Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents' sexual and reproductive health needs in rural Zambia.

INTRODUCTION: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents' access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents' SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents' SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents. METHODS: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz's grounded theory approach was used for the analysis. RESULTS: We present the core category "being both a grandmother and a CBHW", which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents' SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges. CONCLUSION: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people's sexual and reproductive health.

The impact of grandchild care on depressive symptoms of grandparents in China: The mediating effects of generational support from children.

Objectives: Despite extensive studies about the direct effect of grandchild care on caregiver depression in China, understanding of its internal influencing mechanism has been limited. After controlling for socioeconomic factors, this study investigated whether the experience of caring for grandchildren had a long-term impact on the depression levels of grandparents, either directly or indirectly through generational support from adult children. Methods: The subjects of this study were a total of 9,219 adults over 45 who participated in the China Health and Retirement Longitudinal Surveys in 2015 and 2018. We adopted a lag-behind variable to examine the impact of grandchild care on depressive symptoms of grandparents. The proposed mediation model was analyzed using bootstrap modeling, and the KHB method was conducted further to examine differences in the effects of generational support. Results: The experience of caring for grandchildren had a significant negative correlation with the depression level of Chinese grandparents. Moreover, children's support significantly mediated the impact of parenting experience on grandparents' depression. Significantly, instrumental support mediated the effect to the greatest extent, while emotional support from children contributed the least. The intermediary effect has urban-rural heterogeneity. Conclusion: These findings indicated that grandchild care significantly inhibited the depression level of Chinese grandparents through increased intergenerational support from adult children. The implications of the study's findings were discussed.

Grandmothers residing with grandchildren: Social determinants of health, health behaviors, and health outcomes.

The purpose of this study was to explore the associations between social determinants of health, health behaviors, and physical and mental health among African American and Hispanic caregiving grandmothers. We use cross-sectional secondary data from the Chicago Community Adult Health Study, originally designed to understand the health of individual households based on residential context. In a multivariate regression model, discrimination, parental stress, and physical health problems were significantly associated with depressive symptoms in caregiving grandmothers. Considering the multiple sources of stress experienced by this grandmother sample, researchers should develop and strengthen contextually relevant interventions for improving the health of caregiving grandmothers. Healthcare providers must be equipped with skills to address caregiving grandmothers' unique needs related to stress. Finally, policy makers should promote the development of legislation that can positively influence caregiving grandmothers and their families. Expanding the lens through which caregiving grandmothers living in minoritized communities are viewed can catalyze meaningful change.

Mental health and parenting demands among grandparent caregivers of young U.S. children.

Substance abuse epidemics and changes in incarceration and foster care policies have recently placed more young children in grandparent custody. Grandmothers bear much of this caregiving responsibility. Our objective was to compare grandparent caregivers of preschool-aged children (grandparent(s) only or in multigenerational households) to parent caregivers, by caregiver sex, in their mental health, available emotional support, and capacity to manage parenting demands. Using U.S. National Survey of Children's Health data (2016-2019), we used survey-weighted logistic regression models adjusted for socio-demographic confounders and conducted sub-group analyses by caregiver sex. Among 30,046 families with a child aged 1-5 years, 776 (4.1%) were grandparent-only, 817 (3.3%) multigenerational, 28,453 (92.7) parent-headed (weighted percentages). Most caregivers (78.7%) were in Excellent/Very Good mental health, but grandfathers in grandparent-only households were less so. Despite being more likely to parent alone, caregivers in grandparent-only households had about twice the odds of having a source of emotional support (adjusted prevalence odds ratio [aPOR] = 2.07; 95% confidence interval [CI] 1.12, 3.83). Grandmothers, in particular, had greater odds of handling day-to-day parenting demands (aPOR = 2.40, 95% CI 1.35, 4.27) and of reporting rarely/never feeling angry with the child in their care (aPOR = 2.77, 95% CI 1.53, 5.01), compared to mothers in parent households. Caregivers in multigenerational households displayed no differences as compared to parents except for grandfathers in multigenerational households who were more likely often bothered by the child. Despite increasing demands on grandparents, they generally reported faring as well as or better than parent caregivers, especially grandmothers. Their prior experience and social support may make them resilient.

Custodial Grandparent's Job Loss During the COVID-19 Pandemic and Its Relationship With Parenting Stress and Mental Health.

Involuntary job loss during the COVID-19 pandemic adds challenges, especially for custodial grandparents that are taking care of grandchildren. Grandparents are relatively vulnerable, and they need more attention and support when facing the negative impacts of COVID-19. This study analyzed cross-sectional survey data collected from 234 custodial grandparents via Qualtrics Panels in June 2020 in the United States. After using the propensity score weighting adjustment, results from logistic and ordinary least squares regression showed that compared with grandparents that did not lose their job during the pandemic, grandparents that did had more parenting stress and worse mental health. Moderation analysis also showed that social support was a significant moderator of the relationship between job loss and mental health, but not the relationship between job loss and parenting stress. The findings and implications are discussed.

Socio-economic and health determinants of preference for separate living among older adults: A cross-sectional study in India.

INTRODUCTION: The living arrangements among the older population form a basic pointer to the care and support of older adults in India, and living with extended kin is clearly differentiated from living separately. This paper attempts to understand the associations between socio-economic and health-related variables with preference for the separate living among older adults in India. MATERIALS AND METHODS: Using data from Building Knowledge Base on Population Ageing in India (BKPAI), we employed bivariate and probit regressions on a sample of 9540 older adults to fulfil the study objective. RESULTS: Nearly 21% of older adults were living alone/with a spouse. Additionally, those older adults who lived alone/with spouse had specific reasons, i.e. about 14.6% reported that they had no children, 47.3% of older adults had their children away and 15.9% of older adults reported a family conflict. Availability of children is consistently found to be negatively associated with the preference of separate living. Besides, better self-rated health, independence in daily activities, and facing any type of violence were the strongest predictors of preference for separate living. In addition, the background characteristics, including age, sex, education, religion, and ethnicity, were found as significant predictors of living arrangement preference. Preference for co-residential arrangements emerges among older persons who have a feeling of importance within their family. CONCLUSION: Physical proximity to kin and health conditions, in addition to economic conditions, substantially determine the swing towards separate living among older adults in India. This suggests that attention has to be paid to the demand for specialized care and health services among older adults living separately.

Mothers' and Grandmothers' misconceptions and socio-cultural factors as barriers to exclusive breastfeeding: A qualitative study involving Health Workers in two rural districts of Ghana.

BACKGROUND: Education on exclusive breastfeeding (EBF) practices is usually given in the form of health talks by health workers (HWs). The need for HWs to be well-informed about cultural practices and misconceptions that act as barriers to EBF has been documented in literature. This information can guide HWs in developing interventions such as health talks which are culturally sensitive. However, this has not been explored from the perspectives of HWs in Ghana. In this paper, we report mothers' and grandmothers' misconceptions and cultural practices that are barriers to EBF in two rural districts in Ghana from the perspectives of Community Health Workers and Community Health Volunteers. METHODS: We used qualitative data collected in the Kwahu Afram Plains South and North Districts of Ghana through nine focus group discussions (FGDs) among HWs and followed the data saturation principle. All FGDs were audio-taped, transcribed verbatim and translated from local dialects to English. The emerging themes were used in writing a narrative account, guided by the principles of the thematic analysis. RESULTS: Our main findings included mothers' and grandmothers' perceptions that HWs themselves do not practice EBF. Mothers had the perception that grandmothers did not practice EBF but their children grew well, and gestures of babies suggested their readiness to start eating. Misconceptions revealed included beliefs that breastmilk is watery in nature and does not satisfy infants. Another misconception was that babies gain weight faster when not exclusively breastfed but fed on infant formulas. A custom of giving corn flour mixed with water or light porridge during the first few days after birth to welcome newborns was also reported. CONCLUSIONS: The reports of the HWs revealed that several socio-cultural factors and misconceptions of mothers and grandmothers negatively influence EBF practices of mothers. Findings from this study highlight the need for HWs to provide culturally appropriate counselling services on breastfeeding not only to mothers but also to grandmothers and fathers in order to promote EBF and reap its benefits.

Material hardship and parenting stress among grandparent kinship providers during the COVID-19 pandemic: The mediating role of grandparents' mental health.

BACKGROUND: The COVID-19 pandemic has exposed the vulnerability of many families, including grandparent kinship families, to deal with a health/economic crisis. The fear of COVID-19 plus stay-at-home orders have increased individuals' psychological distress. Moreover, school closures and homeschooling further increased parenting stress among caregivers. OBJECTIVES: This study examined the relationship between material hardship and parenting stress among grandparent kinship providers, and assessed grandparents' mental health as a potential mediator to this relationship during the COVID-19 pandemic in the United States. PARTICIPANTS AND SETTING: Grandparent kinship providers (N = 362) that took primary care of their grandchildren participated in a cross-sectional survey via Qualtrics Panels in June 2020 in the United States. METHODS: Descriptive and bivariate analyses, binary logistic regression, and mediation analyses were conducted using STATA 15.0. RESULTS: Suffering material hardship was significantly associated with higher odds of experiencing parenting stress among grandparent kinship providers, and grandparents' mental health partially mediated this association. CONCLUSIONS: Addressing material and mental health needs among grandparent kinship providers is critical to decreasing their parenting stress.

Family Well-being in Grandparent- Versus Parent-Headed Households.

BACKGROUND AND OBJECTIVES: Little is known about the 2% of US children being raised by their grandparents. We sought to characterize and compare grandparent- and parent-headed households with respect to adverse childhood experiences (ACEs), child temperament, attention-deficit/hyperactivity disorder (ADHD), and caregiver aggravation and coping. METHODS: Using a combined data set of children ages 3 to 17 from the 2016, 2017, and 2018 National Survey of Children's Health, we applied survey regression procedures, adjusted for sociodemographic confounders, to compare grandparent- and parent-headed households on composite and single-item outcome measures of ACEs; ADHD; preschool inattention and restlessness; child temperament; and caregiver aggravation, coping, support, and interactions with children. RESULTS: Among 80 646 households (2407 grandparent-headed, 78 239 parent-headed), children in grandparent-headed households experienced more ACEs (ß = 1.22, 95% confidence interval [CI]: 1.07 to 1.38). Preschool-aged and school-aged children in grandparent-headed households were more likely to have ADHD (adjusted odds ratio = 4.29, 95% CI: 2.22 to 8.28; adjusted odds ratio = 1.72, 95% CI: 1.34 to 2.20). School-aged children in these households had poorer temperament (ßadj = .25, 95% CI: -0.63 to 1.14), and their caregivers experienced greater aggravation (ßadj = .29, 95% CI: 0.08 to 0.49). However, these differences were not detected after excluding children with ADHD from the sample. No differences were noted between grandparent- and parent-headed households for caregiver coping, emotional support, or interactions with children. CONCLUSIONS: Despite caring for children with greater developmental problems and poorer temperaments, grandparent caregivers seem to cope with parenting about as well as parents.

Experiences of grandmothers caring for female adolescents living with HIV in rural Manzini, Eswatini: a caregiver stress model perspective.

The HIV pandemic has immense effects on the Eswatini population. The burden of caregiving rests on women, typically grandmothers who are elderly and dealing with chronic diseases themselves. The purpose of this study was to explore and describe the experiences of grandmothers in Eswatini caring for female adolescents living with HIV. The study draws on phenomenological fieldwork of six case studies of grandmother-granddaughter pairs who were purposively sampled. Data were collected through in-depth individual interviews that commenced with broad questions: "How is it for you to care for a female adolescent living with HIV?" for the grandmothers, and "How is it for you to live with HIV?" for female adolescents. Data were transcribed verbatim and analysed thematically following the elements of the caregiver stress theory. Drawing on the caregiver stress model, grandmothers and female adolescents experienced input stimuli of financial difficulties related to daily provisions for food and transport fare. Control processes experienced by grandmothers and female adolescents related to feelings of loss, grief, fear, hopelessness and isolation along with suicidal ideation for female adolescents. Regarding output stimuli, grandmothers and female adolescents developed psychological unrest related to difficulty accepting the HIV diagnosis and concerns about the future. Grandmothers experienced ill health due to the demands of the caregiving role. It is recommended that family, financial and psychological support be made available for grandmothers to lighten the duty of caregiving.

Intergenerational attachment orientations: Gender differences and environmental contribution.

After more than four decades of research and almost 100 attachment studies, the mechanisms of intergenerational transmission of attachment still remain unclear. To better understand the mechanisms moderating the associations of attachment orientations from one generation to the next, this empirical study examined the roles of 1) shared and non-shared environmental factors that characterize critical events in adulthood such as career choice, income and child care; 2) gender differences in attachment between parents (Generation 1, G1) and their adult offspring (Generation 2, G2) and their possible interactions. A sample of 321 families with G2 adults aged 18 and over and two G1 parents up to the age of 81 took part in this study. Both generations completed the Experiences in Close Relationships attachment measure as well as a comprehensive detailed measure of current core characteristics in adulthood (e.g. employment status, income, whether they had children) and demographic variables (gender, age). The findings suggest that the associations between the attachment orientations of G1 and the attachment orientations of G2 were moderated by G2's income, their G1 paternal income and employment status, whether G2 had children (G3) of their own, and their family status after controlling for the age of G2, and the age of both paternal and maternal G1. When the associations for both paternal and maternal G1attachment orientation with both their male and female G2 was analyzed separately, this accounted for 35% of the variance of males' G2 attachment orientation. The discussion focuses on the contribution of these findings to attachment theory and draws clinical conclusions.

A prática discursiva como recurso metodológico à avaliação psicológica / The discursive practice as a methodological resource for psychological assessment / La práctica discursiva como recurso metodológico para la evaluación psicológica

Nesta pesquisa, alicerçada no Construcionismo Social, são pesquisados cinco avós com o objetivo de compreender como as suas práticas discursivas estão ligadas ao processo de litígio pela guarda dos netos. Nesse processo, ficou claro que a prática discursiva pode ser um interessante recurso metodológico na avaliação psicológica, ao possibilitar o entendimento da organização psicológica dos indivíduos em um determinado momento de suas vidas. No caso específico desses avós, foi possível perceber como as suas práticas discursivas - presentes no litígio dos filhos - têm relação com questões psicológicas, sociais e judiciais. Essa constatação permitiu reconhecer que o adoecimento psíquico dos avós, nessas circunstâncias, fortalece o acirramento do litígio e assegura o seu poder parental. AU

Based on Social Constructionism, five grandparents were interviewed in order to understand how their discursive practices are intertwined with the litigation process regarding the custody of grandchildren. Accordingly, it was understood that the discursive practice can be an interesting methodological resource for psychological assessment, by making it possible to understand the psychological organization of individuals, at certain moments in their lives. In the case of these grandparents, it was possible to understand how their discursive practices present in the children's litigation were related to psychological, social and judicial issues. This understanding made it possible to recognize the psychic illness of the grandparents and, in this circumstance, strengthened the aggravation of the litigation and guaranteed its parental power. AU

En esta investigación basada en el Construccionismo Social, cinco abuelos fueron investigados con el objetivo de comprender cómo sus prácticas discursivas están relacionadas al proceso de litigio por la custodia de los nietos. En este proceso, se evidenció que la práctica discursiva puede ser un recurso metodológico fundamental en la evaluación psicológica, al posibilitar comprender la organización psicológica de los individuos en un determinado momento de sus vidas. En el caso específico de estos abuelos, fue posible comprender cómo sus prácticas discursivas, presentes en el litigio de los hijos, tienen relación con cuestiones psicológicas, sociales y judiciales. Esta comprensión permitió reconocer que la enfermedad psíquica de los abuelos, en estas circunstancias refuerza la agudización del litigio y asegura su poder parental. AU

Parenting a 6-Year Old Is Not What I Planned in Retirement: Trauma and Stress among Grandparents Due to the Opioid Crisis.

There is little research about trauma, financial stress, and social service needs emanating from the experience of parenting grandchildren caused by the opioid crisis in the United States. We conducted a qualitative study with 15 grandparents who currently or in the past had custodial care of their grandchildren. We also interviewed nine issue-related stakeholders in Eastern Massachusetts. Specific inquiries centered on events leading up to a change in guardianship, stressors related to legal, financial, and family issues, and system-wide response to the grandparents' needs. Results indicate that the opioid crisis presents distinct challenges for the grandparent-led families and for the systems that serve the new family arrangement. Crisis triggers a change in guardianship and continues throughout the years. The continued crises stem from events related to the parent's opioid use disorder (OUD) and from expenses related to raising a young family, especially when the grandchild has adverse childhood experiences. Our analysis shows that systems break down on a number of levels, and the fluidity of custodial arrangements due to parents' OUD status does not map onto existing support or benefit systems. Policy responses must focus on the immediate and long-term needs of grandparent caretakers, especially since the opioid crisis is likely to continue.

Food cultures and aging: a qualitative study of grandparents' food perceptions and influence of food choice on younger generations.

OBJECTIVE: To explore food perceptions among grandparents and understand the influence of these perceptions on food choice for the younger generations in their family. DESIGN: Qualitative methodology, thematic analysis of the transcripts from fourteen focus groups. SETTING: Grandparents in the southern region of the United States. SUBJECTS: Participants were fifty-eight Black, Hispanic, and White grandparents, predominantly women (72%), ranging in age from 44-86 years (mean age = 65·4 (sd 9·97) years). RESULTS: Grandparents' perceptions related to personal food choice were related to health issues and the media. Grandparents' perceived influence on their children's and grandchildren's food choices was described through the themes of proximity and power (level of influence based on an interaction of geographic proximity to grandchildren and the power given to them by their children and grandchildren to make food decisions), healthy v. unhealthy spoiling, cultural food tradition, and reciprocal exchange of knowledge. CONCLUSION: Our results highlight areas for future research including nutrition interventions for older adults as well as factors that may be helpful to consider when engaging grandparents concerning food decisions for younger generations to promote health. Specifically, power should be assessed as part of a holistic approach to addressing dietary influence, the term 'healthy spoiling' can be used to reframe notions of traditional spoiling, and the role of cultural food tradition should be adapted differently by race.

Aging Well in the Digital Age: Technology in Processes of Selective Optimization with Compensation.

OBJECTIVES: Studies show that using information and communication technology (ICT) contributes significantly to elders' subjective well-being (SWB). Drawing on the Selective Optimization with Compensation (SOC) model, this study aims at exploring the mechanism by which ICT use helps older adults remain engaged in valued life activities and maintain their SWB. METHOD: Involving teams from seven countries (Canada, Colombia, Israel, Italy, Peru, Romania, Spain), 27 focus groups were conducted with a total of 184 grandmothers aged 65 years and older who use ICT. RESULTS: Analysis led to identification of a series of strategies related to ICT use that may be described in SOC terms. "Intentional limited use" and "Selective timing,", for example, are clearly associated with selection. In addition, numerous optimizing strategies were found to be applied in "Instrumental" and "Leisure" activities, whereas some ICT uses offered compensation for "Aging-related" and "General" challenging circumstances. DISCUSSION: The study suggests that ICT is used in all three SOC processes and that its effective application facilitates adjustment and enhances SWB. It should therefore be regarded as a resource that supports existing personal and social resources and life management strategies, and even as a Quality of Life Technology that maintains or enhances functioning in older adulthood.

The implications of childcare on grandparents' health self-management in a Chinese elderly population.

Grandparents caring for grandchildren has become a common experience in China. However, the health implications of grandparenting, especially for health self-management, remain unclear. A cross-sectional study was conducted to investigate the effects of grandparenting on health self-management in older adults in China. Information on socioeconomic characteristics, grandparenting, and health self-management was collected through interviewer-administered questionnaires. Age less than 50, male gender, higher education level, being a local resident, having a chronic illness, and supporting themselves financially were all factors that were significantly positively associated with health self-management (P < .05) in grandparents. Grandparenting characteristics, including caring for grandchildren at night, a caregiving burden of more than 50%, poorly behaved grandchildren, caring for grandchildren more than 6 hours per day, and caring for grandchildren less than 1 year in age were significantly negatively associated with health self-management in grandparents (P < .05). Multiple regression analyses indicated that grandparent age, receiving financial support from children, being a local resident, education level, grandchild behavior and age, and being an urban resident were all statistically significant factors associated with health self-management in grandparents involved in grandparenting. Taken together, these results suggested that financial condition and caregiving burden might be the major factors affecting health self-management in grandparents involved in grandparenting.

Becoming a Grandparent and Its Effect on Well-Being: The Role of Order of Transitions, Time, and Gender.

OBJECTIVES: Although the majority of older people are grandparents, little is known on whether and how the transition into grandparenthood affects their well-being. Moreover, evidence on whether the order of the transition, the time since grandchild's birth, and the sociodemographic characteristics of the offspring modify the grandparental well-being is scarce. Taking into account these factors, our study examines the association between becoming a grandparent and subsequent well-being. METHODS: Our study is based on grandparents aged 50 and older from Waves 4-6 of the Survey of Health, Ageing and Retirement in Europe. Using longitudinal analyses, we investigate associations between becoming a grandparent and subsequent life satisfaction, positive affect, and depression controlling for demographic and socioeconomic factors as well as health and well-being at baseline. Furthermore, we explore the role of modifying factors such as whether the grandchild was first-born, the time since transition, and sociodemographic characteristics of the offspring who became a parent. RESULTS: Becoming a grandparent has a positive effect on well-being only among women who became grandmothers for the first time and via their daughters. Moreover, this effect is particularly strong in the proximity of the birth of the grandchild. No effects were found among first-time grandfathers. Having an additional grandchild does not affect well-being of grandparents, regardless of the offspring's characteristics. DISCUSSION: Transitioning to grandparenthood per se does not affect well-being. More research is needed to further investigate if interpersonal relationships and changes in roles triggered by becoming a grandparent could help promote well-being in later life.

Impact of a community-based intervention on Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's physical activities.

INTRODUCTION: Latino grandparents are often involved in rearing grandchildren, but their roles in promoting children's physical activity (PA) have been largely overlooked. This study examined the impact of a community-based intervention called Nietos Activos y Saludables (Active and Healthy Grandchildren) on Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's (aged 2-12 years) PA. METHOD: The Spanish language intervention, consisting of 4 weekly sessions, was delivered to 12 Latino grandparents (primarily female, aged > 60 years) in Los Angeles County from October to November 2017. Pre- and posttest surveys and postintervention focus groups assessed the intervention impact. RESULTS: Participants indicated that the intervention provided useful information. After intervention sessions, participants achieved a higher score in test on PA requirements for children. They also reported greater knowledge about children's PA, local resources for children's PA, and modifying children's behavior. Additionally, participants reported greater confidence in motivating children in PA and collaborating with parents in promoting children's PA. Results of focus groups generally confirmed the quantitative findings. DISCUSSION: Nietos Activos y Saludables intervention has the promise to increase Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's PA. Future studies should test the impact of the intervention on grandparents' behavior and grandchildren's health outcomes using a randomized controlled trial. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Rural Native and European American Custodial Grandparents: Stressors, Resources, and Resilience.

Native American grandparents by tradition are expected to play a role in rearing grandchildren. However, in many Native grandfamilies, grandparents are rearing grandchildren not by choice or tradition, but as the result of family crises that necessitated grandparent intervention. European American grandparents have likewise been called to rear their grandchildren when their adult children are unable or unwilling to perform parental duties. Less is known about these custodial grandparents' resilience pathways, particularly among rural grandfamilies. Guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation, this study examined the relationships between stressors, resources, and resilience among rural Native and European American custodial grandparents. Correlates of resilience were economic stress and stress management. Significant interactions were found between economic stress and government assistance and economic stress and stress management, indicating complex resilience pathways. Implications of study findings for research and intervention are discussed.