Search

Aim To investigate mid-life employment trajectories in relation to later-life memory function and rate of decline in rural South Africa. Methods Data from the Agincourt Health and Socio-Demographic Surveillance System were linked to the 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa' (HAALSI) in rural Agincourt, South Africa (N  =   3133). Employment was assessed every 4 years over 2000–12 as being employed (0, 1, 2 and ≥3 time points), being employed in a higher-skill occupation (0, 1, 2 and ≥3 time points) and dynamic employment trajectories identified using sequence analysis. Latent memory z-scores were assessed over 2014–22. Mixed-effects linear regression models were fitted to examine the associations of interest. Results Sustained mid-life employment from 2000–12 (β = 0.052, 95% CI: -0.028 to 0.132, 1 vs 0 time points; β = 0.163, 95% CI: 0.077 to 0.250, 2 vs 0 time points; β = 0.212, 95% CI: 0.128 to 0.296, ≥3 vs 0 time points) and greater time spent in a higher-skill occupation (β = 0.077, 95% CI: -0.020 to 0.175, 1 vs 0 time points; β = 0.241, 95% CI: 0.070 to 0.412, 2 vs 0 time points; β = 0.361, 95% CI: 0.201 to 0.520, ≥3 vs 0 time points) were associated with higher memory scores in 2014/15, but not subsequent rate of memory decline. Moving from a lower-skill to higher-skill occupation was associated with higher memory function, but a faster rate of decline over 2014–22. Conclusions Sustained mid-life employment, particularly in higher-skill occupations, may contribute to later-life memory function in this post-Apartheid South African setting. [ABSTRACT FROM AUTHOR]

In this commentary, invited for the 100th anniversary of the Journal , we discuss the addition of randomized experiments, along with natural experiments that emulate randomized trials using observational data, as designs in the social epidemiologist's toolbox. These approaches transform the way we define and ask questions about social exposures. They compel us to ask questions about how well-defined interventions change a social exposure that might lead to changes in health. As such, experiments are of unique public health and policy significance. We argue that they are a powerful approach to advance our understanding of how well-defined changes in social exposures impact health, and how credible social policy reforms may be instrumental to address health inequalities. We focus on two research designs. The first is a "pure" randomized controlled trial (RCT) in which the investigator defines and randomly assigns the intervention. The second is a natural experiment, which exploits the fact that policies or interventions in the real world often involve an element of random assignment, emulating an RCT. To give the reader our bottom line: While acknowledging their limits, we continue to be very excited about the promise of RCTs and natural experiments to advance social epidemiology. [ABSTRACT FROM AUTHOR]

Objectives To quantify how poor health and inhospitable working conditions each contribute to educational disparities in work disability in midlife and old age. Methods We used the Health and Retirement Study (2006–2016) to examine educational disparities in reporting "any impairment or health problem that limits the kind or amount of paid work" in ages 51–80. Results We found disparities to be profound and persistent over time. Blinder–Oaxaca threefold decomposition revealed that distributions of income and employer insurance made the largest contribution to explaining different rates of work limitations among respondents with versus without high school degrees, followed by work characteristics (physical job demands, insufficient hours) and health conditions (diabetes, lung disease). Comparing respondents with high school versus college degrees, distributions of health conditions mattered most (high blood pressure, lung disease, heart disease, stroke), followed by health behaviors (smoking, drinking). Health-induced work limitations are often used as a measure of health, but we found that work characteristics explained 57% of the disadvantage of those without a high school degree and 44% of the disadvantage of high school compared to college graduates. Discussion Work environments appear to play an important role in educational disparities in mid- to late-life disability. [ABSTRACT FROM AUTHOR]

Telomere length (TL) may be a biomarker of aging processes as well as age-related diseases. However, most studies of TL and aging are conducted in high-income countries. Less is known in low- and middle-income countries (LMICs) such as South Africa, where life expectancy remains lower despite population aging. We conducted a descriptive analysis of TL in a cohort of older adults in rural South Africa. TL was assayed from venous blood draws using quantitative polymerase chain reaction (T/S ratio). We examined the correlation between TL and biomarkers, demographic characteristics, mental/cognitive health measures, and physical performance measures in a subsample of the Wave 1 2014–2015 "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" (HAALSI) cohort (n = 510). We used logistic regression to measure the association between TL and mortality through Wave 3 (2021–2022). In bivariate analyses, TL was significantly correlated with age (r = −0.29, p <.0001), self-reported female sex (r = 0.13, p =.002), mortality (r = −0.1297, p =.003), diastolic blood pressure (r = 0.09, p =.037), pulse pressure (r = −0.09, p =.045), and being a grandparent (r = −0.17, p =.0001). TL was significantly associated with age (β = −0.003; 95% confidence interval [CI] = −0.005, −0.003). TL was significantly associated in unadjusted multivariate analyses with mortality, but the relationship between TL and mortality was attenuated after adjusting for age (odds ratio [OR] = 0.19; 95% CI = 0.03, 1.27) and other covariates (OR = 0.17; 95% CI = 0.02, 1.19). Our study is the first analysis of TL in an older adult South African population. Our results corroborate existing relationships between TL and age, sex, cardiometabolic disease, and mortality found in higher-income countries. [ABSTRACT FROM AUTHOR]

Objectives To characterize the extent to which brief cognitive assessments administered in the population-representative U.S. Health and Retirement Study (HRS) and its International Partner Studies can be considered to be measuring a single, unidimensional latent cognitive function construct. Methods Cognitive function assessments were administered in face-to-face interviews in 12 studies in 26 countries (N = 155,690), including the U.S. HRS and selected International Partner Studies. We used the time point of the first cognitive assessment for each study to minimize differential practice effects across studies and documented cognitive test item coverage across studies. Using confirmatory factor analysis models, we estimated single-factor general cognitive function models and bifactor models representing memory-specific and nonmemory-specific cognitive domains for each study. We evaluated model fits and factor loadings across studies. Results Despite relatively sparse and inconsistent cognitive item coverage across studies, all studies had some cognitive test items in common with other studies. In all studies, the bifactor models with a memory-specific domain fit better than single-factor general cognitive function models. The data fit the models at reasonable thresholds for single-factor models in 6 of the 12 studies and for the bifactor models in all 12 of the 12 studies. Discussion The cognitive assessments in the U.S. HRS and its International Partner Studies reflect comparable underlying cognitive constructs. We discuss the assumptions underlying our methods, present alternatives, and future directions for cross-national harmonization of cognitive aging data. [ABSTRACT FROM AUTHOR]

Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. We tested whether infants experiencing an adverse birth outcome—low birthweight or prematurity, as well as lengthy hospital stays—were more likely to be evicted in early childhood, through age 5 years. We analyzed 5,655 observations contributed by 2,115 participants in the Fragile Families and Child Wellbeing Study—a national, randomly sampled cohort of infants born in large US cities between 1998 and 2000—living in rental housing at baseline. We fitted proportional hazards models using piecewise logistic regression, controlling for an array of confounders and applying inverse probability of selection weights. Having been born low birthweight or preterm was associated with a 1.74-fold increase in children's hazard of eviction (95% confidence interval: 1.02, 2.95), and lengthy neonatal hospital stays were independently associated with a relative hazard of 2.50 (95% confidence interval: 1.15, 5.44) compared with uncomplicated births. Given recent findings that unstable housing during pregnancy is associated with adverse birth outcomes, our results suggest eviction and health may be cyclical and co-constitutive. Children experiencing adverse birth outcomes are vulnerable to eviction and require additional supports. [ABSTRACT FROM AUTHOR]

Objectives Drawing on the "Health and Aging in Africa: A Longitudinal Study of an INDEPTH community in South Africa" (HAALSI) baseline survey, we present data on older adults' social networks and receipt of social support in rural South Africa. We examine how age and gender differences in social network characteristics matched with patterns predicted by theories of choice- and constraint-based network contraction in older adults. Method We used regression analysis on data for 5,059 South African adults aged 40 and older. Results Older respondents reported fewer important social contacts and less frequent communication than their middle-aged peers, largely due to fewer nonkin connections. Network size difference between older and younger respondents was greater for women than for men. These gender and age differences were explicable by much higher levels of widowhood among older women compared to younger women and older men. There was no evidence for employment-related network contraction or selective retention of emotionally supportive ties. Discussion Marriage-related structural constraints impacted on older women's social networks in rural South Africa, but did not explain choice-based network contraction. These findings suggest that many older women in rural Africa, a growing population, may have an unmet need for social support. [ABSTRACT FROM AUTHOR]

Background: Understanding how depression is associated with chronic conditions and sociodemographic characteristics can inform the design and effective targeting of depression screening and care interventions. In this study, we present some of the first evidence from sub-Saharan Africa on the association between depressive symptoms and a range of chronic conditions (diabetes, HIV, hypertension, and obesity) as well as sociodemographic characteristics.Methods: A questionnaire was administered to a population-based simple random sample of 5,059 adults aged 40 years and older in Agincourt, South Africa. Depressive symptoms were measured using a modified version of the eight-item Center for Epidemiological Studies-Depression screening tool. Diabetes was assessed using a capillary blood glucose measurement and HIV using a dried blood spot.Results: 17.0% (95% confidence interval: 15.9%-18.1%) of participants had at least three depressive symptoms. None of the chronic conditions were significantly associated with depressive symptoms in multivariable regressions. Older age was the strongest correlate of depressive symptoms with those aged 80 years and older having on average 0.63 (95% confidence interval: 0.40-0.86; p < .001) more depressive symptoms than those aged 40-49 years. Household wealth quintile and education were not significant correlates.Conclusions: This study provides some evidence that the positive associations of depression with diabetes, HIV, hypertension, and obesity that are commonly reported in high-income settings might not exist in rural South Africa. Our finding that increasing age is strongly associated with depressive symptoms suggests that there is a particularly high need for depression screening and treatment among the elderly adults in rural South Africa. [ABSTRACT FROM AUTHOR]

Purpose of the Study This study examined how women who combine long-term care employment with unpaid, informal caregiving roles for children (double-duty-child caregivers), older adults (double-duty-elder caregivers), and both children and older adults (triple-duty caregivers) differed from their workplace-only caregiving counterparts on workplace factors related to job retention (i.e., job satisfaction and turnover intentions) and performance (i.e., perceived obligation to work while sick and emotional exhaustion). The moderating effects of perceived spouse support were also examined. Design and Methods Regression analyses were conducted on survey data from 546 married, heterosexual women employed in U.S.-based nursing homes. Results Compared to workplace-only caregivers, double-duty-elder and triple-duty caregivers reported more emotional exhaustion. Double-duty-child caregivers reported lower turnover intentions and both double-and-triple-duty caregivers felt less obligated to work while sick when perceiving greater support from husbands. Implications Results indicate that double-and-triple-duty caregiving women’s job retention and obligation to work while sick may depend on perceived spouse support, highlighting the important role husbands play in their wives’ professional lives. Findings also lend support to the emerging literature on marriage-to-work positive spillover, and suggest that long-term care organizations should target marital relationships in family-friendly initiatives to retain and engage double-and-triple-duty caregiving employees. [ABSTRACT FROM AUTHOR]

Objective: Workers approaching retirement may be particularly vulnerable to economic downturns. This study assesses whether exposure to economic downturns around retirement age leads to poorer cognitive function in later life. Method: Longitudinal data for 13,577 individuals in the Health and Retirement Study were linked to unemployment rates in state of residence. Random- and fixed-effect models were used to examine whether downturns at 55-64 years of age were associated with cognitive functioning levels and decline at ≥65 years, measured by the Wechsler Adult Intelligence Scale-Revised. Results: Longer exposure to downturns at 55-64 years of age was associated with lower levels of cognitive function at ≥65 years. Compared to individuals experiencing only up to 1 year in a downturn at 55-64 years of age, individuals experiencing two downturns at these ages had 0.09 point (95% Confidence Interval [CI, -0.17, -0.02]) lower cognitive functioning scores at ≥65 years (3 years: b = -0.17, 95%CI [-0.29, -0.06]; 4 years: b = -0.14, 95%CI [-0.25, -0.02]; ≥5 years: b = -0.22, 95%CI [-0.38, -0.06]). Downturns at 55-64 years of age were not associated with rates of cognitive decline. Discussion: Exposure to downturns around retirement is associated with a long-lasting decline in cognitive function in later life. Policies mitigating the impact of downturns on older workers may help to maintain cognitive function in later life. [ABSTRACT FROM AUTHOR]

Background: Much recent work has focused on the value of heart rate recovery (HRR) as a marker of cardiovascular health and a predictor of mortality. This article explores socioeconomic variation in HRR following exposure to a potent physiological stressor.Methods: The sample involved a nationally representative cohort of 4,475 community-dwelling older persons aged 50 years and older participating in the Irish Longitudinal Study on Ageing (TILDA). Participants completed an active stand (ie, vertical stand from a supine position) as part of a detailed clinic-based cardiovascular health assessment. Beat-to-beat HRR to standing was monitored over a 2-minute time horizon using a finometer. Highest level of educational achievement served as the indicator variable for socioeconomic status and mediation analysis was undertaken to explore the pathways through which social inequality comes to affect the speed of HRR using the extensive array of covariates available in TILDA.Results: Participants with primary level education were characterized by a significantly slower HRR after standing compared with the tertiary educated (B = -1.15 bpm, CI95 = -1.78, -0.52; p < .001). Mediation analysis revealed that lifetime smoking accounted for a sizeable proportion (40.4%) of the educational differential. Adjustment for other objectively measured markers of lifestyle measured during the clinic visit accounted for only a small proportion (5.2%) of the difference.Discussion: Smoking may represent a major pathway through which the social environment becomes biologically embedded in the tissues and organs of the body precipitating earlier vascular ageing among more socially disadvantaged groups, emphasizing the need to address the causes of these inequalities. [ABSTRACT FROM AUTHOR]

The relationship between social and community ties and mortality was assessed using the 1965 Human Population Laboratory survey of a random sample of 6928 adults in Alameda County, California and a subsequent nine-year mortality follow-up. The findings show that people who lacked social and community ties were more likely to die in the follow-up period than those with more extensive contacts. The age-adjusted relative risks for those most Isolated when compared to those with the most social contacts were 2.3 for men and 2.8 for women. The association between social ties and mortality was found to be independent of self-reported physical health status at the time of the 1965 survey, year of death, socioeconomic status, and health practices such as smoking, alcoholic beverage consumption, obesity, physical activity, and utilization of preventive health services as well as a cumulative index of health practices. [ABSTRACT FROM AUTHOR]

Background: Sleep is intricately tied to emotional well-being, yet little is known about the reciprocal links between sleep and psychosocial experiences in the context of daily life.Purpose: The aim of this study is to evaluate daily psychosocial experiences (positive and negative affect, positive events, and stressors) as predictors of same-night sleep quality and duration, in addition to the reversed associations of nightly sleep predicting next-day experiences.Methods: Daily experiences and self-reported sleep were assessed via telephone interviews for eight consecutive evenings in two replicate samples of US employees (131 higher-income professionals and 181 lower-income hourly workers). Multilevel models evaluated within-person associations of daily experiences with sleep quality and duration. Analyses controlled for demographics, insomnia symptoms, the previous day's experiences and sleep measures, and additional day-level covariates.Results: Daily positive experiences were associated with improved as well as disrupted subsequent sleep. Specifically, positive events at home predicted better sleep quality in both samples, whereas greater positive affect was associated with shorter sleep duration among the higher-income professionals. Negative affect and stressors were unrelated to subsequent sleep. Results for the reversed direction revealed that better sleep quality (and, to a lesser degree, longer sleep duration) predicted emotional well-being and lower odds of encountering stressors on the following day.Conclusions: Given the reciprocal relationships between sleep and daily experiences, efforts to improve well-being in daily life should reflect the importance of sleep. [ABSTRACT FROM AUTHOR]

Objectives. We investigated the association between employment status and depressive symptoms among Korean individuals according to age and gender. Methods. Data were obtained from a subsample of 3,907 men and 4,914 women aged 45 years and older without any severe disabilities who participated in the 2006 cross-sectional baseline survey of the Korean Longitudinal Study of Aging (KLoSA). We compared depressive symptoms as determined by the Center for Epidemiological Studies-Depression 10-item scale, adjusting for socioeconomic status, physical and cognitive function, and chronic disease. Using multiple regression analysis, we determined both age- and gender-specific differences associated with depressive symptoms and employment status. Results. Employment was associated with fewer depressive symptoms among middle-aged men but not among older men. Unemployment was associated with more depressive symptoms among middle-aged women but not among older women. Conclusion. Work role did not provide any benefit for depressive symptoms among older men and women. We discuss the increased depressive symptoms among older employed men and the differential association of employment status with age and gender in the context of Korean social structure. [ABSTRACT FROM PUBLISHER]

Socioeconomic position consistently predicts coronary heart disease; however, the biologic mechanisms that may mediate this association are not well understood. The objective of this study was to determine whether socioeconomic position (measured as educational level) is associated with inflammatory risk factors for coronary heart disease, including C-reactive protein, interleukin-6, soluble intercellular adhesion molecule-1, monocyte chemoattractant protein-1, and P-selectin. The study sample included 2,729 participants (53.4% women; mean age, 62 ± 10 years) from the US Framingham Offspring Study cohort who attended examination cycles 3 (1984–1987) and 7 (1998–2001) and provided educational attainment data. Inflammatory markers were measured in fasting serum samples. Multivariable linear regression analyses were performed, adjusting for potential confounders including age, sex, and clinical risk factors. In age- and sex-adjusted analyses, educational attainment was significantly inversely associated with C-reactive protein (p < 0.0001), interleukin-6 (p < 0.0001), soluble intercellular adhesion molecule-1 (p < 0.0001), and monocyte chemoattractant protein-1 (p = 0.0004). After further adjustment for clinical risk factors, educational level remained significantly associated with C-reactive protein (p = 0.0002), soluble intercellular adhesion molecule-1 (p = 0.01), and monocyte chemoattractant protein-1 (p = 0.01). In conclusion, educational attainment is associated with inflammatory risk factors for coronary heart disease. The association provides evidence suggestive of a biologic pathway by which socioeconomic position may predispose to coronary heart disease. [ABSTRACT FROM AUTHOR]

In research on the determinants of change in health status, a crucial analytic decision is whether to adjust for baseline health status. In this paper, the authors examine the consequences of baseline adjustment, using for illustration the question of the effect of educational attainment on change in cognitive function in old age. With data from the US-based Assets and Health Dynamics Among the Oldest Old survey (n = 5,726; born before 1924), they show that adjustment for baseline cognitive test score substantially inflates regression coefficient estimates for the effect of schooling on change in cognitive test scores compared with models without baseline adjustment. To explain this finding, they consider various plausible assumptions about relations among variables. Each set of assumptions is represented by a causal diagram. The authors apply simple rules for assessing causal diagrams to demonstrate that, in many plausible situations, baseline adjustment induces a spurious statistical association between education and change in cognitive score. More generally, when exposures are associated with baseline health status, this bias can arise if change in health status preceded baseline assessment or if the dependent variable measurement is unreliable or unstable. In some cases, change-score analyses without baseline adjustment provide unbiased causal effect estimates when baseline-adjusted estimates are biased. [ABSTRACT FROM AUTHOR]

To understand whether neighborhood contexts contribute to the onset or maintenance of mental health problems independently of individual characteristics requires the use of multilevel study designs and analytical strategies. This study used a multilevel analytical framework to examine the relation between neighborhood context and risk of depressive symptoms, using data from the New Haven component of the Established Populations for Epidemiologic Studies of the Elderly, a community-based sample of noninstitutionalized men and women aged 65 years or older and living in the city of New Haven, Connecticut, in 1982. Neighborhoods were characterized by census-based characteristics and also by measures of the neighborhood service environment using data abstracted from the New Haven telephone book Yellow Pages. Living in a poor neighborhood was associated with higher levels of depressive symptoms in older adults, above and beyond individual vulnerabilities. In addition, the presence of more elderly people in the neighborhood was associated with better mental health among older adults. The authors found no evidence that access to services hypothesized to promote social engagement, to provide health services, or to affect the reputation of a neighborhood explained (i.e., mediated) neighborhood variations in depressive symptoms. [ABSTRACT FROM AUTHOR]

The association between socioeconomic position and health is generally believed to be weaker among women than men. However, gender differences in the relation between socioeconomic position and coronary heart disease have not been evaluated in a representative sample of the US population. The authors examined this association in the First National Health and Nutrition Examination Survey (1971–1993), a longitudinal, representative study of the US population (n = 6,913). Information on educational attainment, household income, and covariates was derived from the baseline interview, and that on incident coronary heart disease was obtained from hospital records/death certificates over 22 years of follow-up. Cox's proportional hazards models showed that education and income were inversely associated with incident coronary heart disease in age-only and multivariate models. Risk associated with education varied by gender (p = 0.01), with less than high school education associated with stronger risk of coronary heart disease in women (relative risk = 2.15, 95% confidence interval: 1.46, 3.17) than in men (relative risk = 1.58, 95% confidence interval: 1.18, 2.12) in age-adjusted models. Low education was associated with greater social and psychological risks for women than men; however, metabolic risks largely explained gender differences in the educational gradient in coronary heart disease. [ABSTRACT FROM AUTHOR]

The effect of socioeconomic status (SES) on mortality was examined in the community-dwelling elderly. Data were obtained from four population-based studies that enrolled elderly residents of four US communities (East Boston, Massachusetts; New Haven, Connecticut; east-central Iowa; and the Piedmont region of North Carolina) and followed them for 9 years, starting in 1982 or 1986. Higher SES, whether measured by education, by household income, or by occupational prestige, was generally associated with lower mortality. However, the pattern of findings varied by gender and by community. For men, all three SES indicators were associated with mortality in the majority of cohorts. For women, this was true only for income. SES-mortality associations were attenuated but not eliminated after adjustment for behavior and health status. SES-mortality associations were stronger in New Haven and North Carolina than in East Boston and Iowa. The latter communities are more homogeneous with respect to ethnicity, urbanization, and occupational history than the former. Future research should investigate the relative validity of traditional SES measures for men and women and develop more balanced assessment methods. These findings also suggest that it is important to consider not only individual characteristics but also community attributes that mediate or modify the pathways through which socioeconomic conditions may influence health. Am J Epidemiol 2002;155:520-33. [ABSTRACT FROM AUTHOR]

Limited prospective data have examined the association between living arrangements and emotional well-being. The authors assessed whether older women living with a spouse were less likely to experience a decline in mental health, vitality, or physical function compared with women living alone or with nonspouse others. The association between living arrangement and 4-year change in functional health status was examined prospectively among 28,324 women aged 60–72 years in the Nurses' Health Study. After adjustment for age, baseline function, comorbid conditions, and health behaviors, women living alone had lower risk of decline in mental health (relative risk (RR) = 0.73, 95 percent confidence interval (CI): 0.65, 0.81) and vitality (RR = 0.72, 95 percent CI: 0.65, 0.80) compared with those living with a spouse. Contact with friends and relatives and level of social engagement were significantly protective against a decline in mental health among women living alone but not among women living with a spouse. These results suggest that women living independently are neither socially isolated nor at increased risk for decline in functional health status. In fact, these women actually fare better on measures of psychologic function than do women living with a spouse. [ABSTRACT FROM PUBLISHER]

Because of women's survival advantage, the impact of myocardial infarction (MI) on long-term mortality in women compared with men may be underestimated. The authors examined this issue in a community sample of 2,462 persons aged ≥65 years living in New Haven, Connecticut, who were free of MI at baseline and were followed for 10 years (1982–1992). By using proportional hazards models with MI hospitalizations and the sex-MI interaction as time-dependent covariables, survival for the MI cases from the date of MI was compared with survival of persons who, at the same follow-up time, were still alive and free of MI. Women survived longer than men mainly in the absence of MI. The multivariable-adjusted hazard ratios of death were 0.53 in the absence and 0.87 in the presence of MI, and MI was associated with a greater risk of death in women (adjusted hazard ratio = 5.9) than in men (adjusted hazard ratio = 3.6) (p = 0.01 for the sex-MI interaction). When out-of-hospital fatal infarctions were considered, the impact of MI on survival in women compared with men increased. In conclusion, in this elderly cohort, when viewed from a population perspective, MI had a greater impact on mortality in women and significantly narrowed women's typical survival advantage over men. Am J Epidemiol 2000;152:965–73. [ABSTRACT FROM PUBLISHER]

Examines the relationship among ethnicity, socioeconomic status, and psychological distress in older high-functioning adults in the United States. Influence of social structural factors on distress; Effects of ethnicity on distress; Consideration of age and functional status in relationship examinations.

Examines the performance-based measures of physical performance for an older cohort of relatively high-functioning men and women. Examination of influences of baseline behavioral, social and psychological characteristics in patterns of change in performance.

This study compared the odds of becoming disabled and recovering from disability among blacks and whites aged 65 years and over in two sites of the Established Populations for Epidemiologic Studies of the Elderly (EPESE) project. The authors examined the influence of mortality differences, socioeconomic status, and health-related factors on racial differences in risk of disability and recovery. A Markov model was employed using nine waves of data from the New Haven, Connecticut, site (529 blacks, 2,219 whites) and seven waves of the North Carolina (Piedmont) site (2,260 blacks, 1,876 whites), collected between 1982 and 1992. Blacks below age 75 years had an increased risk of developing disability relative to whites in New Haven (odds ratio (OR) at age 65 years = 3.33,95% confidence interval (CI) 2.13–5.22) as well as in North Carolina (OR at age 65 years = 1.58,95% CI 1.25–1.99). This excess risk diminished with increasing age, and crossed over in New Haven (OR at age 85 years = 0.45,95% CI 0.22–0.95), but not in North Carolina (OR at age 85 years = 1.22,95% CI 0.98–1.51). Adjustment for socioeconomic and health-related factors only partially reduced the excess disability risk among blacks below age 75 years in New Haven, but eliminated the difference in disability risk between blacks and whites in North Carolina. Blacks below age 75 years also had higher mortality risks at both sites. There were no consistent racial differences in recovery from disability. Am J Epidemiol 1997;145:488–97. [ABSTRACT FROM AUTHOR]

The author discusses the value of randomized controlled trial (RCT) methods aimed at examining social interventions. Topics mentioned include challenges posed by adherence to the standard biomedical models for RCTs to social experiments, the impact of maternity leave on women's mental health, and identification of the etiologic period, implementation and sustainability.

The article offers information on the upcoming issue of the "Epidemiologic Reviews."

The author reflects on the significance of the World Health Organization (WHO) Commission on Social Determinants (CSDH). Accordingly, with CSDH, the two worlds of science and policy have collided in an exceptionally productive way, stressing that the commission's searchlight has been sweeping. The author implies that CSDH has framed new strategies for international, national and even local stakeholders in trying to reach out in creating coalitions as well as collaborations at a variety levels.

The purpose of this study was to identify the social and psychological consequences of living with a cognitively impaired spouse among community-dwelling elderly individuals. The study sample consisted of 318 spouse pairs drawn from a representative sample of noninstitutionalized elderly individuals. Our principal findings were that: (a) Cognitive impairment in wives is significantly ( < .05) associated with depressive symptomatology in husbands, whereas cognitive impairment in husbands is only weakly (p ≥ .20) associated with depressive symptomatology in wives; (b) Decreased participation in social/leisure activities is selectively related to spouses' level of cognitive functioning among both men and women; (c) The relationship between wives' cognitive impairment and husbands' depressive symptoms is influenced by perceived availability of financial support from friends and relatives, but not by adl limitations in wives, lack of emotional or instrumental support from wives, household responsibilities among husbands, or lack of participation in social/leisure activities in husband [ABSTRACT FROM PUBLISHER]