ABSTRACT: The overall aim of this pilot project is to conduct comparative analyses and generate findings on the predictors of cognitive health among older individuals in Ghana and Malawi, two Sub-Saharan African countries at different levels of development, Ghana being low-middle-income country and Malawi a low-income country. Importantly, these findings will inform planned pilot data collection activities to test the Harmonized Cognitive Assessment Protocol (HCAP) in both countries and the integration of HCAP in the nationally representative WHO SAGE survey in Ghana. The proposed analyses will examine similarities and differences in the association between demographic, socioeconomic, and health-related predictors of cognition in Ghana and Malawi. The project activities will also provide an opportunity to engage and train a post-doctoral fellow in aging-related research.
ABSTRACT: Visual impairment is common in older adults and is associated with negative outcomes such as falls, depression, anxiety, and cognitive impairment. Because half of all vision loss in the U.S. is preventable or treatable, identifying the burden and consequences of age-related visual impairment can lead to interventions to promote access to eye care and improve population health. Administrative claims data (e.g. Medicare) are an important tool in public health research and have been used to study disease prevalence, healthcare utilization, costs, effectiveness, and outcomes across many areas of medicine. However, their application to the study of visual impairment and eye disease has been limited by the fact that the most important clinical outcomes in ophthalmology (namely, visual acuity and vision-related quality of life) are not captured in administrative claims data. In this study, we will link Medicare claims data with questionnaire and examination data from the National Health and Nutrition Examination Survey (NHANES) to develop and validate a novel visual impairment comorbidity index to predict age-related visual impairment using Medicare diagnosis and procedure codes. This tool will facilitate a new generation of population-based research on the prevalence and health effects of age-related visual impairment using administrative claims datasets.
ABSTRACT: The proposed project aims to analyze recent trends in occupational segregation in the United States by gender, race, nativity, and education, specifically focusing on detailed occupation levels since the 2000s. The research team will also examine the relationship between segregation and job characteristics such as skills, on-the-job training, job quality, preferred entry level education, work tasks, and work environments. To achieve these goals, the research team will construct a new occupation dataset by integrating various sources of occupational information, including Occupational Outlook Handbook, O*NET, Occupational Employment and Wage Statistics, National Employment Matrix and other data from the Census Bureau and the Bureau of Labor Statistics. The team will create a harmonized crosswalk between different years of occupational classifications to ensure data comparability across time. The project’s findings will provide insights into the role of occupations in generating and reproducing social inequality. Moreover, the proposed project will create a valuable data product that future researchers can use to analyze occupations, jobs, and workforce data from US government archival and administrative sources. By examining the influence of changing occupational structures, particularly the emergence of new occupations and the decline of obsolete occupations due to skill-biased technological change, the project will shed light on the evolving social inequality between different demographic groups. Results from the project will reveal discrimination issues in the labor force and help guide workers in choosing career paths, navigating job opportunities, and preparing for occupational changes.
ABSTRACT: Conceptualized as a dynamic process of individual health protective mechanism, disaster preparedness is defined as individual behavior changes in this study, from “not prepared” (NP) stage to “having an intention to prepare” (IP) stage, and ultimately to “already prepared” (AP) stage. Although older adults are much more vulnerable to the health effects of disasters than their middle age and young adult counterparts, the extent to which behavioral transitions from one stage to another differ across the two groups has not been explored. Integrating the Transtheoretical Model (TTM) with Social Cognitive Theory (SCT) and Protection Motivation Theory (PMT), we propose a new model to examine a series of specific reasons behind behavior changes for disaster preparedness. Using 2022 National Household Survey data (FEMA, 2022), this U.S. population study will address the following questions.
1. Are there disparities in behavior changes for disaster preparedness between older adults and non-older adults?
2. If so, to what extent are these disparities accounted for by income differences between the two groups?
3. To what extent does personal disaster experience, preparedness awareness, self-efficacy, and risk perception each contribute to behavior changes for disaster preparedness, especially when people are at different income levels?
The study also seeks to provide a new statistical method to estimate individual behavior changes in departure from the NP stage and in arrival to the AP stage, respectively. To fill the research gap with respect to disaster preparedness for older adults (as recently discussed by NIH/NIA [2002]), the proposed study aims to identify the specific reasons behind older adults’ decision-making process for all-hazards disaster preparedness. We aim to publish our findings from this study in peer-reviewed academic journals. Using these results, we will then employ the present process-oriented approach and subsequent measurement to study how to support older adults’ preparedness when they are exposed in specific hazards (e.g., floodings, wildfires, heatwaves, earthquakes), through extramural funding from NIH and/or NSF.
ABSTRACT: Alcohol use disorder (AUD) is one of the most pronounced public health concerns in the U.S. and cause an enormous burden to the society. In 2019, 14.5 million people of age 12 and older have AUD but only 7.2% of them had received treatment in the past year. Moreover, AUD may be correlated with cognitive decline and dementia could be a onerous burden to Individuals, family members, and the society. Both alcohol consumption and cognitive decline are often correlated to many unoberved factors such as genetics, personality traits, and risk perception therefore resulting in endogneity concerns. To tackle the endogeneity concerns, this project proposes to study the alcohol consumption of individuals of age 50 and older from the genetic perspective, which is pre-determined, and its association with cognitive decline. The development in genome-wide association studies (GWAS) in past decades provide a straightforward method to summarize the genetic tendency of a certain trait (e.g., alcohol consumption) by calculating a Polygenic score (PGS). A higher PGS refers to a higher genetic tendency of a trait. We first aim to establish the association between alcohol consumption PGS and the rate of cognitive decline to alleviate the endogeneity of drinking behaviors. To further characterize the effects of alcohol consumption on cognitive decline, we identify stressful events (e.g., unemployment, divorce) and investigate how individuals respond to stressful events by changing their alcohol consumption. The frequencies and spacing of stressful events can facilitate dose response analyses. We then explore the genetic correlations between alcohol consumption and other traits (e.g., depression, bipolar, smoking behaviors, and personality traits) that often co-exist with AUD to obtain a clear picture of AUD, common comorbidities of AUD, and cognitive decline. Alcohol consumption, as a risk factor of many diseases, is modifiable via behavior modifications. Thus, we next investigate how education and social interactions may interact with alcohol consumption, which may shed light on behavior modification targets.
ABSTRACT: Historically underrepresented populations experience a disproportionate burden of age-related cognitive disorders compared to non-White populations. As a salient resource for coping in Black communities, spirituality may be associated with better brain health, yet research is limited, especially in this population. This study aims to examine: 1) associations between spirituality and cognition, 2) identify possible differences across racial groups and, 3) explore the role of spirituality as a moderator between AD blood biomarkers and cognition. I hypothesize a relationship exists between (a) spirituality and specific cognitive domains including executive function and memory, (b) the protective effect of spirituality on cognition will be stronger in Black individuals, and (c) higher spirituality will attenuate the association between AD blood biomarkers and cognition. Using secondary data from the Penn AD Research Center and Memory Centers, we will use multivariate regression with moderation analyses to elucidate spirituality as a potential resilience factor in minority brain health.
ABSTRACT:
BACKGROUND: Hypertensive disorders of pregnancy (HDP) affect 15% of pregnant individuals, are significant contributors to maternal morbidity and mortality in the US, and disproportionately impact Black individuals. Individuals with HDP have a 12-fold higher risk of chronic hypertension within one year postpartum. HDP is also associated with a 2-fold higher risk of later cardiovascular disease (CVD) and stroke in part through accelerated vascular aging. Improved blood pressure (BP) control early postpartum may prevent vascular remodeling and lower long-term hypertension risk. To date, there are no standardized management guidelines to guide BP control in the postpartum period.
OBJECTIVE: Understand the feasibility of a 12-week remote blood pressure monitoring program combined with self-management compared to usual care among postpartum individuals with hypertensive disorders of pregnancy.
STUDY DESIGN: We will conduct an unblinded pilot two-arm randomized, controlled feasibility trial, with an anticipated sample size of 50 participants. We will enroll racially and socioeconomically diverse postpartum women from Penn with a diagnosis of HDP and on BP medication at 10 days postpartum. Following completion of usual care (10-day BP texting program), participants will be randomized to text-based remote home BP monitoring with built-in self-management tool (intervention arm) or usual care for 26 weeks. Primary outcomes include completion rates and quality of life measures. Secondary outcomes include BP control and primary care follow-up. Qualitative interviews will be performed to assess intervention acceptability across patient groups.
IMPACT: Strategies that improve postpartum CVD risk factor management and reduce disparities in BP control have the potential to be incorporated into standard of care. This trial will generate important data to inform the design of a larger RCT powered to detect difference in BP control as part of a future grant application. This study will provide valuable training experience for Dr. Afari, a cardiology fellow, to advance her research career in women’s health cardiology and developing interventions that improve maternal outcomes in resource poor settings.
Penn Population Studies Newsletter
Population Studies Center | Population Aging Research Center
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