Brown School of Social Work

Background and Objectives: Individual stressors of depressive symptoms in old age are well identified, yet little is known about the neighborhood stressors of depressive symptoms. Guided by the ecological extension of the Pearlin's Stress Process Model, this study explores the rural and urban differences in neighborhood stressors of depressive symptoms among older adults in China. Research Design and Methods: Data came from two waves of the China Health and Retirement Longitudinal Study, a nationally representative survey. The study included 6,548 older adults ages 60 and above in 2011, with follow-up in 2013. Predictors (individual and neighborhood characteristics) were drawn from the 2011 baseline, and outcome, depressive symptoms, was extracted from the 2013 wave. Results: Multilevel modeling results showed that after controlling for depressive symptoms at the baseline, symptoms decreased in neighborhoods where physical environment and social environment were better. Among rural respondents, neighborhood stressors stemmed mainly from the physical environment, whereas among urban residents, the stressors came from the social environment. Discussion and Implications: This study demonstrated and discussed the role that neighborhoods may play in reducing depressive symptoms in later life. Community organizers and policy makers are encouraged to ameliorate community environments to improve mental health among older adults in China.

The World Health Organization (WHO)’s Age-Friendly Community (AFC) initiative has gained worldwide momentum. Yet, measures have not been validated in regions with various levels of socio-economic development. This paper used a nationally representative dataset in China to (a) analyze com- munity-level measures within the framework of AFC and (b) compare the age-friendliness between rural and urban settings in China. Chi- square and t-tests examined the rural and urban differences. Results suggest that many AFC concepts did not apply well in developing areas. The Chinese survey measured important environmental aspects in developing regions that were missing in the WHO AFC framework.

Cross-national studies can elucidate the influence of sociocultural contexts on a wide variety of aging issues. This study aims to develop methods for using secondary data for cross-national comparisons using productive activities as an example. The study also identifies challenges in conducting cross-national research. Using the national representative data from the United States, China, and South Korea, this study developed a sequence of methods for cross-national analysis. Results indicate that productive activities vary by country, and this variation could possibly be due to the

The Aging Semantic Differential (ASD) is the most widely used instrument to measure young people’s attitudes towards older adults. This study translated the ASD to Mandarin and exam- ined its psychometric properties. The Mandarin-ASD contains three latent factors (Personality and Mental Health, Societal Participation, and Physical) that have high internal reliability and reasonable discriminate validity. Social work researchers, practitioners and allied professionals may utilize the ASD- Mandarin instrument to measure young people’s attitudes towards older adults in China. We issue a call for a universal- ASD that can be applied across different cultural contexts.

Population aging is affecting almost every country in the world and has become a global issue. This demographic shift creates huge challenges and opportunities in societies where the population of older adults is large and growing. A productive aging perspective that addresses the challenges of an aging population by drawing on the capacity of the older population is critical. Knowledge about the best ways to support such productive engagement will be essential to shaping societies where older adults, families, and communities all benefit. Culturally-specific and cross-cultural knowledge is also needed. This paper reviews four key elements of a cross-cultural research agenda to develop knowledge on productive engagement in later life: definitions, theoretical frameworks, key research questions, and core values. The aim of this paper is to catalyze research on an important topic and to ensure that this research is carried forward as effectively as possible.

Cross-national studies can elucidate the influence of sociocultural contexts on a wide variety of aging issues. This study aims to develop methods for using secondary data for cross-national comparisons using productive activities as an example. The study also identifies challenges in conducting cross-national research. Using the national representative data from the United States, China, and South Korea, this study developed a sequence of methods for cross-national analysis. Results indicate that productive activities vary by country, and this variation could possibly be due to the differences in sociocultural context and variations in operationalization and measurement. Given the difficulty of making decisions and drawing conclusions across different cultural contexts, team members must include scholars who are familiar with the culture and language of the region of study. Researchers also need to determine whether data sets are valid for cross-national comparisons and understand ...

Individual stressors of depressive symptoms in old age are well identified, yet little is known about the neighborhood stressors of depressive symptoms. Guided by the ecological extension of the Pearlin's Stress Process Model, this study explores the rural and urban differences in neighborhood stressors of depressive symptoms among older adults in China. Data came from two waves of the China Health and Retirement Longitudinal Study, a nationally representative survey. The study included 6,548 older adults ages 60 and above in 2011, with follow-up in 2013. Predictors (individual and neighborhood characteristics) were drawn from the 2011 baseline, and outcome, depressive symptoms, was extracted from the 2013 wave. Multilevel modeling results showed that after controlling for depressive symptoms at the baseline, symptoms decreased in neighborhoods where physical environment and social environment were better. Among rural respondents, neighborhood stressors stemmed mainly from the p...

The intersection of drug use, violence, and depression with HIV-risk among African American women is an under explored area of research. The current analyses examine whether particular sexual risk behaviors are associated with exposure to violence, depression or both among 420 African American out-of-treatment female drug users. Women were stratified into four mutually exclusive groups: drug users with exposure to violence (n 0/64), drug users with clinical depression (n 0/62), drug users with both (n 0/41), and drug users only (n 0/253). Multinomial logistic regression analyses examined the association of demographics and sexual risk behaviors across the tripartite groups. Women with a history of sexually transmitted diseases were more likely to experience violence and depression both alone and jointly. Women who had two or more sexual partners in the last 30 days (OR 0/ 2.26) and women who had an early onset of alcohol use (OR 0/2.50) were at an increased risk for having the full tripartite of drug use, violence and depression. Never being married was a protective factor for the full tripartite. As expected, more risk factors were found among women who had the full tripartite than among women with one or two of the factors. The coexistence of the tripartite factors and sexual risk behaviors may indicate a need to ultimately provide more specialized prevention and intervention efforts to combat HIV infection. This area of research may improve our understanding of the numerous obstacles to HIV intervention among drug-using populations.

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Since 1994, several sites have participated in a NIDA Cooperative Agreement for AIDS Community-based Outreach/Intervention Research Program to examine rates of HIV risk behaviors and evaluate HIV risk reduction interventions among out-of-treatment drug injection and crack cocaine and heroin smokers. We studied the process and outcome of community outreach for recruitment of drug users in AIDS research and education projects in three metropolitan areas: St. Louis, MO; San Antonio, TX, and Durham and Wake Counties, NC. There were two primary areas of focus: (1) the level of accuracy among community health outreach workers (CHOWs) in identifying potentially eligible persons for HIV prevention, and (2) overall effectiveness in recruiting and enrolling persons in formal assessment and intervention studies. We found cross-site and within-site differences in levels of accuracy and in recruitment and enrollment yields. Drug users who had never been in treatment and drug users who had never been tested for HIV infection were underrepresented at all sites. We discuss the factors which may have contributed to cross-site and within-site differences. The findings suggest a need for continued study, refinement, and evaluation of community outreach strategies in order to enroll a broad spectrum of vulnerable groups in HIV prevention activities.

Drug abusers with psychiatric comorbidity are at high risk for becoming exposed to HIV. To address this compelling public health issue, our randomized HIV prevention study compares the effectiveness of the NIDA standard HIV testing and counseling protocol to a four session, ...

DSM-IV antisocial personality disorder diagnosis requires that conduct disorder be exhibited before age 15. However, recent studies have reported on men and women without conduct disorder before age 15 but qualified for the adulthood antisocial personality criterion (AAB). This general-population, retrospective study investigated the plausibility of causal relationships between adolescent drug and alcohol misuse (ADAM) and AAB among subgroups who reported childhood-onset conduct problems (CP), adolescent-onset CP, or no more than one conduct problem. Data from the Epidemiological Catchment Area Study (N ϭ 8,724) suggested that persons with childhood-onset CP are at much greater risk for AAB than persons with adolescent-onset CP. Nevertheless, large proportions of men and women with AAB had adolescent-onset CP or no CP. Regardless of CP history, being drunk by age 18 or having a drug use-related symptom before age 18 increased AAB risk, even after controlling for having a substance use-related disorder in adulthood. Mechanisms that potentially explain these associations are discussed.

This paper explores the relationship between changes in HIV risk behaviors and physical and sexual abuse. A stratified random sampling procedure selected 602 youths from a sample of 2,787 patients seen consecutively at public health clinics in 10 cities. Face-to-face ...

The intersection of drug use, violence, and depression with HIV-risk among African American women is an under explored area of research. The current analyses examine whether particular sexual risk behaviors are associated with exposure to violence, depression or both among 420 African American out-of-treatment female drug users. Women were stratified into four mutually exclusive groups: drug users with exposure to violence (n 0/64), drug users with clinical depression (n 0/62), drug users with both (n 0/41), and drug users only (n 0/253). Multinomial logistic regression analyses examined the association of demographics and sexual risk behaviors across the tripartite groups. Women with a history of sexually transmitted diseases were more likely to experience violence and depression both alone and jointly. Women who had two or more sexual partners in the last 30 days (OR 0/ 2.26) and women who had an early onset of alcohol use (OR 0/2.50) were at an increased risk for having the full tripartite of drug use, violence and depression. Never being married was a protective factor for the full tripartite. As expected, more risk factors were found among women who had the full tripartite than among women with one or two of the factors. The coexistence of the tripartite factors and sexual risk behaviors may indicate a need to ultimately provide more specialized prevention and intervention efforts to combat HIV infection. This area of research may improve our understanding of the numerous obstacles to HIV intervention among drug-using populations.

Since 1994, several sites have participated in a NIDA Cooperative Agreement for AIDS Community-based Outreach/Intervention Research Program to examine rates of HIV risk behaviors and evaluate HIV risk reduction interventions among out-of-treatment drug injection and crack cocaine and heroin smokers. We studied the process and outcome of community outreach for recruitment of drug users in AIDS research and education projects in three metropolitan areas: St. Louis, MO; San Antonio, TX, and Durham and Wake Counties, NC. There were two primary areas of focus: (1) the level of accuracy among community health outreach workers (CHOWs) in identifying potentially eligible persons for HIV prevention, and (2) overall effectiveness in recruiting and enrolling persons in formal assessment and intervention studies. We found cross-site and within-site differences in levels of accuracy and in recruitment and enrollment yields. Drug users who had never been in treatment and drug users who had never been tested for HIV infection were underrepresented at all sites. We discuss the factors which may have contributed to cross-site and within-site differences. The findings suggest a need for continued study, refinement, and evaluation of community outreach strategies in order to enroll a broad spectrum of vulnerable groups in HIV prevention activities.

Drug abusers with psychiatric comorbidity are at high risk for becoming exposed to HIV. To address this compelling public health issue, our randomized HIV prevention study compares the effectiveness of the NIDA standard HIV testing and counseling protocol to a four session, peer-delivered, educational intervention for out-of-treatment cocaine users with and without antisocial personality disorder (ASPD) and major depression. Among the 966 out-of-treatment cocaine users who have completed the 3 month follow-up, all groups, regardless of assignment to standard vs. peer-delivered intervention or psychiatric status, improved significantly in: crack cocaine use, injection drug use, number of IDU sex partners and overall number of sex partners, but not in condom use. Nevertheless, when stratified by psychiatric status, ASPD was associated with significantly less improvement in crack cocaine use (P=0.04) and with a trend for less improvement in having multiple sex partners and having IDU sex partners (P=0.06 and 0.08, respectively). ASPD status was not associated with change in injection drug use or condom use. Depression was associated with a trend (P=0.07) for greater improvement in crack cocaine use but not in any of the other behaviors. When examining the standard and peer intervention groups separately, no consistent differences in the association of psychiatric comorbidity with outcome were discerned between the two groups. We conclude that persons with ASPD and depression respond well to standard HIV prevention interventions, but these psychiatric disorders respectively attenuate and enhance response somewhat. Behavioral interventions tailored for persons with these conditions may be indicated if long-term change in HIV risk behaviors is to be achieved.

DSM-IV antisocial personality disorder diagnosis requires that conduct disorder be exhibited before age 15. However, recent studies have reported on men and women without conduct disorder before age 15 but qualified for the adulthood antisocial personality criterion (AAB). This general-population, retrospective study investigated the plausibility of causal relationships between adolescent drug and alcohol misuse (ADAM) and AAB among subgroups who reported childhood-onset conduct problems (CP), adolescent-onset CP, or no more than one conduct problem. Data from the Epidemiological Catchment Area Study (N ϭ 8,724) suggested that persons with childhood-onset CP are at much greater risk for AAB than persons with adolescent-onset CP. Nevertheless, large proportions of men and women with AAB had adolescent-onset CP or no CP. Regardless of CP history, being drunk by age 18 or having a drug use-related symptom before age 18 increased AAB risk, even after controlling for having a substance use-related disorder in adulthood. Mechanisms that potentially explain these associations are discussed.