Food insecurity and mobility difficulty in middle-aged and older adults: The importance of bio-psychosocial factors.

OBJECTIVE: Food insecurity has been associated with mobility difficulty (MD) in old age. However, there is a scarcity of research on this topic from low- and middle-income countries, while the bio-psychological factors underlying this association are largely unknown. We investigated the food insecurity-MD link in Ghana and explored how sleep, anxiety, loneliness, and physical activity (PA) mediate the association. METHODS: Community-based, representative cross-sectional data from the Aging, Health, Well-being, and Health-seeking Behavior Study were analyzed (N = 1201; Mage = 66.5; women = 63%). MD was assessed with items from the SF-36 of the Medical Outcomes Study. We assessed food insecurity with items on hunger and breakfast-skipping frequency due to lack of food and resources. Adjusted OLS and mediation models via bootstrapping technique evaluated the associations. RESULTS: Results revealed the expected association between food insecurity and MD, such that greater food insecurity was significantly and positively associated with MD across paths (from ß = 0.33 to ß = 0.42, p < .001). Analyses of indirect effects showed that sleep problems (27.8%), anxiety (15.5%), loneliness (17.5%), and PA (18.0%) mediated the association between food insecurity and MD. Cross-level interactions revealed that food insecurity significantly modified the link between each mediator and MD. CONCLUSIONS: Our data provide novel evidence that bio-psychological mechanisms may underlie the food insecurity-MD link and should, therefore, be considered relevant targets for interventions to prevent/manage MD in later life.

Mobility limitations and emotional dysfunction in old age: The moderating effects of physical activity and social ties.

BACKGROUND: This study aims to examine the association between mobility limitations and emotional dysfunction among older Ghanaians and evaluate the buffering effect of physical activity (PA) and social ties in this association. METHODS: The analysis included 1201 adults aged ≥50 from the 2016-17 Aging, Health, Psychological Well-being, and Health-seeking Behavior study. The Medical Outcomes Study Short Form-36 (MOS SF-36) assessed mobility limitations and emotional dysfunction. We measured PA using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Hierarchical OLS regressions were performed to evaluate the hypothesized direct and interactive relationships. RESULTS: The mean age of the sample was 66.2 (SD = 11.9), and 63.3% were women. After full adjustment for potential confounders, OLS regressions found that mobility limitations increased the risk of emotional dysfunction (ß = 0.113, p = 0.004). Moreover, social ties (ß = -0.157, p < 0.001) and PA (ß = -0.096, p < 0.001) were independently and negatively associated with emotional dysfunction. We finally found a significant effect modification of the association of mobility limitations with emotional dysfunction by PA (ß = -0.040, p < 0.002) and social ties (ß = -0.013, p = 0.013). CONCLUSIONS: Mobility-enhancing strategies such as engagement in positive behavioral choices, focusing on regular PA, and maintaining resourceful interpersonal social networks can mitigate the impact of mobility limitations on emotional dysfunction in later life.

A two-mediator serial mediation chain of the association between social isolation and impaired sleep in old age.

Poor sleep is a long-term public health issue that has become increasingly prevalent among socially isolated older adults. However, research on the mechanisms explaining the link between social isolation and impaired sleep (IS) remains limited, particularly in low- and middle-income countries. This study explored the serial mediating effects of loneliness and mental distress on the association of social isolation with IS among Ghanaian older adults. We analyzed data from 1201 adults aged ≥ 50 from Ghana's AgeHeaPsyWel-HeaSeeB study (mean age = 66.14, SD = 11.85, age range = 50-111; women = 63.28%). Measures included the UCLA 3-item Loneliness Scale, modified Berkman-Syme Social Network Index, Sleep Quality Scale, and Mental Distress Questionnaire. We used bootstrapping techniques from Hayes' PROCESS macro program to estimate the hypothesized serial mediation. Social isolation was significantly associated with IS (ß = 0.242, p < 0.001). Crucially, social isolation indirectly predicted IS via three significant mediating pathways. Loneliness accounted for 17.6% (ß = 0.054, CI = 0.096, 0.016), mental distress accounted for 6.5% (ß = 0.020, 95% CI = 0.004, 0.040), and loneliness and mental distress accounted for 32.2% (ß = 0.099, 95% CI = 0.065, 0.138) of the overall effect. The total mediating effect was 56.4%. These findings suggest that the social isolation-sleep link is respectively and serially explained by loneliness and mental distress. Social integrative interventions for sleep quality in old age should target mental and emotional well-being.

Filicide as a cultural practice in Ghana: The qualitative understanding of a family tragedy and its implications for child protection practice.

BACKGROUND: Contrary to evidence from the Western literature, cases of filicide in Ghana are mostly unreported because they are rooted in cultural practices and hidden from the general public. OBJECTIVE: The purpose of this study was to explore the cultural context of filicide in a rural community. Particularly, to provide an understanding of the spirit child (SC) phenomenon, how the killing of a SC is performed and to provide a general understanding of filicide within a particular context. PARTICIPANTS AND SETTING: Four relatives of a family that engaged in a filicide incident took part in the study. The interviews were conducted in a rural community in Ghana where the incident occurred. METHODS: Short written narratives were used to explore the experiences and perceptions of relatives whose family engaged in filicide. RESULTS: Children with severe deformities are likely to be associated with matters of divinity which gives way for the conceptualization of the SC and its attendant filicide. The findings highlight the critical role of traditional healers in rural communities and the consequences of strong community beliefs and expectations that influence parents to commit filicide. CONCLUSION: The study provides directions for child protection workers to address the stigma parents face for having children with severe deformities and to provide education on child welfare legislation.

Food insecurity and sleep quality among older adults: Findings from a population-based study in Ghana.

OBJECTIVE: Sleep architecture in older age is an important public health concern. However, little is known about the effect of food insecurity on sleep quality among older people. We provide the first representative study of the association between food insecurity and poor sleep quality (PSQ) in older adults in the sub-Saharan African context. METHODS: Data were drawn from the 2016-2017 AgeHeaPsyWel-HeaSeeB Study in Ghana. Past 30-day food insecurity was assessed with two items on the frequency of hunger and breakfast-skipping due to lack of food and resources. Participants reported night- and day-time sleep problems and sleep duration. Multiple OLS regressions were used to evaluate the hypothesized associations. RESULTS: Data on 1201 adults aged ≥ 50 years (mean = 63 [SD = 12]; women = 63%) were analyzed. In the full OLS adjusted model, moderate (ß = .144; p < .001) and severe (ß = .184; p < .001) levels of food insecurity were positively and significantly associated with PSQ. Also, older adults reporting moderate (ß = -.153; p < .001) and severe (ß = -.128; p < .001) food insecurity hadfewer sleep hours than those who were food-secure. Women and those aged ≥ 65 were at higher risks of PSQ in the context food insecurity. CONCLUSIONS: Addressing food insecurity may be an effective policy and public health intervention for improving sleep quality and overall well-being in older age.

Food insecurity and geriatric functional limitations: Observational analysis from the AgeHeaPsyWel-HeaSeeB Survey.

BACKGROUND: International literature suggests that food insecurity is linked with increased risks of functional impairment. However, data on the mediational mechanisms underlying this association are largely lacking. This study investigates the indirect relationship (via mental distress) between food insecurity and functional limitations among older adults in Ghana and evaluates the moderating effect of age, sex, and physical activity in this association. METHODS: The analytic sample comprised 1201 adults aged ≥50 years from the AgeHeaPsyWel-HeaSeeB study 2016-2017. We assessed food insecurity using hunger and skipped breakfast-related items. Seven mobility and activities of daily living-related difficulties assessed functional limitations. We used a moderated mediation analysis with the Hayes' PROCESS Macro v3.5 to model the hypothesized associations. RESULTS: About 36% of the sample were functionally limited, and 44% and 9% revealed moderate and severe food insecurity respectively. Food insecurity was associated with increased odds of having functional limitations after full adjustment for potential confounders (OR = 1.25, 95% CI: 1.05-1.50). However, this association was buffered by physical activity; those who engaged in physical activity were 23% less likely to suffer food insecurity-induced functional limitations compared to physically inactive (OR = 0.77, 95% CI: 0.67-0.88). Mental distress significantly mediated the food insecurity-functional limitations association and explained 86.9% of the association (total effect: OR = 2.85; 95% CI: 1.42-2.71; direct effect: OR = 1.05; 95% CI: 1.21-1.87; indirect effect: OR = 1.34; 95% CI: 1.36-2.24). CONCLUSIONS: Food insecurity is a risk factor for functional limitations in old age. Interventions to address food insecurity may benefit functional abilities via regular physical activity and improved mental health outcomes.

Association between physical activity participation and perceived social isolation at older ages: Do social participation, age and sex differences matter?

BACKGROUND: Physical inactivity is a major risk factor for poor health. However, it is unclear how physical activity (PA) is associated with perceived social isolation (PSI) in older age. This study aims to explore 1) association between PA and PSI among older people in Ghana and 2) if social participation (SP), age and sex modify any associations. METHODS: The study focused on 1,201 men and women aged ≥50 years in the AgeHeaPsyWel-HeaSeeB Study. Multivariate ordinary least squares (OLS) models were specified to estimate the regression coefficients and standard errors for the associations of PA and SP with PSI adjusting for potential confounders. RESULTS: Multivariate OLS regressions showed that engagement in SP (b = -0.442; SE = 0.140; p < 0.001) and regular PA (b = -0.338; SE = 0.152; p < 0.005) were independently associated with decreasing PSI. Also, SP modified the PA-PSI association such that resourceful SP reinforced the link between PA and PSI (b = -0.709; SE = 0.276; p < .005). Finding revealed sex (men: b= -0.712; SE = 0.266; p < 0.005; women: p = 0.083) and age differences (65+: b = -0.437; SE = 0.206; p < 0.005; 50-64: b = -0.502; SE = 0.252; p < 0.05) in the effect of PA on PSI. CONCLUSIONS: Findings provide insight into the importance of specific and combined effects of SP and PA on PSI in older age. Public health, clinical practice, and social policy efforts should target social healing and group PA interventions to improve older adults' emotional health.

Developing Social Entrepreneurship as an Intervention to Enhance Disadvantaged Young People's Sense of Self-Worth and Career Competence in Hong Kong.

This is the first empirical research in Hong Kong to examine the impact of social entrepreneurship training on disadvantaged young peoples' career competence including their self-perceived employability, entrepreneurial knowledge, skills and intent, and their psychosocial development including their self-esteem, resilience, and career-linked self-efficacy. The subjects of this research were in-school youths and school drop-outs who joined the three waves of "Social-Up Youth Entrepreneurship Programme" including social entrepreneurship training (T1), internship (T2), and a pre-incubation project funded by a Charities Trust in Hong Kong. This research included a quantitative part, that is, questionnaires, and qualitative part, that is, focus group and individual interviews. At the time of data analysis, 100 disadvantaged young people joined the program at the baseline measure (T0). Only 77 and 31 could be matched and sufficient enough for data analysis at T1 and T2, respectively. The results demonstrated that social entrepreneurship training is positive and promising to enhance disadvantaged young peoples' sense of self-worth and resilience, their entrepreneurial knowledge and skills, and overall self-perceived employability. The impact of the interactive and experiential-oriented social entrepreneurship training was the most significant. The impact of the internship was influenced by the extra burdens added to in-school youths. Because of its potential positive effects, further examination is required. Young people were found to have weak proactivity and flexibility in work, thinking, and interpersonal and communication skills, and the early introduction of curriculum-based youth entrepreneurship training in secondary schools is highly recommended.

Predicting delinquency by self-reported impulsivity in adolescents in Ghana.

BACKGROUND: Impulsivity is one of several variables associated with delinquent and criminal acts, but its utility depends on the psychometric properties of the measure used. AIM: To investigate the latent structure of the abbreviated Barratt Impulsivity Scale (ABIS) and its convergent validity with measures of aggression and psychopathy in a Ghanaian sample. METHODS: In a cross-sectional survey, high school students were recruited from two randomly selected schools in Ghana and asked to respond to the ABIS and measures of delinquency, aggression and psychopathy. RESULTS: Three hundred and sixty-three young people, aged 15-19 were recruited, 149 (41%) boys. Findings supported a three-factor (attention, motor and non-planning) structure of impulsivity, which did not differ by sex. Motor and attentional impulsivity were associated with both violent and general delinquent behaviours. Impulsivity scores also correlated with aggression and psychopathy scores, thus providing evidence of convergent validity. CONCLUSION: The ABIS was shown to have sound psychometrics in a standard Ghanaian secondary school sample. Even in this group, where delinquency and antisocial behaviours were of low frequency, its motor and attention impulsivity scores were shown to have some relationship with violent and general delinquent behaviours, suggesting that the ABIS could be a useful tool across cultures for identifying adolescents at high risk of such problems and intervening early to limit damage. Copyright © 2017 John Wiley & Sons, Ltd.