Editorial Board:
Editor:
George H. Conklin,
 North Carolina
 Central University

Board:
Bob Davis,
 North Carolina
 Agricultural and
 Technical State
 University

Richard Dixon,
 UNC-Wilmington

Ken Land,
 Duke University

Miles Simpson,
 North Carolina
 Central University

Ron Wimberley,
 N.C. State University

Robert Wortham,
 North Carolina
 Central University




Editorial Assistants

Rob Tolliver,
 North Carolina
 Central University

Shannon O'Connor,
 North Carolina
 Central University

John W.M. Russell,
 Technical
 Consultant

® 

Volume 5, Number 1

Spring 2007
 
 

Exploring Health Disparities Affected by Stressful Life Events.
 Are Older African Americans At Greater Risk?*

by

Jeffrey D. Brooks 
Fayetteville State University

Eva Kahana and Andre Nauta
Case Western Reserve University

Boaz Kahana 
Cleveland State University

    One of the early and possibly most widely known uses of the idea that minority elders are somehow more vulnerable than others was Robert Butler's use the phrase "multiple jeopardy (Butler, 1975, p. 30)."  Butler's use of multiple jeopardy includes attributing higher poverty rates and lower life expectancy in minorities to the influences of racism and ageism.  Now researchers apply Butler's idea to differences in mental and physical health.  It should also be noted that more recent studies refer to this as double jeopardy (Ferraro & Farmer, 1996), and debates are ongoing about validity of the double jeopardy hypothesis.  A goal of this study is to shed some light on this debate.

    Evidence of health disparities experienced by black and other minorities in early in life is well documented (Weitz, 2004).  Whereas infant mortality statistics are well established and widely published, information about the elderly is less common, and published research about minorities in later life is relatively rare.  Just a decade ago a special report by Gerontological Society of America (GSA) described minority elders as remaining statistically invisible (Gerontological Society of America, 1994).  Unfortunately, concern about the relative invisibility of minority elders remains valid today.  An additional incentive for this project is the ongoing efforts by the GSA and the Council on Social Work Education to enhance training of workers so they have gerontological skills.  Hence, with these points in mind and the support a National Institute of Health sponsored grant, we report results from our interviewers with retirees who belonged to an HMO.  The sample provides interesting insights for those interested in examining predictions of health disparities between older African Americans and Whites.  We are also fortunate that a rich heritage of stress research and theory is available to give direction to this investigation. 

    Our approach to exploring the double jeopardy hypothesis about health disparities was to investigate exposure to stressful life events and mental health status.  We should point out that our sample is not representative, but rather has characteristics of a unique quasiexperimental method that is well-suited for exploring race differences in exposure to stress and any mental health outcomes experienced as a result of the stressful life events.  Respondents are fairly homogeneous in that they have similar occupations and equal access to healthcare, and so we felt these respondents were suitable for examining the double jeopardy hypothesis.  More specifically, we utilize a stress paradigm because it provides existing methods, theoretical strength and offers practical implications for understand what factors influence mental health in later life.

    In this study we used general predictions derived from the stress paradigm to examine the double jeopardy hypothesis using psychological well being as the dependent variable.  In addition, we attempt to employ specific predictions about the impact of various types of stressful life events (positive, negative, egocentric, nonegocentric) on the measures of mental health and morale.  As such, an additional goal is to examine the fruitfulness of disaggregating the stressful events when examining their influences on well-being.  However, our primary goal is to offer additional results to the debate suggesting elderly African Americans do or do not suffer from the risks or vulnerability implied by the notion of double jeopardy. 

    We will be examining two aspects of double jeopardy.  First, we will look at increased risk for black elderly by considering the number of life events experienced, since increased risk implies that black elderly will experience more stressful events.  Second, we will look at hypothesized increased vulnerability of black elderly.  If racism increases the number of stressors, it is reasonable to assume that the cumulative impact will be greater for black elderly, and therefore the negative impact of events late in life will be larger for blacks.

 Disaggregating Dimensions of Life Events

    A strong precedent exists for examining differences of desirability or the positive nature of events and the undesirability or negative nature of events (Kessler & Mcloud, 1983, Tausig, 1982; Thoits, 1983,).  In addition, the recent work by Aldwin (1990) offers a promising second distinction into egocentric/nonegocentric types of events.  As both typologies are used in this study, a discussion of each follows.

Positive versus Negative Life Events

    Initial interest in the positive and negative nature of events concerned questions about whether the relationship between stressful events and psychological disturbances was due to change per se, or undesirable change (Thoits, 1983).  Studies using a judges ratings or the person's assessment of the desirability or undesirability of an event (Vinokur & Selzer, 1975) found that undesirable events have a significant relationship to a variety of measures of distress, while desirable events do not.  A review found a consistency of findings suggesting that undesirability is the crucial dimension of events implicated in the etiology of psychological disturbance and not the total change associated with events (Thoits, 1983, p. 59).  One additional point is that desirable events have been reported as being associated with reduced symptoms (Grant, Sweetwood, Yeager & Gerst, 1981).  While it would appear undesirable events best predict psychological outcomes, Thoits also points out that there is some evidence that total change (which includes positive and negative events) best predicts physical health outcomes.  It should be kept in mind that the studies of stress reviewed by Thoits did not include older subjects and were not concerned with age differences.  Chiriboga (1982) did study different age groups and employed a longitudinal design in an effort to study consistency in functioning which suggests some interesting points to consider about age and reports of positive and negative events.  The seniors (retirement age at the beginning of the study) showed the greatest increase in reports of life events of the four age groups.  He also reports that those in the retirement stage reported steady increases in positive events concerning the family. 

Egocentric and Nonegocentric Life Events

    The study of egocentric and nonegocentric life events was initially proposed to be useful in demonstrating one aspect of positive changes in later life development (Aldwin, 1990). Nauta and his co-authors (Nauta, Brooks, Johnson, Kahana & Kahana, 1994) tested the egocentric/non egocentric classification of stressful life events and their method of classification will be used here.  Aldwin was interested in disaggregating events because she posits increased concern for others reflects Erikson's (1959) notion of generativity. It is important to point out that while Aldwin accepts the notion that changes in sensitivity to stress occur with advancing age, but she does not theorize that this change should be seen as a deficit or deterioration.  It is not our intention to evaluate Aldwin’s proposition about generativity, rather we are interested in looking for race differences and any impact of the disaggregated groups of stressful events have on mental health. 

    Two studies reporting on the validity of stressful life event scales suggest that it is appropriate to consider egocentric and nonegocentric events as separate dimensions of stressful events.  Miller, Bentz, Aponte and Brogan (1974) report factor analysis for the social readjustment rating scale (Holmes & Rahe, 1967) as producing four factors: two for lifestyle changes such as work and recreation changes (similar to Aldwin's egocentric events), and two for interpersonal changes such as relationship changes and relationship terminations (similar to Aldwin's nonegocentric events).  The measure of stressful events used in this study was initially concerned with validating the change values for older people.  Results from using the Geriatric Scale of Recent Life Events (GSRLE) support both the notion of sensitivity to others and the greater reactivity to nonegocentric events (Kiyak, Liang, & Kahana, 1976).  Using the GSRLE revealed that sensitivity to others differed by age, where the elderly subjects assigned higher change scores for the interpersonal events of marriage, reconciliation, arguments with spouse, divorce, death of spouse and other family problems. 

    Given the literature on the double jeopardy hypothesis, we propose the following hypotheses:

  1)  Black elderly should experience a greater number of life events, particularly those that would be labeled negative and/or nonegocentric, given the combined influences of racism and ageism. 

  2)  Second, if the concept of "double jeopardy" holds true, one would expect that Black elderly will be more vulnerable to the events occurring to themselves and their family and friends than their white counterparts, given the cumulative effects of a lifetime of stress related to racism.  Thus, the impact of these events on psychological well-being should be greater for black elderly than for white elderly. 

    Data were collected from 397 community residing elderly persons who were enrolled in a Detroit-area health maintenance organization (HMO) as part of a study concerned with life stress and illness.  All respondents were aged 55 or older, living in their own homes or apartments, and retired from their lifetime occupations (generally from the auto industry) at the time of the interview.  Face-to-face interviews were conducted with respondents in their homes.  The sample had relatively equal proportions of males and females, as well as blacks and whites (no other racial groups were represented in the sample).

Life Events: Egocentric/nonegocentric and positive/negative events were measured using the GSRLE (Kiyak et al., 1976).  This scale contains a checklist of 33 events (see Table 1) adapted for older respondents from items utilized by Holmes and Rahe (1967).  Respondents were asked to indicate which events they had experienced in the year prior to the interview, and describe the type/amount of change they experienced as a consequence of the event.  However, change scores were not used for this study because of the potential confounding of change with the dependent measures, such that those with lower morale/poorer mental health might give higher change scores for the events they experienced.

    Assignment of life events to positive and negative categories was based on respondents' evaluations of whether the event changed their lives in a positive or negative way.  Table 1 shows the ratings based on the majority response of those experiencing each event.  In those instances where the respondents were relatively equally divided between the two choices, the event was judged to be ambiguous and was dropped from further consideration.  In addition, one event (Respondent divorced) was dropped due to the lack being reported often.  Thus, only 28 of the original