Dynamics of Financial Hardship in the United States: Health and Retirement Study 2006-2016.

The purpose of this study was to examine the temporal trends and dynamics of financial hardship among older adults in the U.S. between 2006 and 2016 using the Health and Retirement Study. Sample included a total of 13,537 eligible person observations with a median age of 68 years. Financial hardship included measures of difficulty paying bills, food insecurity, taking less medication due to cost, and ongoing financial strain. Regression analyses were performed using a three-wave quadrennial model to estimate the prevalence of financial hardship over time, to explore temporal patterns and identify persistent hardship. Findings reveal that 51% of respondents who experienced food insecurity at one or more waves were transient. This pattern was similar to respondents who experienced ongoing financial strain (52% transient). Respondents who reported difficulty paying bills (68%) and reduced medications due to cost (62%) were also transient. Significant predictors across all four domains of financial hardship include age, years of education, marital status, self-rated health. Being African American was positively associated with reduced medication use and food insecurity. This study provides insight into the temporal dynamics of financial hardship in later life. It also highlights the contiguous, intermediate and transient nature of financial hardship among older adult populations.

The price of mental well-being in later life: the role of financial hardship and debt.

OBJECTIVE: This study investigated the associations between various financial hardship and debt indicators and mental health status among older adults. METHODS: Using data from the Health and Retirement Study (HRS), we considered the association between different forms of financial hardship and debt of those who were identified as having high levels of depressive symptoms (N = 7678) and anxiety (N = 8079). Financial hardship indicators: difficulty paying bills, food insecurity, and medication need; debt indicators: credit card and medical debt. Associations were tested using multiple logistic regression analyses and are reported as relative risk (RR) ratios and 95% confidence intervals (CIs). RESULTS: Participants who had difficulty paying bills were more likely to have high levels of depressive symptoms (RR = 2.06, CI = 1.75-2.42, p < 0.001) and anxiety (RR = 1.46, CI = 1.02-2.05, p < 0.001) compared to those who did not have financial difficulty. Similarly, medical debt was associated with depressive symptoms (RR = 1.43, CI = 1.14-1.74, p < 0.01) and anxiety (RR = 1.20, CI = 0.96-1.50, p < 0.01). Credit card debt was not significantly associated with either mental health outcome. CONCLUSION: Indicators of financial hardship and medical debt were associated with depressive symptoms and anxiety in a cohort of older adults. In contrast, the influence of credit card debt appeared to be more complex and vary by individual. These findings indicate that doing without meeting personal salient needs has a particularly adverse effect on psychological well-being.

The Moderating Effect of Social Support and Social Integration on the Relationship Between Involuntary Job Loss and Health.

BACKGROUND: Job loss is a stressful life event that is associated with changes in somatic, behavioral, and affective well-being. This cohort study investigates whether social support and social integration moderate the relationship between job loss and mental health. METHODS: Data from four waves of the Americans' Changing Lives data set were collapsed into three wave-pairs. Our sample comprised 1,474 observations, from which we identified 120 job losses. We applied longitudinal regression models in benchmark moderation analysis; finite mixture modeling was then applied to investigate complex heterogeneity. RESULTS: Our findings suggest that social support, and not social integration, buffered the involuntary job loss-depressive symptoms relationship among a subgroup of individuals who were more likely to be White, higher educated, and have higher social support prior to job loss. CONCLUSION: Policies that incentivize education, promote financial and health literacy, and strengthen families may reduce vulnerability to the mental health effects of job loss.

Tobacco cessation and household spending on non-tobacco goods: results from the US Consumer Expenditure Surveys.

OBJECTIVES: To estimate the impact of tobacco cessation on household spending on non-tobacco goods in the USA. METHODS: Using 2006-2015 Consumer Expenditure Survey data, 9130 tobacco-consuming households were followed for four quarters. Households were categorised during the fourth quarter as having: (1) recent tobacco cessation, (2) long-term cessation, (3) relapsed cessation or (4) no cessation. Generalised linear models were used to compare fourth quarter expenditures on alcohol, food at home, food away from home, housing, healthcare, transportation, entertainment and other goods between the no-cessation households and those with recent, long-term or relapsed cessation. The full sample was analysed, and then analysed by income quartile. RESULTS: In the full sample, households with long-term and recent cessation had lower spending on alcohol, food, entertainment and transportation (p<0.001). Recent cessation was further associated with reduced spending on food at home (p<0.001), whereas relapsed cessation was associated with higher spending on healthcare and food away from home (p<0.001). In the highest income quartile, long-term and recent cessations were associated with reduced alcohol spending only (p<0.001), whereas in the lowest income quartile, long-term and recent cessations were associated with lower spending on alcohol, food at home, transportation and entertainment (p<0.001). CONCLUSIONS: Households that quit tobacco spend less in areas that enable or complement their tobacco cessation, most of which may be motivated by financial strain. The most robust association between tobacco cessation and spending was the significantly lower spending on alcohol.

Relationship Between Falls and Complementary and Alternative Medicine Use Among Community-Dwelling Older Adults.

OBJECTIVES: The objective of this study was to examine the potential relationship between different forms of complementary and alternative medicine (CAM) use and falls among older adults in New York City (NYC). DESIGN: This cross-sectional study of data from the NYC Health Indicators Project survey used modified questionnaire items from several national surveys. SETTINGS: Participants were recruited from 56 senior centers located in the 5 boroughs of NYC. PARTICIPANTS: There were 1273 participants aged 60 years or older included in the final analysis. OUTCOME MEASURES: Of particular interest to the researchers was a dichotomous outcome variable for falls, indicating that an individual had experienced no falls during the past year or one or more falls. Also of interest in the analyses were five CAM therapy types: alternative medical systems, biologically based therapies, manipulative and body-based therapies, mind-body therapies, and movement therapies. RESULTS: Prevalence of falls in NYC was 26.8%, which is consistent with the national average. Prevalence of CAM use was 92%. Participants who had tried manipulative and body-based therapies were more likely to report falling in the past 12 months (odds ratio, 1.65; 95% confidence interval, 1.26-2.15), after adjustment for age and sex. This observed association may reflect older adults with chronic pain who are already at risk for falling and are seeking therapy for this pain. None of the other CAM types were significantly associated with falls. CONCLUSIONS: Because of the growing popularity of CAM use within this population, CAM practitioners should be included in falls prevention strategies. Particular attention should be taken to include practitioners who provide manipulative and body-based therapies (e.g., chiropractors, osteopaths, physical and massage therapists) because of the high risk for falls observed among individuals who use these therapies.

Mechanisms of the Effect of Involuntary Retirement on Older Adults' Self-Rated Health and Mental Health.

This study examined mechanisms of the effect of involuntary retirement on self-rated health and mental health among adults aged 50 or older. Using two waves of the Health and Retirement Study (2006 and 2010), we selected a sample of 1,195 individuals working for pay at baseline who responded to a lifestyle questionnaire in both waves. Regression-based path analyses were conducted to test the mediating effects of financial control, positive and negative family relationships, and social integration on the relationship between involuntary retirement and self-rated health and mental health. Results of mediation analyses indicated that transition to involuntary retirement was directly negatively associated with subsequent self-rated health and indirectly negatively associated with mental health via perception of less financial control. Voluntary retirement was indirectly positively associated with both self-rated and mental health via perception of more financial control. No significant direct or indirect effects of retirement were found when retirement was measured with an aggregate measure without specifying its voluntariness. Findings emphasize the importance of specifying the voluntariness of retirement and recognizing the heterogeneity in the mechanisms of involuntary and voluntary retirement.

The effect of retirement on alcohol consumption: results from the US Health and Retirement Study.

BACKGROUND: Prior research examining the association between retirement and alcohol consumption is inconsistent with respect to salience, direction and magnitude. Reasonable conceptual arguments for both positive (e.g. coping, introduction of leisure time) and negative (e.g. severance of work-related social relationships) changes further complicate investigations of this critical association, as do differences in study design, national setting and measurement of alcohol use. METHODS: This prospective longitudinal study analyses 2-year wave-pairs drawn from seven waves (14 years) of data from the US Health and Retirement Study to assess the effect of complete retirement on weekly alcohol consumption (n = 9979 observations; 4674 unique participants). We use multiple regression analysis in a two-period follow-up design and account for potential selection bias and reverse causality not addressed in prior research on this topic. RESULTS: We find that retirement is positively associated with subsequent weekly alcohol consumption for men who reported drinking at both follow-up and the prior study wave (ß = 1.9, 95% confidence interval = 0.43-3.36). No association was observed among women. CONCLUSION: Our results suggest that health care professionals should monitor the drinking habits of retired men, as older individuals are particularly susceptible to the adverse effects of heavy alcohol use.

The impact of early occupational choice on health behaviors.

Occupational choice is a significant input into workers' health investments, operating in a manner that can be either health-promoting or health-depreciating. Recent studies have highlighted the potential importance of initial occupational choice on subsequent outcomes pertaining to morbidity. This study is the first to assess the existence and strength of a causal relationship between initial occupational choice at labor entry and subsequent health behaviors and habits. We utilize the Panel Study of Income Dynamics to analyze the effect of first occupation, as identified by industry category and blue collar work, on subsequent health outcomes relating to obesity, alcohol misuse, smoking, and physical activity in 2005. Our findings suggest blue collar work early in life is associated with increased probabilities of obesity, at-risk alcohol consumption, and smoking, and increased physical activity later in life, although effects may be masked by unobserved heterogeneity. The weight of the evidence bearing from various methodologies, which account for non-random unobserved selection, indicates that at least part of this effect is consistent with a causal interpretation. These estimates also underscore the potential durable impact of early labor market experiences on later health.

Mind-body techniques, race-ethnicity, and depression among urban senior center participants.

As the older adult population grows and becomes more diverse, more of its members are turning to complementary and alternative medicine (CAM). There are mixed findings regarding racial and ethnic differences in the use of CAM. This article explores racial and ethnic differences in use of a category of CAM known as mind-body techniques (MBT) among senior center participants with symptoms of depression. It also examines the relationship between use of MBT and depression severity. A cross-sectional survey was conducted with a representative sample of senior center participants in New York City, from which a subsample of those with depressive symptoms was drawn. Racial and ethnic differences in MBT use were identified, as was a significant negative relationship between MBT use and depression severity. African American elders were more likely to have used MBT than other racial or ethnic groups. When controlling for race or ethnicity, health status, and barriers to medical care, predictors of depression severity included health status, experiencing barriers to medical care, and Hispanic identity. Findings suggest that being female or younger is associated with a higher likelihood of using CAM. Contrary to some prior research, education level was not associated with use of MBT.

Racial and ethnic diversity in senior centers: comparing participant characteristics in more and less multicultural settings.

The 2008 Health Indicators Project surveyed a probability sample (N = 1,870) of New York City senior center participants. Attendees of racially and ethnically diverse and nondiverse senior centers were compared across 5 domains: demographics; health and quality of life; social support networks; neighborhood perceptions and engagement; health service access/utilization. Although homogeneous and diverse center participants demonstrate similar health and quality-of-life outcomes, those from diverse centers demonstrate greater risk of social isolation, receive less family support, and more likely seek medical care from hospitals or community clinics. Implications and future directions for research, practice and policy are discussed.

Inequality and the association between involuntary job loss and depressive symptoms.

Although socioeconomic status (SES) has been to shown to be associated with susceptibility to involuntary job loss as well as with health, the ways in which individual SES indicators may moderate the job loss-health association remain underexplored. Using data from the Americans' Changing Lives study, we estimate the ways in which the association between job loss and depressive symptoms depends on five aspects of SES: education, income, occupational prestige, wealth, and homeownership. Our findings indicate that higher SES prior to job loss is not uniformly associated with fewer depressive symptoms. Higher education and lower prestige appear to buffer the health impacts of job loss, while financial indicators do not. These results have a number of implications for understanding the multidimensional role that social inequality plays in shaping the health effects of job loss.

Environmental factors associated with primary care access among urban older adults.

Disparities in primary care access and quality impede optimal chronic illness prevention and management for older adults. Although research has shown associations between neighborhood attributes and health, little is known about how these factors - in particular, the primary care infrastructure - inform older adults' primary care use. Using geographic data on primary care physician supply and surveys from 1260 senior center attendees in New York City, we examined factors that facilitate and hinder primary care use for individuals living in service areas with different supply levels. Supply quartiles varied in primary care use (visit within the past 12 months), racial and socio-economic composition, and perceived neighborhood safety and social cohesion. Primary care use did not differ significantly after controlling for compositional factors. Individuals who used a community clinic or hospital outpatient department for most of their care were less likely to have had a primary care visit than those who used a private doctor's office. Stratified multivariate models showed that within the lowest-supply quartile, public transit users had a higher odds of primary care use than non-transit users. Moreover, a higher score on the perceived neighborhood social cohesion scale was associated with a higher odds of primary care use. Within the second-lowest quartile, nonwhites had a lower odds of primary care use compared to whites. Different patterns of disadvantage in primary care access exist that may be associated with - but not fully explained by - local primary care supply. In lower-supply areas, racial disparities and inadequate primary care infrastructure hinder access to care. However, accessibility and elder-friendliness of public transit, as well as efforts to improve social cohesion and support, may facilitate primary care access for individuals living in low-supply areas.

Linking neighborhood characteristics to food insecurity in older adults: the role of perceived safety, social cohesion, and walkability.

Among the 14.6% of American households experiencing food insecurity, approximately 2 million are occupied by older adults. Food insecurity among older adults has been linked to poor health, lower cognitive function, and poor mental health outcomes. While evidence of the association between individual or household-level factors and food insecurity has been documented, the role of neighborhood-level factors is largely understudied. This study uses data from a representative sample of 1,870 New York City senior center participants in 2008 to investigate the relationship between three neighborhood-level factors (walkability, safety, and social cohesion) and food insecurity among the elderly. Issues relating to food security were measured by three separate outcome measures: whether the participant had a concern about having enough to eat this past month (concern about food security), whether the participant was unable to afford food during the past year (insufficient food intake related to financial resources), and whether the participant experienced hunger in the past year related to not being able to leave home (mobility-related food insufficiency). Unadjusted and adjusted logistic regression was performed for each measure of food insecurity. Results indicate that neighborhood walkability is an important correlate of mobility-related food insufficiency and concern about food insecurity, even after controlling the effects of other relevant factors.

The influence of neighborhood factors on the quality of life of older adults attending New York City senior centers: results from the Health Indicators Project.

PURPOSE: To examine the association between self-assessed quality of life (QOL) and perceived neighborhood safety, social cohesion, and walkability among older adults in New York City (NYC). METHODS: We used data from the 2008 Health Indicators Project, a cross-sectional survey of 1,870 older adults attending 56 NYC senior centers. QOL, a binary measure, was created by dichotomizing a 5-point Likert-scaled global assessment. Neighborhood safety, social cohesion, and walkability were multi-component scale variables that were standardized due to varying response metrics. Multivariate binomial logistic regression analysis was performed on 1,660 participants with complete data. RESULTS: After adjusting for covariates, QOL was significantly associated with neighborhood safety and social cohesion. A one-standard deviation increase in neighborhood safety and social cohesion increased the log odds of having higher QOL by 30% (odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.14, 1.48; P ≤ 0.001) and 36% (OR = 1.36; 95% CI = 1.16, 1.59; P ≤ 0.001), respectively. Higher QOL was not significantly associated with neighborhood walkability. CONCLUSION: The results of this study underscore the need for initiatives that focus on enhancing age-friendly neighborhood features in large urban centers such as NYC and beyond.

The effect of job loss on overweight and drinking.

This paper examines the impact of job loss due to business closings on body mass index (BMI) and alcohol consumption. We suggest that the ambiguous findings in the extant literature may be due in part to unobserved heterogeneity in response and in part due to an overly broad measure of job loss that is partially endogenous (e.g., layoffs). We improve upon this literature using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data from the Health and Retirement Study. For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. These results suggest the health effects of job loss could be concentrated among "at risk" individuals and could lead to negative outcomes for the individuals, their families, and society at large.

Job loss and depression: the role of subjective expectations.

Although the importance of expectations is well documented in the decision-making literature, a key shortcoming of the empirical research into effects of involuntary job loss on depression is perhaps its neglect of the subjective expectations of job loss. Using data from the US Health and Retirement Study surveys we examine whether the impact of job loss on mental health is influenced by an individual's subjective expectations regarding future displacement. Our results imply that, among older workers in the age range of 55-65 year, subjective expectations are as significant predictors of depression as job loss itself, and ignoring them can bias the estimate of the impact of job loss on mental health.

Differential changes in body mass index after retirement by occupation: hierarchical models.

OBJECTIVES: This paper examines whether retirement differentially affects body mass index (BMI) patterns by occupation; occupation embodies differences in on-the-job physical demands as well as socioeconomic characteristics that could lead to variation in post-retirement BMI. METHODS: We use 12 years of national data from the US and hierarchical linear models to compare BMI trajectories among four broad occupational classes. RESULTS: We find that those in service and other blue-collar occupations have significant increases in the slopes of their BMI trajectories after retirement, whereas participants in white-collar occupations exhibit no change. This may be due to differences in the physical requirements across blue and white collar jobs or differences in health habits post-retirement. CONCLUSIONS: Retirement may provide an opportunity to help prevent obesity in older individuals, especially blue collar workers.