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 implementation and evaluation of a peer mentoring program for at-risk ninth-grade students. The program was established to ensure the academic achievement of at-risk students attending a college preparatory high school in an urban setting by connecting high-achieving high school students with at-risk ninth-grade students in mentoring relationships that included the provision of tutoring in major subject areas. Within the model implemented, school leadership also sought to collaborate with teachers in improving instruction. The chapter presents the rationale for developing a peer mentoring program, the multitude of factors operating in influencing student academic achievement, the process of developing a model peer mentoring program, and the results of a quantitative and qualitative evaluation of the program. The program is emerging as an effective intervention, especially having success in reducing academic failure in the major subject areas of math and science for Black males.

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 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.

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 offers a compelling example of the kind of new perspectives needed to guide the field of equity in health. It presents an Africanist perspective that highlights the important role of evidence-based and culturally appropriate models for reducing global health disparities. The chapter describes the PEN-3 cultural model. The model is composed of three primary domains: Cultural Identity, Relationships and Expectations, and Cultural Empowerment. When a health issue is identified, a 3 × 3 table is created to group the interaction between the domain of Relationships and Expectations with the domain of Cultural Empowerment. The chapter discusses the three categories of Relationships and Expectations: perception, enablers, and nurturers. Cultural Empowerment is an affirmation of the possibilities of culture, which ranges from positive to negative. The Cultural Empowerment domain is composed of three categories: positive, existential, and negative. The Cultural Identity domain is used to determine point of intervention entry.

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.

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.

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 calls for collaboration on national research priorities to eliminate health disparities. It provides a historical perspective on the condition of health disparities in the United States. Eliminating disparities in health will require transdisciplinary and interdisciplinary strategies with partners in and outside of government. The chapter defines health disparities and describes some of the contributors in the United States. It presents contributing factors to health disparities, including individual factors (behavioral and personal), structural or system factors, and institutional factors. The chapter describes a framework for health disparities research and summarizes some of the critical health disparities that should be addressed through research. It also describes efforts to develop health disparities research priorities. The chapter proposes a framework for establishing research priorities related to health disparities; and suggests an approach for engaging in collaborative, interdisciplinary research and next steps.

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 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 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 discusses the challenge of reducing health disparities by training peer educators, and thereby effectively cultivating Black leadership and potential partners for participation in ethnographic community-based participatory research. Such community insiders may, also, ideally, be members of hard to reach subpopulations, such as Black men who have sex with men (MSM) and face intense cultural-based and societal-wide stigma and homophobia. The chapter explains the rationale for peer education to address HIV/AIDS. It highlights how the use of evidence-based and theory-based models can be useful in the design and implementation of effective peer education training programs that not only prepare peer educators to educate others, but also prepare peer educators to overcome any personal stigmatizing attitudes and behaviors, and empower them to address stigma when encountered in the community.

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.

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 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.

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 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.

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 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 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.

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 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.

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 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 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 describes a model of training community health workers and peer educators for HIV/AIDS prevention in Africa, one that integrates African Healing Wisdom and evidence-based behavior change strategies. It presents an approach to training community health workers and peer educators specifically created for contemporary Sierra Leone, Africa, successfully piloted there, and more recently used in Ghana. The chapter also presents the results of the successful collaboration and partnership between the Research Group on Disparities in Health of Teachers College, Columbia University in New York City, and a Non-Governmental Organization in consultative status with the economic and social council of the United Nations–StarSpirit International, Inc. The model of training community health workers and peer educators being put forth in this chapter is consistent with what Elder (2001) envisions.

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 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.

This chapter provides an overview of the rural public health workforce and its present challenges; aspects of present-day practice, including competency development, training, and social capital; and strategies for sustaining the rural public health workforce in this era of rapid transformation. The rural work environment is distinct from that of urban public health practice, and the workers themselves have less access to local professional support networks as well as education and training opportunities. Rural public health workers are more likely to be part-time and less likely to have a background in public health. Leadership training is of particular importance for rural workers, because rural health practice is so autonomous that most workers will serve in a leadership role at some point. More than other health care workers, rural health providers need collaborative as well as clinical skills.

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.

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.

Aging is associated with the emergence of a variety of chronic physical and/or mental health conditions. Chronic conditions like heart disease and diabetes are highly prevalent and are the most common causes of mortality in older adults in the United States. Poor physical health can increase risk for mental illness, particularly depression and anxiety, in combined effect with bereavement, poor social support, and functional decline; for rural older adults, these psychiatric comorbidities occur in a context of limited access to care that greatly complicates effective management. The most common psychiatric diagnoses in older adults are depression, anxiety, substance abuse, and dementia. Informal care networks are even more essential in rural communities with poor access to health care services. Telehealth interventions such as Supporting Caregivers of Rural Veterans Electronically (SCORE) are an emerging method of closing the health care gaps for older adults in rural areas.

The Encyclopedia of Bioethics notes four overlapping areas of ethical inquiry: theoretical ethics; clinical ethics; regulatory and policy ethics; and cultural health care ethics. Rural ethics tends not to be concerned with more commonly encountered ethical domains, such as conflicts about end-of-life decision making or issues associated with threats to privacy and confidentiality. Moral distress, an underpinning of many ethical conflicts, occurs when an individual knows the ethically appropriate action to take, but situational or contextual constraints make it nearly impossible to pursue this course of action. This chapter discusses predominate rural contextual features that contribute to moral distress and ethical situations in that setting, specifically health status and health care resources; overlapping personal and professional boundaries; variance in cultural perspectives; threats to confidentiality and privacy; and professional practice expectations.

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 provides a conceptual framework for understanding access to medical care and discusses many of the barriers faced by residents of rural communities. The sociodemographic characteristics of rural residents differ from those of urban populations in ways that may affect their need for medical care. A substantial body of research indicates that individuals without health insurance coverage are at substantially greater risk for poor medical care access and health outcomes. One of the more intractable access problems facing rural Americans is the relatively lower supply of medical care professionals practicing in rural versus urban settings. To address the shortage of health care professionals, the more limited financial resources of rural residents, and the geographic dispersion of rural populations, the federal government has implemented a number of programs aimed at improving access to rural medical care.

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 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 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.

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.

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 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 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 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 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 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.

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 focuses on three current environmental health issues of great importance to rural populations environmental justice, gene-environment interactions, and climate change. Community-based participatory research (CBPR) has proven effective in several research studies, including determining the etiology of environmentally related diseases, exposure assessments, and interventions in marginalized communities. Genetic differences and susceptibilities may determine who will have worse health from short-term or protracted exposure to various environmental conditions compared to their nonexposed contemporaries. Effects of climate change will vary by population group and area of the globe and will include impacts on public health, human rights, social equality, society, and economic well-being. From the extremes of weather causing human injuries, hyper- and hypothermia, droughts resulting in famine, increases in respiratory ailments, vector and water-borne diseases, and human displacement and death, climate is expected to continue to change with time and continue to influence public health.

The concept of probability is familiar to epidemiologic investigators and workers in public health and preventive medicine. In epidemiology and public health/preventive medicine, investigators often must ask if the initially observed results of their work could have occurred by pure chance or if some other definitive factors have been operating to produce the observed efforts. Subjective probability considers probability as a measure of the confidence that one has in the truth of a particular proposition. Biostatisticians generally subscribe to the other concept of probability, objective probability, which is itself divided into two categories: classical and relative frequency. Random sampling, with and without replacement, is a crucial step in the process of epidemiologic investigation of health characteristics of a population. A measure of biostatistical dependence, such as a correlation coefficient, or regression coefficients, visual summary biostatistics gives a biostatistical and visual overview of a sample, using a histogram.

This chapter explores the various types of cardiovascular disease (CVD) namely hypertension (HTN), heart attack, and stroke, and the factors that increase risk for CVD. Coronary heart disease (CHD), the main cause of a heart attack, occurs when plaque builds up on the inner lining of the wall of the coronary arteries that supply blood to the heart muscle. The chapter also explores some of the best-established risk factors for CVD, with a particular focus on any existing knowledge of differences in those risk factors between rural and urban groups. Physical activity is important for cardiovascular health, as physical inactivity increases the risk of HTN, diabetes, heart disease, and stroke. Cigarette smoking contributes to CVD and stroke, with nearly one fifth of all deaths from CVD attributed to smoking. Several factors, including gender, race/ethnicity, and location of residence, have been associated with CVD disparities in rural populations.

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 highlights many of the pressing health challenges and concerns in rural areas, as well as some of the promising practices that are emerging in addressing rural public health issues. As rural health researchers and practitioners look to the future, there are a number of directions and advancements that will help us continue to advance the needs of this particularly underserved group. One of the largest barriers to the continued growth of telehealth is the issue of license portability/scope of practice. Beyond the provision of clinical care, the Internet and videoconferencing are being increasingly used for the purposes of health promotion and patient education. There are also several advances within the federal government that indicate a growing level of both recognition of and support for rural-focused health research and outreach.

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 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 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.

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.

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.

Churches offer unique advantages for health promotion. They often play a pivotal role in the social welfare, service, and education of their communities, particularly in communities with limited resources, such as rural, low-income, and minority communities. A church-based health promotion intervention that addressed heart disease, hypertension, stroke, cancer, substance abuse, arthritis, nutrition, exercise, smoking, stress, obesity, and access to care was developed for rural African American older adults in Northern Florida. Although a large number of church-based health promotion programs have been conducted, a relatively small number of these programs have been conducted in rural areas. Given the limited number of church-based programs in rural areas, the success of rural faith health promotion is unclear. Persons living in rural areas face considerable challenges to good health. The poorer health outcomes in rural areas are well documented, in addition to the myriad of factors that contribute to these disparities.

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.

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 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.

This chapter presents an overview of diabetes, its effects in rural areas, a description of diabetes programs that have been implemented in rural areas, and recommendations for addressing the diabetes epidemic in rural America. A core problem in addressing diabetes in rural areas is the frequent lack of diabetic education. The American Association of Diabetes Educators (AADE7) framework focuses on seven key components of diabetes education: healthy eating, being active, monitoring, taking medication, problem solving, reducing risks, and healthy coping. Development of rural-specific educational interventions that address key barriers for rural populations is very important. This can include exploration of a number of novel approaches such as telehealth-based intervention strategies and church-based diabetes education programs. By continuing to grow the rural-specific diabetes literature, researchers and practitioners can help provide evidence-based practices to rural areas that sorely need them.

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 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 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.

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.

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 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 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 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 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.

Graphics are an important and versatile feature in the biostatistics of epidemiology and public health. In the R environment, to output a given mathematical expression as a graphic, one may use the function plotmath (), in the package grDevices. Blood pressure is the pressure of the circulating blood against the walls of the blood vessels. A public health study investigated the effect of body weight on the resting metabolic rate (rmr) for women. Within the R environment for statistical computing and graphics, the Grid Graphics System is an add-on package. The lattice package is a powerful, elegant, high-level data visualization system, with an emphasis on multivariate data, which is sufficient for typical graphics needs. The data from the Connecticut Tumor Registry present age-adjusted numbers of melanoma skin cancer incidences per 100,000 people in the U.S. state of Connecticut for the years from 1936 to 1972.

The successful candidate will collaborate with fellow biostatistics staff and clinical investigators to design, evaluate, and interpret clinical studies. There are several steps involved in turning data into information, and these steps are known as data processing. The data-coding step is important because it makes data entry and data processing easier. Data capture is the process by which data are transferred from paper, such as questionnaires and survey responses, to an electronic file in a computer. Tally charts are used to record data such as the number of occurrences of a particular event and to develop frequency distribution tables. Batch keying is one of the oldest methods of data capture; the data are input through a computer keyboard. Quality assurance refers to all planned activities necessary to provide confidence that a product or service will satisfy its purpose and the users’ needs.

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.

A case-control study is a class of epidemiologic observational study. The case-control study may be considered an observational epidemiologic study of people with the disease of interest together with a suitable control group of persons without the disease. A cohort study is a form of longitudinal study used in epidemiologic investigations. Randomized controlled trials (RCTs) are considered a superior methodology in the hierarchy of evidence in therapy because they restrict the potential for any biases by randomly assigning one case-subject pool to an intervention and another subject pool to nonintervention. Research and investigations in epidemiology and the health sciences make wide use of case-control studies. The Bacillus Calmette-Guerin (BCG) vaccine is widely used against tuberculosis (TB). A great deal of medical research undertakes shorter-term clinical trial studies. Current smoking at diagnosis is an important independent predictor of shortened lung cancer survival.

A randomized trial (RT) or randomized controlled trial (RCT) is a specific type of scientific experiment, and it is the preferred design for a clinical trial in epidemiology. The process of developing a new drug to meet a particular health need consists of many definitive stages or developmental phases. The goal of the analysis is to determine the epidemiologic causality while adjusting for the effects of all confounding associations. In epidemiologic investigations, confounding may be controlled by using experimental controls or combined experimental and analytical controls. The CRAN package survival, BIV estimates the bivariate distribution function for sequentially ordered events under univariate censoring. This package contains a number of R functions designed for special applications in survival analysis. To model the categorical dependent variables that have limited ranges, one approach is to use a logistic regression model analysis.

Integral to theories of moral development is the matter of not only what individuals think but also how they think. Across the life span, moral development is shaped by challenging events that prompt individuals to question the frameworks they have created for finding ways to determine what is good and what is bad. College students encounter new ideas and values that differ from those of their families, in the classroom, in the residence hall, in the dining facility, in the student union, and sometimes on the athletic field or court. In order to illustrate how moral development unfolds within a college student population, this chapter introduces a fictitious character who displays each stage of moral development for two theories–Lawrence Kohlberg’s (1963, 1984) and Carol Gilligan’s (1982) models of moral development. The chapter discusses the underpinnings of two specific moral development theories.

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.

The Myers–Briggs type indicator (MBTI) was designed to help people understand themselves and others by helping them appreciate the diverse strengths of different personality types. It has been widely used in counseling as well as business to work on team building and relationships. There is, therefore, room for using this assessment within the field of student affairs to help build teams and groups both for professionals in the field and for students. This chapter discusses the basic information about the MBTI and implications for student affairs. The instrument is considered as a personality assessment for normal individuals designed to assess personality type. The MBTI offers strength-based guidance in every realm of living concerning individual growth to interpersonal relationships, in academic matters to spiritual terrains. From the office of the president to the chaplain, the MBTI is a useful and effective tool on a college campus.

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.

Perry’s theory of development has had a significant impact on the field of psychology and is essential to understanding the cognitive development of college students. This chapter provides an overview of Perry’s theory and describes the ways in which it still applies to college students on a diverse, pluralistic college campus. The chapter discusses how Perry’s theory continues to apply to the diversified college student population common in modern American institutions of higher education. It outlines the ways in which Perry’s scheme applies to Fatima, the contextual and pluralistic challenges faced at each position, and future development, should Fatima continue to courageously accept responsibility for her moral development and overcome the ambiguities of relativism. The chapter describes utilizing Perry’s scheme as a lens through which to view Fatima’s development, anticipate deflections from growth, and identify strategies and campus and community resources to foster inclusivity, personal exploration, and continued development.

Sociocultural theories situate learning and development as embedded within cultural, institutional, and historical contexts. Within these contexts, the focus is on how individual learning and development is mediated by social interactions and culturally organized activities. The goal within a sociocultural approach is to understand the relationship among cultural, institutional, and historical situations and their influences on human cognition. This chapter provides an overview of the history and development of sociocultural theories. It discusses two specific sociocultural theories: Cultural-Historical Activity Theory (CHAT) and communities of practice. Communities of practice, the central component of another sociocultural theory, developed out of the work of Jean Lave and Etienne Wenger on situated learning that focused on the role of participation in a community and social learning. The chapter concludes with a discussion of the application of sociocultural theories and closing vignettes.

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.

This chapter focuses on the racial identity development of Black or African American college students and of students who identity as biracial or multiracial. Although racial identity development theories do not support biological distinction between racial groups in the United States, they recognize how different conditions of domination or oppression of various groups have influenced their construction of self. In this chapter Black is used to refer to the racial identity of U.S.-born persons of African descent who may categorize themselves as Black, Black American, African American, or Afro Caribbean. The term biracial is used to describe persons with two parents of differing monoracial or multiracial descents. It is worth noting that some individuals may claim Black racial identity although neither of their parents identify as Black, such as the case of civil rights activist Rachel Dolezal. This chapter goes in depth into such alternative experiences of Black identity development.

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.

Informal and loosely generated models of White identity development began to emerge in the late 1970s and early 1980s; however, the first formal White identity development model, or typology, was proposed by Helms in 1984. This chapter describes her model, followed by an application of the model to the opening vignette. It identifies strategies for educators and student affairs practitioners to work with students like Craig to begin to more fully understand his Whiteness, the sociopolitical realities of race on campus and, in general, increase his multicultural competence, and engage in healthy interracial interactions. The chapter also discusses the summary of the literature examining the steps educators and student affairs practitioners can take to promote their own cross-cultural interactions and multicultural knowledge in order to more effectively work with students struggling with their own racial identity, followed by the strategies to promote healthy interracial interactions among students.

Epidemiology aims to assess the cause of disease. An observed statistical association between a risk factor and a disease does not necessarily allow one to infer a causal relationship. The Bradford-Hill criteria are widely used to provide a framework within which to assess whether an observed association is likely to be causal. The subdiscipline of forensic epidemiology is directed at the investigation of specific causation of disease or injury in an individual or a group of individuals in instances in which causation is disputed or unclear, for presentation in legal settings. Opportunities for exposure are often influenced by behaviors such as hygiene, sexual practices, and other personal choices, as well as by age and gender. Smoking and alcohol interact in some cases of head/neck cancer, and these cases are attributable both to cigarette smoking and to alcohol drinking.

At its core, Kolb’s construct of experiential learning is more than simply a theory. Experiential learning theory (ELT) holds that learning is “the process whereby knowledge is created through the transformation of experience”. Although ELT is often used in formal classroom settings, there are many out-of-classroom environments in student affairs that use and benefit from it as well. One way in which colleges and universities use experiential learning is through service-learning courses and projects. Several scholars have reported that using service learning in conjunction with ELT provides students with meaningful ways to engage not only with the community, but also to come to know more about diversity and social justice. Because out-of-classroom learning is such a key component in higher education and in the holistic development of students, using Kolb’s experiential learning model can aid students in meaning making as it facilitates personal growth.

Students may enter higher education with a strong set of ideals, firm models of career options, and certain confidence in their ultimate direction; however, it is not uncommon for students to begin college unprepared for life after graduation, let alone housing assignments and first semester coursework. This chapter focuses on the difficulties surrounding the major choice, the factors that influence decision making, career theories in student affairs, and campus and community resources available to assist students in gathering important data about their major and career choices. Selecting a college major and making career decisions are not easy, and require self-knowledge, self-examination, and research on what is available in the world of work. Essential to student success is the ability of student affairs professionals to accurately recognize when students are struggling and make an appropriate referral for career counseling, academic support services, or personal counseling.

Identity development operates on two simultaneous continuums, level of exploration and level of commitment. High levels of exploration and high levels of commitment suggest identity achievement, denoting the active process of developing an identity. With social identity groups, identity encompasses several unique facets because of the influence of the sociopolitical context (i.e., privilege and oppression) associated with social identity. Understanding oneself as a gay person is not simply understanding one’s attractions and sexual/affectional orientation, but also understanding that identity within a context, in which one might face marginalization from the larger community, institutional discrimination, and internalized homonegativity. In the same way, lesbian, bisexual, transgender, gender nonconforming, and queer identities also experience stigmatization. For lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, emergence of identity development begins with an initial questioning of one’s heterosexuality or gender conformity.

Transition is a process that takes place over time rather than at one point in time, and every transition begins with an ending. Schlossberg (2008) explained that each phase of the transition allows for a way of viewing and navigating the transition. Building student programming efforts around Schlossberg’s Transition Model adds an important foundation to any transitional program. Taking stock is a process by which transitioners examine their situation and coping resources for the situation. Taking stock consists of analyzing four domains: (1) Situation - the situation at the time of the transition; (2) Support - the people and assets that strengthen and encourage the student; (3) Self - who the student is (identity), his or her optimism level, and dealing with ambiguity; (4) Strategies - ways and functions of coping. Incorporating the Four Ss as standard components ensures a holistic approach in bolstering student success and retention.

Traditionally, there has been a division of labor in higher education between academics and student affairs. This chapter is designed to focus on the plausibility of using theory to facilitate communication across the many departments and divisions of higher education. It is important to remember that the student affairs profession “grew from the campus up, not from theory down”. Early institutions of higher education followed the Oxbridge model with historically based residential living systems in which educators resided in residence halls with the students. This concept of faculty–student integration remains a valuable component in student success today, and is discussed in greater detail in this chapter. One useful “language” for student affairs practitioners is found in Erikson’s stages of psychosocial development. Erik Erikson pioneered a theoretical framework and proposes an eight-staged life-span model through which developing individuals permeate starting at birth and eventually ending with death.

Many adults understand the pressures of having multiple responsibilities that require attention in a variety of life circumstances. Whether giving attention to work, friends, school, religious activities, romantic relationships, family, or even recreation, adulthood requires the ongoing ability to multitask a variety of expectations and responsibilities. Before reaching adulthood, each person has experienced influences that affect how we think, feel, and react to life’s circumstances. This chapter offers professionals and educators one model for understanding these influences and their impact on college students who oftentimes are transitioning to a new world of adult responsibilities for the first time. Ecological theory originally developed out of the work of Urie Bronfenbrenner (1977) within the field of developmental psychology. The concepts described in Bronfenbrenner’s ecological theory offer a number of important implications for supporting students in a college setting.

Holland theorized six distinct worker personalities (Realistic, Investigative, Artistic, Social, Enterprising, and Conventional). This is often referred to as RIASEC. The theory includes six work environments that correspond to the same personality types (Realistic, Investigative, Artistic, Social, Enterprising, and Conventional). Although people possess aspects of each type, the general thesis of the theory is that salient types (work personalities) will emerge in each individual. Holland’s work represents a significant contribution to career development and counseling. Understanding Holland’s focus on interests as expressions of personality aids career counselors and student development specialists in helping students gain critical self-understanding. Exploring the match between personalities and work environments is a fundamental aspect of applying this theory to student development. Helping students to explore and learn about different careers that may be of interest to them is congruent with the goals of higher education institutions and student development theories.

Concurrent with the release of Education and Identity in 1969, the United States was at the nexus of social unrest and expanding funding and support for educational initiatives. The decades of the 1950s and 1960s saw a great increase in research and practice focused on developmental theorists working in the area of higher education. At the forefront of this work was theorist Arthur Chickering. The primary construct of Chickering’s (1969) work is the Seven Vectors of Development. The vectors are: (a) developing competence, (b) managing emotions, (c) moving through autonomy toward interdependence, (d) developing mature interpersonal relationships, (e) establishing identity, (f) developing purpose, and (g) developing integrity. This vector addresses competence across three domains: intellectual, physical and manual, and interpersonal. This chapter briefly outlines Chickering’s life work, and ways in which practitioners can apply his theory to their daily interactions with college students.

This chapter briefly examines the history of the student affairs profession, specific issues students face when adjusting to college, and the role of student affairs professionals in providing support to students. It is essential that those who work in higher education institutions today possess a comprehensive understanding of the range of challenges that their students face. Student affairs professionals carry the responsibility of creating an atmosphere and environment that promotes student development both personally and professionally outside the classroom. The chapter discusses the importance of using theories to assist students. There are a number of different theories that are commonly used by student affairs professionals. The use of theories as a framework can provide student affairs professionals a way to communicate across departments, and beyond the “silos”, to ensure that programs are addressing the emotional, social, and cognitive needs of the diverse students who are pursuing their education on campus.

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.

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.

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.