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Cardiovascular disease is a leading cause of death worldwide. There is limited evidence that exposure to current-use pesticides may contribute to cardiovascular disease risk. We examined the association between residential proximity to the application of agricultural pesticides and cardiovascular risk factors among 484 adult women in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) Study, a cohort based in an agricultural region of California. Outcome assessment was completed between 2010 and 2013. Using participant residential addresses and California's Pesticide Use Reporting database, we estimated agricultural pesticide use within 1 km of residences during the 2-year period preceding outcome assessment. We used Bayesian hierarchical modeling to evaluate associations between exposure to 14 agricultural pesticides and continuous measures of waist circumference, body mass index, and blood pressure. Each 10-fold increase in paraquat application around homes was associated with increased diastolic blood pressure (β = 2.60 mm Hg; 95% credible interval [CrI], 0.27-4.89) and each 10-fold increase in glyphosate application was associated with increased pulse pressure (β = 2.26 mm Hg; 95% CrI, 0.09-4.41). No meaningful associations were observed for the other pesticides examined. Our results suggest that paraquat and glyphosate pesticides may affect cardiovascular disease development in women with chronic environmental exposure. This article is part of a Special Collection on Environmental Epidemiology. [ABSTRACT FROM AUTHOR]

Objectives The Latino population is one of the largest, most diverse, and fastest-growing demographic groups in the United States. Although Latinos enjoy longer life spans and reduced mortality risk relative to non-Hispanic Whites, they have higher rates of chronic health conditions such as diabetes and dementia and live more of their older years with poor health and disability. Such inequities point to the need for this research focused on examining resiliency strategies and barriers to successful aging among various U.S. Latino subgroups. Methods This qualitative study used thematic content analysis to examine resiliency strategies and barriers to successful aging among Mexican immigrant women (n  = 40) residing in an underserved agricultural community and entering mid-life (mean = 49 years old). Results With regards to barriers to successful aging, 3 themes emerged: (1) stressful lifestyle in the United States compared to the participants' home countries; (2) stress from expectations at home; and (3) stress due to work and the various components around work. The following 4 resiliency strategies emerged: (1) family as a motivation for moving forward in life and focusing on the success of children; (2) having a positive mindset; (3) praying to God for strength to overcome obstacles; and (4) self-care. Discussion Despite experiencing barriers to successful aging, participants practice various resiliency strategies to age successfully. Because many of the barriers identified are related to poverty-related stressors, systemic solutions addressing the social determinants of health are needed. [ABSTRACT FROM AUTHOR]

Background: Spouses of persons living with dementia may face heightened psychosocial distress in the years immediately before and after their partner's death. We compared the psychosocial needs of spouses of partners with dementia with spouses of partners with non‐impaired cognition nearing and after the end of life, focusing on loneliness, depression, life satisfaction, and social isolation. Methods: We used nationally representative Health and Retirement Study married couples data (2006–2018), restricting to spouses 50+ years old. We included 2098 spouses with data on loneliness and depressive symptoms 2 years before and after the partner's death. We additionally examined a subset of spouses (N = 1113) with available data on life satisfaction and social isolation 2 years before their partner's death. Cognitive status of partners was classified as non‐impaired cognition, cognitive impairment not dementia (cognitive impairment), and dementia. We used multivariable logistic regression to determine: 1) the change in loneliness and depression for spouses pre‐ and post‐partner's death, and 2) life satisfaction and social isolation 2 years before the partner's death. Results: Spouses were on average 73 years old (SD: 10), 66% women, 7% Black, 7% Hispanic non‐White, 24% married to persons with cognitive impairment, and 19% married to partners with dementia. Before their partner's death, spouses married to partners with dementia experienced more loneliness (non‐impaired cognition: 8%, cognitive impairment: 16%, dementia: 21%, p‐value = 0.002) and depressive symptoms (non‐impaired cognition: 20%, cognitive impairment: 27%, dementia: 31%, p‐value < 0.001), and after death a similar prevalence of loneliness and depression across cognitive status. Before their partner's death, spouses of partners with dementia reported less life satisfaction (non‐impaired cognition: 74%, cognitive impairment: 68%; dementia: 64%, p‐value = 0.02) but were not more socially isolated. Conclusion: Results emphasize a need for clinical and policy approaches to expand support for the psychosocial needs of spouses of partners with dementia in the years before their partner's death rather than only bereavement. [ABSTRACT FROM AUTHOR]

The growing body of evidence linking intergenerational education and late-life cognitive decline is almost exclusively from high-income countries, despite rapid intergenerational changes in education in low- and middle-income countries (LMICs). We used data from the Mexican Health and Aging Study (n  = 8,822), a cohort study of Mexican adults aged ≥50 years (2001–2018), to evaluate whether parental education (none vs. any formal schooling), one's own education (less than primary school vs. completion of primary school), or an adult child's education (less than high school vs. completion of high school) was associated with verbal memory z scores. We used linear mixed models with inverse probability of attrition weights. Educational attainment in all 3 generations was associated with baseline verbal memory scores, independent of the prior generation's education. Lower parental (β = −0.005, 95% confidence interval: −0.009, −0.002) and respondent (β = −0.013, 95% confidence interval: −0.017, −0.010) educational level were associated with faster decline in delayed (but not immediate) verbal memory z scores. Associations between adult child's education and respondent's verbal memory decline varied by exposure specification. The educational attainment of parents and adult children may influence the cognitive aging of middle-aged and older adults in LMICs. These results have important implications given recent structural shifts in educational attainment in many LMICs. [ABSTRACT FROM AUTHOR]

Objectives: This study examines whether perceived neighborhood characteristics relate to pain outcomes among middle-aged and older adults. Methods: Data were from the Health and Retirement Study (2006–2014; n = 18,814). Perceived neighborhood characteristics were physical disorder, social cohesion, safety, and social ties. We fitted adjusted generalized estimating equation models to evaluate prevalence, incidence, and recovery of moderate-to-severe limiting pain 2 years later. Results: The mean age of our sample was 65.3 years; 54.6% were female and 24.2% reported moderate-to-severe limiting pain at baseline. Positive neighborhood characteristics were associated with low prevalence (e.g., prevalence ratio [PR]:.71 for disorder) and reduced incidence (e.g., PR:.63 for disorder) of moderate-to-severe limiting pain. Positive neighborhood characteristics were associated with a high recovery rate from moderate-to-severe limiting pain (e.g., PR = 1.15 for safety), though the 95% CIs for disorder and cohesion crossed the null. Discussion: Neighborhood characteristics may be important determinants in predicting pain in later life. [ABSTRACT FROM AUTHOR]

Objectives Midlife stressors may be particularly consequential for cognitive performance and disparities in cognitive decline. This study examined Black–White differences in trajectories of cognition among middle-aged adults and the effects of acute and chronic stressors on these trajectories. Methods Data come from 4,011 cognitively healthy individuals aged 51–64 (620 Black and 3,391 White) who participated in the 2006–2018 waves of the Health and Retirement Study. Stressors included a count of recent life events and measures of financial strain and everyday discrimination. Global cognition was assessed using a modified version of the Telephone Interview for Cognitive Status. Linear mixed models with random slopes and intercepts assessed change in cognition over time. Race-by-time, race-by-stressor, time-by-stressor, and race-by-stressor-by-time interactions were assessed as were quadratic terms for time and each stressor. Results After adjusting for sociodemographic, health behaviors, and health-related factors, Black respondents had lower initial cognitive performance scores (b = −1.75, p <.001) but experienced earlier but slower decline in cognitive performance over time (Black × Time2 interaction: b = 0.02, p <.01). Financial strain, discrimination, and recent life events each had distinct associations with cognitive performance but did not influence racial differences in levels of or change in cognition over time. Discussion Middle-aged Black adults have lower initial cognition levels and experience earlier but less accelerated cognitive decline compared to White middle-aged adults. Midlife acute and chronic stressors influence baseline cognition but do so in different ways. Future research should examine the influence of other stressors on racial differences in cognitive decline at other points in the life course. [ABSTRACT FROM AUTHOR]

Background: US preterm-birth rates are 1.6 times higher for Black mothers than for White mothers. Although traffic-related air pollution (TRAP) may increase the risk of preterm birth, evaluating its effect on preterm birth and disparities has been challenging because TRAP is often measured inaccurately. This study sought to estimate the effect of TRAP exposure, measured at the street level, on the prevalence of preterm birth by race/ethnicity.Methods: We linked birth-registry data with TRAP measured at the street level for singleton births in sampled communities during 2013-2015 in Oakland and San Jose, California. Using logistic regression and marginal standardization, we estimated the effects of exposure to black carbon, nitrogen dioxide and ultrafine particles on preterm birth after confounder adjustment and stratification by race/ethnicity.Results: There were 8823 singleton births, of which 760 (8.6%) were preterm. Shifting black-carbon exposure from the 10th to the 90th percentile was associated with: 6.8%age point higher risk of preterm birth (95% confidence interval = 0.1 to 13.5) among Black women; 2.1%age point higher risk (95% confidence interval = -1.1 to 5.2) among Latinas; and inconclusive null findings among Asian and White women. For Latinas, there was evidence of a positive association between the other pollutants and risk of preterm birth, although effect sizes were attenuated in models that co-adjusted for other TRAP.Conclusions: Exposure to TRAP, especially black carbon, may increase the risk of preterm birth for Latina and Black women but not for Asian and White women. [ABSTRACT FROM AUTHOR]

Background: Evaluating the long-term health consequences of migration requires longitudinal data on migrants and non-migrants to facilitate adjustment for time-varying confounder-mediators of the effect of migration on health.Methods: We merged harmonized data on subjects aged 50+ from the US-based Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS). Our exposed group includes MHAS-return migrants (n = 1555) and HRS Mexican-born migrants (n = 924). Our unexposed group includes MHAS-never migrants (n = 16,954). We constructed a lifecourse data set from birth (age 0) until either age at migration to the United States or age at study entry. To account for confounding via inverse probability of treatment weights (IPTW), we modeled the probability of migration at each year of life using time-varying pre-migration characteristics. We then evaluated the effect of migration on mortality hazard estimated with and without IPTW.Results: Mexico to the United States migration was predicted by time-varying factors that occurred before migration. Using measured covariates at time of enrollment to account for selective migration, we estimated that, for women, migrating reduces mortality risk by 13%, although this estimate was imprecise and results were compatible with either large protective or deleterious associations (hazard ratio [HR] =0.87, 95% confidence interval [CI]: 0.60, 1.27). When instead using IPTWs, the estimated effect on mortality was similarly imprecise (HR = 0.98, 95% CI: 0.77, 1.25). The relationship among men was similarly uncertain in both models.Conclusions: Although time-varying social factors predicted migration, IPTW weighting did not affect our estimates. Larger samples are needed to precisely estimate the health effects of migration. [ABSTRACT FROM AUTHOR]

Few studies have examined the associations between health and the cross-border ties that migrants maintain with their family members in communities of origin. We draw on theory related to social ties, ethnic identity, and mental health to examine cross-border ties as potential moderators of the association between migration-related stress and psychological distress among Latino migrants. Using data from the National Latino and Asian American Survey, we find that remittance sending is associated with significantly lower levels of psychological distress for Cuban migrants, and difficulty visiting home is associated with significantly greater psychological distress for Puerto Rican migrants. There were significant associations between migration-related stressors and psychological distress, although these associations fell to nonsignificance after accounting for multiple testing. We found little evidence that cross-border ties either buffer or exacerbate the association between migration-related stressors and psychological distress. We consider the findings within the current political and historical context of cross-border ties and separation. [ABSTRACT FROM AUTHOR]

Context Paid caregivers of low-income older adults navigate their role at what Hochschild calls the 'market frontier': the fuzzy line between the 'world of the market,' in which services are exchanged for monetary compensation, and the 'world of the gift,' in which caregiving is uncompensated and motivated by emotional attachment. We examine how political and economic forces, including the reduction of long-term services and supports, shape the practice of 'walking the line' among caregivers of older adults. Methods We used data from a longitudinal qualitative study with related and nonrelated caregivers ( n = 33) paid through California's In-Home Supportive Services (IHSS) program and consumers of IHSS care ( n = 49). We analyzed the semistructured interviews ( n = 330), completed between 2010 and 2014, using a constructivist grounded theory approach. Findings Related and nonrelated caregivers are often expected to 'gift' hours of care above and beyond what is compensated by formal services. Cuts in formal services and lapses in pay push caregivers to further 'walk the line' between market and gift economies of care. Both related and nonrelated caregivers who choose to stay on and provide more care without pay often face adverse economic and health consequences. Some, including related caregivers, opt out of caregiving altogether. While some consumers expect that caregivers would be willing to 'walk the line' in order to meet their needs, most expressed sympathy for them and tried to alter their schedules or go without care in order to limit the caregivers' burden. Conclusions Given economic and health constraints, caregivers cannot always compensate for cuts in formal supports by providing uncompensated time and resources. Similarly, low-income older adults are not competitive in the caregiving marketplace and, given the inadequacy of compensated hours, often depend on unpaid care. Policies that restrict formal long-term services and supports thus leave the needs of both caregivers and consumers unmet. [ABSTRACT FROM AUTHOR]

Objectives. We determined the impact of premigration circumstances on postmigration psychological distress and self-rated physical health among Latino immigrants. Methods. We estimated ordinary least squares and logistic regression models for Latino immigrants in the 2002-2003 National Latino and Asian American Study (n = 1603). Results. Mean psychological distress scores (range = 10-50) were 14.8 for women and 12.7 for men; 35% of women and 27% of men reported fair or poor physical health. A third of the sample reported having to migrate; up to 46% reported unplanned migration. In multivariate analyses, immigration-related stress was significantly associated with psychological distress, but not with self-rated health, for both Latino men and women. Having to migrate was associated with increased psychological distress for Puerto Rican and Cuban women respondents and with poorer physical health for Puerto Rican migrant men. Unplanned migration was significantly associated with poorer physical health for all Latina women respondents. Conclusions. The context of both pre- and postmigration has an impact on immigrant health. Those involved in public health research, policy, and practice should consider variation in immigrant health by migration circumstances, including the context of exit and other immigration-related stressors. [ABSTRACT FROM AUTHOR]

Low-income older adults with disabilities in California depend on a variety of public programs to help them remain in their own homes. The availability of those services has been in flux since 2009 because of cuts caused by the recession. This article reports on a qualitative study of 33 California seniors who depend on fragile arrangements of paid and unpaid assistance. Thematic analyses of in-depth interviews conducted with these older adults and their caregivers indicate that the disability needs of these individuals are often unstable, with both physical and mental health status sometimes changing day to day. Most have nowhere else to turn for help if their public services are cut. All share the common goal of staying at home and maintaining their independence. Public services serve as a crucial link in the support networks of these individuals. [ABSTRACT FROM PUBLISHER]

Objective: To understand perceptions regarding their illness of patients who present to the Emergency Department at the end of life. Methods: Semistructured one-on-one interviews were performed with a convenience sample of seriously ill, Emergency Department (ED) patients with advanced illness presenting to an urban, public hospital. A bilingual Latina health promoter used a predetermined discussion guide to conduct all interviews. Non-English- or Non-Spanish-speaking patients and those with uncontrolled symptoms or cognitive deficits were excluded. All interviews were recorded and transcribed, and grounded theory methodology was used to analyze the results. Results: Thirteen patients with advanced illness participated, 8 of whom were Spanish-speaking only. Because of difficulty accessing care and financial concerns, patients with advanced illness present to EDs when their pain or other symptoms are out of control. The majority derive great comfort and strength from their faith in God, who they believe determines their fate. Most listed spending time with family, and not being a burden, as most important at the end of life, and many expressed a preference to die at home surrounded by loved ones. Almost none had spoken to physicians about their care preferences. Conclusions: Patients with advanced illness present to the ED of a safety net hospital when symptoms are out of control. They have many financial concerns, want to spend their remaining days with family, and do not want to be a burden. Most derive immense comfort from faith in God, but do not feel they have control over their own fate. [ABSTRACT FROM AUTHOR]

Purpose: Migrating from Mexico to the U.S. is a major, stressful life event with potentially profound influences on mental health. However, estimating the health effects of migration is challenging because of differential selection into migration and time-varying confounder mediators of migration effects on health.Methods: We pooled data from the Mexican Health and Aging Study (N = 17,771) and Mexican-born U.S. Health and Retirement Study (N = 898) participants to evaluate the effects of migration to the U.S. (at any age and in models for migration in childhood or adulthood) on depressive symptom-count, measured with a modified Centers for Epidemiologic Studies-Depression scale. We modeled probability of migrating in each year of life from birth to either age at initial migration to the U.S. or enrollment and used these models to calculate inverse probability of migration weights. We applied the weights to covariate-adjusted negative binomial GEE models, estimating the ratio of average symptom-count associated with migration.Results: Mexico to U.S. migration was unrelated to depressive symptoms among men (ratio of average symptom-count= 0.98 [95% CI: 0.89, 1.08]) and women (ratio of average symptom-count = 1.00 [95% CI: 0.92, 1.09]). Results were similar for migration in childhood, early adulthood, or later adulthood.Conclusions: In this sample of older Mexican-born adults, migration to the U.S. was unrelated to depressive symptoms. [ABSTRACT FROM AUTHOR]