The medical model in psychiatry assumes medical intervention is the treatment of choice for the constellations of diagnosed symptoms that comprise various mental disorders. These treatments may include pharmacotherapy, electroconvulsive treatment, brain stimulation, and psychosurgery. Therefore, psychopharmacology for older adults can be considered palliative rather than a cure for a brain disease causing psychopathology. Older adults experience many psychopathological problems, including anorexia tardive, anxiety disorders, delusional disorders, mood disorders, personality disorders, schizophrenia, and co-occurring disorders with substance abuse/dependence disorders. Therefore, it is critical for the social worker to understand the various manifestations of psychological problems in older adults from the perspective of an older adult, rather than extrapolating information commonly taught in social work programs that neglect to focus on older adults and restrict teaching to psycho-pathological problems in younger and middle-aged adults.

The baby boom cohort brings with it multiple types of substance abuse. Bisexual older adults have more co-occurring psychological problems than heterosexual older adults, older gay males, and older lesbians. An interesting finding is that immigration is contributory to older adult substance abuse. Older adults with alcohol-abuse problems do not seek help for their problems. Rather, they are often identified as having an alcohol-use problem when seeking care for other medical or psychological problems. Social workers assessing an older adult for alcohol abuse often confuse symptoms of possible alcohol abuse with dementia. Prescribing opioids and synthetic opioids to an older adult is complicated. An older adult can suffer from many forms of inner tension. Combining motivational interviewing with cognitive behavioral therapy is shown to be more effective for treating substance abuse that either therapeutic modality alone.

For older adults, the phenomenon of death is accepted and does not induce the fear experienced by younger adults. Older adults who do not engage in end-of-life planning may receive unwanted, unnecessary, costly, and painful medical interventions or withdrawal of desired treatment. Many older people feel that the goal of palliative care is to make the best possible dying experience for the older adult and his/her family. In addition to palliative care, an older adult will most likely find himself or herself in an intensive care unit as part of his or her terminal care. Euthanasia, or hastened death, is seen by some as an alternative to palliative care. A psychological aspect of death that an older adult is concerned with, in addition to place of death, is whether he or she will die in his or her sleep or die suddenly, making the death experience an individual phenomenon.

The concept of risk behaviors became a model for public health interventions in the late 1970s and 1980s. This chapter describes contemporary knowledge on the risk behaviors of gender and sexual minority (GSM) persons. It highlights research findings, with particular attention paid to studies of different GSM subgroups, and evaluates interventions that have sought to modify behaviors in the pursuit of better health outcomes. The chapter then focuses on the potential contributions of other theoretical frameworks to the study of GSM risk behaviors, including opportunities to incorporate disclosure, resilience, intersectionality, and minority stress theories. It also presents recommendations for future directions for researching health risk behaviors among GSM persons, addressing the risk of harming GSM populations, and diverting attention and resources from addressing justice and social determinants of GSM health. The chapter concludes with suggestions for future research and interventions in support of more equitable health outcomes.

As in the non-lesbian, gay, bisexual, and transgender (LGBT) community, gender and sexual minority (GSM) individuals who are also members of one or more racial/ethnic minority populations face unique sociocultural dynamics that impact the ability to achieve and maintain health. This chapter describes the literature that has examined racial/ethnic disparities in a variety of outcomes, and describes what is known regarding the actual impact of intersectionality whenever possible. Reflective of the current literature, the chapter centers on the African American and Hispanic sexual minority male population, HIV, substance use, and mental health as outcomes. It begins with an exploration of barriers to health that reach across outcomes and populations and discusses four specific outcomes with more developed bodies of literature (HIV/sexual health, substance use, mental health/suicide, and victimization). Finally the chapter summarizes the initial evidence from three emerging lines of inquiry (chronic conditions, incarceration, and women’s health).

Using Bronfenbrenner’s Ecological Systems Theory, this chapter highlights the unique strengths and challenges faced by gender and sexual minority (GSM) youth and highlights future directions for research that we believe hold promise in promoting the health and well-being of this special population. It presents a review of the research as applied to physical and mental health disparities that impact GSM youth and discusses the two dominant psychosocial models that explain the contributing factors to these disparities. Notably, public opinion has been shifting toward greater acceptance and inclusion of the lesbian, gay, bisexual, and transgender community, and the 21st century has seen a large increase in the number of protections and rights afforded to GSM individuals. Future research should continue to examine and replicate the impact of minority stress in more recent cohorts of GSM adolescents to determine whether improvements in the social environment result in decreases in health disparities.

Research on the health and health care needs of gender and sexual minority (GSM) people is burgeoning, in part due to increased awareness of the importance of identifying the health care needs of these long-neglected populations. This increase in knowledge related to GSM health is a critical part of improving the quality of GSM people’s health and health care. This chapter considers how practitioners might integrate existing knowledge about GSM health into their clinical work to establish an affirmative context for GSM patients. More contemporary approaches take a more process-oriented view, focused on the appreciation of cultural differences at personal, professional, organizational, and societal levels. These approaches place greater emphasis on training clinicians to think critically about how patients’ cultural backgrounds and identities impact their life experiences. The authors draw on these approaches to provide practical recommendations for providers to deliver competent care to GSM individuals.

This concluding chapter summarizes the major points regarding elder abuse (EA) presented in the preceding chapters. It concludes the chapter by taking one last opportunity to encourage exploration and initiation of system-level efforts to solve a major public health problem. The socioecological framework for violence prevention utilized within domestic and global public health work is applicable and extendable to EA. Throughout this book, the authors have argued that EA is a public health problem and that EA may well be among the most under-recognized and under-resourced population health problems of the early 21st century. Public health has frameworks, tools, approaches, relationships, structures, systems, and a variety of agents and organizations poised to address the problem of EA. The imprimatur of the growing population of older adults and the character of demographic transitions occurring globally provide the perfect rationale for action—now.

This chapter explores recent insights from preclinical and clinical studies of cancer induced bone pain (CIBP). There are various neuropathic, nociceptive, and inflammatory pain mechanisms that contribute to CIBP. Neuropathic pain can be induced as tumor cell growth injures distal nerve fibers that innervate bone and pathological sprouting of both sensory and sympathetic nerve fibers. These changes in the peripheral sensory neurons result in the generation and maintenance of tumor induced pain. CIBP is usually described as dull in character, constant in presentation, and gradually increasing in intensity with time. A component of bone cancer pain appears to be neuropathic in origin as tumor cells induce injury or remodeling of the primary afferent nerve fibers that normally innervate the tumor bearing bone. The treatment of pain from bone metastases involves the use of multiple complementary approaches including radiotherapy, chemotherapy, surgery, bisphosphonates, and analgesics.

Cancer can affect the autonomic nervous system in a variety of ways: direct tumor compression or infiltration, treatment effects (irradiation, chemotherapy), indirect effects (e.g., malabsorption, malnutrition, organ failure, and metabolic abnormalities), and paraneoplastic/autoimmune effects. This chapter focuses on a diagnostic approach and treatment of cancer patients with dysautonomia, with an emphasis on immune-mediated autonomic dysfunction, a rare but potentially highly treatable cause of dysautonomia. Autonomic dysfunction can be divided into nonneurogenic (medical) and neurogenic (primary or secondary) causes. Orthostatic hypotension is a cardinal symptom of dysautonomia. The autonomic testing battery includes sudomotor, vasomotor, and cardiovagal function testing and defines the severity and extent of dysautonomia. Conditions encountered in the cancer setting that are associated with autonomic dysfunction include Lambert-Eaton Myasthenic Syndrome, anti-Hu antibody syndrome, collapsin response-mediator protein 5, subacute autonomic neuropathy, neuromyotonia (Isaacs’ syndrome), and intestinal pseudo-obstruction. The chapter describes various pharmacologic and nonpharmacologic therapies for treatment of orthostatic hypotension.

Despite treatment advances in the world of oncology, problems with sexuality, intimacy, and fertility persist for many women and men treated for cancer. Life expectancy of cancer patients, both young and old, has significantly increased due to advances in treatments of malignant diseases. Consequently, medical attention has expanded its focus to improving the quality of life of patients who have undergone cancer treatment. Sexual function and feeling healthy enough to be a parent represent two of the strongest predictors of emotional well-being in cancer survivors, and parenthood can represent a return to normalcy, contributing happiness and life-fulfillment. Often, cancer survivors fear that their disease or treatment history may adversely affect offspring conceived posttreatment, contributing risk for congenital anomalies, impaired growth and development, or even for malignancy. This chapter provides physical psychosocial spiritual dimensions of the fertility issues or symptom followed by its nonpharmacological and pharmacological treatment.

In human cancer, the role of genetic mutations, epigenetic alterations, and cellular repair mechanisms are becoming increasingly apparent. Recent studies have elucidated significant variations of the genetic codes that underpin cancer development in a variety of cancer subtypes. Genetic variations provide a backbone upon which cancer cells can adapt to overcome both intrinsic and extrinsic mechanisms designed to limit the growth of abnormal cells. This chapter provides an overview of the types of mutations, various epigenetic modifications, DNA repair mechanisms, and their relationship to the development of cancer, as well as various techniques utilized for the detection of these genetic alterations in cancer. With the development of new, advanced, and sensitive molecular techniques like next-generation sequencing and digital droplet polymerase chain reaction, our understanding of cancer biology is rapidly developing, and a critical appreciation and knowledge of these cancer-associated changes will likely lead to continued development of more effective therapies.

The vast majority of cervical cancer cases are human papillomavirus -mediated. Incidence and mortality significantly declined with introduction of screening with Pap smears. Adenocarcinoma often presents with larger tumors (“barrel cervix”) with higher risk of local failure. Cervical cancers are often asymptomatic and detected on screening, or can present with abnormal vaginal discharge, post-coital bleeding, dyspareunia, or pelvic pain. Three Food and Drug Administration approved vaccines are available that prevent the development of cervical cancer. Imaging includes positron emission tomography/computed tomography (nodal staging), pelvic magnetic resonance imaging (to delineate local disease extent and guide decisions on fertility vs. non-fertility sparing approaches). Treatment at early stages is often surgical, while Radiation therapy (RT)+/− Chemotherapy (CHT) is employed in later stages. When treating definitively, External beam radiation therapy is followed by an intracavitary or interstitial brachytherapy boost. Post-operative RT +/− CHT is occasionally indicated for adverse pathologic features.

World Health Organization grade III gliomas are referred to as anaplastic gliomas. The general treatment paradigm includes maximal safe surgical resection followed by adjuvant radiation therapy and chemotherapy (CHT). The randomized trials that established a survival benefit from chemotherapy used Procarbazine, Lomustine, and Vincristine (PCV). Concurrent and adjuvant temozolomide (TMZ) is given more often and is still subject to ongoing study. An improved understanding of genomics is rapidly informing the clinical behavior and treatment. Histologic subtypes of anaplastic gliomas include anaplastic astrocytoma and anaplastic oligodendroglioma (AO). Headache and seizures are the most common symptoms of anaplastic gliomas. Adjuvant radiation improves overall survival after surgery compared to observation or CHT alone and is indicated for all high-grade gliomas. Despite the survival advantage demonstrated with PCV in patients with AOs and AOs, many substitute TMZ as it is easier to administer and generally better tolerated.

The obesity epidemic is even more pronounced in rural America, and is a growing concern as rural adults and children are now more likely to be obese than urban adults and children. People who are overweight or obese are at increased risk for chronic disease and conditions such as hypertension, coronary heart disease, stroke, gallbladder disease, osteoarthritis, and some types of cancers. For women, obesity also is associated with complications of pregnancy, menstrual irregularities, hirsutism, and psychological disorders such as depression. Stress has been linked to obesity in adults and in children, and rural residents are continually subject to the stresses of poverty, limited access to health care, and geographical and social isolation. In rural communities, community organizations and families need to come together to identify common goals related to obesity prevention and identify and mobilize human and community assets to implement strategies they believe will work for their community.

This chapter provides new data and a critical look at the comparative assessment of different ethnic groups’ overall levels of savings given their different experiences in the labor market. It focuses on how employers differentially treat minorities to their disadvantage with a multiple regression analysis that identifies the independent negative impact of being a minority on retirement sponsorship and pension plan participation. Minorities have lesser access to employer-sponsored retirement plans because they are particularly affected by the substitution of defined benefit (DB) plan coverage for less secure and less comprehensive defined contribution (DC) plans. Social Security is an important source of retirement income for all Americans. Minorities are disproportionately employed in lower-paid industries and occupations, which have lower rates of retirement account coverage. Qualitative research and interdisciplinary collaborative studies of minority retirement behavior have emerged.

Migrant farmworkers are a distinct population within rural public health. This chapter considers the demographics, health behaviors, health conditions, access barriers, and programs and resources for the mobile poor population. Migrant and seasonal farmworker health issues that warrant special consideration include those related to occupational and environmental health, infectious diseases, mental and behavioral health, food insecurity, housing, and oral health. Present programs in health and education available to migrant farmworkers reach only a minority of farmworker families and need expansion as well as enhancement. Primary care services will be most effective when patient-centered care is coupled with outreach efforts and preventive health coverage. Cancer care, palliative care, and end-of-life care are areas in need of thoughtful program implementation. Public health practitioners and planners will be assisted by understanding the agricultural labor force in their region of concern, and the available resources for social and health services.

This chapter discusses the identification of individual differences in health behaviors and health status among minorities. Sickle cell disease (SCD), a genetic disorder, may serve as an optimal model for understanding issues of aging in minority populations. SCD is an important model of multifactorial conceptualization of genetic-based chronic disease among aging populations. Generally, molecular genetic methodologies are called to mind when people consider the role of genetic factors in health and disease. Behavioral genetic methods will be particularly useful if one begins studying minorities from the perspective that there is significant heterogeneity within populations of minorities. Conceptual and methodological discussions of heterogeneity within minority populations are particularly timely given the changing sociodemographic features of ethnic/racial populations related to health disparities. Socioeconomic status and education have been found to be important variables associated with the development of chronic illness.

This chapter focuses on the following topics: demography, gender, age at diagnosis/onset of cardiovascular disease (CVD), Medicare usage, work and retirement, social support, social context and neighborhoods, ethnography of families, qualitative research, and social policy. These topics constitute some of the key areas that should be the focus of future research on the sociology of minority aging. The chapter provides a rich description of trends in the ethnic and racial composition of older cohorts to illustrate the dramatic changes that have taken place in the United States in the past century. The rising costs of health care and the increasing older minority population, additional reform will be needed to maintain the sus-tainability of the program. Additional work examining within-race group differences is key to understanding minority aging issues given the large amount of cultural diversity in the United States.

Rural America may seem an unlikely setting for new trends in substance abuse. This chapter compares rural and urban areas and the rural continuum for prevalence of substance use and abuse, efforts to prevent substance abuse, treatment availability and accessibility, and continuing care and long-term support for abstinence. It also presents models of service delivery that address resource limitations common to rural areas. Van Gundy also found that substance abuse rates vary across racial and ethnic groups, though rates differ when socioeconomic status and other factors are considered. Nonmedical use of prescription drugs is a growing national problem and one that heavily impacts rural areas. Societal effects include the strain and economic costs absorbed by emergency rooms, treatment agencies, social service agencies, and the legal and criminal justice systems in coping with the consequences of meth abuse. Treatment models with relevance for rural providers address the shortcomings of existing services.

This chapter presents an illustration of the complexities involved in studying ethnic and racial influences on psychosocial processes and how they are intimately tied to physical outcomes in later life. It focuses on psychology as a discipline, minority aging research during the last several decades has revealed the need for multidisciplinary and intersectional conceptual and research approaches. The chapter also focuses on the age, gender, socioeconomic, cultural, and racial and ethnic graded influences on life course development that eventuate in unequal burdens of psychological and physical health morbidity and mortality for certain groups in late life. No section on psychology could be complete without a discussion of religion and spirituality among racial and ethnic minorities. Generational processes are clearly implicated in ideas about the cyclical nature of poverty and health behaviors that are intricately linked with environmental factors and social influence.

This chapter examines the Older Americans Act (OAA) through the prism of the coming nexus of aging and ethnic/racial diversity. It explains that the OAA can serve as a foundation for building a home- and community-based set of services for all older adults and persons with disabilities and for addressing aging in the 2lst century. The OAA is the primary federal program providing a host of services that enable older persons and their families to live in their homes and communities with a measure of dignity and independence. The OAA, Administration on Aging (AOA), and aging network today provide five major categories of services: access to social and legal services, nutrition, home- and community-based long-term social and supportive services, disease prevention and health promotion, and vulnerable elder rights protections. The OAA and the AOA remain secondary players in national agenda setting for an aging population.

This chapter focuses on informal caregiving among minority groups. It also focuses on context of caregiving and discuss the various specific challenges caregivers of minority older adults face. The chapter examines some of the specific caregiving interventions tailored for families of color and discuss the implications for practice, policy, and research. Medical advances and greater longevity point to healthier and longer lives for many, but both formal and informal caregiving remain a concern as individuals age and develop conditions that require care. Caregivers are often able to realize the positive aspects of caregiving when they are not struggling with financial or social support challenges. Despite the vast literature on caregiving in general, research pertaining to the needs and experiences of racial/ethnic minority older adults and their caregivers is limited, particularly for American Indians, Pacific Islanders, specific Asian American and Latino subgroups, and religious minorities groups such as Muslim Americans.

This chapter presents an integrative approach to the psychological study of minority populations and the reduction of health disparities through positive nonmaterial resources. It provides a brief introduction to positive psychology and to the concept of early life origins of disease, highlighting the value of integrating these seemingly disparate literatures as a lens for studying health and broader aging processes among minority populations. Minority status whether based on ethnicity, gender, socioeconomic status (SES), citizenship, religion, or other factors is a robust determinant of health, well-being, and success across the life span and intergenerationally. Positive psychology is relevant to health and development particularly physiological and psychological adaptation to stress across the life span, and even across multiple generations among humans in general and among minority populations in particular. Health inequalities are the result of unique challenges to successful psychological and physiological adaptation faced by minority group members.

This chapter discusses current thinking in the field of social support and social relationships, and physical and mental health among older racial and ethnic minorities. Social relationships are an important predictor of health and psychological well-being across the life course. Many minority older adults will face the continued challenges of declining functional status due to physical and mental health conditions over the course of their lives. Most empirical studies on social support among older racial and ethnic minority adults explore the association between social support and both physical and mental health. The wealth of studies on social support among minority older adults has much to offer with respect to understanding the correlates of emotional support and patterns of assistance. The biological mechanisms explaining the link between social support and physical health outcomes have been largely unexplored among older racial and ethnic minority groups.

This chapter presents reasons for why many individuals prefer receiving mental health care in a primary care setting. In fact, more persons with a mental health problem or illness are treated by a primary care provider than by a specialty mental health care provider. The chapter also presents the background for integration, including definitions, models, barriers, and evidence from the general integration literature. It describes the history of integration in rural areas and best practices of integrating care in rural areas. The chapter presents practical strategies for integrating care in rural areas. It provides case studies of integrated care in rural communities. The chapter reviews the experience and lessons learned by four rural primary care providers who have successfully integrated care. A number of national trends and policy initiatives are likely to influence access to rural mental health care in the years ahead.

This chapter examines racial and ethnic differences in disability in the United States with a focus on their patterns, trends, and determinants. Disability is responsible for massive social and economic costs to individuals, families, and health care systems. Racial and ethnic differences in health are one of the most widely studied topics in U.S. health disparities research. The risk of disability among older Asians is an understudied area, despite the growth of this population subgroup in recent years due to increased volume of immigration from Asia to the United States. There is an ongoing interest in measuring and understanding the patterns and causes of racial/ethnic differences in disability in the United States. Rising obesity may play an important role in the findings for Hispanic women and for the trend in disability for all race/ethnic groups.

This chapter describes the role of supplementary education–typically, a form of additional structured education that takes place outside of the school classroom–and how it can prepare learners for high academic achievement and effective engagement in the process of learning that is key to academic success. The idea of supplementary education is based on the premise that beyond exposure to the school’s formal academic curriculum, high academic achievement is closely associated with exposure to family and community-based activities and learning experiences that occur outside of school. The chapter presents the rationale and need for supplementary education. Related types of supplementary education include those that are implicit parenting, nutrition, family talk, parental employment, decision making, reading along with the children, socialization and acculturation, social networks, travel, and environmental supports, and those that are explicit (academic development, tutorials, advocacy, remediation, one-on-one tutoring SAT preparation, Saturday academies, specialized services, socio-cultural and child-centered social groups).

This chapter examines the history of long-term services and supports (LTSS) programs to document their racially and ethnically disparate impact, and explain the current research on the access and quality of LTSS used by older adults in communities of color. LTSS are a set of health and social services delivered over a sustained period to people who have lost or never acquired some capacity for personal care. The high costs of LTSS have led a smaller number of low-income older adults to consume a large share of Medicaid expenditures. Cultural beliefs about family responsibility to care for older adults as well as attitudes toward the use of formal and/or public health and long-term care services can shape older adults’ use of LTSS. The coming sociodemographic shift of older minority adults calls attention to other structural and cultural issues that facilitate or inhibit the appropriate use of LTSS.

A growing body of research documents racial and ethnic disparities in physical and mental health among older Americans. This chapter discusses larger stress process literature and reviews research on discrimination as a source of stress that is an influential determinant of racial and ethnic differences in the health status of older Americans. It provides a brief overview of disparities in health among older Americans. The chapter discusses the biology of stress, elaborates on key elements of the general stress process framework, and highlights findings pertinent to the health of older minorities. It reviews the research on personally mediated discrimination and health that includes findings from both age-diverse samples and those specific to older adults. The chapter also reviews the literature on coping with discrimination and the contribution of institutionalized discrimination to health inequalities. Lacking are investigations on the joint impact of perceived discrimination and residential segregation.

Lesbian, gay, and bisexual (LGB) individuals are more likely than their heterosexual peers to experience a variety of mental health and health-related problem behaviors, including emotional distress, suicidality, substance use, and sexual risk behaviors. This chapter investigates potential ethnic/racial differences in gay-related and non-gay-related stress among a sample of Black, Latino, and White LGB youths in New York City. It further examines whether ethnic/racial disparities exist in various mental health and health-related behaviors of LGB youths. The chapter then examine whether gay-related stress may account for the potential ethnic/racial disparities among LGB youths. The chapter reviews the research on sexual orientation disparities in health among LGB youths, followed by a review of what is currently known about potential ethnic/racial disparities in stress and health among LGB youths.

This chapter provides new insights, direction, and applicability of qualitative research methods in social network analysis, with special emphasis on the minority elder population. It describes how specific qualitative approaches may be applied and contribute to increased understanding in social network analysis. The chapter provides a list of suggested future directions to address issues that are void in the literature on social networks and minority elders. The social networks of older adults provide them with the greatest amount of care and support. Any definition of social networks needs to be grounded in both microstructural and macro-structural perspectives. The social networks of minority elders are uniquely shaped by the cultural norms and values associated with the diverse racial and ethnic groups with which they identify. The conceptual guidance from the life course perspective can also inform understanding the structure and function of social networks among minority elders.

This chapter describes four specific minority groups within rural areas namely African American; Hispanic; lesbian, gay, bisexual, and transgender (LGBT); and American Indian/Alaskan Native. It also describes leading health issues such as diabetes, heart disease, stroke, hypertension, and cancer among rural Hispanics, contributing factors to health disparities among rural Hispanics. The chapter offers recommendations to improve health and eliminate disparities among rural Hispanic populations. For rural African American communities, community-based settings like churches have been found to engender higher participation and retention rates for health promotion programs. Factors such as poverty, health insurance, and having a health care provider contribute to the health disparities among rural Hispanics. Innovations such as telehealth and community-based participatory research hold much promise for advancing health within rural minority groups such initiatives should be encouraged, supported, and appropriately funded to begin to address health inequity in the doubly underserved populations.

This chapter presents new paradigms for inclusive health care, articulating the need for both individual patient and population health approaches, while highlighting the role of home-based interactive computer technology in having a wide impact. It describes the high costs of health and mental health behaviors. The chapter explains science’s and health care practices low impact on health and mental health behaviors. It describes higher impact paradigms that can complement current paradigms of research and practice. Integrated health care paradigm is an innovative approach to population health, which would integrate services across biological and behavioral disciplines. The chapter discusses in detail clinician and computer paradigms, clinician and computer-based clinical trials, from single to multiple behavior change paradigms, high specificity vs. high generality, and higher impact science and service.

This chapter focuses on more integrated approach or process for developing a health intervention for ethnic minority groups that incorporates accepted principles of medicine and scientific methodology. The changing demographic has led to complex challenges in the U.S. health care system. The delivery of effective health care services hinges on health care professionals’ ability to recognize varied understandings of and approaches to health care across cultures. Health care providers may employ different strategies to increase participation of service users by bridging barriers to communication and understanding that stem from these racial, ethnic, cultural, and linguistic differences. In the context of health or health care improvement, little debate exists concerning the recognized need to help ethnic minority patients maintain and restore health. There are two general approaches for developing culturally appropriate health interventions. The first approach is from science to practice and the second approach is from practice to science.

This chapter discusses the history, organization, development, and the future of Medicare and applies Andersen’s Behavioral Model of Health Services Use to understand utilization among the elderly and conduct a systematic literature review. It analyzes racial/ethnic disparities in health care utilization among the elderly using Andersen’s model and discuss the implications of the current proposals for changes in Medicare for health care utilization especially among minority aging. Racial/ethnic differences in seniors’ use of medical care were sizable before the Medicare program. The focus on deficits and controlling the cost of government has in turn increased the focus on health care and entitlement programs like Medicare. Medicare is important to ensure access to health care for the elderly, particularly the poor and minorities. However, with the rising health care costs and changing demographics, it is clear that Medicare needs some type of reform to ensure its continuing viability.

This chapter provides selective review of research on religion and spirituality across three groups of racial and ethnic minority older adults African American, Asian American, and Hispanic/Latino. It discusses major denomination and faith traditions, as well as information about types and patterns of participation and their sociodemographic correlates. The chapter examines informal social support provisions within faith communities and the types of assistance exchanged. It also examines associations between religion, spirituality and physical/mental health, and psychological well-being. Religion and spirituality, through a variety of psychosocial mechanisms and pathways are thought to have largely beneficial impacts on physical and mental hea.

Twenty-five years into the epidemic, AIDS remains a significant public health issue that highlights the persistence of health disparities in the United States. This chapter provides an example of the best case scenario outcome: a new emergent evidence-based model for reducing HIV/AIDS risk with serodiscordant couples worthy of dissemination, and adaptation to new culturally distinct populations. It reviews current research on HIV prevention for couples and highlight the rationale for conducting couple-based intervention research. The chapter describes the process of designing Project Connect, a cultural- and gender-specific HIV/STI prevention intervention. It presents theories that guided the study. The chapter describes the content of the intervention and finally discusses the implications of the efficacy of Project Connect for the design and dissemination of culturally-congruent interventions to address the AIDS epidemic among ethnically diverse women and their male partners.

This chapter focuses on aging and health issues in all of America’s major minority populations including African Americans, Hispanics/Latinos, Asian Americans, as well as Native Americans. It addresses the issues of health inequality and health advantage/disadvantage. The chapter introduces relatively new areas of inquiry including long-term care, genetics, nutrition, health interventions, and health policy issues. In addition to possible genetic factors, the literature has emphasized the influence of poverty and socioeconomic status as well as stressors associated with minority group status. The system of long-term care services will need to be restructured to take into account issues affecting minority populations such as health care coverage, housing and income supports, as well as cultural issues as filial piety and trust. The field of minorities, aging, and health has been dominated by a health inequality perspective that has been illustrated by the application of cumulative disadvantage/cumulative inequality theory.

This chapter introduces the scope of this volume by reviewing thirteen guiding principles for a new field of equity in health. The thirteen guiding principles are: The drive for a major paradigm shift, the drive for new models of health care and training, the drive for new theories, perspectives, and identities, the drive for evidence-based approaches, the drive for transdisciplinary teams and community-based participatory research, the drive for globalization and global collaboration, the drive for cultural competence and cultural appropriateness, the drive for health literacy and linguistic appropriateness, the drive to ensure the right to health, the drive for social justice and acknowledgment of forces in the social context, the drive to protect and support the most vulnerable, the drive to repair damage, restore trust, and take responsibility, and the drive to redistribute wealth and access to opportunity. These principles provide hope for a future global transformation in health.

This chapter describes the use of new media designed by education technologists to improve learning. It illustrates the potential of such media to disseminate an evidence-based model for HIV/AIDS risk reduction, enrich the training experience, and expand the possibilities for disseminating content arising from various fields. The chapter describes the Columbia Center for New Media Teaching and Learning (CCNMTL) an organization devoted to providing service to University faculty, who aspire to use digital media as part of their educational efforts. It shows how in conjunction with the Social Intervention Group (SIG) at the Columbia University School of Social Work. CCNMTL developed a multimedia version of Project Connect that may improve its efficacy, exponentially extend its dissemination, and also enhance classroom practice in related fields by repurposing Connect’s assets for classroom use. Lastly, the chapter explains how CCNMTL’s work with SIG led to the development of the Triangle Initiative.

This chapter provides a selective review of research on social support among older African American, Hispanic, Asian American, and Native American adults. It focuses on social support as a dependent variable in relation to different sources and types of aid provided to older African American, Hispanic, Asian American, and Native American adults. The chapter highlights the findings in three specific areas: marriage and romantic relationships, extended family and non-kin as sources of informal social support, and black-white differences in informal social support. Informal social support networks are critical for individuals of all ages but especially for older adults who are dealing with difficult life circumstances. Older African Americans depend on informal social support networks of family and friends for assistance in emergency situations, as well as for help with various tasks of daily life. Elderly Asians often utilize kin and social support networks for a variety of reasons.

The Social Education and Health Advocacy Training (SEHAT) project is a peer-led client-centered participatory program that aims at increasing health awareness and preventive behaviors among the prisoners, with an emphasis on HIV prevention. This chapter discusses the value of peer-led prison-based interventions. It explains the theoretical rationale for the SEHAT intervention, the process of designing SEHAT and developing strategic partnerships. The SEHAT intervention drew upon various theories of health behavior change such as the Health Belief model, Transtheoretical Model, Social Learning Theory, social support, as well as elements of relapse prevention in its skills training sessions. The chapter presents the planning, funding, implementation, and time-lines for the SEHAT program. It also describes the accomplishments and evolution of SEHAT to date, and finally, SEHAT’s future directions and needs.

This chapter focuses on the factors that intersect with race and ethnicity in shaping the experiences of families from racial and ethnic minority communities. It presents a conceptual framework using a Venn diagram that shows the intersection between aging and having a serious mental illness (SMI) or developmental disabilities (DD), limited services for these aging populations, and being a person of color with SMI or DD. People with DD and SMI are now experiencing increased life expectancy due to improved medical and technological advances. However, understanding the needs of aging adults with DD and SMI from diverse communities in the United States and their caregiving families is particularly challenging, because historically, there have been racial and ethnic disparities in the use of specialty health care services. Older adults with DD and SMI from racial minority groups are disadvantaged on multiple domains.

This chapter frames the behavior of patients within a psychosocial model of resilience, underscoring the role of adaptive coping strategies. It presents the results of a study exploring the utility of resilience theory in guiding understanding of the beliefs and practices of African Americans toward colon cancer screening. The chapter proposes that resilience theory will provide a framework for understanding where health-prevention and related behaviors fit in the overall life schemas of persons at risk. The chapter also uses resilience theory to understand the processes that would lead to better access to and actual use of colorectal cancer screening in minority populations. These research findings have potential to guide the development of a targeted intervention to encourage colorectal cancer screening among minority individuals. This study is a first step to explore personal views of key representatives of the African American community, female elders, with regard to colorectal cancer screening.

Mental health professionals play a critical role in enforcing social justice in mental health care service. This chapter discusses various characteristics of and attitudes about mental health services that may serve as barriers to parity in mental health service delivery and services among African Americans. It describes strategies for mental health providers and systems in addressing these service delivery disparities. These strategies improve the quality of mental health services for African American clients, minimize structural barriers in the receipt of mental health care among African Americans, and decreases the stigma associated with counseling use among African Americans and promote more favorable help-seeking attitudes among African Americans. Mental health professionals should work at the individual, community, and institutional levels to address external barriers, differential quality of care, and beliefs that African Americans may bring into their interactions with mental health systems.

This chapter delves into critical issues involved in finding an appropriate balance between scientific and ethical considerations in assessing merits of community health intervention research. It discusses the emerging challenges to the field posed by the recent call for “evidence-based” public health and addresses the need for achieving a sound balance among the demands for collecting the most rigorous scientific evidence possible. The chapter then takes up the question of ethical concerns regarding fair allocation of public resources at National Institutes of Health. It argues that the skew toward individual interventions has resulted in an undue emphasis on individual behavior change as a common yet not necessarily warranted outcome measure in the hierarchy of funded research. It concludes with a recommendation based on the work of Daniels and Sabin (1997) for using a fair procedure, called “accountability for reasonableness”, for making decisions regarding priority of different types of health research.

This chapter recognizes how men who have sex with men (MSM) are currently living at the intersection of two epidemics–one involving HIV/AIDS and another involving methamphetamine (MA) drug use. It offers recommendations for researchers and clinicians working with this special population. The chapter discusses the range of health disparities impacting MSM to place their lives in context. It describes recruitment and study participation issues with MSM communities and clinical treatment issues with MSM using methamphetamine Health care access disparities are more emphasized among MSM of color who may have a more difficult time due to socioeconomic status, insurance status, as well as fear of stigma and disclosure by health care providers. Reaching out to and communicating with MSM communities require cultural sensitivity, cultural competence, and replacing any maladaptive responses with adaptive responses, such as acceptance, respect, and empathy–going well beyond tolerance.

The idea of protecting the health of rural populations, or rural public health if we will, is not new. In reality, however, most public health principles and practices are developed, applied, and evaluated in urban settings. As the field of public health grew beyond infectious disease concerns to encompass areas such as maternal and child health, chronic diseases, and mental health, the shift from an urban focus to a more inclusive view of all geographic diversities did not follow, however. Two of the most pressing challenges faced by rural residents are poverty and access to basic health services. Many researchers agree that one major complication in examining rural health outcomes is the lack of a consistent, objective measure of rurality. Because rural economies often center on agriculture, a highly volatile market, economic uncertainty is almost a staple in rural communities.

This chapter provides definitions and theoretical perspectives regarding the productive engagement of older adults. It explores the productive engagement of four ethnic minority groups African Americans, Hispanic Americans, Asian Americans, and Native Americans. The chapter discusses programs and policies that will help increase the productive engagement of older adults. It is possible that older adults will be judged by their ability to be productive and expected to be productive. Those older adults who have been disadvantaged across the life course will continue to be disadvantaged in later life when they still face discrimination in access to or support for productive engagement. Both definitions and theoretical perspectives are important to understanding the productive engagement of older racial/ethnic minorities. At the societal level, increasing the productive engagement of older adults, in general, may increase the supply of experienced employees, volunteers, and caregivers.

This chapter focuses on potential new lines of inquiry that emerge from the synthesis of research in ethnic geography, urban studies, race/ethnicity, and age/life course. It emphasizes the importance of integrating work from ethnic geography into studies of minority older adults and their neighborhoods. There has been a long tradition of work on the role of neighborhoods for minority older adults, ranging from their health-protective elements to their challenges for older adults. Research on neighborhood context for minority older adults could benefit from an expanded view of age in studies of place. Research on minority older adults and neighborhoods could also benefit from an expanded focus on place in studies of age, namely integrating research from ethnic geography. Integrating research from multiple levels of context, ranging from cross-national migration to attachment to place, opens a new vista of inquiry on minority aging and neighborhoods.

This chapter describes the impact of intersecting identities that affect lesbian and bisexual (LB) women of color. It discusses the communication and legal concerns that may lead to complex and difficult diagnostic and treatment considerations and problems of access to health care, and offers recommendations for health care researchers and practitioners. The chapter refers to the concept of multiple identities or the notion that most patients have more than one important locus of identity and that they may include more than one identity that is disadvantaged. This is particularly relevant for LB women of color. The Communication and legal issues are illustrated via two brief cases, which demonstrate a number of communication issues that often arise in the acquisition of important medical information from LB women of color. Sexism and heterosexism affect women of color and White women differently. Racism affects African American heterosexual, lesbian, and bisexual women differently.

This chapter provides an overview of key theoretical considerations that are important to understanding mortality and longevity differences across groups. It focuses on the historical and social contexts as well as the life course processes that are most important in understanding patterns and trends of race/ethnicity, aging, and mortality/longevity in the United States. The chapter provides a new empirical analysis of race/ethnicity and U.S. adult mortality risk, focusing on key demographic and socioeconomic factors that influence mortality differentials across groups. It also focuses on critical research needs and on the ways that social and health policy might effectively influence future mortality and longevity trends for all race/ethnic subgroups in an increasingly diverse and aging society. The understanding of race/ethnic patterns and trends of mortality and longevity must also consider the ways in which the life course unfolds in unique ways across groups.

This chapter provides a comprehensive overview of the challenges involved in eliminating health disparities. The U.S. Department of Health and Human Services (HHS, 1985) Secretary’s Task Force report on Black and Minority Health was a landmark document with regards to minority health. The report identified a number of important categories of diseases that caused the overwhelming majority of excess death in minority populations. Despite signs of tremendous medical progress, minority racial and ethnic groups continue to experience an unequal burden of serious illnesses, premature death, and disability in the United States (Zerhouni, 2005). The illnesses that make up the burden described are “complex” or “multifactorial diseases”, as they arise from combined actions of many genes, environmental risk factors, including socioeconomic factors and risk-conferring behaviors. Another environmental consideration is social and behavioral determinants of disease and disability.

This chapter provides definitions and scope of the problem of eliminating disparities in end-of-life (EOL) care. It provides a translation of the theories and research that can be used to guide social work practice with minority older adults. The chapter suggests that when working with minority elderly, the psychosocial needs of the patient and family become even more critical in decisions that may affect the timing of death. The term end-of-life care traditionally refers to the last phases of an illness before death; however, experiences across the earlier course of the illness are critical to shaping the anticipation, expectations, and preparedness for care during the terminal phases of illness. In terms of EOL care decision making and the disparity in hospice utilization across racial groups, Critical Race Theory (CRT) offers insight for looking at race relations in a broader context than the traditional perspective.

Improved nutritional status is an important component of efforts to improve the health of older adults, whose ability to consume a healthy diet is affected by comorbidities and behavioral, cognitive, and psychological factors. In addition to genetics and nutrition intake, nutritional status of the elderly could be affected by socioeconomic factors, such as education and income levels, and environmental factors, such as proximity to stores and transportation, that can affect food variety and availability. Nutrition and aging are connected inseparably because eating patterns affect progress of many chronic and degenerative diseases associated with aging. Anthropometric measurements are often used for nutritional assessment of older adults and are reliable across ethnicities. The Mini-Nutritional Assessment (MNA) tool was developed to evaluate the risk of malnutrition among frail older adults. Dietary patterns may better capture the multifaceted effects of diet on body composition than individual nutrients or foods.

This chapter examines conceptual frameworks and theories on racial and ethnic health disparities that can apply to cardiovascular diseases (CVD) among middle-age and older age adults; investigate age at onset/diagnosis of CVD as it varies by race and ethnicity, with some explanations as to why these disparities exist; understand difficulties with CVD self-care/management by race and ethnicity, with some explanations as to why these disparities exist; and discuss future directions, considering data, prevention, and intervention, and policy needs. Several conceptual models and theories can address racial and ethnic CVD disparities among middle-age and older age adults, including the social determinants of health (SDOH) model, the social-ecological model, and life course theory. An earlier age at onset/diagnosis of CVD for racial and ethnic minorities potentially leads to earlier health declines and earlier death because of access to care and self-management difficulties.

This chapter describes, toward the goal of closing the academic achievement and health gaps, an example of a supplementary education program rooted in an academic, community and faith-based coalition. It presents the context for and subsequent development, implementation, evaluation, and refinement of a supplementary education program. The chapter presents the process, and the results of an evaluation of the supplementary education model for its 5 year anniversary. It describes the key theories guiding Goldquest program development. Key program features include ensuring effective engagement in the learning process via the use of marbles given to reward/shape behavior, and youth involvement in community service via the National Association for the Advancement of Colored People (NAACP). The twelve key program components are: Marbles, Practice SAT, Math of the Day, Word of the Day, Math Game, Word Game, Deep Breathing, The Radio Show, Activity Sheets, Peer Tutoring, NAACP Peer Teaching, and NAACP Membership.

This chapter focuses on the changing health care policy climate. These changes can either reduce current barriers or create new challenges to health care. The Patient Protection and Affordable Care Act (ACA) has reformed the Medicare payment system and incorporated the voice of older minority adults in shaping the performance of their local health care delivery system. Health care access inequity and policy-based remedies have historic roots in U.S. civil rights legislation. The civil rights of older adults and their access to health care were resolved through Medicare. ACA policy creates an opportunity to reframe health disparities research as a consumer issue. However, the terms health disparities, older minorities, and barriers to care are not usually viewed as consumer issues. Standardization of health care practice creates research opportunities for social gerontologists to evaluate policy and its impact on health care access disparities.

This chapter outlines the process of successful grant-writing to obtain funds to support community-based health disparities research and services. It provides background information intended to clarify common conceptual elements of community-based participatory research (CBPR) that influence the development of community-based projects and proposals. The primary focus is on an academic/community model for health disparity community-based initiatives, which often serves as the foundation for proposal and project development. The chapter includes recommended strategies for initiating and maintaining community partnerships for effective proposal development and program sustainability based on the historical and collective experience of Morehouse School of Medicine. It argues the fundamental importance of community participation in all aspects of proposal development–from the definition of the problem or need to outcome evaluation.

This chapter summarizes and discusses the findings of the predictors of nursing home admissions and the issues regarding access among four groups of racial/ethnic minority older adults: blacks/African Americans; Hispanics/Latinos; Asians/Pacific Islanders; and American Indians/Native Americans. It provides a summary of the need for providing culturally competent nursing home care and future directions for alleviating racial/ethnic disparities and segregation in nursing home care. Minority older adults were once disproportionately underrepresented among nursing home residents. With the demographic revolution among racial/ethnic minorities and older adults, the number of racial/ethnic minority nursing home residents will continue to increase. Improvement in the quality of nursing home care for racial/ethnic minorities also requires culturally competent care. In providing culturally competent nursing home care, nursing home administrators and staff should involve community representatives from faith/spiritual communities and from civic and cultural organizations in the facility’s planning, monitoring, and quality-improvement meetings.

This chapter provides a review of public policy and public programs related to important aspects of the welfare state in the United States, with particular attention to the impact of various policies and programs related to income support, health care, and housing on low-income and minority Americans. It focuses on the guiding principles that motivate the various parties in today’s welfare state debates and investigate how the basic structure of the way social welfare is guaranteed in the United States affects low-income and minority individuals. The chapter also focuses on the general features of our economic, political, and social systems that place minority Americans at serious risk of poverty and ill health throughout life, including its waning years. The welfare state represents a relatively late development in human social, economic, and political history. Social Security is particularly important for minority Americans.

This chapter considers aging in place both within larger community and societal contexts as well as through description of the unique experiences of older Latinos or Hispanics, African Americans, Asian Americans, Native Americans, and Pacific Islanders. In addition to racial and ethnic status, aging in place may also be influenced by changes in longevity, family demographics, caregiving, and household structures. Most considerations of aging in place emphasize the importance of the fit between the physical environment and the individual to successfully age. The recent addition to the model of the individual life course and historical change now offers a means to recognize three particularly influential components of aging in place relevant for African Americans, Latinos, Asian Americans, Native Americans, and Native Hawaiian/Pacific Islanders: social capital, the impact of the social environment, and acculturation. The characteristics of assisted-living residences or assisted-living facilities vary across the United States.

This chapter presents pertinent historical background on the Children’s Health Fund (CHF) and details on the partnerships allowing the work of the Children’s Health Fund’s Childhood Asthma Initiative (CAI) to go forth, both at the South Bronx Health Center for Children and Families (SBHCCF) and the New York Children’s Health Project (NYCHP). It offers three case studies of asthmatic patients and their parents that highlight the contemporary asthma education challenge. The chapter describes the work of the CAI and our models of interactive community asthma education. It introduces the CAI model for integrating asthma education into the public school literacy and science curriculums, and also presents emergent principles and recommendations for others to follow for creating a comprehensive community-wide health education initiative. The chapter introduces an innovative model of interactive comprehensive community-wide health education focused on increasing asthma awareness via partnerships, community collaborations, and the public school curriculum.

This chapter presents a case for examining aging in the United States through an inter-sectionality lens. It begins by presenting age, gender, and race/ethnicity as social constructions, followed by a conceptual overview of intersectionality to highlight strengths as well as challenges in this approach, particularly as it relates to health. The chapter reviews the most current thinking on gender and minority health, with special attention to social roles and contextual factors, and methodological approaches. The social construction of gender has been widely addressed in the sociological literature, with identified insights for better understanding health and the aging process. Research on gender and physical health outcomes draws much greater scholarly attention than mental health in later life. The intersectionality paradigm has provided new directions for identifying the importance of gender as a key element for predicting health across the life course.

This chapter discusses new policies to counter those that have been destructive to communities, led to the incessant displacement of communities, and effectively created the social context for the emergence of health disparities. The chapter uses interviews and observations collected as part of a study of urban renewal to suggest that these seemingly discrete policies have interacted to create a set of disadvantages that contribute to the spread of AIDS and as well as other health and social problems. It proposes that incessant displacement is at the root of America’s health disparities. The chapter analyzes interviews for comments specific to the policies of segregation, redlining, urban renewal, planned shrinkage/catastrophic disinvestment, gentrification, HOPE VI, and mass incarceration. In addition, the chapter examines the movement of populations over time in the Newark, NJ area using methods from population, community, and ecosystem ecology and quantitative geography.

This chapter describes the unique issues of HIV prevention and treatment in rural areas in the United States. The associated cultural factors can serve as barriers to accessing HIV prevention and treatment services, such as lack of insurance coverage and provider shortages in rural areas. Barriers to receiving health care include provider shortages and inexperience, lack of consistent primary care provider contact despite available Ryan White funds, lack of social support, and stigma. Fear of disclosure, lack of health care and support services, and limited treatment options are barriers to effective prevention and treatment in many rural areas across the country. Rural midwestern communities are characterized by limited access to primary care, self-care education, mental health and family support services, and community educational programs. Online health promotion interventions could be particularly useful for men who have sex with men (MSM) living in rural areas who are at risk for HIV/AIDS.

This chapter discusses various factors that influence cognitive aging in racial/ethnic minority groups. It presents evidence regarding the relationships between cognition and self-rated health, cardiovascular disease, hypertension, and mortality. The chapter explains the role of language and bilingualism as it relates to minority cognitive aging. To advance the current knowledge regarding cognitive aging in minorities, appropriate research designs are vitally important. Cross-group research has generated literature on cognitive aging in racial/ethnic minority groups. The cognitive aging advantages of improved educational quality associated with desegregation appear to have been diminished by negative aspects of the school environment, such as racism experienced by African American students. The inclusion of racial/ethnic minorities in cognitive aging research challenges scientists to use appropriate research designs and broaden research questions by examining within-group variability to better describe the diverse aging population.

This chapter discusses the kind of classroom-based interventions that hold the promise of closing the gap, or reducing academic disparities between low-and high-income students. At the core of interventions is the learn unit–which can be measured as the key component of effective engagement for learning. The chapter discusses the research on learn units and its implications for improving academic outcomes for low-income students. It recommends that teachers present learn units more frequently by modifying their current instructional behaviors, and by using curricula and tactics such as Direct Instruction, Precision Teaching, and response cards, which all increase learn units. The chapter also reviewes components of programs that effectively use learn units to instruct students. It highlights models of schooling that measure learn units and/or academic engagement, including the Comprehensive Application of Behavior Analysis to Schooling, Juniper Gardens Children’s Project, and the Morningside Academy.

Social work is an applied discipline with a long tradition of using the theories and methods of social sciences to enhance practice, policy, and research. In their professional roles, social workers practice work with minority older adults and their families in diverse community-based and institutional settings that encompass social and health services. The conduct of social work practitioners and researchers in working with human populations is guided by the Code of Ethics of the National Association of Social Workers. A more sustained and concerted effort is required to ensure that there is a sufficient supply of gerontologically trained social workers to meet the growing demands of a more aged and diverse society. Social work researchers and practitioners will need to be responsive to the impact of government social spending cuts on the availability and delivery of services to their elderly clients who are most in need.

This chapter explores health disparities impacting people with disabilities, underscoring the need for future global health leaders to embrace the value of pursuing equity in health for all within a movement that also represents the needs of the special population of people with disabilities. It defines the complexity of understanding health disparities for people with disabilities and describes the relationship between disability and health. The chapter explores the access to health care inequities that exist for people with disabilities. It describes the relationship between unemployment and the benefits that are and are not available to people with disabilities such as Social Security, Supplemental Security, Medicare, and Medicaid. The chapter discusses the future research and policy changes that are necessary for improving access to health care for people with disabilities.

This chapter introduces the online multimedia peer education smoking cessation program for Korean youth. It begins with a presentation of the three empirically derived models in which the program is rooted and from which the training curriculum arises. The chapter presents the training outline and program flow-chart/time-line for the overall online multimedia peer-education smoking cessation program. It provides a sample script of the kind deemed desirable for submission within the planned contest, illustrating the links between the curriculum content and what trained peer educators should produce in their scripts to achieve desired effectiveness. The chapter presents an analysis of the script, highlighting how the script reflects the program’s roots in the three evidence-based theories and concludes by offering key ingredients to success of the proposed program. The program reflects contemporary social trends and interests among Korean youth, integrating an interactive Internet intervention, peer-led education, and the use of multimedia.

This chapter provides an overview of recent population estimates, trends, and projections of older adults, with a specific focus on minority populations. It explains aging trends among several specific minority groups and discusses their different profiles in general demographic terms. The chapter focuses on older immigrants from Latin America and Asia, although there are significant streams of immigration from Europe, the Middle East, Africa, and other regions of the world. Minority elders represent the fastest growing segment of the older population in the United States, and as a result, the older adult population is becoming racially and ethnically more diverse. In addition to race and ethnic minority classifications, persons immigrating to the United States may be considered a minority group. The sex ratio among minority elders differs substantially from that of the total population, due to gender imbalances in immigration patterns and variability in the female survivorship advantage across groups.

Health professionals and consumers increasingly rely on various types of health-related data and information to support a broad range of functions ranging from public policy, research, service planning, and delivery through consumption. Informatics, the science of information management in health care, offers applications that can be used to support each of these functions and more. This chapter describes a role for health informatics and information technology (HIIT) in shaping a global research agenda to eliminate health disparities, covering international developments. HIIT can be useful in many ways to address disease burden and disparities. For example, it can support surveillance of disease and health threats, manage services and resource allocations, track service utilization, document epidemiological and etiological relationships in disease processes, facilitate clinical decision making, and organize patient health information.

This chapter reviews the evidence to date from the hypertension (HTN) literature that addresses three major components of the conceptual framework described in the Institute of Medicine (IOM) report as an umbrella to frame the mechanisms for hypertension-related disparities between African Americans and Whites. Relevant patient-related factors in hypertension literature include poorer responsiveness to treatment; poorer rates of adherence to prescribed antihypertensive medications; and patient preferences and beliefs about HTN and its treatment. At provider-level, disparities may result from poor doctor-patient communication in the medical encounter due to a racial/ethnic mismatch between the patient and physician; greater rates of clinical inertia; differential rates of prescribing behavior; and stereotypic beliefs about African American patients due to low levels of cultural competency. Problems at the level of health care system include a lack of access to and quality of health care; and changes in the financing and delivery of health care services.

Scholarship on ethnic minority families and aging has wrestled implicitly or explicitly with the understanding of a theoretical dichotomy not uncommon in the field of sociology as a whole: the role that culture plays as either an epiphenomenon and/or as an integral element of the social structure. Interpretations of that basic structural versus cultural duality may derive from broader ideological perspectives, but they may also reflect a superficial framing of the concept of culture in scholarly analyses of ethnic minority families. This chapter presents a review of ethnographic literature on minority families and aging that is grounded in both racial/ethnic and feminist perspectives. It discusses three major topics that emerged as most salient in recent ethnographic studies: the concepts of familism, family obligations, and filial piety; the role of living arrangements, urban/rural space, and the neighborhood context on family experiences; and intergenerational relations, health, and caregiving.

This chapter studies the quality of health and health inequality among racial/ethnic groups as well as across geographic areas of the State of New York, and focuses on income-related health inequality. The chapter generates a continuous measure of health by modeling the five-category self-assessed health (SAH) as an Ordered Probit Model conditioned by several objective determinants including different diseases, behavioral risk factors, and socio-demographic characteristics. It is organized as follows: The estimation procedures-the methods to calculate quality of health; describes income related health inequality and their determinant; documents the data used in the empirical analysis is documented; presents the results; and finally summarizes the conclusions. The chapter uses an ordered response model to transform the order scale variable into a cardinal variable. It offers New York health policy makers certain guidelines to eliminate health disparity in the population.

This chapter attempts to evaluate the expected utility of two approaches to racial disparities, one based on race as a social construct and the other based on race as a proxy for geographic ancestry and genetics. Current social and political discourse favors individual-level and technology-based solutions over extensions of social contract implicit in American politics. The first “ethnic drug”, BiDil, was approved by FDA for treatment of heart failure specifically in African Americans. Birth weight, is the most important determinant of infant mortality differences between Whites and African Americans. The chapter explores “healthy immigrant” hypothesis in a study of birth weight patterns emerging in the generation after women migrated from African or Caribbean countries. It discusses the importance of eliminating racial disparities for reducing white infant mortality. The chapter suggests that a redirection of disparities research will come as part of a more profound change involving the whole society.

This chapter describes how cardiovascular health disparities were addressed via the Chinese-American Healthy Heart Coalition, while distilling principles for effective collaborations that others may follow. It emphasizes the use of a community-wide multipronged integrated approach to providing culturally competent and linguistically appropriate health education and health care services for medically underserved Chinese immigrants, as well as use of an asset-based community development intervention approach focused on increasing social capital. It discusses innovative strategies used by the Healthy Heart Coalition in addressing cardiovascular diseases among Chinese Americans in New York City. In addition, the discussion covers the process involved in capacity building, sustaining and managing a coalition, as well as lessons learned through this collaborative venture. The chapter presents a case study, which illustrates the substantial resources, time, and effort required in forming such partnerships, and discusses strategies that the Healthy Heart Coalition used to counter some of the major challenges.

A number of strategies have been developed to address the problems faced by rural populations in achieving a healthy mental status. Many of these approaches directly counteract some of the barriers to maintaining mental health or receiving mental health services that rural residents face. Two of the most promising approaches are integrated care services and telehealth technologies. Currently, licensure restrictions limit the ability of telehealth to meet the demand for services, and policy advocacy to expand scope of practice to allow for more widespread use of tele-mental health services would help directly address the provider shortages seen in rural settings. By becoming familiar with the unique needs, mental health burdens, and cultural influences of rural populations and combining that knowledge with the latest information on evidence-based approaches to address barriers to care in rural areas, mental health professionals can begin to make a difference in the lives of rural populations.

This chapter discusses treatment planning for gastrointestinal radiotherapy. It describes patient setup, immobilization, and planning technique for esophageal cancer external beam radiation therapy (EBRT). The chapter provides patient setup and immobilization, motion management techniques, target delineation, and planning technique for pancreas fractionated EBRT. It explains patient setup and immobilization, motion management techniques, and planning technique for pancreas stereotactic body radiation therapy (SBRT). The chapter presents patient setup and immobilization, motion management techniques and planning technique for rectal cancer EBRT. It describes patient setup and immobilization, and planning technique for anal cancer EBRT. Finally the chapter explores patient setup and immobilization, motion management techniques and planning technique for liver SBRT.

This chapter discusses strategies for radiation therapy treatment planning for thoracic cancer. It provides a brief description of immobilization on 3D and modulated radiation therapy (intensity modulated radiation therapy [IMRT], volumetric modulated arc therapy [VMAT]), and stereotactic body radiation therapy (SBRT). It describes the image acquisition for 3D and modulated radiation therapy (IMRT or VMAT) and SBRT. The chapter discusses the localization for 3D and modulated radiation therapy (IMRT or VMAT) and SBRT. It presents the beam energy requirements for 3D plans, IMRT and VMAT, and SBRT. The chapter also provides treatment planning volumes for beam energy. Finally it describes treatment planning for 3D, IMRT and VMAT, and SBRT.

Intracranial imaging is vital to the initial evaluation, staging and treatment planning, and posttreatment follow-up of brain tumor patients. The modalities used to evaluate the brain are CT and MRI. A familiarity with basic radiologic concepts can enable a provider to better translate the intracranial process to clinical care. This chapter is intended to give the clinician a baseline for interpreting images independently in either the acute or chronic setting. Imaging of the brain using CT and MRI techniques is essential to the evaluation of patients with intracranial malignancy, both in the acute and chronic setting. Knowledge of basic imaging principles related to the presence of an intracranial mass and familiarity with findings unique to certain malignancies are useful tools for the clinician. These skills can be built over time by reviewing patient images independently, utilizing the kinds of fundamentals discussed in this chapter.

Interventional pain procedures are an adjunct to pharmacologic therapy for cancer pain. While pain at the location of the tumor might be the primary cause of pain, cancer patients may also have non-cancer related pain as a result of altered anatomy or biomechanics, for example, myofascial pain. Myofascial pain is pain or autonomic phenomena referred from active trigger points in the muscles, fascia, and tendons. This chapter discusses about the therapies for muscular pain which includes the trigger point, botulinum toxin, acupuncture, therapies for peripheral nerve mediated pain, local blockade, ultrasound guided procedures, sympathetic blocks, complex regional pain syndrome, spinal procedures, epidural steroid injections, neuromodulation, vertebral procedures and facet arthropathy. Kyphoplasty and vertebroplasty not only have been studied most extensively in stabilizing compression fractures from osteoporosis, but have also been used to treat fractures resulting from osteolytic metastasis, myeloma, vertebral osteonecrosis, and hemangioma.

This chapter provides a brief description on principles of breast reconstruction in cancer. Breast cancer will impact one in eight women over the course of their lifetime. While breast conserving therapy is a mainstay of surgical treatment with outcomes equivalent to mastectomy in many cases, some women require or elect to have mastectomy to treat their cancer or high-risk state. Breast reconstruction is an essential aspect of the overall postmastectomy treatment, with important psychosocial impacts on patient well-being, as the reconstruction is an attempt to improve their outward appearance, their sense of femininity, and ultimately, their self-esteem. Postmastectomy reconstruction can be categorized into three modalities: implant-based reconstruction, autologous tissue-based reconstruction utilizing the patient’s own tissue, or a combination of implant and autologous-based reconstruction. Immediate postmastectomy reconstruction is currently considered the standard of care in breast reconstruction. Breast reconstruction has a positive impact on postmastectomy physical and mental quality of life.

The chapter discusses strategies for radiation therapy treatment planning for lymphoma. It explains clinical application, patient setup and immobilization. Treatment planning describes dose specification, extended field radiation therapy, involved/regional field radiation therapy, and involved site radiation therapy. Radiation therapy is used as monotherapy, or as an adjunct to chemotherapy to treat Hodgkin’s and Non-Hodgkin’s lymphoma. The chapter provides clinical application, patient setup, and treatment planning with dose specification, and treatment techniques for total skin electron irradiation. The clinical application for total skin electron irradiation is definitive treatment of cutaneous T-cell lymphoma, also called mycosis fungoides. The chapter also presents clinical application, patient setup, and treatment planning for total body irradiation. Total body irradiation is used on its own, or as an adjunct to chemotherapy as part of a myeloablative regimen, to condition the host prior to receiving a hematopoietic transplantation.

Treatment planning consists of clinical treatment planning and technical treatment planning. Clinical treatment planning refers to the treatment intent, treatment modality, and treatment dose scheme. Technical treatment planning refers to the details of patient positioning, placement of radiation beams, and the aperture shapes of radiation beams designed to achieve highly conformal radiation dose distributions to the treatment target volumes while protecting the critical organs. Treatment plan quality depends on the radiation beam orientation in combination with the treatment couch angles; the number of beams; radiation beam energies; and beam shapes or number of sub shapes. The chapter provides a brief description on: source-to-skin (patient) distance versus source-to-axis (isocenter) distance treatment planning; treatment target volumes and planning margins; treatment plan types; prescription and normalization methods; open field, wedged field, and field-in-field; forward planning versus inverse planning; boost: sequential versus integrated; intensity modulated radiation therapy and volumetric modulated arc therapy delivery methods.

Involvement of neural plexus structures in a patient with cancer may result from direct invasion by tumors originating within nerve tissue, local metastatic extension or distant spread from diseased organs, or compression by adjacent tumor masses. The function of the neural components may also be severely affected by sequelae or complications of surgical intervention or radiation therapy. Clinical history may suggest a possible etiology; however, physical examination may be of limited value in evaluation of plexopathy depending on the structure affected. Conventional radiologic methods are usually nonrevealing, although they may be helpful in advanced disease. As new techniques are introduced, improved resolution and ability to analyze chemical composition of tissues advanced MRI to the method of choice in diagnosis and assessment of treatment response in patients with plexopathy. This chapter discusses the role of conventional and new modalities in evaluation of plexus disease, including indications, current techniques, advantages, and pitfalls.

Endocrine late effects are among the common late effects seen in cancer survivors, and can be quite complex for the patients, their caregivers, and the medical providers to delineate. This chapter educates the importance of basic concepts and facts that can help in caring for survivors at risk for endocrinopathies. It discusses risk factors, evaluation and management of growth hormone deficiency, thyroid disorders, gonadal dysfunction, adrenal gland disorders, disorders of glucose homeostasis, fluid and sodium homeostasis disorders, calcium homeostasis and bone health disorders, bone density in cancer patients, and endocrine complications resulting from abnormal body mass index (BMI). It is important to evaluate and optimize bone mineral density (BMD) in cancer survivors. Long-standing underweight or overweight/obesity may negatively impact morbidity and quality of life in cancer survivors; monitoring/intervention according to guidelines is thus advised.

Gastrointestinal (GI) complications of cancer are significant and can be challenging to manage. Dysphagia, nausea, vomiting, diarrhea, constipation, fecal impaction, bowel obstruction, and infections are just a few of the adverse effects experienced by the cancer patient. This chapter discusses the current strategies for diagnosis and treatment. The treatment of cancer with chemotherapy agents, immunotherapy, and radiotherapy has dramatically improved the prognosis and survival of many patients diagnosed with cancer. However, these interventions may cause significant GI side effects that can limit tolerability of treatment. The prevention and treatment strategies often utilize a combined pharmacological approach and target the receptors located in the chemoreceptor trigger zone and periphery. Cancer rehabilitation includes vigilant monitoring for GI complications of cancer. GI complications resulting from cancer treatment are variable in presentation and often multifactorial. Proper diagnosis of treatment related symptoms and more serious sequelae are imperative.

Neurologic paraneoplastic disorders are nonmetastatic syndromes that are not attributable to toxicity of cancer therapy, cerebrovascular disease, coagulopathy, infection, or toxic/metabolic causes. Paraneoplastic disorders can affect any part of the central or peripheral nervous systems. Several syndromes should always raise the possibility of a paraneoplastic etiology, including limbic encephalopathy, subacute cerebellar degeneration, opsoclonus–myoclonus, severe sensory neuronopathy, Lambert–Eaton myasthenic syndrome, and dermatomyositis. Most types of tumor can be associated with paraneoplastic disorders, but the most common and best known are thymoma with myasthenia gravis and small cell lung carcinoma with Lambert–Eaton myasthenic syndrome. Paraneoplastic encephalomyelitis is characterized clinically and pathologically by patchy, multifocal involvement of any or all areas of the cerebral hemispheres, limbic system, cerebellum, brainstem, spinal cord, dorsal root ganglia, and autonomic ganglia. The most common clinical manifestation of paraneoplastic encephalomyelitis is subacute sensory neuronopathy reflecting involvement of the dorsal root ganglia.

This chapter discusses dermatological toxicities of anticancer therapies and mainly focuses on two adverse events: hand–foot syndrome (HFS) and paronychia. HFS is a well-documented reversible adverse effect of many chemotherapeutic therapies, causing a wide variety of cutaneous symptoms ranging from erythema, dysesthesia, pain, and desquamation of the palms and soles to impairing daily activities of living. The standard approach used in the management of HFS is treatment interruption or dose modification, with symptom improvement reported within 1 to 2 weeks. Paronychia is the inflammation of the nail folds, jeopardizing the nail fold barrier and potentially exposing the nail matrix to damage. Paronychia is also an adverse effect of chemotherapeutic agents. The known causes of acute paronychia prior to the introduction of epidermal growth factor receptor (EGFR) inhibitors included staphylococci, streptococci, and pseudomonas, whereas, Candida albicans was frequently associated with chronic paronychia, with diabetes mellitus being a predisposing factor.

This chapter provides a brief description on evaluation and treatment of lung and bronchus cancer. An estimated 234,030 cases of lung cancer will occur in 2018, accompanied by an estimated 155,870 deaths from the disease. Lung cancer is the second most common cancer in men and women but is the leading cause of cancer mortality in both. This chapter discusses epidemiology, pathology, screening, diagnosis, and prevention of lung cancer. Paraneoplastic syndromes are a combination of symptoms produced by substances formed by the tumor or produced by the body in response to the tumor. Lung carcinoma is a pathologically heterogeneous tumor. The most important distinction is between small cell carcinoma and non-small cell carcinoma. Treatment for early-stage disease usually involves one or more modalities of treatment, which include surgery, chemotherapy, and radiation therapy. Patients with advanced disease are treated with chemotherapy, immunotherapy, or targeted therapy.

This chapter addresses nonpharmacologic pain approaches in cancer survivors. It is important to note that effective pain management usually involves a multipronged approach that may include over-the-counter or prescription medications, injections, and potentially more invasive procedures such as radiation therapy and surgery. It describes those therapies that are commonly prescribed and have some evidence to suggest that they may be useful in reducing pain symptoms in cancer survivors. Most physical modalities have not been studied extensively in cancer patients due to the concern of exacerbating an underlying malignancy. Those that are generally believed to be safe include cryotherapy (e.g., the use of cold packs), biofeedback, iontophoresis, and transcutaneous electrical nerve stimulation, and massage. Pharmacologic management certainly has an important role, as do nonpharmacologic measures. While there is certainly some evidence to suggest that the nonpharmacologic interventions, especially therapeutic exercise can be quite helpful to cancer survivors.

Breast cancer is the most common cause of cancer among women in the United States, with approximately 260,000 new cases of breast cancer and more than 40,000 breast cancer related deaths anticipated in 2018. Fortunately, an improved understanding of the importance of tumor biology has led to significant advances in the management of breast cancer in both the adjuvant and metastatic settings, as well as an improvement in patient morbidity and breast cancer specific survival. When an abnormality is detected on screening, breast cancer diagnosis and management typically require a multidisciplinary approach that incorporates some combination of radiology, surgery, pathology, medical oncology, radiation oncology, and/or specialists in rehabilitation. This chapter provides an overview of the principles of using systemic therapy (i.e., medications that are absorbed and carried throughout the bloodstream, such as chemotherapy and endocrine therapy) for the management of breast cancer.

Melanoma has traditionally been a challenging disease to manage due to a lack of effective therapies for advanced disease. Fortunately, recent advances in our understanding of the molecular pathways underlying melanoma pathogenesis and of tumor immunology have led to unprecedented advances in targeted and immunological therapies that have dramatically improved patient outcomes. This chapter serves as a practical guide for the nononcologist and provides updated information on the epidemiology, prevention, staging, biology, and management of melanoma. The introduction of immune checkpoint inhibitors and targeted agents has dramatically improved survival for patients with advanced melanoma. Novel immune checkpoint molecules such as CD40, CD137, OX40, and LAG-3, are already under investigation in early phase I studies. With a growing number of treatment options, continued efforts to find the optimal combination and sequence of therapies will be important.

Head and neck cancer is a group of cancers that are linked by a shared anatomical space. The anatomical space includes structures that are critical for speech, swallowing, breathing, vision, and hearing. It has long been recognized that head and neck cancer and its therapy adversely impact function. Rehabilitation in the head and neck cancer population is often challenging: it requires the coordinated care of experienced clinicians spanning a wide array of specialties. This chapter begins with a discussion of the socioeconomic considerations that are paramount in treating head and neck cancer patients. This is followed by a broad overview of the epidemiology, etiology, pathology, and staging of head and neck cancers. The chapter then discusses the specific modalities of therapy used in the treatment of head and neck cancer with an emphasis on the associated toxicities. Finally, it discusses site-specific considerations that impact functional outcomes.

Renal function impairment can affect a cancer patient’s functional capacity and mobility and thus limit participation in a rehabilitation program. This chapter discusses how acute or chronic declines in renal function can affect cancer patients’ ability to participate in rehabilitation programs and to provide information on how to optimize this very important aspect of their care. Acute and chronic kidney disease (CKD) can hinder a patient’s mental status and functional status due to electrolyte derangements. Additionally, CKD can result in anemia and mineral bone disease, which can affect a patient’s capacity to exercise and increase the risk of fractures. Patients on dialysis benefit from rehabilitation, and additional research should be fueled into structuring home exercise programs. Careful selection of pain medications that are renally dosed can provide temporary relief for patients with kidney disease and allow them to participate in rehabilitation.

This chapter describes strategies for radiation therapy treatment planning for soft tissue sarcoma. It explains simulation and immobilization for abdomen/thorax/pelvis, and extremities. Bolus is added over any postoperative surgical scars during simulation or during treatment planning, typically 5 to 10 mm. Surgical scars and drain sites should be wired for bolus to aid visualization during treatment planning. The chapter discusses image registration and localization, preoperative versus postoperative radiotherapy, planning goals and critical structure objectives, and external beam radiation therapy treatment techniques. It presents treatment planning for preoperative radiotherapy with examples of abdomen and thigh. The chapter also describes treatment planning for postoperative radiotherapy with examples of chest wall/abdomen wall, thorax, calf (left), lower limb, dual-isocenter intensity modulated radiation therapy/volumetric modulated arc therapy, and extended source-to-skin distance. Finally, it discusses treatment planning with brachytherapy examples.