Numeracy and Preventive Health Care Service Utilization among Middle-Aged and Older Adults in the U.S.

Objectives: Determine whether a specific numeracy skill cut-point(s) reflects an empirical threshold in the context of preventive health service utilization, and identify associations between numeracy and preventive health services utilization among middle-aged and older adults in the United States.Methods: A nationally representative sample (n = 2,989) of adults 45 years and older from the International Assessment of Adult Competencies (PIAAC) was analyzed. Binary logistic regression was used to examine the utilization of dental checkup, vision screening, influenza vaccination, and osteoporosis screening, using multiple numeracy level classifications.Results: A dichotomous classification of numeracy skill levels (low vs. moderate to high proficiency) was associated with dental checkup utilization, but vision screening, influenza vaccination, and osteoporosis screening.Conclusions: Middle-aged and older adults with sufficient numeracy skills are more likely to have had a dental check up in the past 12 months. Findings suggest that numeracy may be more relevant for long-term vs. short-term risk assessment in determining preventive health care service utilization.Clinical Implications: Two-level numeracy categories are recommended in preventive health contexts. Numeracy proficiency-sensitive risk communication by health care providers and education programs may enhance awareness of preventive health care and promote the utilization of specific preventive health service utilization among older adults.

The Roles of Education, Literacy, and Numeracy in Need for Health Information during the Second Half of Adulthood: A Moderated Mediation Analysis.

We examine complex pathways that link health information seeking behavior with education and health literacy (decomposed into general literacy and numeracy), and how these pathways differ by perceived health status (need) among a nationally representative sample of Americans age 50 and older (n = 2,750). Data come from the Program for International Assessment of Adult Competencies (PIAAC). Multi-group structural equation models were used to examine the use of eight health information sources (newspapers, magazines, internet, radio, TV, books, friends/family, and health professionals). Findings partially support the long-standing notion that health seeking behaviors are directly linked to educational attainment, and provide some of the first nationally representative evidence for how education functions through distinct health literacy components to shape health information seeking behaviors by health status. Findings from this moderated mediation analysis point to the importance of examining, and addressing, health literacy disparities in access to and use of health information.

Mistrust in Physicians does not Explain Black-white Disparities in Primary Care and Emergency Department Utilization: The Importance of Socialization During the Jim Crow era.

PURPOSE: Compared to whites, blacks under-utilize primary care (PC) and over-utilize emergency department (ED) services. The aim of this study is to determine whether mistrust in physicians explains these black-white disparities, and the potentially modifying influence of socialization under racially segregated health care (i.e., raised in the U.S. South during the Jim Crow era). METHODS: Data come from the nationally representative Americans' Changing Lives Study (n=1,578). Poisson regression techniques are utilized to respectively model PC and ED utilization among a sample of non-Hispanic black and white adults aged forty-years and older. CONCLUSION: Mistrust in physicians does not explain black-white disparities in PC or ED utilization. Blacks under-utilize PC services compared to whites, net of predisposing, need, and enabling factors, but this is especially apparent among blacks who were raised in the U.S. south during the Jim Crow era and continue to reside in the South. Blacks greatly over-utilize ED services compared to whites, but this is greatest among those raised in the south during the Jim Crow era and/or those currently residing in the South.

Cognitively Intact and Happy Life Expectancy in the United States.

OBJECTIVES: We examined the number of years to be lived with and without cognitive impairment and with high self-assessed quality of life (i.e., happiness) among a nationally representative sample of Americans aged 65 years and older. Two key questions are addressed: Can people have a high quality of life despite being cognitively impaired? Which is longer: happy life expectancy or cognitively intact life expectancy? METHOD: Data from nine waves of the Health and Retirement Study (1998-2014) were used to estimate transition probabilities into and out of cognitively intact/impaired-un/happy states, as well as to death. Recently extended Bayesian multistate life table methods were used to estimate age-specific cognitively intact and happy life expectancy net of sex, race/ethnicity, education, and birth cohort. RESULTS: Happiness and cognitive impairment were shown to coexist in both the gross cross-tabulated data and in the life tables. Happy life expectancy is approximately 25% longer than cognitively intact life expectancy at age 65 years, and by age 85, happy life expectancy is roughly double cognitively intact life expectancy, on average. DISCUSSION: Lack of cognitive impairment is not a necessary condition for happiness. In other words, people can have a high quality of life despite being cognitively impaired.

Associations Between Perceived Environmental Pollution and Mental Health in Middle-Aged and Older Adults in East Asia.

Given the widely used objective measures of environmental pollution in previous research, this study investigated subjective measures in relation to mental health among middle-aged and older adults in three East Asian countries-China, Japan, and South Korea. The samples from the 2010 East Asian Social Survey included 2502 Chinese, 1794 Japanese, and 871 South Korean adults aged 40 and older. Linear regression models were used to examine the associations between mental health measure (SF-12) and 4 perceived environmental pollution indicators (ie, air, water, noise, and pollution index). Greater perceived pollution indicators, as well as the perceived pollution index, were associated with poorer mental health, even after adjusting for covariates in all three countries. Although results need to be further verified in future research, national-level efforts to improve perceptions of environmental pollution may be useful to enhance the mental health of East Asian middle-aged and older adults.

Literacy, Numeracy, and Health Information Seeking Among Middle-Aged and Older Adults in the United States.

Objectives: Health literacy is often viewed as an essential skill set for successfully seeking health information to make health-related decisions. However, this general understanding has yet to be established with the use of nationally representative data. The objective of this study was to provide the first nationally representative empirical evidence that links health information seeking behaviors with health literacy among middle-age to older adults in the United States. Methods: Data were obtained from the 2012/2014 Program for the International Assessment of Adult Literacy (PIAAC). Our analytic sample is representative of adults age 45 to 74 years (N = 2,989). Results: Distinct components of health literacy (i.e., literacy and numeracy) were uniquely associated with the use of different health information sources (e.g., health professionals, the Internet, television). Discussion: Findings should be useful for government agencies and health care providers interested in targeting health communications, as well as researchers who focus on health disparities.

Objective and Subjective Socioeconomic Status, Their Discrepancy, and Health: Evidence from East Asia.

Socioeconomic status (SES) is largely understood to be a fundamental determinant of health. Recently, subjective socioeconomic status (SSS) has emerged as a potentially important predictor of health above and beyond traditional (i.e., objective) SES indicators (OSS). The current study adds to this emerging body of research by examining the potentially important role of status discrepancies for health outcomes. We used nationally representative data from three East Asian countries (China, Japan, and South Korea) (2010 East Asian Social Survey) and a non-linear statistical technique (i.e., diagonal mobility model) to simultaneously model the independent contributions of OSS and SSS and their discrepancy for three health outcomes. Findings showed that SSS does, in fact, explain additional variation in health net of OSS in most cases, and status discrepancy is not associated with any of the three health outcomes. While status discrepancy was not found to be a driving factor in determining the predictive power of SSS net of OSS (at least in East Asia), the present study adds robustness to the accumulating evidence that challenges the social inequality hypothesis and provides a basis from which future research can build and contribute further to the understanding surrounding socioeconomic status and health outcomes.

Experienced Subjective Well-Being During Physically Active and Passive Leisure Time Activities Among Adults Aged 65 Years and Older.

BACKGROUND AND OBJECTIVES: The encore years, or later life stages when adults enjoy health and free time, are the prime opportunity for leisure to maximize the overall quality of life. Physically active leisure is widely known to be linked to overall subjective well-being (SWB). However, experienced SWB or momentary emotion during active leisure as well as passive leisure has yet to be examined. RESEARCH DESIGN AND METHODS: Data were derived from the 2012/2013 American Time Use Survey Well-being modules. Propensity score matching (PSM) was used to identify comparable matched samples of older adults. RESULTS: The PSM identified 211 older adults who reported a series of emotions (i.e., happy, meaningful, tired, sad, stressed, pain) during active leisure, and the comparable counterpart (n = 211) during passive leisure. Results from the Wilcoxon Rank Sum tests showed that active leisure was associated with greater levels of experienced happiness and meaningfulness, as well as with lower levels of sadness (p < .05). DISCUSSION AND IMPLICATIONS: Physically active leisure is linked to greater levels of experienced SWB among older adults. Although more detailed roles of active and passive leisure for experienced SWB are yet to be verified, choices that older adults make in their free time may significantly impact their experienced SWB and, in turn, their overall quality of life. Aging and public health policies should enhance accessibility to active leisure to promote older adults' SWB.

The Importance of the Baby Boom Cohort and the Great Recession in Understanding Age, Period, and Cohort Patterns in Happiness.

Twenge, Sherman, and Lyubomirsky (TSL) claim that long-term cultural changes have increased young adults' happiness while reducing mature adults' happiness. To establish their conclusion, TSL use trend analyses, as well as more sophisticated mixed-effects models, but their analyses are problematic. In particular, TSL's trend analyses ignore a crucial cohort effect: well-known lower happiness among baby boomers. Furthermore, their data aggregation obscures the ephemerality of a recent period effect: the Great Recession. Finally, TSL overlook a key finding of their mixed-effects models that both pre- and post-Boomer cohorts became happier as they aged from young to mature adults. Our reanalyses of the data establish that the Baby Boomer cohort, the short-lived Great Recession, and unfortunate data aggregation account for TSL's results. The well-established, long-term relationship between age and happiness remains as it has been for decades despite any cultural shifts that may have occurred disfavoring mature adults.

Everyone's talking about it, but does it work? Nursing home diversion and transition.

In response to increasing Medicaid expenditures and consumer preferences, states are reforming their long-term care systems to provide more community-based services. One popular reform is renewed efforts to prevent unnecessary long-term nursing home placement (diversion) and to provide nursing home residents an opportunity to return to the community (transition). Nearly 3,800 individuals, 60 years old and older, participated in Ohio's statewide nursing home diversion and transition initiative between March 2010 and May 2011. This research tracked outcomes for consumers and evaluated the implementation of the new program. Nearly 80% of diversion and transition participants who were still living at the time of their 6-month follow-up were residing in the community. An agency-level process analysis revealed innovative intervention strategies, promising practices, and barriers. Process results found that Area Agencies on Aging (AAAs) have become more proactive in working with high-risk individuals, with agencies identifying new at-risk consumers through hospital and nursing home interventions.