Unraveling the Threads: Sleep Difficulties, Neighborhood Physical Disorder, and Subjective Cognitive Decline in Older Americans.

Background: Research suggests that the neighborhood in which people live can be a risk or protective factor for various health outcomes, including cognitive decline to Alzheimer's disease. Similar to the impact of neighborhood on health outcomes, sleep difficulties have been linked to cognitive function in older adults. However, few studies have examined how neighborhood physical disorders moderate the effects of sleep on subjective cognitive decline (SCD). Objective: The study examined the moderating effect of neighborhood factors on the relationship between sleep difficulties and SCD. Methods: Data were obtained from 2,494 respondents (1,065 males and 1,429 females) from Wave 11 of the National Health and Aging Trends (NHATS) data. Sleep difficulties were operationalized as the presence of difficulties in falling and staying asleep. Neighborhood physical disorder (e.g., vandalism, graffiti) was based on interviewer observations of respondents' neighborhoods. SCD was operationalized as subjective reports of increasing or worse memory loss in the past 12 months and present memory rating. We utilized Linear regression to test neighborhood physical disorder as a moderator of the relationship between sleep difficulties and SCD. Results: We found a significant interaction between sleep difficulties and neighborhood physical disorder on SCD (ß=0.03, SE = 0.01, 95% CI[0.00,0.51], p < 0.001). Participants who reported higher average sleep difficulties and higher levels of neighborhood physical disorder were more likely to report SCD. Conclusions: Our findings add to inform future health interventions and policy recommendations that address modifiable sources of cognitive decline and risk of Alzheimer's disease.

Strategies for Recruiting Older Black Men into Aging and Alzheimer's Research.

BACKGROUND: Despite their high risks for Alzheimer's disease, older Black men are minimally represented in Alzheimer's research and clinical trials. The absence of older Black men in Alzheimer's research limits our ability to characterize the changes associated with cognitive impairments in older Black men-a key health disparity concern. METHODS: Drawing on lessons we learned from years of community-based participatory research in Newark, NJ, we highlight recruitment strategies developed alongside community partners to guide our enrollment and retention efforts for Black men. RESULTS: We identified seven recruitment strategies: provide indirect health education through social programming, target older men through the younger men in their lives, go beyond Black churches, use older Black men as trained community ambassadors, enlist the women in Black men's lives, frame research participation as a legacy to leave their sons, and use past and current Black men participants as role models. CONCLUSIONS: These recruitment strategies help us address many barriers to recruiting older Black men. They can be easily implemented by researchers conducting aging and brain health research or interested in working with older Black men and under-represented populations.

The Need to Appear Healthy: Concealment of Chronic Illness, Privacy, and Self-Sufficiency Among Chronically Ill Older Nigerians.

Background and Objectives: Prior research has highlighted the beneficial impact of social networks and social support on older adults' physical and psychosocial well-being. However, the impact of the relationship between chronic illness and social networks on the psychosocial well-being of older Nigerians remains understudied. This study explored how older Nigerians with chronic illnesses navigate the physical, mental, and emotional changes due to their chronic disease diagnosis within their social contexts. Research Design and Methods: The current qualitative study used semistructured in-depth interviews with 19 purposively sampled older adults, aged 50 years and over, chronically ill, and receiving clinical care to examine the role of social networks in how chronically ill older Nigerians cope with their diagnosis. Results: Three main themes reflecting participants' experiences emerged from the findings: (1) closely knit circles, (2) privacy and self-sufficiency, and (3) body image. Results show that chronically ill older Nigerians prefer to keep the knowledge of their conditions strictly within their close family circles. It was considered horrific to inform friends, community members, and religious groups about one's chronic illness. Findings further reveal that the need to appear healthy to one's social network stems from the fear of being discriminated against and attempts to maintain some level of normalcy when interacting with others. Additionally, feelings of inferiority and shame limited their participation in social activities and social network maintenance. Discussion and Implications: We discuss the implications of the results for the mental well-being and quality of life of chronically ill older Nigerians and make recommendations for policies and resources that can improve the well-being of chronically ill Nigerians.

Cognition and Wealth Changes in Mid-to-later Life: A Latent Class Trajectories Approach Using the Health and Retirement Study.

ObjectivesTo assess how cognitive trajectories from mid-to-later life relate to wealth change, overall and by mid-life income. Methods: Data were from participants (51-64 years) in the 2000-2018 U.S. Health and Retirement Study who were cognitively healthy at baseline (year 2000; unweighted n = 3821). Longitudinal latent class analyses generated cognitive and wealth trajectories, independently, and multinomial logistic regressions estimated the association between cognitive trajectories and wealth profiles, overall and by median income. Results: We identified three cognitive: cognitively healthy (CH), increasing cognitive impairment (ICI), and increasing dementia (ID) and four wealth profiles: stable wealth loss (SWL), delayed gradual wealth loss (DGWL), stable wealth gain (SWG), and gradual wealth gain (GWG). The ID group had higher probability of being in the SWL group and lower probability of SWG, which was more pronounced in respondents with greater median income. Discussion: Individuals with ID may be vulnerable to wealth loss, particularly for middle-class households.

How will I live this life that I'm trying to save? Being a female breast cancer survivor in Nigeria.

OBJECTIVES: Nigeria is experiencing an increasing rate of new cancer cases while marred by a weak health system. As cancer prevalence increases in Nigeria, especially among women, it is crucial to understand the experiences of female cancer survivors, given that their quality of life may be influenced by perceptions of cancer and what it means to be a cancer survivor. DESIGN: This study employed a qualitative descriptive method. Semi-structured interviews were conducted with a purposive sample of 30 female breast cancer survivors in Abuja, Nigeria. RESULTS: The three major themes were views about being a cancer survivor, cancer can be stigmatizing, and life after cancer diagnosis and therapy. CONCLUSION: We argue that cancer-related identity and cancer-related stigma are key factors with help-seeking and quality-of-life implications. Tailored interventions such as cancer health education and social support for cancer survivors may help reduce the burden of cancer in Nigeria.

HIV knowledge and information access among women cancer survivors in Nigeria.

Women in Nigeria have a high burden of diseases, such as cancer and HIV. Nigerian women also have inadequate access to health information, especially for disease prevention and health promotion. Researchers have indicated that living with HIV can be particularly harmful to the health and survival of cancer survivors. However, there is a dearth of research on Nigerian women cancer survivors' knowledge of cancer and HIV linkage and their access to HIV health information. This knowledge gap may have negative health consequences. Therefore, there is a need to ensure HIV prevention among Nigerian women cancer survivors by improving access to health information. This study used a qualitative descriptive method to examine HIV knowledge and access to health information among women cancer survivors in Nigeria. Semi-structured interviews were conducted with a purposive sample of 30 women cancer survivors from Abuja, Nigeria. We identified three themes from the data, illuminating women's knowledge of the connection between HIV and cancer. The themes include: (a) perception of HIV versus cancer which described views of HIV and cancer as distinct health conditions, (b) perceived effect of HIV on cancer given that HIV can worsen cancer outcomes, and (c) sourcing for HIV health information which highlighted issues of inadequate or inaccessible HIV-cancer information. Our findings showed that targeted health education interventions are required to address the lack of HIV information among cancer survivors.

Reverence and Reciprocity in Prioritization of Care to a Parent: The Role of Cultural Ecologies and Implications for Decolonizing Relationality.

Relationship research in the dominant psychological science portrays the prioritization of conjugal over consanguine relationships as a healthy standard. We argue that this "standard" pattern is only evident in cultural ecologies of independence. Drawing on the Confucian concept of filial piety, we conducted five studies and two mini meta-analyses to normalize the prioritization of mother over spouse. Cultural ecologies were operationalized by a variety of indexes, including histories of residential mobility, country, manipulated relational/residential mobility, and race. While participants situated in cultural ecologies of independence prioritized care to spouse over mother, participants inhabited in interdependence prioritized care to mother over spouse. Both American and Chinese participants showed greater prioritization of care for mother over spouse when they imagined a relational ecology of interdependence versus independence. Authoritarian filial piety mediated cultural-ecological variation on relational prioritization. Results illuminate cultural-ecological foundations of care and naturalize love as dutiful fulfillment of obligation.

"We Don't Do Any of These Things Because We are a Death-Denying Culture": Sociocultural Perspectives of Black and Latinx Cancer Caregivers.

This qualitative study explored the unique challenges and experiences faced by Black and Latinx cancer survivors through the lens of their caregivers, including the specific cultural, social, and systemic factors that influence cancer survivorship experience within these communities in the United States. We conducted six focus group discussions (three Latinx and three Black groups) with a total of 33 caregivers of cancer survivors, (Mean age = 63 years). Data were analyzed using inductive content analysis; The sociocultural stress and coping model was used as a framework to interpret the findings. We identified three main themes: 1) families as (un)stressors in survivorship such as the vitality of social connections and families as unintended burden; 2) responses after diagnosis specifically whether to conceal or accept a diagnosis, and 3) experiencing health care barriers including communication gaps, biased prioritizing of care, and issues of power, trust, and need for stewardship. This study's findings align with previous research, highlighting the complex interplay between cultural, familial, and healthcare factors in cancer survivorship experiences within underserved communities. The study reiterates the need for culturally tailored emotional, physical, financial, and informational support for survivors and their caregivers. Also, the study highlights a need to strengthen mental health and coping strategies, to help address psychological distress and improve resilience among survivors and their caregivers.

Different Interpretations of "Honor Your Parents": Implications for Obligation of Parental Caregiving.

OBJECTIVES: Many religious and cultural settings embrace the principle to "honor your parents." However, how individuals understand and enact this mandate varies by cultural context and community. The different understanding of "honor your parents" draws attention to motivations for parental caregiving across cultural contexts. This study investigates how individuals in 3 different cultural settings conceptualize "honoring your parents" and how these conceptualizations affect their perceptions of obligations to care for an older parent. METHODS: Semistructured interviews with 153 individuals in the United States, Ghana, and Nigeria explored the concept of "honor your parents," how it is understood, and its relationship to the perceived obligation to care for one's parents. A content analysis was applied to all transcripts and analyzed for discussion. RESULTS: Among individuals in the United States, "honor your parents" is less likely to be conceived as providing material and instrumental care to a parent, and more in terms of emotional care. In contrast, individuals in Nigeria and Ghana closely associated "honor your parents" with providing material and instrumental care to a parent. DISCUSSION: Understanding how different conceptions of "honor your parents" translate to expectations for and modes of parental caregiving can illuminate how caregiving needs can be met for the aging populations of the United States, Ghana, and Nigeria.

Pathways to health outcomes after cancer diagnosis: A systematic review of cancer survivorship in Nigeria.

OBJECTIVE: With advancements in medicine and technology, more people are surviving cancers. However, cancer mortality in Nigeria remains high. The yearly estimate is 72,000 cancer-related deaths, making cancer one of the leading causes of death in Nigeria. The current study aimed to identify and synthesize factors that facilitate or hinder cancer survivorship in Nigeria and add to our understanding of the patterns of cancer survivorship in LMICs, such as Nigeria. METHOD: Following preferred reporting items for systematic reviews and meta-analyses guidelines, a systematic review was conducted across PubMed, Cochrane, and Scopus databases. We identified 31 peer-reviewed studies that examined cancer treatment, management, care, and survivorship in Nigeria. RESULTS: Eight themes emerged from 31 peer-reviewed studies that examined the factors that facilitate or hinder cancer survivorship among Nigerians. They include themes such as self-care and management, treatment options, availability of pseudo-doctors/pharmacists, and the desire to live. The themes were further grouped into three overarching themes: psychosocial, economic, and health care. CONCLUSION: Cancer survivors in Nigeria face many unique experiences that impact their health outcomes and chances of survivorship. Therefore, understanding cancer survivorship in Nigeria must involve studies on diagnosis, treatment, remission, surveillance, after-cancer care, and end-of-life. With enhanced support, cancer survivors will have improved health, thereby reducing the cancer mortality rate in Nigeria.

A historical review of pain disparities research: Advancing toward health equity and empowerment.

BACKGROUND AND PURPOSE: This theory-guided review draws on 30 years of published data to examine and interrogate the current and future state of pain disparities research. METHODS: Using the Hierarchy of Health Disparity Research framework, we synthesize and present an overview of "three generations" of pain disparities scholarship, while proposing directions for adopting a "fourth generation" that redefines, explains, and theorizes future pain disparities research in a diverse society. DISCUSSION: Prior research has focused on describing the scope of disparities, and throughout the historical context of human existence, racialized groups have been subjected to inadequate pain care. It is imperative that research not only illuminates existing problems but also provides solutions that can be implemented and sustained across varying social milieus. CONCLUSION: We must invest in new theoretical models that expand on current perspectives and ideals that position all individuals at the forefront of justice and equity in their health.

"He [the doctor] said I should go and wait for my death:" Dualities in care and support access among female cancer survivors.

INTRODUCTION: While some countries have positive outlooks and technology at their disposals to detect and treat cancer in its earliest stages, other countries frequently demonstrate trends of late-stage presentation and treatment hesitancy. Nigeria is a nation that has a high cancer burden, with poorer outcomes than higher income countries (HICs). To add to the body of cancer knowledge in global health, and inform relevant policies to improve cancer survivorship, our study offers insight on cancer survivors' experiences in accessing care and support in Nigeria. METHODS: The study employed a qualitative descriptive method. Semi-structured interviews were conducted with a purposive sample of 30 female breast cancer survivors in Nigeria (Mage = 42 years). Their responses were transcribed, coded, and analyzed for themes. RESULTS: The four major themes identified were: 1) views about chemotherapy and treatments; 2) support from families and others; 3) support from health care providers; and 4) religion and coping. Each of these themes include sub-themes that offer insights on the dualities of cancer survivorship. DISCUSSION: The high cancer death rate in Nigeria may be masking the growing number of cancer survivors, especially women diagnosed with breast cancer. It is important to design interventions that not only target cancer prevention but improving the health and quality of life of those affected by cancer in Nigeria until end of life. The findings highlight a critical need for more attention on cancer survivorship in Nigeria.

Perceived risk of COVID-19 diagnosis and stigma among Nigerians.

The World Health Organization (WHO) classified Nigeria as one of the 13 African countries with a higher risk of spreading COVID-19. Although the Nigerian government and its health agencies set directives in place to help curb the spread of COVID-19, there are instances of unconcerned attitudes and adherence to false and superstitious beliefs surrounding COVID-19 among Nigerians. The current study examined the general perception of COVID-19 risk among Nigerians. Additionally, it examined the fear of possible stigmatization if an individual is diagnosed with COVID-19. A cross-section of 332 Nigerian men and women responded to measures on perceived vulnerability to diseases, perception of risk of being infected with COVID-19, COVID-19 stigma, and social and demographic characteristics. The findings show that respondents with a higher perception of vulnerability to diseases reported higher COVID-19 risk and perception of COVID-19-related stigma. Further, we found that gender, age, and education impacted COVID-19 risk and perception of COVID-19-related stigma. Our findings suggest that risk perceptions and attitudes towards COVID-19 can impact the level of preparedness against a pandemic. Also, the findings could inform strategies for the proper implementation of health protective measures at national, state, and local government levels during a viral outbreak.

A Mini-Review of Strategies for Recruiting Older African Americans to Alzheimer's Disease Research.

African Americans experience higher incidence and prevalence of Alzheimer's disease (AD). Yet, they continue to be underrepresented in AD research, limiting the ability to generalize findings to the increasingly diverse US population. To reduce AD disparities, targeted efforts are needed to increase the representation of African Americans in AD research. This mini review identified evidence-based strategies that increased research participation among older African Americans. Four recruitment strategies emerged from eight published peer-reviewed studies that directly evaluated the effectiveness of strategies aimed at increasing the number of African American participants in Alzheimer's research. The strategies include community outreach and education, face-to-face discussions, remote access, and referral and partnership with local organizations. Across different locations, these strategies increased the number of African Americans enrolled into AD research, the number of people that signed up to donate their brains for AD research upon death, and the knowledge and perception of AD in the communities. Targeted efforts are effective in increasing AD research participation among older African Americans, especially when combined with approaches that emphasize transparency and mutual trust and involve the community as stakeholders in the research process.

Health Information Seeking and Mental Health Support Utilization Among Individuals in U.S. Prisons.

This study examined factors influencing health information and mental health support seeking among individuals in U.S. prisons using the 2014 data from the Programme for the International Assessment of Adult Competencies. Results showed that not only are age, race, health status, receiving health information (e.g., from health experts, friends, and other incarcerated individuals), and readiness to learn associated with health information seeking from the media, but so too are competencies such as literacy, numeracy, and problem-solving skills. Years of education moderated the association between social trust and seeking mental health support. In addition, gender, work duration, and attending substance abuse support groups, life skills groups, and religious groups are associated with seeking mental health support in prisons. Findings from this study may provide insight for correctional health stakeholders working in partnership to deliver more tailored health and mental health interventions in U.S. prison settings.

Factors influencing compliance with public health directives and support for government's actions against COVID-19: A Nigerian case study.

Because COVID-19 is a novel viral pandemic, there is a dearth of research in the body of evidence that explore factors that can influence compliance with public health recommendations and Nigerian government's actions to prevent the spread of COVID-19. Hence, this study's aim is to address this gap to help inform policymakers and the actions of public health leaders in Nigeria. The study included a sample of 336 adult Nigerians who responded to an online Qualtrics survey. Descriptive and linear regression analyses were conducted to determine the predictors of compliance with COVID-19 public health directives and support for government's action against COVID-19 spread. Perceived risk of stigmatization, perceived threat of COVID-19, town/city, gender, and confidence in government's ability to curb the spread and impact of COVID-19 were found to be significantly associated with compliance with COVID-19 public-health directives, and support for governments action against COVID-19. Given Nigeria's weak health system and high level of poverty, there is need to ensure the public health responses to the pandemic are effective and contextually relevant. Nigerians and other concerned global health stakeholders will benefit from research that provides more information on issues of non-compliance with COVID-19 public health directives and government actions.

Dying To Be Men: Masculinity and Early Cancer Detection Among Nigerian Men.

Cancer incidence and mortality in Nigeria are increasing at an alarming rate, especially among Nigerian men. Despite the numerous public health campaigns and education on the importance of early cancer detection in Nigeria, there exist high rate of fatal/advanced stage cancer diagnoses among Nigerian men, even among affluent Nigerian men. However, there is limited information on patterns of cancer screening and psychosocial predictors of early cancer detection behaviors among Nigerian men. In this cross-sectional study, we examined demographic and psychosocial factors influencing early cancer detection behaviors among Nigerian men. Participants (N = 143; Mage = 44.73) responded to survey assessing: masculinity, attachment styles, current and future cancer detection behaviors, and sociodemographic characteristics. We found that among the participants studied, education, masculinity and anxious attachment were significantly associated with current cancer detection behaviors. Additionally, education and anxious attachment were significantly associated with future cancer detection behaviors. Our finding is best served for clinicians and public health professionals, especially those in the field of oncology in Sub-Saharan Africa. Also, the study may be used as a groundwork for future research and health intervention programs targeting men in Sub-Saharan Africa.

Dilemma Tales as African Knowledge Practice: An Example From Research on Obligations of Support.

This contribution to the Frontiers research topic collection on African Cultural Models considers dilemma tales: an African knowledge practice in which narrators present listeners with a difficult choice that usually has ethical or moral implications. We adapted the dilemma tale format to create research tasks. We then used these research tasks to investigate conceptions of care, support, and relationality among participants in Ghanaian, African American, and European American settings that vary in affordances for embedded interdependence vs. modern individualism. Results revealed hypothesized patterns, such that judgments about the inappropriateness of institutionalized eldercare (vs. home elder care) and prioritization of material support to parent (over spouse) were greater among Ghanaian participants than European American participants. Responses of African American participants were more ambiguous, resembling European American acceptance of institutionalized eldercare relative to Ghanaian participants, but resembling Ghanaian tendencies to prioritize support to parent (over spouse) relative to European American participants. Results illuminate that standard patterns of hegemonic psychological science (e.g., tendencies to prioritize obligations to spouse over mother) are the particular product of WEIRD cultural ecologies rather than context-general characteristics.

General Well-Being in Adult Black Males With Chronic Illness.

As individuals age, they witness a decline in physical health and functional capacities. The presence of one or more chronic illnesses challenges their quality of life and general well-being, thus, impacting their abilities to function physically, psychologically, and socially. We investigated reports of general well-being in older Black males with chronic illness(es) in a study of N = 145 participants, aged 35 to 63, and identified as Black/African American male. Participants responded to items assessing general well-being; ethnic identity; self-esteem; active coping; the presence of chronic illness(es); and additional demographic, social and ecological characteristics. Analyses of responses indicated that marital status (ß = -.17, p < .05), ethnic identity (ß = -.34, p = .00), self-esteem (ß = .22, p = .03) are significant determinants of general well-being in Black males with chronic illness(es). Data further showed active coping (ß = -.41 p = .09) to be negatively correlated with well-being. We discuss the implications of results for the understanding of health outcomes among this marginalized population.