%0 Journal Article %J Gerontologist %D 2014 %T Physical and mental health of transgender older adults: an at-risk and underserved population. %A Fredriksen-Goldsen, Karen I %A Cook-Daniels, Loree %A Kim, Hyun-Jun %A Erosheva, Elena A %A Emlet, Charles A %A Hoy-Ellis, Charles P %A Goldsen, Jayn %A Muraco, Anna %K Data Collection %K Health Status %K Humans %K Mental Health %K Middle Aged %K Risk Factors %K Transgender Persons %K Vulnerable Populations %X

PURPOSE: This study is one of the first to examine the physical and mental health of transgender older adults and to identify modifiable factors that account for health risks in this underserved population.

DESIGN AND METHODS: Utilizing data from a cross-sectional survey of lesbian, gay, bisexual, and transgender older adults aged 50 and older (N = 2,560), we assessed direct and indirect effects of gender identity on 4 health outcomes (physical health, disability, depressive symptomatology, and perceived stress) based on a resilience conceptual framework.

RESULTS: Transgender older adults were at significantly higher risk of poor physical health, disability, depressive symptomatology, and perceived stress compared with nontransgender participants. We found significant indirect effects of gender identity on the health outcomes via fear of accessing health services, lack of physical activity, internalized stigma, victimization, and lack of social support; other mediators included obesity for physical health and disability, identity concealment for perceived stress, and community belonging for depressive symptomatology and perceived stress. Further analyses revealed that risk factors (victimization and stigma) explained the highest proportion of the total effect of gender identity on health outcomes.

IMPLICATIONS: The study identifies important modifiable factors (stigma, victimization, health-related behaviors, and social support) associated with health among transgender older adults. Reducing stigma and victimization and including gender identity in nondiscrimination and hate crime statutes are important steps to reduce health risks. Attention to bolstering individual and community-level social support must be considered when developing tailored interventions to address transgender older adults' distinct health and aging needs.

%B Gerontologist %V 54 %P 488-500 %8 2014 Jun %G eng %N 3 %R 10.1093/geront/gnt021 %0 Journal Article %J Gerontologist %D 2013 %T The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors. %A Fredriksen-Goldsen, Karen I %A Emlet, Charles A %A Kim, Hyun-Jun %A Muraco, Anna %A Erosheva, Elena A %A Goldsen, Jayn %A Hoy-Ellis, Charles P %K Aged %K Aged, 80 and over %K Bisexuality %K Cross-Sectional Studies %K Depression %K Female %K Health Behavior %K Health Services Accessibility %K Health Status %K Health Status Indicators %K Homosexuality, Female %K Homosexuality, Male %K Humans %K Logistic Models %K Male %K Mental Health %K Middle Aged %K Minority Health %K Quality of Life %K Resilience, Psychological %K Risk Factors %K Social Stigma %K Social Support %K Socioeconomic Factors %X

PURPOSE: Based on resilience theory, this paper investigates the influence of key health indicators and risk and protective factors on health outcomes (including general health, disability, and depression) among lesbian, gay male, and bisexual (LGB) older adults.

DESIGN AND METHODS: A cross-sectional survey was conducted with LGB older adults, aged 50 and older (N = 2,439). Logistic regressions were conducted to examine the contributions of key health indicators (access to health care and health behaviors), risk factors (lifetime victimization, internalized stigma, and sexual identity concealment), and protective factors (social support and social network size) to health outcomes, when controlling for background characteristics.

RESULTS: The findings revealed that lifetime victimization, financial barriers to health care, obesity, and limited physical activity independently and significantly accounted for poor general health, disability, and depression among LGB older adults. Internalized stigma was also a significant predictor of disability and depression. Social support and social network size served as protective factors, decreasing the odds of poor general health, disability, and depression. Some distinct differences by gender and sexual orientation were also observed.

IMPLICATIONS: High levels of poor general health, disability, and depression among LGB older adults are of major concern. These findings highlight the important role of key risk and protective factors, which significantly influences health outcomes among LGB older adults. Tailored interventions must be developed to address the distinct health issues facing this historically disadvantaged population.

%B Gerontologist %V 53 %P 664-75 %8 2013 Aug %G eng %N 4 %R 10.1093/geront/gns123 %0 Journal Article %J Stat Med %D 2013 %T Using group-based latent class transition models to analyze chronic disability data from the National Long-Term Care Survey 1984-2004. %A White, Toby A %A Erosheva, Elena A %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disabled Persons %K Humans %K Models, Statistical %K Prevalence %K United States %X

Latent class transition models track how individuals move among latent classes through time, traditionally assuming a complete set of observations for each individual. In this paper, we develop group-based latent class transition models that allow for staggered entry and exit, common in surveys with rolling enrollment designs. Such models are conceptually similar to, but structurally distinct from, pattern mixture models of the missing data literature. We employ group-based latent class transition modeling to conduct an in-depth data analysis of recent trends in chronic disability among the U.S. elderly population. Using activities of daily living data from the National Long-Term Care Survey (NLTCS), 1982-2004, we estimate model parameters using the expectation-maximization algorithm, implemented in SAS PROC IML. Our findings indicate that declines in chronic disability prevalence, observed in the 1980s and 1990s, did not continue in the early 2000s as previous NLTCS cross-sectional analyses have indicated.

%B Stat Med %V 32 %P 3569-89 %8 2013 Sep 10 %G eng %N 20 %R 10.1002/sim.5782 %0 Journal Article %J Brain Imaging Behav %D 2012 %T CSF biomarker associations with change in hippocampal volume and precuneus thickness: implications for the Alzheimer's pathological cascade. %A Stricker, Nikki H %A Dodge, Hiroko H %A Dowling, N Maritza %A Han, S Duke %A Erosheva, Elena A %A Jagust, William J %K Aged %K Aged, 80 and over %K Alzheimer Disease %K Amyloid beta-Peptides %K Biomarkers %K Female %K Hippocampus %K Humans %K Magnetic Resonance Imaging %K Male %K Middle Aged %K Organ Size %K Parietal Lobe %K Peptide Fragments %K Reproducibility of Results %K Sensitivity and Specificity %X

Neurofibrillary tangles (NFT) and amyloid plaques are hallmark neuropathological features of Alzheimer's disease (AD). There is some debate as to which neuropathological feature comes first in the disease process, with early autopsy studies suggesting that NFT develop first, and more recent neuroimaging studies supporting the early role of amyloid beta (Aβ) deposition. Cerebrospinal fluid (CSF) biomarkers of Aβ₄₂ and hyperphosphorylated tau (p-tau) have been shown to serve as in vivo proxy measures of amyloid plaques and NFT, respectively. The aim of this study was to examine the association between CSF biomarkers and rate of atrophy in the precuneus and hippocampus. These regions were selected because the precuneus appears to be affected early and severely by Aβ deposition, and the hippocampus similarly by NFT pathology. We predicted (1) baseline Aβ₄₂ would be related to accelerated rate of cortical thinning in the precuneus and volume loss in the hippocampus, with the latter relationship expected to be weaker, (2) baseline p-tau(181p) would be related to accelerated rate of hippocampal atrophy and cortical thinning in the precuneus, with the latter relationship expected to be weaker. Using all ADNI cohorts, we fitted separate linear mixed-effects models for changes in hippocampus and precuneus longitudinal outcome measures with baseline CSF biomarkers modeled as predictors. Results partially supported our hypotheses: Both baseline p-tau(181p) and Aβ₄₂ were associated with hippocampal atrophy over time. Neither p-tau(181p) nor Aβ₄₂ were significantly related to cortical thinning in the precuneus over time. However, follow-up analyses demonstrated that having abnormal levels of both Aβ₄₂ and p-tau(181p) was associated with an accelerated rate of atrophy in both the hippocampus and precuneus. Results support early effects of Aβ in the Alzheimer's disease process, which are less apparent than and perhaps dependent on p-tau effects as the disease progresses. However, amyloid deposition alone may be insufficient for emergence of significant morphometric changes and clinical symptoms.

%B Brain Imaging Behav %V 6 %P 599-609 %8 2012 Dec %G eng %N 4 %R 10.1007/s11682-012-9171-6 %0 Journal Article %J J Am Stat Assoc %D 2012 %T Modeling Criminal Careers as Departures from a Unimodal Population Age-Crime Curve: The Case of Marijuana Use. %A Telesca, Donatello %A Erosheva, Elena A %A Kreager, Derek A %A Matsueda, Ross L %X

A major aim of longitudinal analyses of life course data is to describe the within- and between-individual variability in a behavioral outcome, such as crime. Statistical analyses of such data typically draw on mixture and mixed-effects growth models. In this work, we present a functional analytic point of view and develop an alternative method that models individual crime trajectories as departures from a population age-crime curve. Drawing on empirical and theoretical claims in criminology, we assume a unimodal population age-crime curve and allow individual expected crime trajectories to differ by their levels of offending and patterns of temporal misalignment. We extend Bayesian hierarchical curve registration methods to accommodate count data and to incorporate influence of baseline covariates on individual behavioral trajectories. Analyzing self-reported counts of yearly marijuana use from the Denver Youth Survey, we examine the influence of race and gender categories on differences in levels and timing of marijuana smoking. We find that our approach offers a flexible model for longitudinal crime trajectories and allows for a rich array of inferences of interest to criminologists and drug abuse researchers.

%B J Am Stat Assoc %V 107 %P 1427-1440 %8 2012 %G eng %N 500 %R 10.1080/01621459.2012.716328 %0 Journal Article %J Proc Natl Acad Sci U S A %D 2010 %T Reconceptualizing the classification of PNAS articles. %A Airoldi, Edoardo M %A Erosheva, Elena A %A Fienberg, Stephen E %A Joutard, Cyrille %A Love, Tanzy %A Shringarpure, Suyash %K Classification %K Methods %K National Academy of Sciences (U.S.) %K Periodicals as Topic %K Publications %K Statistics as Topic %K United States %X

PNAS article classification is rooted in long-standing disciplinary divisions that do not necessarily reflect the structure of modern scientific research. We reevaluate that structure using latent pattern models from statistical machine learning, also known as mixed-membership models, that identify semantic structure in co-occurrence of words in the abstracts and references. Our findings suggest that the latent dimensionality of patterns underlying PNAS research articles in the Biological Sciences is only slightly larger than the number of categories currently in use, but it differs substantially in the content of the categories. Further, the number of articles that are listed under multiple categories is only a small fraction of what it should be. These findings together with the sensitivity analyses suggest ways to reconceptualize the organization of papers published in PNAS.

%B Proc Natl Acad Sci U S A %V 107 %P 20899-904 %8 2010 Dec 7 %G eng %N 49 %R 10.1073/pnas.1013452107 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2010 %T Use of spoken and written Japanese did not protect Japanese-American men from cognitive decline in late life. %A Crane, Paul K %A Gruhl, Jonathan C %A Erosheva, Elena A %A Gibbons, Laura E %A McCurry, Susan M %A Rhoads, Kristoffer %A Nguyen, Viet %A Arani, Keerthi %A Masaki, Kamal %A White, Lon %K Age Factors %K Aged %K Aged, 80 and over %K Asian Americans %K Cognition Disorders %K Emigrants and Immigrants %K Hawaii %K Humans %K Japan %K Language %K Language Tests %K Male %K Multilingualism %K Multivariate Analysis %K Neuropsychological Tests %K Regression Analysis %K Speech %X

OBJECTIVES: Spoken bilingualism may be associated with cognitive reserve. Mastering a complicated written language may be associated with additional reserve. We sought to determine if midlife use of spoken and written Japanese was associated with lower rates of late life cognitive decline.

METHODS: Participants were second-generation Japanese-American men from the Hawaiian island of Oahu, born 1900-1919, free of dementia in 1991, and categorized based on midlife self-reported use of spoken and written Japanese (total n included in primary analysis = 2,520). Cognitive functioning was measured with the Cognitive Abilities Screening Instrument scored using item response theory. We used mixed effects models, controlling for age, income, education, smoking status, apolipoprotein E e4 alleles, and number of study visits.

RESULTS: Rates of cognitive decline were not related to use of spoken or written Japanese. This finding was consistent across numerous sensitivity analyses.

DISCUSSION: We did not find evidence to support the hypothesis that multilingualism is associated with cognitive reserve.

%B J Gerontol B Psychol Sci Soc Sci %V 65 %P 654-66 %8 2010 Nov %G eng %N 6 %R 10.1093/geronb/gbq046