Older adults are vastly underrepresented in clinical trials in spite of shouldering a disproportionate burden of disease and consumption of prescription drugs and therapies, restricting treatments' generalizability, efficacy, and safety. Eliminating Disparities in Clinical Trials, a national initiative comprising a stakeholder network of researchers, community advocates, policymakers, and federal representatives, undertook a critical analysis of older adults' structural barriers to clinical trial participation. We present practice and policy change recommendations emerging from this process and their rationale, which spanned multiple themes: (1) decision making with cognitively impaired patients; (2) pharmacokinetic differences and physiological age; (3) health literacy, communication, and aging; (4) geriatric training; (5) federal monitoring and accountability; (6) clinical trial costs; and (7) cumulative effects of aging and ethnicity.

Despite an observed decrease in overall cancer death rates in the USA, immigrant minorities continue to experience disproportionately higher cancer incidence and mortality rates. Thirteen focus groups were conducted in the Haitian, English-Speaking Caribbean, Latino, Korean, and Chinese communities of New York City to better understand their health-seeking behaviors with respect to cancer prevention, screening, and treatment. Focus groups addressed the degree to which cultural, linguistic, and systematic barriers impact these behaviors and explored methods to support salutary behaviors. Findings underscored that, while there are many similarities across immigrant groups, there are significant variations between the immigrant groups to necessitate a tailored community-based approach. The prevalent misinformation observed among all groups warrants the prompt development of culturally competent programs for cancer control with immigrant minorities.

Objective We sought to explore the association of religious and spiritual coping with multiple measures of well-being in Latinos caring for older relatives with long-term or permanent disability, either with or without dementia. Methods Using a multi-dimensional survey instrument, we conducted in-home interviews with 66 predominantly Mexican-American Catholic family caregivers near the US–Mexico border. We assessed caregivers' intrinsic, organizational and non-organizational religiosity with the Duke Religiosity Index, as well as Pargament's brief positive and negative spiritual coping scale to determine the association of religiosity with caregivers' mental and physical health, depressive symptomatology and perceived burden. Results Using regression analysis, we controlled for sociocultural factors (e.g. familism, acculturation), other forms of formal and informal support, care recipients' functional status and characteristics of the caregiving dyad. Intrinsic and organizational religiosity was associated with lower perceived burden, while non-organizational religiosity was associated with poorer mental health. Negative religious coping (e.g. feelings that the caregiver burden is a punishment) predicted greater depression. Conclusion Measures of well-being should be evaluated in relation to specific styles of religious and spiritual coping, given our range of findings. Further investigation is warranted regarding how knowledge of the positive and negative associations between religiosity and caregiving may assist healthcare providers in supporting Latino caregivers.

Although some research suggests that the healthy immigrant effect extends to cognitive functioning, it is unclear whether this general pattern varies according to gender. We use six waves of data collected from the original cohort of the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate a series of linear growth curve models to assess variations in cognitive functioning trajectories by nativity status and age at migration to the U.S.A. among women and men. Our results show, among women and men, no differences in baseline cognitive status (intercepts) between early- (before age 20) and late-life (50 and older) immigrants and U.S.-born individuals of Mexican-origin. We also find, among women and men, that middle-life (between the ages of 20 and 49) immigrants tend to exhibit higher levels of baseline cognitive functioning than the U.S.-born. Our growth curve analyses suggest that the cognitive functioning trajectories (slopes) of women do not vary according to nativity status and age at migration. The cognitive functioning trajectories of early- and late-life immigrant men are also similar to those of U.S.-born men; however, those men who migrated in middle-life tend to exhibit slower rates of cognitive decline. A statistically significant interaction term suggests that the pattern for middle-life migration is more pronounced for men (or attenuated for women). In other words, although women and men who migrated in middle-life exhibit higher levels of baseline cognitive functioning, immigrant men tend to maintain this advantage for a longer period of time. Taken together, these patterns confirm that gender is an important conditioning factor in the association between immigrant status and cognitive functioning.

This study sought to explore cultural attitudes toward caregiving and long-term care and their influence on patterns of long-term care use among Mexican American family caregivers of relatives aged 50 and older. Using a cross-sectional design, the researchers used mixed methods and conducted interviews with 66 Mexican American family caregivers in San Diego, California. They applied the Andersen behavioral model of health service utilization to examine familism, gender roles, acculturation, religiosity, and knowledge and perceptions of longterm care as factors in usage. Caregivers with greater long-term care use displayed lower levels of familism, were knowledgeable about services, had a care recipient with health insurance, shared caregiving responsibilities, and were less acculturated. Medicaid coverage for low-income care recipients was associated with higher long-term care use. Although familism may deter service use, caregivers empowered with resources and knowledge or Medicaid coverage are inclined to use long-term care services.

Objectives We used community-based ethnography and public health risk assessment to assess beliefs about pesticide exposure risks among farmworkers in the Lower Yakima Valley of Washington State. Methods We used unstructured and semistructured interviews, work-site observation, and detailed field notes to gather data on pesticide exposure risks from 99 farmworkers. Results Farmworkers’ pesticide-relevant beliefs and attitudes could be grouped into 5 major themes: (1) dry pesticides are often perceived as a virtually harmless powder, (2) farmworkers who identify themselves as allergic to pesticides are more acutely affected by exposure, (3) the effect of pesticide exposure is more severe for those perceived as physically weak, (4) protective equipment is used selectively in response to financial pressure to work rapidly, and (5) some farmworkers delay decontamination until they find water deemed an appropriate temperature for handwashing. Conclusions We elucidated farmworkers’ pesticide-relevant beliefs regarding perceived danger and susceptibility to pesticides, the need to put safety second to financial considerations, and reasons for delaying decontamination. Researchers and policymakers should incorporate these data in study designs and legislation concerned with farmworker exposure to pesticides.

Caregiving burden has been shown to predict use of home care services among Anglo Americans. In a previous study, only one of two dimensions of caregiving burden predicted such use among Mexican American caregivers. Because acculturation and familism may affect burden, we conducted analyses to test three hypotheses: increased acculturation decreases familism; decreased familism increases burden; and increased burden increases use of home care services. Among 140 Mexican American family caregivers, acculturation was positively correlated with familism; familism was not significantly correlated with burden; objective burden was positively correlated with use of home care services, and objective and subjective burden significantly interacted in their effect on the use of home care services. Targeted interventions may be needed to increase use of home care services and preserve the well-being of Mexican American elders and caregivers.

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