Kyriakos S. Markides - US grants

This study aims to collect a third wave of data on a sample of older Mexican Americans and Anglos studied in 1976 and 1980 in San Antonio. This will enable the examination of differences in ethnic patterns of aging. More specifically, the double jeopardy hypothesis predicting and increasing disadvantage of minority group members is investigated in the areas of health, psychological distress, life satisfaction, and subjective age. The study also examines characteristics of dropouts in longitudinal research, including those deceased, those that cannot be located, and those who refuse to be re-intereviewed. Subjective health and subjective age area examined to test the hypothesis that they are significant predictors of survivorship net of objective health and actuarial life expectancy. Finally, the study investigates whether religiosity increases with age and whether it attains increasing importance for positive adjustment as people get older Ethnic differences in this area are also explosred.

The purpose of this application is to investigate a number of health-related variables in middle-aged and older Mexican Americans. Data will be employed from the southwestern sample of the recently completed Hispanic Health and Nutrition Examination Survey (H-HANES). This is the largest study of the health of Hispanics. Moreover, it oversampled persons 45 to 74 enabling the performance of relatively detailed multivariate analyses for a number of subgroups (by age, gender, etc). Our findings will be generalizable to the Mexican Origin population of the five Southwestern states. Variables of primary interest include self-ratings of health, activity limitation due to health problems or disability, presence of hypertension, physical activity, depression, preventive health care utilization, smoking, and alcohol consumption. We propose to approach the analysis of the data within a conceptual model in which acculturation into the larger society is the key independent variable influencing health and mental health. Acculturation has been receiving increased attention in the literature on Hispanics as a potential determinant of health because of the stress it may involve or because it alters certain health behaviors (e.g., smoking, alcohol consumption, utilization of services). However, we argue that the association between level of acculturation and health is quite complex. We hypothesize that a number of factors "buffer", or modify the influence of acculturation. These include age, gender, marital status, employment status, socioeconomic status and health insurance coverage. We plan to operationalize and examine this model utilizing a variety of multivariate statistical techniques. First, we plan methodological analyses with the acculturation scale and the two depression scales to examine their applicability to the various age groups in the sample. Our substantive analyses will utilize variations of Ordinary Least Squares multiple regression analysis when the dependent variable is continuous (e.g. total depressive symptoms, number of drinks consumed). We plan to utilize logistic regression analysis when the dependent variable is dichotomous (e.g., presence of hypertension, high depressive symptomatology). Modifier effects of variables will be assessed through subgroup analyses (e.g. by conducting separate regression analyses for persons age 65 to 74 and for younger persons) and/or by introducing multiplicative terms into the equations.

This application proposes to utilize data from the Southwestern Sample of the Hispanic Health and Nutrition Examination Survey to investigate alcohol consumption patterns among Mexican Americans by age and gender. Based on interview data on frequency and volume of consumption, four subgroups of subjects are identified: 1) Life-Time Abstainers; 2) Long-Term Abstainers -- people who have not has a drink for a year or more; 3) Recent Abstainers --those not having a drink during the four-week period prior to the interview, but who had drunk during the previous year; and 4) Current Drinkers -- persons who drank during the four weeks prior to the interview. The characteristics of these groups are delineated and examined. In addition to age and gender, these include socioeconomic status, marital status and level of acculturation into the larger society. We hypothesize that differences in drinking levels between older men and younger men reflect "aging" effects, in the sense that they represent reductions from earlier drinking levels. Reasons for quitting or slowing down by older and middle-aged men will relate primarily to health and financial factors. The considerably lower drinking levels of older women, on the other hand, will reflect "cohort" differences in that they represent a continuation of previous drinking patterns. Reasons for not drinking relate primarily to "religious" and socialization factors. Predictors of previous drinking patterns by former drinkers are also examined. We hypothesize that low levels of acculturation are related to previous heavy drinking and the perception of past drinking problems. Low acculturation, on the other hand, is expected to be related to abstinence in middle-aged and older women. Given the exploratory nature of this investigation, many of the analyses will involve descriptive statistics. Multiple regression approaches (both OLS and Logistic) are employed in examining predictors of drinking patterns.

Abstract This application seeks funds to conduct two in-person follow-ups of the Hispanic EPESE (Established Population for the Epidemiological Study of Elderly) during 2009-2010 and 2011-2012. The study's baseline was conducted during 1993-1994 when a representative sample of 3,050 Mexican Americans age 65 and over residing in the five Southwestern states - Texas, New Mexico, Colorado, Arizona, and California - were interviewed and followed up four times. By 2004-2005 (Wave 5) 1,167 of the original subjects now aged 75 and over were re-interviewed. An additional representative sample of 902 Mexican Americans also aged 75 and over was added at Wave 5 giving us a combined sample of 2069 subjects aged 75 and over. Of these, 1542 were re-interviewed in 2007 (data still being processed), approximately 2 1/2 years later. The study thus far has generated over 170 publications and has provided valuable information related to the health and health care needs of older Mexican Americans. Wave 7 is proposed to take place in 2009-2010 and we estimate interviewing slightly over 1,000 surviving subjects aged 80 and over. We also propose to interview a focal relative, most likely a child, who will supply information on the subjects' health, family, and financial situation. Both will be followed up two years later in 2011-2012. We expect that we will re-interview 700 subjects aged 82 and over and 800 of the focal relatives. Family members of deceased subjects will provide information on circumstances surrounding the subjects' death, which we have done over the years by using a proxy death questionnaire. Our first and new aim will be accomplished primarily by interviewing the focal relatives who will provide assessments of the older subjects' financial, family, and health situation. We will assess the nature and extent of any caregiving arrangements in very old Mexican Americans and the physical, psychological, and financial burdens of advanced age on the extended family. Given the advanced age of the sample, we expect to have sufficient numbers of subjects entering nursing homes and assisted living facilities to learn about factors leading to institutionalization. Although the rate of institutionalization among Mexican Americans is lower than that in the general population, our data thus far have suggested that it may be rising. We will have the opportunity to assess the influence of psychosocial and medical factors leading to institutionalization. We continue to assess trajectories of change in physical function, depressive symptomology, and cognitive function. We also propose to do a more extensive assessment of cognitive function including assessments made by the focal relatives. As we have done in the past, we plan to rapidly archive the data and to encourage others to use them. The Mexican American population is experiencing rapid rates of aging, and very little is known about the health, health care needs, and financial situation of the very old. Our findings thus far suggest that this is a population characterized by rising life expectancy which is accompanied by increased disease burden and increasing disability rates.

? DESCRIPTION (provided by applicant): The University of Texas Medical Branch (UTMB) is a leading center for research on minority health and aging. UTMB has hosted an NIA-supported pre-doctoral and post-doctoral training program in minority health and aging since 1999. UTMB also has an MD-PhD Combined Degree Program since 1983 and has educated more than 100 clinician-scientists. Students accepted into the program complete an integrated MD-PhD curriculum that combines aspects of both the Medical School and Graduate School experiences to optimize the education of clinician-scientists. The Department of Preventive Medicine and Community Health (PMCH) hosts a Council on Education for Public Health (CEPH) newly accredited Population Health Science PhD program. The Population health Sciences program will partner with the MD-PhD Combined Degree Program to recruit 5 MD- PhD students over the five year period. The proposed MD-PhD program in clinical and behavioral sciences on health disparities in aging will focus on core areas of strengths in minority aging and health disparities research at UTMB, including: Hispanic and Hispanic/Latino health and aging, and disparities in health outcomes in older adults. These are areas in which the University has committed substantial resources toward creating new faculty positions and has demonstrated significant success in obtaining peer-reviewed (R01) support. In concert with the recently accredited graduate program in Population Health Sciences, we are proposing an integrated curriculum throughout medical school and the graduate years that will address both clinical aspects and cutting edge research on health disparities in older adults. The Graduate School of Biomedical Sciences and Provost's Office have made significant commitments in the past few years to enhancing the excellence of graduate education at UTMB. These commitments include the President's Scholars Program to recruit outstanding graduate students and the establishment of an Office of Postdoctoral Affairs that includes organized training and opportunities in career development and mentoring. We have developed a formal structure and related activities to enhance recruitment and facilitate the placement of our trainees regionally and nationally. We believe that our clinician scientist trainees will be competitive for leadership positions among th next generation of aging researchers and clinicians.

ABSTRACT - TECHNIQUE DEVELOPMENT CORE A goal of the Center for Large Data Research and Data Sharing in Rehabilitation is to create a program for sharing and archiving existing rehabilitation research datasets so they are available for secondary analysis. The Technique Development Core will contribute to this goal by building the infrastructure and developing a process for data sharing and archiving completed rehabilitation research datasets. The Specific Aims of the Core are to: Aim 1. Develop a portal and related infrastructure to archive and share data from completed disability and rehabilitation research studies. Aim 2. Modify and expand our existing Center?s web site and Data Directory in order to integrate the new data archiving and sharing portal (aim 1). The addition of the data archiving and sharing portal will expand the Data Directory developed in the current funding cycle to make it a robust ?Metadata? tool for the disability and rehabilitation community. The development and merging necessary to create the data archiving and sharing portal will require collaboration among the three consortium institutions. The University of Michigan will support the basic infrastructure for the data archiving program. The research team at the University of Michigan has been archiving data in the social, psychological and behavioral sciences for over 40 years. They have well-defined and established procedures in place to archive data from completed studies. They also have the ability to maintain appropriate confidentiality, privacy and security standards. The long history of the data sharing program at the University of Michigan will ensure the sustainability of the rehabilitation data archived through Core?s activities. The activities of the Technique Development Core will be integrated with the other cores supported by the P2C Center. Education and training related to data sharing will be coordinated with the Promotion and Dissemination Core. Practical experience in conducting secondary analysis using archived data will be provided through the Pilot Studies Core. Achieving the Technique Development Core's aims will allow rehabilitation scientists to meet the emerging federal requirements for data sharing and archiving information generated from studies supported with government funding. The Core?s activities will also provide a rich source of new archived data that can be analyzed to advance rehabilitation science and improve patient care.

Administrative Core Abstract The Administrative Core of the Texas RCMAR will be responsible for the overall direction and operation of the Center. It will coordinate proposed activities and assure that the other two cores and affiliated institutions interact optimally to accomplish the center objectives: to enhance the diversity of the aging research workforce by recruiting and mentoring scientists from underrepresented populations for sustained careers in behavioral, social, economic and medical research focused on minority populations, primarily Hispanics/Latinos in Texas, the Southwestern United States, and Mexico. Specific aims include: to maintain information flow of activities and decisions, to create mechanisms and procedures to ensure that Texas RCMAR cores interact to maximum benefit, to work with the Research Education Core (REC) to oversee the solicitation, review and selection of pilot studies for funding. The Administrative Core will establish an Executive Committee headed by Dr. Markides and consisting of Dr. R. Wong, leader of the REC, Dr. Y.F. Kuo, leader of the Analysis Core, Dr. K. Peek, Vice Chair of Education in the Department of Preventive Medicine and Community Health, Dr. E. Volpi, Director of the UTMB Sealy Center on Aging and the UTMB Claude Pepper Older Americans Independence Center, A.R. Brasier, Director of UTMB's Clinical and Translational Science Award (CTSA), and J. Angel, Professor of Public Affairs at the University of Texas at Austin, and Director of the Annual International Conference on Aging in the Americas. The Administrative Core will also recruit an External Advisory Panel consisting of at least five members. The Administrative Core will assure that the Texas RCMAR interacts with other University of Texas Medical Branch NIH-funded centers including the UTMB Claude Pepper Independence Center, the UTMB Clinical and Translational Science Award, and the National Archive for Computerized Data on Aging (NACDA) at the University of Michigan.

ABSTRACT The overall purpose of the Texas RCMAR is to provide an infrastructure that facilitates the development of research on health and aging in minority populations with special focus on the Hispanic population in the United States as well as in Mexico. Special focus is given to mentoring researchers from underrepresented populations. The Texas RCMAR is based at the University of Texas Medical Branch with the University of Texas at Austin being the primary collaborating institution. To accomplish its objectives, the Texas RCMAR will have three cores: Administrative Core, Analysis Core, and Research Education Core. The Administrative Core will be directed by Kyriakos S. Markides, PhD, Gnitzinger Professor at the University of Texas Medical Branch (UTMB). As overall RCMAR Principal Investigator/Director, Dr. Markides will oversee and promote the activities of the other two cores. The Analysis core will be directed by Yong-Fang Kuo, PhD, Director of the UTMB Office of Biostatistics and Professor of Internal Medicine (Geriatrics) and of Preventive Medicine and Community Health. The Analysis Core will provide methodological and statistical support to promote the research and career development of minority aging investigators, especially those from underrepresented populations. The Core will interface with the Research Education Core to support Pilot research projects of mentored investigators and to participate in an annual two-day conference on minority aging to take place each September in conjunction with the annual International Conference on Aging in the Americas (ICAA) directed by Jacqueline Angel, PhD, University of Texas at Austin and member of our Research Education Core. The Research Education Core (REC) will be directed by Rebeca Wong, PhD, Kempner Professor and Director of UTMB's Pan American Health Organization Collaborating Center on Aging and Health. The REC will oversee funding of five pilot grants by minority investigators at UTMB, UT Austin and elsewhere. An effort will be made to recruit RCMAR scholars through the ICAA network of investigators conducting research on Hispanic aging in the United States and Mexico. Special emphasis will be given to providing training opportunities to Hispanic Servicing Institutions (e.g., University of Texas Pan American) and major universities in Texas with large numbers of minority/Hispanic students and faculty (e.g., Texas A&M University).