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Objectives. This article describes dimensions of complementary therapy use among rural older adults, employs these dimensions to delineate sets of complementary therapy use, and describes the personal characteristics related to each set of complementary therapy use. Methods. Data are from in-depth interviews conducted with 62 African American and White rural older adults. Results. Three dimensions of complementary therapy use are delineated: types of therapies used, mindfulness in therapy use, and sharing information with conventional health care providers. The intersection of these dimensions indicates 5 patterned sets of complementary therapy use among rural older adults: (a) mindful use of only home remedies; (b) mindful use of home remedies and contemporary supplements; (c) mindful use of home remedies, contemporary supplements, and complementary practices; (d) nonmindful use of home remedies and contemporary supplements; and (e) use of conventional care only. Involvement in the 5 sets of therapy use is related to sex, ethnicity, educational attainment, and migration. Discussion. Understanding how older adults include sets of complementary therapies in their health self-management is important for improving their health care resources, expectations, awareness, and priorities. Key Words: Complementary and alternative medicine--Health disparities--Health self-management--Minority aging--Rural aging.

Work-family conflict research has focused almost exclusively on professional, White adults. The goal of this article was to expand the understanding of culture and industry in shaping experiences and consequences of work-family conflict. Using in-depth interview data (n = 26) and structured survey data (n = 200) from immigrant Latinos employed in the poultry processing industry, the authors evaluated predictions drawn from emerging models emphasizing the influence of cultural characteristics such as collectivism and gender ideology on work-family conflict. Results indicated that immigrant Latinos in poultry processing experienced infrequent work-to-family conflict; both the level and the antecedents of work-to-family conflict differed by gender, with physical demands contributing to greater conflict for women but not men. In addition, there was little evidence that work-family conflict was associated with health in this population. These results demonstrate how traditional models of work-family conflict need to be modified to reflect the needs and circumstances of diverse workers in the new global economy. Keywords: work-family conflict, immigrant workers, culture, job demands, quantitative-qualitative design

Objectives. Guided by the self-regulatory model, we describe the proportions of older adults who include herbal remedies in their health self-management, determining differences in herb use in terms of personal and health characteristics, indicators of culture, and personal resources. Methods. Data were from the 2002 National Health Interview Survey, which included a supplement on the use of herbal remedies. We limited the present analysis to adults aged 65 and older who were Black, Hispanic, Asian, or White. Results. Herbs were an important component of the health self-management of older adults. Whereas about one quarter of Asian and Hispanic elders used herbal remedies, about 10% of Black and White elders used them. Older adults differed by ethnicity in the herbs they used and their reasons for using herbs. Predictors of herb use included gender, age, and health status. Ethnicity and region of the country, indicators of culture, and education, a personal resource, were significant predictors of herb use when personal and health characteristics were controlled. Discussion. A complex set of factors is associated with the inclusion of herbs in the health self-management of older adults, with cultural and personal resources being extremely important.

Objective To evaluate diet quality of rural older adults using national dietary guidelines and the Healthy Eating Index (HEI). Design Five to six 24-hour recalls were conducted at monthly intervals over a 6-month period, using the Nutrition Coordinating Center food grouping system to calculate intake. Subjects Included in this cross-sectional study were 63 females and 59 males aged 65 to 93 years residing in two rural North Carolina counties; one third of each sex group was African American, Native American, or white. Inclusion criteria included age >65 years, education [less than or equal to] 12 years, and low income. Analyses HEI scores were computed from the average of the recalls, and compared using one-way analysis of variance. Multiple regression modeling was utilized to evaluate effects of demographic and self-reported health variables on HEI score. Results Most study participants did not meet minimum Food Guide Pyramid recommended servings of grains, fruits, vegetables, and dairy. They exceeded recommendations for discretionary calorie servings (median=3.3 and 5.3 for females and males, respectively). Using the HEI, 24% had poor diets, 75% needed improvement, and only 1% had good diets. Of the participants with an eighth-grade education or less, men had a mean HEI score 9.6 units lower than women. Conclusion These rural adults are not meeting recommended nutrition guidelines, and most are consuming diets considered poor or needing improvement. Health care providers should recognize barriers that put these older adults at risk for poor nutrition and should be prepared to initiate referrals to community resources. Nutrition counseling should include strategies to increase whole grain, fruit, vegetable, and reduced-fat dairy consumption with the ultimate goal of improving dietary intake to prevent declines in functional status and independence associated with aging.

Household food insecurity is higher among minority households in the U.S., but few data exist on households of recent minority immigrants, in part because such households are difficult to sample. Four studies of a total of 317 Latino immigrant families were conducted in different regions and during different seasons in North Carolina. A Spanish translation of the 18-item U.S. Food Security Survey Module was used to assess the prevalence of food insecurity and hunger. In 3 of the studies, a total of 76 in-depth interviews were conducted to gather information on immigrants' experiences of food insecurity. Households in the 4 studies classified as food secure ranged from 28.7 to 50.9%, compared with 82.4% in the U.S. in 2004. Food insecurity without hunger ranged from 35.6% to 41.8%, compared with 13.3% in the U.S. The highest rates of hunger reported were 18.8% (moderate hunger) and 16.8% (severe hunger) in an urban sample. Qualitative data indicate that food insecurity has both quantitative and qualitative effects on diet. Immigrants experience adverse psychological effects of food insecurity. They report experiencing a period of adjustment to food insecurity leading to empowerment to resolve the situation. Reactions to food insecurity differ from those reported by others, possibly because immigrants encounter a new and not chronic situation. Overall, these findings suggest that immigrant Latinos experience significant levels of food insecurity that are not addressed by current governmental programs.

This article examines the feasibility of using a short-form version of the Center for Epidemiologic Studies--Depression Scale (CES-D) in community mental health research with Mexican immigrants. Several features of three published short versions of the CES-D were examined using data combined from seven diverse Mexican immigrant samples from across the United States (N = 685). Results indicate that published short-form versions of the CES-D are reliable, they account for most of the variance in scores from the full CES-D, and there is little evidence that the use of short forms attenuates associations with other concepts relevant to understanding the mental health of Mexican immigrants. Although additional validation research is necessary, the results of this study suggest that short-form versions of the CES-D can be used to study mental health among Mexican immigrants. Keywords: Mexicans; depressive symptoms; measurement; community research; immigrants

This study determines elements of a social history that could assist primary care providers in identifying and treating anxiety and depression among immigrant Mexicans. Cross-sectional data were obtained through interviewer-administered [...]

Background. Falls are a recognized danger for older adults with diabetes. Persons in rural communities with diabetes may face additional risks from falling due to environmental and activity differences. Methods. Data were obtained in a cross-sectional survey of a stratified random sample of 691 community-dwelling adults (42.7% white, 31.4% African American, and 25.9% Native American) at least 65 years old with two or more Medicare claims for diabetes in 1998-2000, living in two rural counties in North Carolina. Falls data were self-reported for the previous year. Demographic data, foot-related symptoms, diabetes medications, and other health characteristics were reported. Results. Three hundred two persons (43.7%) reported falling at least once, including 171 (26.2%) who experienced two or more (frequent) falls. Frequent fallers were more likely to be male (odds ratio [OR] = 1.76; 95% confidence interval [CI] = 1.17, 2.66), report tingling or numbness in feet (OR = 1.75; 95% CI = 1.13, 2.70), have had a stroke (OR = 1.81: 95% CI = 1.19, 2.76), have longer duration of diabetes (OR = 1.21; 95% CI= 1.00, 1.47), have lower physical functioning (OR = 0.97; 95% CI = 0.96. 0.99) and mobility (OR = 0.89; 95% CI = 0.82, 0.96), and take a greater number of prescription medications (OR = 1.07; 95% CI= 1.01, 1.13). Conclusions. For rural older adults with diabetes, falls history should be screened to identify those at risk. Further research should investigate unique environmental factors contributing to falls for rural elderly persons.

Objectives. This study describes complementary and alternative medicine (CAM) use among rural older adults with diabetes, delineates the relationship of health self-management predictors to CAM therapy use, and furthers conceptual development of CAM use within a health self-management framework. Methods. Survey interview data were collected from a random sample of 701 community dwelling African American, Native American, and While elders residing in two rural North Carolina counties. We summarize CAM use for general use and for diabetes care and use multiple logistic modeling to estimate the effects of health self-management predictors on use of CAM therapies. Results. The majority of respondents used some form of CAM for general purpose, whereas far fewer used CAM for diabetes care. The most widely used CAM categories were food home remedies, other home remedies, and vitamins. The following health self-management predictors were related to the use of different categories of CAM therapies: personal characteristics (ethnicity), health status (number of health conditions), personal resources (education), and financial resources (economic status). Discussion. CAM is a widely used component of health self-management among rural among older adults with diabetes. Research on CAM use will benefit from theory that considers the specific behavior and cognitive characteristics of CAM therapies.

In this presentation, a diabetes explanatory model of rural, African American adults at high risk for diabetes is described. Kleinman's explanatory model of illness was used as the organizing framework. African American men and women (N = 42), between the ages of 18 and 51, participated. Participants described their knowledge and beliefs about diabetes, preventing diabetes, and whether diabetes could be cured or controlled. A common explanatory model of diabetes was not shared among the participants, and gender and age differences were apparent. Common themes included diabetes 'running in families,' 'eating too much sugar,' and 'not taking care of yourself' as causes of diabetes. Weight and physical activity or exercise were not seen as contributing to the development of diabetes. Participants were not sure if diabetes could be prevented. These results provide information to address primary prevention of diabetes in this at-risk group. Keywords: African American; diabetes; explanatory models; prevention; rural

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.05.009 Byline: Shannon L. Smith (a), Sara A. Quandt (a), Thomas A. Arcury (b), Lindsay K. Wetmore (a), Ronny A. Bell (a), Mara Z. Vitolins (a) Keywords: African American; Aging; Native American; Nutrition; Rural; Salt; USA Abstract: This paper draws upon qualitative research conducted among older adults in the rural, southern United States in which they articulated their beliefs and experiences with nutrition and foods, and lay models of the connection of diet with chronic disease. Salt emerged as a focus of contention. The goals of the paper are to (1) present the culturally constructed meaning of salt, (2) contrast the cultural meaning with biomedical views, and (3) discuss how these findings can be applied to health education and better doctor-patient communication. Data were collected in two rural communities characterized by high rates of poverty and a high proportion of minority residents. A total of 116 African American, Native American and white adults aged 60 years and older participated in 55 in-depth interviews or seven focus groups. A systematic analysis of text showed that salt was a highly contested component of food. While valued for its role in traditional foods and cuisine, it also held negative connotations because of biomedical links to chronic diseases prevalent in the population. We suggest that attempts to control salt intake are made difficult by the changes in taste perceptions that accompany aging. Respondents' articulation of salt's role in health and disease shows cross-over among different chronic diseases and a lay interpretation of blood as the medium through which salt affects disease. These older adults' narratives demonstrate their attempts to reconcile the important role of traditional foods in their identity as Southerners with their attempts to meet medical recommendations for healthy eating. Author Affiliation: (a) Department of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, USA (b) Department of Family & Community Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA

Purpose The purposes of this study were to assess the level of foot self-care performed in a rural, multiethnic population of older adults and to identify factors associated with foot [...]

Purpose The purpose of the study was to describe self-monitoring of blood glucose (SMBG) practices of 698 older adults with type 2 diabetes in the rural Southeast, to identify characteristics [...]

The prevalence of type 2 diabetes is increasing in the United States, particularly among minority individuals. Primary prevention programs for diabetes must be designed to address the beliefs of the populations they target. Little research has investigated the beliefs of those who do not have diabetes. This analysis uses in-depth interviews collected from Latino immigrants, not diagnosed with diabetes, living in a rural US community. Structured by the explanatory models [EM] of Illness framework, this analysis delineates the EMs of diabetes in this community. A significant number of the participants had little knowledge and few beliefs about diabetes. The EMs of those with knowledge of diabetes were varied, but several beliefs were widely held: (a) diabetes is a serious disease that is based on heredity or is inherent in all persons, (b) diabetes can result from several factors, including strong emotions and lifestyle characteristics (an unhealthy diet, not taking care of oneself), (c) beliefs about strong emotion and the importance of blood are related to diabetes causes, symptoms and treatment, and (d) a major and undesirable outcome of diabetes is weight loss. These results provide information for the design of health programs for the prevention of type 2 diabetes. Keywords: Diabetes: Minority health; Latinos/Hispanic; Explanatory models; Health beliefs; USA