening are more likely to use herbal TCM (RR = 1.32, CI = [1.17, 1.48]), acupuncture (RR = 1.66, CI = [1.27, 2.18]), massage therapy (RR = 1.61, CI = [1.17, 2.21]), tai chi (RR = 1.69, CI = [1.19, 2.40]), and other forms of TCM (RR = 1.36, CI = [1.04, 1.79]). Those with cervical cancer are less likely to use herbal TCM (RR = 0.42, CI = [0.19, 0.93]). Conclusion: Contrary to previous studies, our results suggest that U.S. Chinese older women who have engaged in cancer screening use TCM while those with self-reported cancer did not use TCM at a higher rate. This warrants further research on TCM utilization to identify reasons of use in this population and encourage patient-centered care.

Among older Chinese adults in the United States, depression is a common health problem. Using data from the first population-based survey of older Chinese Americans ( N = 2,929) and applying negative binomial and ordinary least squares regression models, this study examines the relationship between social engagement (including cognitive activity and social activity) and sense of loneliness and hopelessness. Findings reveal that social engagement is significantly and negatively related to both loneliness and hopelessness after controlling for sociodemographic characteristics and health status. In addition, it is found that different aspects of social engagement present differential associations with sense of loneliness and hopelessness: Social activity is significantly associated with lower rate ratios of loneliness, whereas cognitive activity is significantly related to reduced levels of hopelessness. Our findings address the importance of engaging in cognitively stimulating and socially integrating activities in promoting psychological well-being for U.S. Chinese older adults.

Objective: Andersen’s Behavioral Model of Health Services Utilization was used as a framework to examine the influence of acculturation and health literacy on cancer screening behaviors among older Chinese Americans living in the greater Chicago area. Method: Data were obtained from the Population Study of Chinese Elderly in Chicago ( N = 3,157; mean age = 72.8 years). Logistic regression analyses were conducted to examine the impact of acculturation and health literacy on lifetime cancer screening utilizations and adherence to cancer screening guideline established by American Cancer Society (ACS) after controlling for predisposing, enabling, and need factors of Andersen’s behavioral model. Results: Lifetime rates of ever had cancer screening were low among older Chinese Americans living in the greater Chicago area. The majority of study participants were not adherent to ACS early detection cancer screening guidelines. Results from multivariate analyses showed that higher health literacy (odds ratio range = 1.39-1.72) and acculturation (odds ratio range = 1.28-2.06) levels were associated with an increased likelihood of lifetime and current cancer screening among older Chinese Americans. Discussion: The findings of this study highlight the importance of working to improve health literacy and developing effective interventions to increase cancer screening among older Chinese Americans.

Objective: The primary purposes of the present study are (a) to investigate the stress–cognition relationship among U.S. Chinese older adults and (b) to examine the moderating role of health status on the stress–cognition relationship. Method: Data were drawn from the Population Study of Chinese Elderly in Chicago (PINE), which investigated 3,157 Chinese adults over 60 years old living in Chicago. Participants reported health status and completed the Chinese Perceived Stress Scale. Cognitive functions were measured by the East Boston Memory Test, the Digit Span Backward, the Symbol Digit Modalities Test, and Chinese Mini-Mental State Examination. Results: Controlling for age, sex, education, and income, perceived stress was negatively associated with cognitive functions, whereas health status was positively associated with cognitive functions. In addition, older adults’ health status interacted with stress such that the negative relationships between perceived stress and cognitive functions were more pronounced for those who had poor health than for those who had good health. Conclusion: Findings suggest that physical health is a critical factor moderating the relationship between perceived stress and cognitive functions among U.S. Chinese older adults. Longitudinal research is needed to examine the complex relationships among stress, health, and cognitive functions of U.S. Chinese older adults.

Objectives: This study aims to examine the association between social engagement and cancer screening utilization among a Chinese American older population. Method: Data were drawn from the Population Study of Chinese Elderly (PINE). In total, 3,157 Chinese older adults enrolled in this study. Cancer screening utilization was assessed by asking whether participants had utilized cancer screenings. Social engagement was measured with 16 questions. Results: After controlling for potential confounders, a higher level of social engagement was associated with increased utilization in blood stool test (OR 1.03, [1.02, 1.05]), colonoscopy (OR 1.02, [1.01, 1.03]), mammography (OR 1.06, [1.05, 1.08]), Pap test (OR 1.04, [1.03, 1.06]), and prostate specific antigen (PSA) test (OR 1.03, [1.01, 1.05]). Compared with those with low levels of social engagement, older adults with high levels of social engagement were more likely to have utilized a blood stool test (OR 1.85, [1.46, 2.35]), a colonoscopy (OR 1.37, [1.09, 1.72]), a mammography (OR 3.05, [2.25, 4.14]), and a Pap test (OR 1.99, [1.49, 2.66]), but not more likely to have utilized a PSA test (OR 1.40, [0.97, 2.03]). Conclusion: This study underscores the association between active social engagement and increased utilization of cancer screening among a Chinese American older population. Improving social engagement could be helpful in promoting cancer screening utilization.

Background: The aim of this study was to understand the associations between acculturation and oral health among older Chinese immigrants in the United States. Method: We used data from the PINE study, which included the foreign-born older Chinese immigrants ( N = 3,128). We measured acculturation by measuring participants’ length of stay and behavioral acculturation. Participants’ tooth and gum symptoms were the outcome variables. Results: Longer stay in the United States was significantly associated with fewer gum symptoms but not with tooth symptoms. Behavioral acculturation was not significantly associated with either tooth or gum symptoms. The middle tertile of behavioral acculturation, compared with its upper and lower tertiles, deemed to be a more significant risk factor of tooth/gum symptoms. In addition, older immigrants with more social interactions with the Americans were more likely to have tooth symptoms. Discussion: In the future, we will conduct a study using longitudinal data to help us better understand the relationship between acculturation and oral health in Chinese American population.

Objective: This study aims to examine the association between neighborhood disorder with self-neglect among a community-dwelling Chinese American older population. Method: Data were extracted from the Population Study of Chinese Elderly (PINE), a cross-sectional study of 3,157 participants living in the greater Chicago area. Self-neglect was assessed with systematic observations of participants’ personal and home environment. Neighborhood disorder was measured through eight questions. Logistic regression was used to examine the association between neighborhood disorder and self-neglect. Results: After adjusting for potential confounding factors, every one point higher in neighborhood disorder score was significantly associated with greater risk for overall self-neglect (odds ratio [OR] = 1.13, [1.11, 1.16]), mild self-neglect (OR = 1.14, [1.11, 1.17]), and moderate/severe self-neglect (OR = 1.12, [1.09, 1.16]). Regarding the phenotypes of self-neglect, every one point higher in neighborhood disorder score was significantly associated with greater risk for hoarding (OR = 1.17, [1.14, 1.20]), personal hygiene (OR = 1.15, [1.12, 1.19]), house in need of repair (OR = 1.12, [1.10, 1.15]), unsanitary conditions (OR = 1.12, [1.09, 1.15]), and inadequate utilities (OR = 1.10, [1.05, 1.15]). Discussion: This study underscores the significant association between disordered neighborhood and greater risk of self-neglect among Chinese American older adults. Improving neighborhood disorder problems could benefit for elder self-neglect prevention.

Purpose: This study examined the association between social support and depressive symptoms among U.S. Chinese older adults. Methods: Data were from the Population Study of Chinese Elderly in Chicago (PINE) study. Independent variables were positive and negative perceived social support (PSS). Dependent variable was depressive symptoms. Multinomial logistic regression analyses were performed. Results: A total of participants were 3,157 Chinese older adults with the mean age of 72.8 years (range 60-105 years). After controlling for confounding factors, Chinese older adults with higher positive PSS were 12% (odds ratio [OR] = 0.88, 95% confidence interval [CI] = [0.85, 0.92]) and 18% (OR = 0.82, 95% CI = [0.79, 0.86]) less likely to report mild and moderate-severe depressive symptoms, respectively, compared to reporting minimal depressive symptoms; On the contrary, Chinese older adults with higher negative PSS were 34% (OR = 1.34, 95% CI = [1.24, 1.46]) and 38% (OR = 1.38, 95% CI = [1.26, 1.52]) more likely to report mild and moderate-severe depressive symptoms, respectively. Discussion: The study findings corroborate previous research that social support is significantly associated with depressive symptoms. Our findings reinforce the importance of developing strategies to utilize positive social support and limit negative support in practice for the depressed older adults. Further studies should be conducted to better understand the associations between different dimensions of social support and depression among U.S. Chinese older adults.

Background: Depressive symptoms are detrimental to the overall health and well-being of older adults. This study aimed to examine the association between filial piety and depressive symptoms among U.S. Chinese older adults. Method : Data were derived from the Population Study of Chinese Elderly in Chicago (PINE), a community-engaged, population-based epidemiological study of U.S. Chinese older adults aged 60 years and above in the Greater Chicago area. The Patient Health Questionnaire-9 (PHQ-9) was adopted to measure depressive symptoms. Six domains of filial piety were evaluated, involving respect, happiness, care, greeting, obedience, and financial support. Regression analyses were performed. Results: After adjusting for age, sex, education, annual personal income, marital status, living arrangement, number of children, years in the United States, years in the community and medical comorbidities, every one point lower in filial piety expectation score was associated with increased risk of depressive symptoms (RR [rate ratio] = .96, .95-.98). And every one point lower in filial piety receipt score was associated with increased risk of depressive symptoms (RR = .94, .93-.95). Discussion : This study provides insights to research on filial piety and depressive symptoms by examining expectation and perceived receipt of filial piety. Future studies are needed to investigate the association between filial discrepancy and depressive symptoms.