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Objectives This study explored the association between place-based characteristics (e.g. neighborhood socioeconomic deprivation) and physical health within older Black adults, a critical gap in the literature as identified by the National Institute on Minority Health and Health Disparities. Methods The sample was from Wave 1 data of Baltimore Study of Black Aging: Patterns of Cognitive Aging (N = 450; M age = 68.34). Variables included the area deprivation index (ADI), objective (e.g. average blood pressure) and subjective (e.g. self-rated health) measures of physical health. Multiple linear regression models were conducted controlling for key sociodemographic characteristics. Results Participants reporting better self-rated health and less likely to need help with activities of daily living were significantly more likely to be living in more disadvantaged neighborhoods based on national and state ADI, respectively, even after adjusting for covariates. A significant age and ADI interaction revealed better self-rated health was associated with a more disadvantaged neighborhood particularly for individuals ≤66 years. There was no significant association between ADI and objective physical health measures. Discussion The findings suggest that national- and state-level place-based characteristics should be considered along with individual-level factors, which can enrich the scientific understanding of how neighborhood characteristics relate to varying health indicators among older Black adults. [ABSTRACT FROM AUTHOR]

Objectives Black persons in the United States are more likely to suffer from social inequality. Chronic stress caused by social inequality and racial discrimination results in weathering of the body that causes physiological dysregulation and biological age being higher than chronological age (accelerated aging). Depression has been linked to both racial discrimination and accelerated aging and accelerated aging has been demonstrated to be higher in Black than White persons, on average. However, we know little about accelerated aging across the life course in Black Americans. Methods We used mixed-effects growth models to measure biological age acceleration, measured with cardiometabolic markers, over a 20-year period in Black participants of the Coronary Artery Risk Development in Young Adults Study who were aged 27–42 years at analytic baseline. We included an interaction between depressive symptoms and time to determine whether risk of depression was associated with a faster rate of biological aging. Results We found that the rate of biological aging increased over a 20-year span and that those at risk for depression had a faster rate of biological aging than those not at risk. We also found that various social factors were associated with biological age acceleration over time. Discussion Given the known association between perceived racial discrimination and depressive symptoms, we provide a novel instance of the long-term effects of social inequality. Specifically, biological age acceleration, a marker of physiological dysregulation, is associated with time among Black persons and more strongly associated among those with depressive symptoms. [ABSTRACT FROM AUTHOR]

Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially. [ABSTRACT FROM AUTHOR]

Objective: To examine the interrelated effects of cardiovascular health, education, and cognitive functioning in African Americans. Method: The present study utilized data from the Baltimore Study of Black Aging to examine whether (a) cardiovascular health and educational attainment predicted cognitive functioning, after controlling for age, and (b) there was an interaction between cardiovascular health and education in predicting cognitive functioning. Results: Using hierarchical regression analyses, results showed education was significant for all cognitive measures; however, cardiovascular health was significant for only three. Discussion: These findings suggest that although self-reported cardiovascular health contributes to variability in late life cognition in African Americans, education is a more universal predictor that should be further examined. [ABSTRACT FROM AUTHOR]

The current study tested a non-linear model of religious coping among Black patients with Sickle Cell Disease (SCD). We predicted that moderate prayer and church attendance would be associated with less severe affective and sensory ratings of pain, lower levels of psychopathology, and less frequent care utilization. The participants were 67 SCD patients, mean age 36.82 ± 11.47 (range 18–70) of which 45% were men. Using ANOVA procedures, our results indicated a main effect for the frequency of prayer which showed significant differences for anxiety and hostility. Post-hoc t tests revealed that participants who endorsed moderate frequency of prayer reported significantly less anxiety and hostility, relative to participants who reported high or low frequency of prayer. However, participants who endorsed moderate levels of prayer also reported a significantly higher frequency of visits to the emergency department, relative to participants who reported high or low frequency of prayer. However, reports of pain and psychopathology were more linear with participants who reported the highest frequency of church attendance having the highest reports, moderate among those with moderate frequency of church attendance, and lowest among those with infrequent church attendance. These findings challenge and extend the traditional linear conceptualization of religious coping on clinical outcomes among patients with SCD. Directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Coping is recognized as an increasingly important consideration in the management of chronic disease. Prayer, hostility and John Henryism appeared to be the most frequently discussed but least understood coping strategies associated with health outcomes in African Americans. The current study evaluated if prayer, hostility and John Henryism (JH) predicted psychiatric morbidity and pain in 67 adult African American patients with Sickle Cell Disease. We used a set of simple regressions to analyze continuous predictors (hostility and JH) and Analyses of Variance (ANOVA) to analyze the categorical predictor (prayer). Each of the coping variables was a statistically significant predictor of psychiatric morbidities. However, coping did not exert effects on the absolute value of pain. In summary, coping influenced reactions to pain but not reports of pain itself. [ABSTRACT FROM AUTHOR]

Depression is typically considered relative to individuals and thought to originate from both biological and environmental factors. However, the environmental constraints and insults that African Americans experience likely influence the concordance by age and gender for depression scores among adult African American twins. Monozygotic (MZ) (n = 102) and Dizygotic (DZ) (n = 110) twins, age 25-88 years in the Carolina African American Twin Study of Aging were examined using an 11-item version of the CES-D measure of depressive symptomatology. Those participants with scores above nine were considered depressed. Overall, the MZ pairs had a higher concordance than the DZ pairs implying genetic influence. Both MZ and DZ males had higher concordances than either female zygosity groups. The difference between the concordance rates for MZ and DZ twin pairs was greater in males than females. By age group, the difference between the concordance rates for younger MZ and DZ twin pairs was much larger than for older pairs. The results suggest that, even though African Americans may be at risk for depression due to contextual/environmental factors, genetic influences remain important. [ABSTRACT FROM AUTHOR]

Presents an overview of behavioral medicine research on sociodemographically diverse populations in the U.S. Implications of social and economic diversity on behavioral medicine research; Elimination of health disparities in racial and ethnic populations; Influence of social and economic classifications on the treatment of disease.

Abstract: Objectives: To determine the prevalence, age of onset, severity, associated disability, and treatment of major depression among United States ethnic groups, national survey data were analyzed. Methods: National probability samples of US household residents aged 18-years and older (n =14,710) participated. The main outcomes were past-year and lifetime major depression (World Mental Health Composite International Diagnostic Interview). Major depression prevalence estimates, age of onset, severity, associated disability, and disaggregated treatment use (pharmacotherapy and psychotherapy) and treatment guideline concordant use were examined by ethnicity. Results: The prevalence of major depression was higher among US-born ethnic groups compared to foreign-born groups, but not among older adults. African Americans and Mexicans had significantly higher depression chronicity and significantly lower depression care use and guideline concordant use than Whites. Discussion: We provide concise and detailed guidance for better understanding the distribution of major depression and related mental healthcare inequalities and related morbidity. Inequalities in depression care primarily affecting Mexican Americans and African Americans may relate to excesses in major depression disease burden. [ABSTRACT FROM AUTHOR]

Data from the Interplay of Genes and Environment across Multiple Studies (IGEMS) consortium were used to examine predictions of different models of gene-by-environment interaction to understand how genetic variance in self-rated health (SRH) varies at different levels of financial strain. A total of 11,359 individuals from 10 twin studies in Australia, Sweden, and the United States contributed relevant data, including 2,074 monozygotic and 2,623 dizygotic twin pairs. Age ranged from 22 to 98 years, with a mean age of 61.05 (SD = 13.24). A factor model was used to create a harmonized measure of financial strain across studies and items. Twin analyses of genetic and environmental variance for SRH incorporating age, age 2 , sex, and financial strain moderators indicated significant financial strain moderation of genetic influences on self-rated health. Moderation results did not differ across sex or country. Genetic variance for SRH increased as financial strain increased, matching the predictions of the diathesis-stress and social comparison models for components of variance. Under these models, environmental improvements would be expected to reduce genetically based health disparities.

Although men have greater societal and economic privileges, men have higher all-cause mortality rates than women, even after controlling for education. Further, racial/ethnic mortality disparities exist among men with varying levels of education. Few studies have explored the independent effects of education and all-cause mortality between non-Hispanic Black and non-Hispanic White men with the same level of education. Our purpose was to identify trends in racial differences in all-cause mortality between non-Hispanic White and non-Hispanic Black men with the same level of education. Data for the study came from the National Health Interview Surveys 2000-2011 linked to the 2000-2009 Mortality Files. The Student's t and chi-square tests were used to assess the mean and proportional differences between non-Hispanic White and non-Hispanic Black men (≥18 years of age) across a range of demographic and health-related factors. Cox proportional hazard models were specified to examine the association between level of education and all-cause mortality adjusting for the demographic and health characteristics. Except for men who did not complete high school, statistically significant differences in all-cause mortality are present between non-Hispanic Black and non-Hispanic White men with the same level of education. The findings reveal the importance of understanding the level of education on differences in all-cause mortality between non-Hispanic Whites and non-Hispanic Blacks.

Background: Race differences in chronic conditions and disability are well established; however, little is known about the association between specific chronic conditions and disability in African Americans. This is important because African Americans have higher rates and earlier onset of both chronic conditions and disability than white Americans., Methods: We examined the relationship between chronic conditions and disability in 602 African Americans aged 50 years and older in the Baltimore Study of Black Aging. Disability was measured using self-report of difficulty in activities of daily living (ADL). Medical conditions included diagnosed self-reports of asthma, depressive symptoms, arthritis, cancer, diabetes, cardiovascular disease (CVD), stroke, and hypertension., Results: After adjusting for age, high school graduation, income, and marital status, African Americans who reported arthritis (women: odds ratio (OR)=4.87; 95% confidence interval(CI): 2.92-8.12; men: OR=2.93; 95% CI: 1.36-6.30) had higher odds of disability compared to those who did not report having arthritis. Women who reported major depressive symptoms (OR=2.59; 95% CI: 1.43-4.69) or diabetes (OR=1.83; 95% CI: 1.14-2.95) had higher odds of disability than women who did not report having these conditions. Men who reported having CVD (OR=2.77; 95% CI: 1.03-7.41) had higher odds of disability than men who did not report having CVD., Conclusions: These findings demonstrate the importance of chronic conditions in understanding disability in African Americans and how it varies by gender. Also, these findings underscore the importance of developing health promoting strategies focused on chronic disease prevention and management to delay or postpone disability in African Americans., Publication Indices: Pubmed, Pubmed Central, Web of Science database., (Copyright © 2016. Published by Elsevier Inc.)

Purpose: Few studies have examined the behavioral and clinical indicators of sleep difficulty among older African Americans diagnosed with arthritis. This study aimed to examine the association of sleep, pain, and comorbid indicators among this population., Method: Using a cross-sectional design, 193 older African Americans (70.4 ± 9.11 years of age) completed a series of questions assessing health, pain, and sleep., Results: Findings showed that young old participants (β = -.28, p < .001) reported more difficulty sleeping and being awakened due to pain (β = -.17, p < .05) than the old old adults., Conclusion: There is significant within-group variability, with young old adults being most affected by sleep difficulties., Implications for Practice: While the relationship between pain and sleep may be intuitive for majority populations, the dynamics of this association may be useful in promoting sleep awareness and providing resources for caregivers and health care professionals to better meet the needs of this population., (© The Author(s) 2014.)

Background: Perceived discrimination is a major source of health-related stress. The purpose of this study was to model the heterogeneity of everyday-discrimination experiences among African American and Caribbean Blacks and to identify differences in the prevalence of mood and substance use outcomes, including generalized anxiety disorder, major depressive disorder, alcohol-use disorder, and illicit drug-use disorder among the identified subgroups., Method: The study uses data from the National Survey of American Life obtained from a sample of African American and Caribbean Black respondents (N=4,462) between 18 and 65 years., Results: We used latent profile analysis and multinomial regression analyses to identify and validate latent subgroups and test hypotheses, yielding 4 classes of perceived everyday discrimination: Low Discrimination, Disrespect and Condescension, General Discrimination, and Chronic Discrimination. Findings show significant differences exist between the Low Discrimination and General Discrimination classes for major depressive disorder, alcohol-use disorder, and illicit drug-use disorder. Moreover, we find significant differences exist between the Low Discrimination and Chronic Discrimination classes for the four disorders examined. Compared with the Chronic Discrimination class, members of the other classes were significantly less likely to meet criteria for generalized anxiety disorder, major depressive disorder, alcohol-use disorder, and illicit drug-use disorder., Conclusions: Findings suggest elevated levels of discrimination increase risk for mood and substance-use disorders. Importantly, results suggest the prevalence of mood and substance-use disorders is a function of the type and frequency of discrimination that individuals experience., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Several studies have demonstrated a lower apolipoprotein E4 (APOE ε4) allele frequency in African-Americans, but yet an increased age-related prevalence of AD. An algorithm for prevention clinical trials incorporating TOMM40'523 (Translocase of Outer Mitochondria Membrane) and APOE depends on accurate TOMM40'523-APOE haplotypes., Methods: We have compared the APOE and TOMM40'523 phased haplotype frequencies of a 9.5 kb TOMM40/APOE genomic region in West African, Caucasian, and African-American cohorts., Results: African-American haplotype frequency scans of poly-T lengths connected in phase with either APOE ε4 or APOE ε3 differ from both West Africans and Caucasians and represent admixture of several distinct West African and Caucasian haplotypes. A new West African TOMM40'523 haplotype, with APOE ε4 connected to a short TOMM40'523 allele, is observed in African-Americans but not Caucasians., Conclusion: These data have therapeutic implications for the age of onset risk algorithm estimates and the design of a prevention trial for African-Americans or other mixed ethnic populations., (Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.)

Because of the excess burden of preventable chronic diseases and premature death among African American men, identifying health behaviors to enhance longevity is needed. We used data from the Third National Health and Nutrition Examination Survey 1988-1994 (NHANES III) and the NHANES III Linked Mortality Public-use File to determine the association between health behaviors and all-cause mortality and if these behaviors varied by age in 2029 African American men. Health behaviors included smoking, drinking, physical inactivity, obesity, and a healthy eating index score. Age was categorized as 25-44 years (n = 1,045), 45-64 years (n = 544), and 65 years and older (n = 440). Cox regression analyses were used to estimate the relationship between health behaviors and mortality within each age-group. All models were adjusted for marital status, education, poverty-to-income ratio, insurance status, and number of health conditions. Being a current smoker was associated with an increased risk of mortality in the 25- to 44-year age-group, whereas being physically inactive was associated with an increased risk of mortality in the 45- to 64-year age-group. For the 65 years and older age-group, being overweight or obese was associated with decreased mortality risk. Efforts to improve longevity should focus on developing age-tailored health promoting strategies and interventions aimed at smoking cessation and increasing physical activity in young and middle-aged African American men.

Social support and functional ability are related to a number of outcomes in later life among African Americans, including cognitive performance. This study examined how providing and receiving social support was related to fluid and crystallized cognitive abilities among aging African American adults after accounting for functional limitations, age, education, sex, income, and self-reported health. Data from 602 African American adults (M = 69.08, SD = 9.74; 25% male) were analyzed using latent variable modeling. Fluid ability was a second-order factor indicated by measures that assessed verbal memory, working memory, perceptual speed, and inductive reasoning. Crystallized ability was a first-order factor indicated by three measures that assessed vocabulary (Shipley Verbal Meaning Test and parts A and B of the ETS Vocabulary Test). Results indicated that the receipt of social support was negatively related to both fluid and crystallized abilities, while the provision of support was positively related to fluid and crystallized ability. Follow-up tests found that the receipt of support was more strongly related to fluid ability than crystallized ability. There was no significant difference regarding the relationship of provision of support with fluid ability compared to crystallized ability. Results discuss the importance of considering the social context of older adults when examining cognitive ability.

This study examined the fluid-crystallized distinction of cognitive abilities in African Americans. We analyzed the factorial invariance of a battery of cognitive ability measures in a sample of 197 community-dwelling African American elders. Specifically, factorial invariance was tested in groups of African American elders differing in age (50-61 years, 62-79 years) and education (low, high). Using a partial invariance approach, if non-invariance was found between two groups, we explored the specific model parameters that contributed to the overall lack of invariance. The results indicated that the factor structure was confirmed in the sample as a whole. Evidence of strict invariance was found between age groups. However, a lack of invariance of specific factor loadings, intercepts, and uniqueness terms was found between education groups. The importance of highlighting idiosyncrasies in cognitive performance among African Americans is shown using a within group variation approach.

The knowledge gained from studying diverse populations should help to address inequities and prepare us to deal with the needs of the increasing number of older minorities in this country. At the same time, research that is not properly conducted threatens to lead us astray and misconstrue relationships and outcomes related to behavioral aspects of aging. In this article, we propose that simple comparisons between groups are neither necessary nor sufficient to advance our understanding of ethnic minorities. We discuss common pitfalls conducted in group-differences research, including a specific treatment on the issue of statistical power issues. Our goal is to encourage the use of multiple methodological designs in the study of issues related to racial and ethnic minorities by demonstrating some of the advantages of lesser employed approaches.

Blacks experience disproportionately elevated rates of tobacco-related morbidity and mortality. Blacks experience delayed smoking initiation relative to other racial/ethnic groups, highlighting the importance of examining smoking correlates occurring in late adolescence/early adulthood. The current study reports data collected as part of an ongoing collaborative effort to assess alcohol and drug use on the campuses of historically black colleges and universities (HBCUs). Two-thousand, two-hundred, seventy-seven African-American subjects, aged 20.3 +/- 3.9 (range 18-53), completed the CORE Alcohol and Drug survey and a brief demographic questionnaire. Results indicated that 90% of all subjects overestimated the rate of smoking among their peers. Overestimating was associated with a > 80% increase in the risk of smoking. These data highlight the need to correct misinformation regarding smoking norms among students at some HBCUs.

Normative neuropsychological data for U.S. racial/ethnic minorities are limited. Extant norms are based on small, regional groups that may not be nationally representative. The objectives of this study were to (1) provide norms for a modified Symbol Digit Modalities Test (M-SDMT) based on a nationally representative sample of African Americans, Caribbean Blacks, and non-Latino Whites (NLW) living in areas with large populations of Blacks; and (2) determine significant correlates of M-SDMT performance. The M-SDMT was administered to a subset of respondents from the National Survey of American Life in standard face-to-face interviews. M-SDMT performance was influenced by race/ethnicity, age, education, and gender. African Americans and NLW groups had similar M-SDMT performances, which differed from Caribbean Blacks. The Black ethnic differences in M-SDMT were not explained by the sociodemographic factors considered in this study. Unlike previous work, this study supports the consideration of Black ethnicity when evaluating Black neuropsychological test performance.

Objectives: Despite greater negative environmental influences such as lower socioeconomic status, less parental education, more single-parent households and urban dwelling, African Americans are less likely to begin smoking than European Americans. The goal of the current investigation was to examine the proportion of genetic and environmental influences on smoking in a sample of adult African-American twins., Design: Birth records from North Carolina Register of Deeds Offices were used to identify participants for the Carolina African-American Twin Study of Aging (CAATSA). Participants completed an in-person interview that included measures of health status, cognition and psychosocial measures., Participants: Data for the analysis come from 200 pairs of same-sex twins (97 identical pairs and 113 fraternal), with a mean age = 46.9 years (SD = 13.9) and 38% of the sample being men., Results: Compared to previous research on smoking, our estimates are very similar with genetics, accounting for about 60% of the individual variance in current smoking. We did find that there was a significant amount of genetic variance in pack years but no shared environmental influences., Conclusion: Similarity in proportions of genetic influences lead to larger questions about the genes involved in smoking among African Americans working in the same manner as in Caucasians or other groups. Additionally, this same question holds for the environmental variance. It is perhaps most likely that while the proportions of environmental variance are similar between groups that the actual source of variance (e.g., poverty, urban rural context, socioeconomic status, attitudes of family and friends) may differ when comparing ethnic groups.