Mortality and Physical Functioning in Epidemiologic Studies of Three Older Populations

Mortality experienced in the first three years of follow-up of three Established Populations for Epidemiologic Studies of the Elderly (EPESE) is examined in relation to the participants' self-reported functional ability. In East Boston, Massachusetts (N=3,812), Iowa and Washington Countries, Iowa (N=3673), and New Haven, Connecticut (N=2812), noninstitutionalized persons aged 65 and older were asked a series of questions to determine their functional status. These measures, used in logistic regression analyses of the mortality data, showed that an increased number of reported disabilities significantly increased the risk of mortality over and above the effects of the age and sex of the participant, or the methodogical differences among the sites. Disabilities in gross mobility (e.g., ability to walk a half mile, climb stairs, or perform heavy work around the house) were more strongly related to mortality than were measures of activity of daily living.     

Combination training and resistance training as effective interventions to improve functioning in elders

The purpose of the study was to determine whether resistance training (RT) or a combination of resistance and aerobic training (CT) resulted in the most improvement in measures of functional ability in functionally limited elders. Elderly adults who exhibited some limits in functional ability were randomly assigned to either a CT, RT, or control (C) group. Both RT and CT exercised three times per week for 16 weeks. At Weeks 0 and 17, participants completed six measures of strength and six functional tests. A 3 (group) x 3 (time) ANOVA with repeated measures on the time factor was used to analyze the results. CT and RT scored significantly better than C at Week 17 for biceps curl, elbow extension, chair stand, and time up the stairs. These findings demonstrate that RT and CT are both effective at increasing measures of strength and functional ability in elderly adults who begin exercise with functional limitations.     

The Sexual Inhibition (SIS) and Sexual Excitation (SES) Scales: I. Measuring sexual inhibition and excitation proneness in men

This study involves the development and initial validation of a questionnaire measuring the propensity for sexual inhibition and excitation in men: the Sexual Inhibition Sexual Excitation Scales (SIS/SES). The underlying theoretical model postulates that sexual response and associated behavior depend on dual control mechanisms, involving excitatory and inhibitory neurophysiological systems. The scales and their discriminant and convergent validity and test-retest reliability are described. In a sample of 408 sexually functional men (mean age = 22.8 years), factor analyses identified three higher-level factors: two related to sexual inhibition and one to sexual excitation. Multigroup Confirmatory Factor Analyses revealed that the factor structure provided an acceptable fit to the data obtained in a second (N = 459; mean age = 20.9 years) and third (N = 313; mean age = 46.2 years) sample of men, with similar distributions and relationships with other measures. Theoretical issues and areas for further research, including male sexual dysfunction and risk taking, are discussed.     

Stair-ascent performance in elderly women: effect of explosive strength training

Explosive-type strength training may alter kinetics and neuromuscular activity during stair ascent in elderly women. This may improve functional ability. Nineteen women (69.7 ± 3.4 yr) were randomly allocated to strength training (TG; twice per wk, 12 wk) or a control group (CG). Stair ascent was assessed at self-chosen (AFV), standardized (ASV), and maximal velocity (AMV) pre- and posttraining. Ground-reaction force (GRF) and EMG quantified kinetics and neuromuscular activity. After training, TG increased AMV and AFV velocity by 8% (p = .02) and 17% (p= .007), respectively (TG vs. CG; p< .05). This was accompanied by elevated rectus femoris EMG (from 21% to 48%, p< .047). At AFV, TG increased GRF first peak force 4% (p= .047), and CG increased second peak force 5% (p = .036). Muscle coactivation remained unaltered in both groups. Explosive-type strength training led to enhanced stair-climbing performance at maximal and self-chosen speed, reflecting an improved functional ability.     

Stress, life events, and socioeconomic disparities in health: results from the Americans' Changing Lives Study

It has been hypothesized that exposure to stress and negative life events is related to poor health outcomes, and that differential exposure to stress plays a role in socioeconomic disparities in health. Data from three waves of the Americans' Changing Lives study (n = 3,617) were analyzed to investigate prospectively the relationship among socioeconomic indicators, five measures of stress/negative life events, and the health outcomes of mortality, functional limitations, and self-rated health. The results revealed that (1) life events and other types of stressors are clearly related to socioeconomic position; (2) a count of negative lifetime events was positively associated with mortality; (3) a higher score on a financial stress scale was predictive of severe/moderate functional limitations and fair/poor self-rated health at wave 3; and (4) a higher score on a parental stress scale was predictive of fair/poor self-rated health at wave 3. The negative effects of low income on functional limitations attenuated to insignificance when waves 1 and 2 stress/life event measures were controlled for, but other socioeconomic disparities in health change remained sizable and significant when adjusted for exposure to stressors. The results support the hypothesis that differential exposure to stress and negative life events is one of many ways in which socioeconomic inequalities in health are produced in society.     

The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly

Elderly participants experiencing difficulty in chair rising and with a maximum knee-extensor torque below 87.5 N . m were randomized to different versions of a strength-training program for the knee-extensors: to a high-guidance group (HG; two group sessions supervised by a physical therapist and one unsupervised home session per week, n = 17), a medium-guidance group (MG; one supervised group session and two unsupervised home sessions per week, n = 16), or a control group (C; no exercise, n = 16). Maximal isometric knee strength increased more in HG than in C (p = .03) and with increasing guidance (p = .03). The effect was mainly the result of participants with low initial strength. Walking speed increased more for HG than for C (p = .02) and than for MG (p = .06). No statistically significant improvements were seen on other functional tests. In summary, the study shows a trend toward better results with more supervision, but more and larger studies are needed to confirm this.     

In sickness but not in health: self-ratings, identity, and mortality

Self-rated health as a predictor of mortality has been studied primarily in large, representative populations, with relatively little progress toward understanding the information processing that individuals use to arrive at these ratings. With subsamples of National Health and Nutrition Examination Survey (NHANES) Epidemiologic Follow-up Study (NHEFS) data for respondents with circulatory system disease (N = 3,709) and respondents with no diagnosable disorders (N = 1,127) at baseline, we test the idea that individuals with experience of chronic disease of the circulatory system will have more predictive self-ratings of health than healthy individuals. Poor or fair self-rated health increased the adjusted hazard of all-cause mortality for respondents with circulatory system disease, but not for respondents who were healthy. Additional analyses confirm that poor or fair self-rated health is particularly predictive for respondents with self-reported history of circulatory system diagnoses and perception of symptoms, but not for respondents without symptoms or diagnoses prior to the NHANES physical exam.     

Measuring Adoptive Identity: Validation of the Adoptive Identity Work Scale

Guided by Erikson's as well as Grotevant and colleagues’ identity theorizing, three studies were conducted to assess the validity and reliability of the Adoptive Identity Work Scale (AIWS), a self-report measure of the identity work contributing to one's adoptive identity. Adult adoptees were solicited in a series of surveys (study 1: N = 196; study 2: N = 119; study 3: N = 217) to complete existing measures of adoptive identity and well-being as well as the newly formed AIWS. The studies reported here provide concurrent, construct, and predictive validity for the AIWS, consisting of five items measuring reflective exploration and five items measuring preoccupation.     

Adulthood depression, anxiety, and trauma symptoms: a comparison of women with nonabusive, abusive, and absent father figures in childhood

We collected data from 447 women (aged 18 or higher) from seven domestic violence programs and five substance use disorder treatment programs in a midwestern state. Women who reported a nonabusive natural/adoptive father or stepfather (N=185), abusive natural/adoptive father or stepfather (N=200), or absent father figure (N=40) were compared on a series of mental health measures with multivariate analysis of variance and pairwise post hoc comparisons using the Bonferroni test. Women with absent father figures were found to have significantly lower mean scores on the Beck Anxiety Inventory, Beck Depression Inventory, and Trauma Symptom Checklist-40 (TSC-40) than women with abusive fathers. There were no significant differences between women with absent father figures and women with nonabusive father figures on the Beck Anxiety Inventory, Beck Depression Inventory, and TSC-40. Implications for research, practice, and policy are discussed.     

Effectiveness of an educational intervention to increase knowledge and reduce use of risky behaviors associated with cumulative trauma in office workers

OBJECTIVE: This pilot project assessed the effectiveness of an intervention to increase knowledge and reduce risky behaviors related to cumulative trauma disorders (CTD) in office workers. STUDY DESIGN: All 124 employees from the administrative offices of a health maintenance organization were invited to participate. Subjects were followed across time using an identification number. Data were collected via questionnaire in June 1994 (pretest1) (N=84), August 1994 (pretest II) (N= 63) and September 1995 (posttest) (N=40). The yearlong intervention focused on functional activities to prevent CTD. RESULTS: of chi-square analyses for the 40 subjects who completed all surveys indicated this intervention significantly increased overall knowledge of CTD (p =.002). Significant changes in self-reported hand/wrist (p =.016) and neck/shoulder (p =.003) posture were also found. CONCLUSIONS: This study is a first step in identifying effective educational interventions to increase knowledge and reduce risk factors related to CTD in office workers.     

Ergonomics in a hospital and a university setting: The effect of worksite analysis on upper extremity work-related musculoskeletal disorders

OBJECTIVES: The purpose of this study was to determine whether individuals with work-related injuries receiving worksite analysis would have less lost workdays than individuals not receiving worksite analysis. Therapeutic management of work-related injuries in a hospital and a university setting were also compared. STUDY DESIGN: Over a one-year period, employees who sustained an upper extremity work-related injury were issued questionnaires regarding their injury, treatment, functional status and pain level. Participants were divided into three groups: group 1 consisted of hospital employees (N=14) who underwent worksite analysis, group 2 included university employees (N=15) who underwent worksite analysis whereas group~3 included university employees (N=14) who underwent no analysis. RESULTS: All groups were similar in demographics, functional status, and pain level. Satisfaction with the worksite analysis was similar for groups one and two. CONCLUSION: A pattern of less absenteeism but greater modified duty days was associated with those individuals undergoing worksite analysis.     

A validity scale for the Sharp consumer satisfaction scales.

Because of the apparently inflated scores commonly reported for consumer satisfaction with mental health services, we developed a 5-item validity scale for the SHARP questionnaire. The scale discriminated significantly (P less than .001) between those former clients who offered suggestions for improvement of services and those who did not (N = 38). In another experiment, the scale significantly improved the ability to predict the 46 clients' true scores from their obtained scores via stepwise regression (p less than .01). Weights were obtained from that sample of former clients, which significantly reduced the deviation of the obtained satisfaction scores from the true scores, with all p less than .05. In two successive experiments (N = 49 and 26), weights were applied to new samples, significantly reducing deviation from the criterion scores for 5 of the 6 scales (p less than .05), and new weights were then derived. A final set of weights was derived from the combined samples of the three experiments, (N = 121) which significantly improved prediction of the criterion and lowered the mean on all scales, with all p less than .05.     

Childhood sexual abuse, dissociation, and adult self-destructive behavior

Female college students reporting a history of childhood sexual abuse (N=175) and not reporting a history of childhood sexual abuse (N=260) were compared on indices of six self-destructive behaviors, including drug use, alcohol abuse, binge eating, self-mutilation, risky sex, and suicidality. The samples were also compared on two measures of dissociation, the Trauma Symptom Checklist dissociation subscale and the Dissociative Experiences Scale. The CSA group had significantly higher mean scores on all the indices of self-destructive behavior except self-mutilation (where the mean difference approached significance), and on both measures of dissociation. One or both dissociation measures were related significantly to each index of self-destructive behavior except binge eating. Multiple regression mediation analyses provided support for the hypothesis that dissociation mediates the relationships between CSA and both drug use and alcohol abuse. Dissociation also explained significant variability when added to the regressions of risky sex and suicidality on CSA.     

Comparison style, physical self-perceptions, and fitness among older women

This study examined the relationships between older women's comparison styles, physical self-perceptions, and functional fitness. Participants were community-dwelling women (N = 102, age 65-99) living in the mid-Atlantic region of the United States. Individuals were categorized as relying primarily on social comparisons, temporal comparisons, or a combination of both styles. Also of interest was whether individuals evaluated themselves positively or negatively when making comparisons. Participants who evaluated themselves positively as compared with others were found to have higher levels of physical self-perception. Analyses revealed that women who relied primarily on temporal comparisons had higher self-perceptions of their functional ability than those who relied on a combination of comparison styles. An avoidance of both temporal and social comparisons was also related to higher levels of physical self-perception.     

Exploring the multiplicity of childhood sexual abuse with a focus on polyincestuous contexts of abuse

This study explored the prevalence of multiple abusers and polyincest in a clinical sample of 88 adult women, focusing on interviews with a subset of 30. For the sample as a whole, 43% reported three or more abusers and 23% reported polyincest. The narrative data was divided into three categories defined as Single-Abuser (N=8), Multiple Abuser (N=8), and Polyincestuous (N=14). These were compared to determine how survivors perceived family members' and others' reactions to disclosure of CSA. All three groups experienced various forms of silencing. The most negative responses were linked to polyincestuous abuse. Three themes were identified as denial/ minimization/normalization, fear/reprisal, and negative/inadequate. Results suggest the need for further research on the frequency of multiple abusers among victims of sexual abuse, as well as the ways in which family and social contexts serve as collusive environments for the practice of CSA.     

Physical aggression and control in heterosexual relationships: the effect of sampling

This study investigated the proposition by Johnson (1995) that there are distinct patterns of physical aggression within relationships, characterized as common couple violence and patriarchal terrorism. The present samples comprised students (N = 113), women from a domestic violence refuge (N = 44), and male prisoners (N = 108). Participants completed measures of physical aggression, controlling behavior, fear of injuries, and injuries. Reports of these measures were entered into a Discriminant Function Analysis (DFA). With the exception of self-reported use of controlling behavior, the variables showed univariately significant differences between the groups. The DFA produced two significant functions which together correctly classified 75% of cases. These results support the view that there are distinct patterns of aggressive relationships corresponding to those identified by Johnson (1995).     

Family/work roles' relation to perceived stress: Do gender and ethnicity matter?

This exploratory research examines whether gender and ethnic differences exist in family- and work-related variables that best predict perceived stress. The Anglo male (N=115) and female (N=199) and Mexican-American male (N=35) and female (N=85) respondents each had the roles of employee, spouse, and parent. Data were collected by mail questionnaire from state-classified employees at the three land-grant universities in Colorado, New Mexico, and Wyoming as part of Cooperative Regional Research Project W-167. Regression analysis indicates that role overload is a significant predictor of stress for Anglo males and females and Mexican-American females, thus providing some support for the role strain theory, which suggests that increasing the number of roles drains personal resources and may increase stress. Satisfaction with family roles enters regression equations as significant predictors for two sample groups. Other variables enter only one of the four regression equations; thus ethnicity and gender differences are found in the variables predicting perceived stress and should be considered in future research in this area. The research was funded by the Colorado, New Mexico, and Wyoming Agricultural Experiment Stations as part of Cooperative Regional Research Project, W-167, “Work, Stress, and Families.” Her research interests include issues related to balancing work and family and to family resource management. She received her Ph.D. from Pennsylvania State University. Her research interests include grief and loss issues and family support systems. She received her Ph.D. from Arizona State University. His research interest is minority families, and his Ph.D. is from Florida State University. Her research interest is Latino family functioning. Her Ph.D. is from New Mexico State University. His research interest is human resource development emphasizing ranching families. He received his Ph.D. from Iowa State University.     

Problem gambling in a federal prison population: results from the South Oaks Gambling Screen

Three hundred and sixty three medium security federal prison inmates were interviewed with the South Oaks Gambling Screen (SOGS) with 5.2% of the sample achieving SOGS scores greater than 4 and another 7.4% attaining scores of 3 or 4, traditional markers of pathological gambling and problem gambling, respectively. Attempts were made to evaluate the relative accuracy of the continuum and dichotomy models of problem gambling by contrasting three groups of subjects (SOGS < 3, SOGS = 3 or 4, SOGS > 4) on a series of gambling-related measures and comparing the relative ability of the SOGS and a dichotomized version of the SOGS to account for residual variance in these same gambling-related measures. Results were consistent with the view that problem gambling embodies features of both a continuum and dichotomy. Nearly half the subjects had desisted from problem gambling on their own, although self-remitters displayed less severe and extensive patterns of problem gambling than non-remitting subjects.     

The impact of function on work status for community dwelling disabled persons with arthritis: an analysis of the National Health Interview Survey Disability Supplement

Arthritis is one of the most common diseases and a leading cause of disability in adults. Returning injured workers to work and preventing work disability is the primary mission of occupational health professionals. The purpose of this study was to identify risk factors associated with work disability and intervention strategies. This study is a retrospective cohort analysis of secondary individual level data. The data for the study were collected by the National Health Interview Survey, Disability Supplement (NHIS-D) 1995. Community dwelling disabled persons with functional limitations due to arthritic conditions were included in this analysis. A total of 286 records were available for logistic regression analysis. The outcome variable was work status, either working or not working. The significant predictors of working status were ability to lift 10 pounds (OR = 1.64), college education (OR = 0.21), age (OR = 1.03), and less than high school education (OR = 2.48). Thirty-four percent of the variance in working status was explained by the model that also included health status, difficulty standing, difficulty walking up steps, difficulty walking 1/4 mile, ethnicity, and gender. Younger disabled persons with arthritis, who have little difficulty lifting 10 pounds, and have some college education have better odds of working. Occupational health professionals need to look for ways to improve the educational status and functional lifting ability of disabled individuals with arthritis.