 Good morning, okay, we are ready, welcome to UTSA, and thank you all for being here. I'm Harriet Romo, I'm a professor in the Sociology Department and the director of the Mexico Center here at UTSA. And so I'm moderating this panel this morning on contextualizing elder care among Mexican origin caregivers in the 21st century Mexico and the United States. So the context and the neighborhoods of where these folks are living are very important. So we've got some really interesting presentations this morning and we'll go right through the order of our program. But I'll introduce each one and then when it's their turn they'll go to the podium to present so that they'll be captured on the video for the people participating online. So our first speaker is Dr. Carolyn Mendis-Luck. She has a PhD in public health from the School of Public Health at UCLA and a master's in public health in community health sciences from UCLA as well. She's now an assistant professor in the College of Public Health and Human Sciences at Oregon State University. She's been an active scholar. She was a Robles, Garcia Robles fellow in Mexico City. She's been a researcher that has directed some big projects at UCLA and she's also been very active in teaching about the aging frontier and taught also and lectured about race in class. So welcome Dr. Mendis-Luck. If you can't hear me, please raise your hand and I'll try to speak in tune this morning. So I'm very pleased to be with all of you today to talk about my research and I first want to say thank you to Rojaveo and Jackie for the kind of invitation to speak. And I'm going to be talking about informal family caregiving among women of Mexican origin. So women from Mexico City and Mexican origin women living in East Los Angeles, California. So I'm going to give a little background first. So historically women predominate as caregivers and this is a context of care that occurs throughout the world, not just in the Americas. And when we think about the Mexican culture and it's so closely tied to caregiving that it's important to look at what the literature says about the Mexican culture, particularly about the family. So there's a rich description in the literature that the Mexican family is united, lives within an extended family network and that people within the family are founded to one of them, depend on one another and sacrifice for each other for the greater good of the family. So what I just described can be called familismo. Mariarismo and respeto are two other cultural values that are important that have been written about in the literature. And I have some critics about these concepts though. Particularly that they simplify and romanticize complex interpersonal relationships and processes. So it's not without its critics, although this is what the literature says about the Mexican culture. So in my prior work I found that the tenants are actually present in the caregiving experiences of Mexican origin women. And important forms of caregiving include emotional aspects of giving care, companionship, love and attention. All of these are forms of caregiving that I have found in my research. And lastly this idea of attentiveness or in Spanish it's called estada pendiente. That's an integral part of caregiving. It's about vigilance in watching out and always being there for the person being cared for. So this study that I'm going to talk about today explored the cultural beliefs related to family care and aging among women of Mexican origin. Particularly we were interested in examining what were the gender roles related to giving care to older adults. What were the beliefs about older adults and aging beliefs in general. And so that's what I'll be pursuing today. I'm going to focus though on two areas, gender roles and the elderly. So this analysis is actually an analysis of two different data sets that we combined. They came from two prior studies that I was a PI on. And the first data set came from Mexico City. It was collected in Mexico City for my dissertation. And then the second set came from interviews with women in East Los Angeles. The East Los Angeles study replicated the study from Mexico. So both studies share the same qualitative study design methods and instruments, including the topics that are covered on the interview guide and the eligibility criteria. So the analysis for this study was first, a couple of things. So first we took the data that had already been transcribed. We uploaded it into Atlas TI, which is a software program to manage qualitative data. We analyzed the data in the language of the interview, whether it was in Spanish or in English. And then we followed a systematic protocol in our analysis. The first step of that was, since we had these two studies, we had to combine them both into one. Each study had its own code list and coded terms. And we had to merge all of those, reconcile so that we could have one code list for the two sets of data, which is now one big combined data set. And that was very mechanical and just took a long time to do. The next part of the analysis, which was really the analysis, is that we did three steps. Content analysis, taxonomic analysis, organization, and code mapping. And these three steps build on each other to identify, at the end, identify matter content. And so there are specific procedures within each step on how to do that. I'm not going to go into detail on how to do that. I'd be happy to answer questions if you have any later on. But right now we're at the code mapping stage. So we are still developing thematic content. However, I do have some preliminary data that I'm able to share with you today. So first I want to give you a look at the samples. So we interviewed a total of 85 women. 41 were from Mexico City, 44 from East Los Angeles. And of those in East Los Angeles, 18 were U.S. born, and 26 were immigrant women. Mexico City caregivers tended to be younger than their East LA counterparts. And more of them worked outside the home and were married. Also not shown here, for most of the study participants for the full sample, they had lower than secondary education levels and lower incomes with respect to the average incomes in each country. So they were not well resourced women. And lastly, they were all long-term residents in their local communities. So this table shows some caregiving characteristics of the caregiving situation and characteristics of the care receiver. And what I'd like to point out here is that in terms of the length of caregiving, that seemed to be similar across groups. And the majority of caregivers cared for a parent, followed by a husband, and then after other relatives. The majority of caregivers shared the same houses as the person they were caring for. And East LA caregivers were older on average than the immigrant women or the Mexican women. And another interesting fact that I want to point out is that the Mexico City caregivers were taking care of relatively healthy older adults compared to the East LA caregivers. So when you look at that, 27% of caregivers were taking care of someone who had no physical illness and had no need for ADL health. So they were relatively healthy. Whereas the caregivers in East LA were taking care of really highly impaired older adults, or older adults with multiple conditions. So this first series of results is on social and gender roles. So we found that women were socialized into the role throughout their lives. This wasn't something that was talked about in the family, at least not explicitly. Rather, it was something that they learned over time through observing others. So they saw caregiving being played out by other family members and they were taught by those experiences as well as being taught how to do some caregiving activities by those family members. But there were really no explicit discussions about the obligation to provide care. So I also want to say here that most, if not all the women, regardless of where they lived felt that caregiving was something that women will always do. In the future, going forward. We also found that fulfilling the role was an opportunity to serve a parent or a non-spousal relative to see the family member improve or maintain their health or to ensure respect and good treatment of a family member. And so when we looked more at the data, look closely at the data, we saw that this fulfillment of the role was viewed a little bit differently for these two groups. Mexican caregivers saw this fulfillment as satisfaction, whereas the U.S.-born caregivers really focused on fulfilling the role so as to provide good treatment, good medical treatment, good physical care to their family member. And then lastly, we saw a small group of women talk about this idea that even though they know women will always be the caregiver, that a man's role should be the same in terms of caregiving. And we found that interesting that although they said, yes, a man's role should be the same, but that's not what's going to happen or what they expect is going to happen, but that it should be the same. And then when we looked at, well, who's in this group of, this small group of women, they were primarily U.S.-born women and immigrant women. Very few Mexican caregivers expressed the same sentiment. So I'm going to give you a couple of examples here first in terms of a general in general. And this one comes from, let's see, what's her name? This one quote comes from Julia. She's 37 years old at the time of the interview and she had been caring for her 68-year-old mother-in-law for the past 15 years. And she said, men are more about the street working and going out more, but women are about the house and the children. So here we can see the differentiation in responsibilities by men and women in general. The second one has to do with gender roles related to caregiving. And this quote comes from Susanna. She was 49 years old and she was caring for her 80-year-old mother for the past year. She was an immigrant caregiver living in East Los Angeles. And she said, women are more understanding. Men just focus on working and they forget about the rest. He helps economically, but he doesn't help or understand the way a woman does. So here, again, we can see that there's this differentiation in men and women's focuses, but also underline in this quote is the idea that women are inherently better. Okay, thanks. Yeah, keep me on top. So this next set is about beliefs about the elderly. And so what we found was that caregivers talked about the elderly as being a vulnerable group of people, that they were vulnerable to being viewed by others as being a burden, a hassle, or getting in the way. Some caregivers felt that elders lost status in the family or their identity or their authority in the family because of increasing dependency, role reversals because of being ill. This change of role was not necessarily because of chronological age. It had to do more with health and other extenuating circumstances. So this exemplar comes from Laura. She was taking care of her 71-year-old husband for the past 10 years. She's also an immigrant caregiver. And she says, when a person gets older, they lose the capability to make decisions. So then they are indecisive. They don't know if they are doing good things or bad things. So then the children help the grandparents make decisions. Yes, because when they are already too sick, they can't decide anymore. Okay, again, this quote getting at the sort of changes in roles due to a diminished capacity. So this small snippet of findings that I shared with you do or are consistent with some of the tenets that I talked about earlier, but also these themes played out differently across groups. And this may speak to changes in or reflect an acculturation experience for the immigrant caregivers. But nevertheless, there's some ideals, cultural ideals that still persisted despite living in a different environment and social context. So there were some limitations. One of them I'll point out, because I don't want to run out of too much time, is that the data, even though there were parallel studies, the data were collected at two different times. And so that fact could have affected the results that we found, because women were coming in at different historical periods of time, different lifetimes, things happening in their lives that could have affected how they answered their questions. Also the data for the first study is 18 years old. So we have to ask the question, how relevant is it to 2016? But I argue that the data still are relevant because we saw some consistencies across the groups. And so because of that consistency in some of those findings that I tend to think, well, the data isn't so bad after all. So lastly, I'm just going to leave this sort of as a discussion. I'm not going to talk about this too much, but I'm going to pose the questions here. So we know that the landscape of our lives are changing. And in particular, as those related to caregiving are women's increased workforce participation, delayed and reduced fertility, population aging. All of these, among other factors, are happening in the Americas today. So what implications do they have for caregiving? Will family ties weaken? Will we still see this families will play out? Will expectations change? Will caregiving remain a gendered responsibility? Will beliefs about elderly shifts to accommodate changes? Will future elderly adjust their expectations? The results that I showed here, I think indicate that there is a shift underway, but that women will continue to struggle to fulfill their role obligations amidst all of this changing landscape. So what will happen, I think, is really up for a conversation. So I'll leave it at that. Thank you. Thank you very much. You set the stage for the questions at the end of the panel discussions. Our next presenter is Kate Cagney, and she is an Associate Professor of Sociology and Health Studies and Director of the Population Research Center, NORC and at the University of Chicago. She has worked with issues of social inequality and its relationship to health with a focus on neighborhoods, race and aging and the life course. She brings urban sociology theory and methods and research to health, examining outcomes such as asthma prevalence, physical activity, mortality during crises, and looking at the evolution of a new community in Chicago called Lakeside. She also focuses on the development of new methods to define and measure neighborhoods and social networks with smartphones related to data collection. So thank you very much, Kate, for being here. And I wanted to say special thanks to Jackie for bringing me here and also to all of you for the great day we had yesterday, and I know I've enjoyed all of our conversations, but now I feel like I have to do a little work. And so I'm going to walk you through some research on neighborhood social context and its relationship to health. And I want to focus, particularly given the substance of this conference, really thinking carefully about the context of community and how it might matter for the health of older Latinos. So let's look at that diagram. One thing that Chicago School Theory doesn't do is really think carefully and think about this point in the distribution in which we're thinking about concentration in these groups. So this is collective efficacy theory and its relationship to health. When we think about structural features, and it's this piece, ethnic heterogeneity, which we're going to draw today, think about it in relation to residential and stability communities, economic disadvantage. When this work was originally theorized by Sean McKay, Burgess, and others at Chicago, it was primarily meant to describe research and crime. And what we've tried to do in my work with Chris Browning is to look carefully at how these same kinds of features that might alter community context would have implications for health in the same way they might have implications for crime. And again, this is what we're trying to think about, the blue that connects the structural features of community with particular kinds of outcomes. So what are our research questions? So we want to ask, do changing residential patterns have implications for the health of older adults? Will Latinos have fewer physical and mental health documents over time when compared to whites? And will racial and ethnic health disparities be greater in changing neighborhoods? Just based on population composition, and we can think of this in general as an enclavement that may come up in the Q&A, what we all think an enclave might be is to try to define one with secondary data, which is really hard to do, or to use the census to help us, and how that might matter for the impact of that change. Will an influx of Latinos in high concentration Latino neighborhoods reinforce this health-remoting aspect in community? And will an influx of Latinos in low concentration neighborhoods lead to a health-compromising context? So really the story is let's try to understand the distinctions between high and low concentration communities and how change in those communities, adding additional people of that same ethnic group, matters for the health of older adults. That's the story. So we're trying to educate this theory. Is it about ethnic revitalization in community, or is it the concern about ethnic heterogeneity and extent to which disparate groups may not have the same kind of balance in our community, or may not have the same language, other things which they would share, cultural bonds that could lead to higher levels of social capital or policy. So that's it. So if you will, sort of the sociological puzzle we're trying to get at. Okay. So I'm going to use the National Social Life Health and Aging Project. I'm going to raise the PI, and I'm going to raise the friend to many in this room. It's a national representative panel study of community dwelling older adults. We have one in 2005, 2006. We have two in 2010, 2011. My friend. That's her. All right. I'm not the only one that's hearing it. Good. Respondents are linked to Census 2000 and the American Community Survey. The sample is restricted to those who lodge and are able to participate in it, too. I do want to take, I know I've found out from a lot of time, I do want to take a second to say and chat. This is a really terrific data source that combines both, you know, the sort of traditional social survey data, along with really amazing biological data, and probably what is most, what is richest with my Aging Project's data is it's also coupled with really detailed data on social networks and change in social networks. Also, I know, it's like I said, also what's great and interesting in things like the recession and the impact of the recession on the health of older adults and chef is a terrific source because, you know, by some frequent fake, we have a data collection effort that, right, bounds the economic crisis. So just as an aside, and FYI, people are interested in that work. Great. Our outcomes, you know, many people talked about these two weeks' outcomes yesterday, so I'll just remind you that we're looking at activities of daily living, difficulty in seven items, and depressive symptoms with the above item short form of the CDSE. And I know we didn't talk about as much as yesterday, so I won't describe what we need to hear. Neighborhood variables, percent change in the 2000 census from the American community survey. So we're actually, we can talk about this too in the Q&A, but we're really looking at percent change in community, not the law. Number of people who are adding in community are about percent, but the extent to which it's altered the composition of communities. So if you, 10% Latino population, and it increases by 50%, I mean, definitely 15%, excuse me. With me here on how we do that calculation. Yes, so it's a very simple kind of characterization, but really built off that larger map I showed you earlier. So we look at present population composition, most below poverty. Again, motivated by the early Chicago work that I shared with you. Population, current residents in different houses, those that were 65. And I won't draw this out in detail today, but we're also really interested in this role of disorder, and we ask interviewers in the NSHAP data source to provide insight into whether the house is in a disordered state and the homes around it are disordered. Okay, individual level variables, race, form, age, status, gender, age, health status, number of conditions, cognitive health, and then our social network characteristics, which I will describe in detail here. And now, see, we're using logistic regression for ADL limitations, OLS, for the depressive symptomatology. Wave 1, wave 2, it's a count for the complex survey design, and I spend a lot of time doing neighborhood effects research, and I will take hierarchical linear modeling anywhere I can, but we're actually not doing it here because we don't really have the nested structure. In these data, to pursue the analysis in that way, although we may do that as a check, a lot of it's going to help our baseline health. What I'm going to walk through are, briefly, some individual characteristics I want to concentrate on the neighborhood characteristics and then think about the interaction. And what we want to focus on most is whether is a kind of health result we see for folks who are resting in low concentration communities versus high concentration communities. Okay, these are our summary statistics just to show you, this isn't, you know, NCHEP is amazing in many ways. We have some over-sampling Latino population, but still a relatively low sample of just over 230. I just want to show you briefly here, these are our neighborhood characteristics by track, and so we're seeing for whites, African-Americans, and Latinos significant changes in percent increase for Latinos who rest in the communities and less so for the Latinos in our sample because they already were residing. How many? Five. There were already residing in communities that were down at Latino, so that's why we don't see as dramatic a change. And I'll also show you too that we have some nice variation on that disorder measure. Okay, so this is our first model in youth equality with ADLs. And we see as we anticipated that the Latino population in the NCHEP sample was less likely over the course of time between wave one and wave two, less likely to develop. New activities are getting limited limitations, so that answers our first question. And we also see for depressive symptomatology, again, less likely to develop depressive symptomatology over the interval. But sort of keep that in mind because that's going to be contingent on these context measures that we described earlier. So this is neighborhood baseline. It changes for any difficulty with activities in daily living and depressive symptoms. And what I really want to note here is that we seem to see sort of something that's suggested in the change in neighborhood disorder over time, since it increased the odds of developing depressive symptomatology. But at least in this characterization, we don't see any effect right now from Latino in the trap or change in that trap or our two outcome variables. So this is really our key result. And so this is race, ethnicity, and change in percent Latino in trap goes living in high and low concentration Latino neighborhoods. So we see with a low concentration Latino neighborhood, you have the percent change Latino in trap. We actually see a coefficient that suggests that that change has a particularly important role in the extent to which people are developing depressive symptomatology. In the high concentration Latino neighborhoods, it actually appears to be protective, right? For the Palahane symptomatology. So again, so in the low concentration neighborhoods, where you're seeing an influx of Latinos, the older girls are reporting higher levels of depression. In the high concentration neighborhoods, an influx of Latinos is protective. Are you all with me? So what we see, and what's fascinating I think to us, is this divergent influence by the concentration of population distribution. And we see something that's sort of suggested on the ABL front, but it's mostly this depressive result that we're most interested in. So over a five-year period, Latinos in our sample reporting fewer activities and daily living limitations with compared to whites. Racial ethnic health disparities appear to increase in these changing neighborhoods. So when you have a greater influx of population of any form, you're seeing greater change in health status. The health of Latinos was differentially impacted by the neighborhood experience of greater influx of Latinos, and this is our key finding. Latinos are, for example, in higher levels of depressive symptoms in low concentration, changing Latino neighborhoods. And that our Latino older girls had fewer ABLs and depressive symptoms in high concentration, changing neighborhoods. And really, our hope here, I guess, is that this approach may help resolve and mix findings where concentration might need a particular kind of treatment. We want to think about the nonlinear aspects of concentration. So limitations. No measures of cultivation, language, length of time in the U.S., experience of discrimination, selection. Neighbor choice may be associated with health. Immortality selection may underestimate these racial ethnic health disparities. Census traps, of course, are crude proxies for neighborhoods and we're developing a lot of new methods now, one of which we're tracking people with iPhones and having them define their neighborhoods for us rather than imposing neighborhood definitions based on municipal boundaries. And I'll conclude by saying Latino population growth is critical to mention of neighborhood change, so we want to emphasize that rapidly changing neighborhoods may contribute to racial ethnic health disparities, particularly for older adults. Attention to compositional differences and thresholds. And again, that there's really, we think, this nonlinear effect may frighten site intercommunity impact outcomes.