Examining First and Second-Level Digital Divide at the Intersection of Race/Ethnicity, Gender, and Socioeconomic Status: An Analysis of the National Health and Aging Trends Study.

BACKGROUND AND OBJECTIVES: Significant societal and technological changes in the 2010s called for an up-to-date understanding of the digital divide among older adults in the United States (U.S.). This trend study aimed to examine the effects of race/ethnicity and the intersecting effects of race/ethnicity with other marginalized identities related to gender, income, education, and occupation on the first- and second-level digital divide. RESEARCH DESIGN AND METHODS: Utilizing a nationally representative sample of older community dwellers from the National Health and Aging Trends Study, we conducted weighted logistic regressions at three time points (2011/2013, 2015, and 2019). The first-level digital divide was measured by access to working phones or computers/laptops; the second-level divide was measured by seven activities in personal-task, social, and health-related Internet use. RESULTS: The first-level racial/ethnic digital divide became non-significant in 2019, whereas the disparities in all second-level measures persisted. The intersecting effects of race/ethnicity with low education and/or low income became non-significant in 2019 for personal-task use. However, the interactions with low education and/or low income became significant for social and health-related use in 2015 and/or 2019. DISCUSSION AND IMPLICATIONS: This study highlights the persistence of the second-level racial/ethnic digital divide among older community dwellers in the U.S., especially the exacerbated social and health-related digital divide for people of color with low socioeconomic status. By considering intersections of marginalized social identities, policymakers and stakeholders should develop targeted strategies to bridge the digital divide, promote health outcomes, and reduce health disparities.

Older adults' online activities and cognition: Investigating the psychological mechanisms and age and gender differences.

OBJECTIVES: This study aimed to investigate psychological mechanisms underlying the association between older adults' Internet use and cognition and examine potential age and gender group differences. METHODS: 2064 older participants were extracted from the Waves 2012, 2013, and 2016 Health and Retirement Study. Internet use was measured by two sets of variables: Internet access and different types of online activities (i.e., informational use, social use, online shopping, and online banking). Path analyses were applied to test the proposed mechanisms via three mediators (i.e., loneliness, depressive symptoms, and perceived control). Multi-group analyses were conducted to examine the potential group differences. RESULTS: Internet use was positively associated with cognition. Despite the large direct effect, small but significant indirect effects via depressive symptoms and perceived control were identified across all online activities. Multi-group analyses revealed age-group differences in the mechanisms: depressive symptoms mediated the effects of all online activities on cognition among young-old adults, while perceived control mediated all the effects among old-old adults. Gender group differences were also identified: depressive symptoms mediated the effects of all online activities on cognition among older women and most online activities among older men, whereas perceived control mediated the associations between informational and instrumental (i.e., online shopping and banking) use and cognition among older men. DISCUSSION: This study highlights the mediating effect of depressive symptoms and perceived control and age and gender differences regarding the Internet use-cognition association. Internet-based cognitive interventions should consider these psychological mediators and age and gender differences for the best results.

Bridging the Access Gap: A Decade of Narrowing the Digital Divide for Hispanic Older Adults in the United States.

Objectives: This study examines the digital divide between Hispanic and non-Hispanic White older adults in the United States from 2011 to 2021, using an intersectionality perspective. Methods: Eleven waves of data from the National Health and Aging Trend were analyzed through multilevel logistic regression, focusing on the intersection between race/ethnicity and time (measured by survey waves) within gender, education, and income subgroups. The digital divide was measured by Internet access. Results: Despite the enduring digital access gap, the longitudinal analysis revealed a narrowing digital divide between Hispanic and non-Hispanic White older adults, especially those with low education and income. Discussion: The observed trend signifies progress in digital inclusivity initiatives yet highlights ongoing challenges in fully bridging the divide for the Hispanic older adult community. Future efforts should not only focus on access but also on enhancing the effective usage of digital technologies to promote health equity and well-being.

Doctors' recommendations and healthy lifestyle behaviors among individuals with hypertension in Brazil.

Little is known about whether doctors' recommendations encourage healthy behaviors among individuals with hypertension in Brazil. This study examined the biological, social, and health factors related to doctor's recommendations and the associations between doctor's recommendations and healthy behaviors. The sample consisted of individuals with hypertension (N = 18,260) from Brazil's 2019 National Health Survey. The outcomes examined included smoking, drinking, diet, salt intake, physical activity, and doctor visits. Study findings indicated that more than 80% of people with hypertension in Brazil received doctors' recommendations to adhere to medical care and engage in healthy behaviors. Those who received recommendations were more likely to practice healthy eating and exercise regularly but also to be obese/overweight, smoke, and drink excessively. Nonetheless, the findings concerning diet and exercise suggest the value of doctors' recommendations for individuals with hypertension in Brazil.

A biopsychosocial examination of chronic back pain, limitations on usual activities, and treatment in Brazil, 2019.

BACKGROUND: Chronic back pain is prevalent in Brazil, leading to enormous healthcare costs and social burdens. It also disproportionately affects low-income and less-healthy people. OBJECTIVES: This study examines the associations of chronic back pain with biological, psychological, and social factors; how it limits usual activities; and how chronic back pain influences the use of treatment services. METHODS: Using Brazil's National Health Survey (PNS-2019), multivariate logistic regressions were conducted to examine how biological, psychological, and social factors correlate with chronic back pain, limitations on usual activities, and pain treatment. RESULTS: PNS-2019 data showed that 23.4% (95% CI 22.8-24.0) of Brazilian adults aged over 20 reported back pain. A higher prevalence of chronic back pain was associated with biological factors (older age, being female, overweight or obese, current smoking, and having more chronic conditions), lower social conditions (low education, low per capita household income, non-married, and living in rural areas), and poor psychological health (more depressive symptoms). Chronic back pain is more likely to limit usual activities among those with low social conditions (lower education, lower income), poor physical and behavioral health (obese, current smokers, and those with a greater number of chronic conditions), and worse psychological health (more depressive symptoms). However, married people and those who do not consume alcohol were also more likely to report limited activities. Among those with back pain, 68% received at least one form of treatment. Those with intense limitations on their usual activities were 2.2 times as likely to report treatment. People with higher social conditions (higher income, college education, and private health insurance) were more likely to receive treatment. CONCLUSION: The results show significant biological, psychological, and social disparities in the prevalence of chronic back pain in Brazil. The findings point to the need for tailored policies and prevention programs with attention to vulnerable groups. Even though Brazil has universal health care, those with better socioeconomic conditions are more likely to receive treatment.