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.