David Chiriboga
University of South Florida, Child & Family Studies, FMHI, Faculty Member
Research Interests: Nursing, Gerontology, Mental Health, Focus Groups, Medicine, and 15 moreMental Illness, Aggressive Behavior, Interviews, Humans, Nursing Homes, Florida, Focus Group, Education Systems, Attitudes, Mental Disorders, Nursing Home, Aged, Continuity of Patient Care, Homes for the Aged, and Inservice training
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Research Interests: Nursing, Mental Health, Medicine, Humans, Nursing Homes, and 15 moreFemale, Florida, Male, Mental Disorders, Mental Health Care, Health Status, Medicaid, Nursing Home, Clinical Sciences, Aged, Ethnic Group, Geriatric Assessment, Ethnic Difference, Homes for the Aged, and Health services for the aged
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Research Interests: Family Medicine, Health Care, Consumer Behavior, Health insurance, Language, and 15 moreMedicine, Hospitals, Humans, Korea, Female, Male, Patient Satisfaction, Medical Care, Aged, Asian Americans, Odds, Functional Disability, attitude to health, Delivery of Health Care, and Medical and Health Sciences
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Preliminary studies have revealed an association between cultural competence and an improvement in the quality of healthcare services, increased patient satisfaction, and increased effectiveness of services. This study examined factors... more
Preliminary studies have revealed an association between cultural competence and an improvement in the quality of healthcare services, increased patient satisfaction, and increased effectiveness of services. This study examined factors that helped to explain patients' perceptions of their providers' interpersonal sensitivity - one component of cultural competence. The respondents were 2075 racially/ethnically diverse adults, aged 50 years and older, who responded to a national telephone survey. Results indicate that one of the main factors predicting interpersonal sensitivity is self-rated physical health: those who reported better health were more likely to see their provider as exhibiting higher levels of sensitivity. This was true for Hispanic/Latino patients. The results also suggest that having a provider of the same race/ethnicity was a significant factor only for Hispanic/Latino patients. Despite findings from previous research, racial/ethnic concordance may not be universally effective in improving interpersonal sensitivity in healthcare settings for all racial/ethnic groups.
Research Interests: Interpersonal Communication, Health Care, Cultural Competence, Medicine, Humans, and 15 moreFemale, Male, Interpersonal Relations, Ethnic Groups, Health Status, Patient, Aged, Middle Aged, Concordance, Ethnic Group, Patient Care, Ethnic diversity, Health Care Provider, Health Care Surveys, and Medical and Health Sciences
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OBJECTIVES To examine associations among perceived racial discrimination, ethnic resources, and mental distress in older Korean Americans. Ethnic resources included ethnic identity (how closely individuals identify themselves with other... more
OBJECTIVES To examine associations among perceived racial discrimination, ethnic resources, and mental distress in older Korean Americans. Ethnic resources included ethnic identity (how closely individuals identify themselves with other members of the same ethnic background) and sense of community (individuals' feelings of belonging to their ethnic group). We examined the direct effect of perceived racial discrimination and these ethnic resources, as well as their interactions, hypothesizing that mental distress associated with perceived racial discrimination would be reduced by ethnic resources. DESIGN Using survey data from the Study of Older Korean Americans (N = 2,150), linear regression models of mental distress were examined for direct and interactive roles of perceived racial discrimination and ethnic resources. RESULTS Mental distress was directly associated with perceived racial discrimination (B = 1.90, SE = .20, p < .001), ethnic identity (B = -.41, SE = .13, p < .01), and sense of community (B = -.45, SE = .12, p < .001). Perceived racial discrimination interacted significantly with sense of community (B = -1.86, SE = .28, p < .001). Subgroup analyses suggested that in the context of experiencing racial discrimination, a high sense of community can serve as a buffer against mental distress. CONCLUSIONS Ethnic resources are a benefit in coping with experiences of discrimination. The moderating role of sense of community suggests the value of fostering social capital in ethnic communities to protect and promote older immigrants' mental health.
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Abstract Objectives To investigate the relationship between cognitive performance and cognitive health appraisals across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States and to explore within-group... more
Abstract Objectives To investigate the relationship between cognitive performance and cognitive health appraisals across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States and to explore within-group variations by examining interactions between cognitive performance and background and health variables. Method The sample (N = 3,099) included 2,260 non-Hispanic White, 498 non-Hispanic Black, and 341 Hispanic adults aged 65 or older, from the 2016–2017 Harmonized Cognitive Assessment Protocol. Regression models of cognitive health appraisals, indicated by self-rated cognitive health, were examined in the entire sample and in racial and ethnic subgroups to test direct and interactive effects of cognitive performance, indicated by the Mini-Mental State Examination (MMSE). Results The regression model for the entire sample showed direct effects of cognitive performance and race/ethnicity on cognitive health appraisals, as well as a significant interaction between cognitive performance and being non-Hispanic Black. Cognitive performance and cognitive health appraisals were positively associated in non-Hispanic Whites but not significantly associated in non-Hispanic Blacks. Our subsequent analysis within each racial/ethnic group showed that the effect of cognitive performance in non-Hispanic Blacks and Hispanics became either reversed or nonsignificant when background and health variables were considered. Modification by age or chronic medical conditions in each racial and ethnic group was also observed. Conclusion Overall, these findings suggest that perceptions and appraisals of cognitive health vary by race and ethnicity and hold implications for how these differences should be considered in research and practice with diverse groups of older adults.
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The study explored determinants of depressive symptoms among 297 Hispanic older adults living in public housing ( Mage = 76.0, SD = 7.74). Following a basic stress model, the focus was on the effects of demographic variables, risk factors... more
The study explored determinants of depressive symptoms among 297 Hispanic older adults living in public housing ( Mage = 76.0, SD = 7.74). Following a basic stress model, the focus was on the effects of demographic variables, risk factors (functional disability, self-perceived health, and acculturation), and social resources (network of relatives and network of friends). Hierarchical regression analyses revealed that financial status, which was a significant predictor in the initial model, became non-significant when risk factors were taken into consideration. All three risk factors were found to be significant; depressive symptoms were predicted by greater levels of functional disability, more negative self-perceived health, and lower levels of acculturation. In the final model, networks of both relatives and friends were shown to be significant even after we controlled for the effects of demographics and risk factors. Findings discussed in the article were made in the context of culture and residential setting.
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OBJECTIVES The present study examined the factors associated with social isolation in Asian Americans. Three types of social isolation (social isolation from family, social isolation from friends, and overall social isolation), identified... more
OBJECTIVES The present study examined the factors associated with social isolation in Asian Americans. Three types of social isolation (social isolation from family, social isolation from friends, and overall social isolation), identified by the Lubben Social Network Scale-6, were examined with a sample of Asian Americans representing diverse ethnic groups (Chinese, Asian Indian, Korean, Vietnamese, Filipino, and other Asians) and a broad age range (18-98). DESIGN Using data from the 2015 Asian American Quality of Life Survey (N = 2609), logistic regression models examined how each type of social isolation was predicted by sociodemographic (age, gender, ethnic origin, marital status, education, and perceived financial status), health-related (chronic medical conditions and self-rated health), and immigration-related (proportion of life in the United States and English proficiency) variables. RESULTS The percentage of the sample that fell into the category of social isolation from family, social isolation from friends, and overall isolation ranged from 18.2% to 19.3%. At 36% in the friend category and 33% in the overall category, the Vietnamese sample showed a heightened risk of social isolation. Regression analyses indicated that, for both family and friend categories, individuals who were in the middle-aged group (40-59 years old) and who had limited English proficiency demonstrated higher odds of being isolated. Reflecting relational differences in family and friend networks, the risk associated with unmarried status was specific to social isolation from family, whereas having unmet financial needs was only associated with social isolation from friends. CONCLUSIONS The study findings expand our understanding of the multiple domains of social isolation in an understudied population and emphasize the importance of developing prevention and intervention programs to foster social connectedness among Asian Americans. Our findings on risk factors and ethnic variations help identify the groups to be prioritized in intervention efforts and suggest ways to approach them.
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Objectives:Based on Andersen’s health care utilization model, the present study examined factors associated with dental service use in older Korean Americans. Focus was on predisposing characteristics (age, gender, marital status,... more
Objectives:Based on Andersen’s health care utilization model, the present study examined factors associated with dental service use in older Korean Americans. Focus was on predisposing characteristics (age, gender, marital status, education, and region), oral health needs (problems with teeth or gums and self-rated oral health), and enabling factors (dental health insurance, length of stay in the U.S., acculturation, and family network).Methods:Using data from surveys with Korean Americans aged 60 or older (N = 2,128), a Poisson regression model examined predictors of dental visit in the past 12 months.Findings:More than 21% of the sample reported having a problem with teeth or gums, and over half rated their oral health as either fair or poor. Approximately 71% lacked dental health insurance. The number of dental visits in the past 12 months averaged 1.40 (SD = 1.74), with about 38% having no dental visits at all. Multivariate analyses showed that higher levels of education, the presence of a problem with teeth or gums, dental health insurance coverage, longer length of stay in the U.S., and larger family networks were associated with 1.01 to 1.35 times higher number of dental visits.Conclusion:The findings not only confirmed the critical role of dental health insurance as a service enabler but also highlighted the importance of considering older ethnic immigrants’ oral health and dental care from the perspectives of culture and family.
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Objectives: The objective is to examine how older Korean Americans’ perceived burdensomeness to their healthcare partners is associated with the characteristics of older adult participants ( egos) and their healthcare partners ( alters).... more
Objectives: The objective is to examine how older Korean Americans’ perceived burdensomeness to their healthcare partners is associated with the characteristics of older adult participants ( egos) and their healthcare partners ( alters). Methods:Surveys of 2150 participants in the Study of Older Korean Americans provided ego data. Participants were also asked to list up to three individuals whom they usually asked for help on health-related matters or healthcare use, which generated 3402 alters. Multilevel modeling was conducted to examine the role of the characteristics of egos and alters, as well as their cross-level interactions. Results: Perceived burdensomeness was negatively associated with English-speaking ability and residence in a low Korean density area. Perceived burden was also lowered when emotional support was received from the alters, and this pattern was pronounced among those with multi-comorbidity. Discussion: By identifying older immigrants prone to the sense of b...
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Given the importance of healthy eating in the later years of life, the present study examined factors associated with dietary risks in older Korean Americans. We hypothesized that dietary risks would be associated with sociodemographic... more
Given the importance of healthy eating in the later years of life, the present study examined factors associated with dietary risks in older Korean Americans. We hypothesized that dietary risks would be associated with sociodemographic disadvantages, adverse health conditions, and limited sociocultural resources. Dietary risks were assessed with a scale covering five behavioral and situational risk factors (eating alone, skipping meals, functional challenges, oral health problems, and financial difficulties). Analyses of the data from the Study of Older Korean Americans ( N = 2,150) showed that the sample on average had 1.13 risks ( SD = 1.31), eating alone having the highest frequency (35.6%). Supporting the hypothesis, higher levels of dietary risks were found in individuals with sociodemographic disadvantages, poorer physical and mental health status, smaller social networks, and lower acculturation. Findings suggest concerted efforts to promote dietary behaviors and call attenti...
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Background This study examines associations among social isolation, loneliness, and cognitive health risks in older Korean Americans, focusing on the mediating role of loneliness in the relationship between social isolation and objective... more
Background This study examines associations among social isolation, loneliness, and cognitive health risks in older Korean Americans, focusing on the mediating role of loneliness in the relationship between social isolation and objective and subjective measures of cognitive impairment. Methods Data are from 2061 participants in the Study of Older Korean Americans, a multi-state survey of Korean immigrants age 60 and older (Mage = 73.2, SD = 7.93). Social isolation was indexed with the Lubben Social Network Scale− 6; loneliness, with the short-form UCLA Loneliness Scale. Objective and subjective measures of cognitive impairment included the Mini-Mental State Examination and a single-item self-rating of cognitive health. Results In the logistic regression model for objective cognitive impairment, social isolation was significantly associated, but loneliness was not. In the model for subjective cognitive impairment, both social isolation and loneliness were significant factors. However...
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Research has focused on the socioeconomic/cultural characteristics of individuals to address health disparities among immigrant populations. Dyadic studies of acculturation and healthcare utilization among older immigrants are rare. Using... more
Research has focused on the socioeconomic/cultural characteristics of individuals to address health disparities among immigrant populations. Dyadic studies of acculturation and healthcare utilization among older immigrants are rare. Using data from 263 older Korean immigrant couples in the U.S. (Mean_age = 74.75 for husbands; 71.03 for wives), this study examined how each spousal acculturation levels (e.g., English proficiency, familiarity with American culture) are associated with healthcare utilization (e.g., usual source of care, medical checkup) and difficulty in using health services, controlling for sociodemographic characteristics. Overall, husbands showed higher levels of acculturation than their wives, but there was also substantial similarity between spouses (ICC = .58). For healthcare utilization, one’s own acculturation (actor effect) was significant only for wives, but spouse’s acculturation (partner effect) was significant only for husbands. For difficulty in health se...
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This study examined factors affecting the feelings of loneliness among older Korean Americans. Data were drawn from a survey with older Korean Americans aged 60 or over (N = 2,150) in five states (California, New York, Texas, Hawaii, and... more
This study examined factors affecting the feelings of loneliness among older Korean Americans. Data were drawn from a survey with older Korean Americans aged 60 or over (N = 2,150) in five states (California, New York, Texas, Hawaii, and Florida), conducted during 2017−2018. In hierarchical multiple regression models, loneliness was regressed on five blocks of variables: (1) demographic/health (age, gender, education, financial status, chronic conditions, and physical disabilities); (2) immigration-related (length of stay in the U.S., and acculturation); (3) social engagement (having meals alone, family network, friend network, activity participation, and community engagement); (4) negative family interactions; and (5) interactions of negative family interactions with social engagement variables. A significant interaction was found in the relationship between friend network and negative family interactions: the impact of negative family interactions on loneliness was buffered by fri...
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Abstract Objectives: The present study examined the associations between immigration-related factors and objective and subjective cognitive status with older Korean Americans’ concern about developing Alzheimer’s Disease (AD). It was... more
Abstract Objectives: The present study examined the associations between immigration-related factors and objective and subjective cognitive status with older Korean Americans’ concern about developing Alzheimer’s Disease (AD). It was hypothesized that (1) AD concern would be associated with immigration-related factors and (2) self-rated cognitive status would mediate the relationship between cognitive performance (Mini Mental State Examination (MMSE) scores) and concern about AD. Method: Using data from the Study of Older Korean Americans (n = 2061, mean age = 73.2; 66.8% female), the direct and indirect effect models were tested. Results: Korean American immigrants with a higher level of acculturation had better cognitive performance, more positive self-ratings of cognitive status, and a lower level of concern about AD. Both poor cognitive performance and negative self-ratings of cognitive status were associated with increased concern about AD. Supporting the mediation hypothesis, the indirect effect of cognitive performance on AD concern through self-rated cognitive status was significant (bias corrected 95% confidence interval for the indirect effect = −.012, −.003). Conclusion: The mediation model not only helps us better understand the psychological mechanisms that underlie the link between cognitive status and AD concern but also highlights the potential importance of subjective perceptions about cognitive status as an avenue for interventions.
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The purpose of this study is to identify social network types in older Korean Americans and to examine their direct associations, as well as interactions with living arrangement, on mental distress. Drawn from the Study of Older Korean... more
The purpose of this study is to identify social network types in older Korean Americans and to examine their direct associations, as well as interactions with living arrangement, on mental distress. Drawn from the Study of Older Korean Americans (SOKA), participants were aged 60 or over and lived in five states. Analyses included 2,140 cases surveyed during 2017−2018. To identify social network types, latent profile analyses were conducted using 10 network-related criterion variables. A model with five social network types was identified as best fit. The groups were labeled as diverse, moderately diverse, family deficit, friend deficit, and restricted. As hypothesized, greater mental distress was associated with belonging to more deprived networks such as family deficit and restricted groups. Interaction effects also suggest that members of the restricted group were more distressed when they lived alone than when they lived with others. Implications based on the results are discussed.
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In the present study, we examined self-rated health as a mediator between physical health conditions (chronic diseases and functional disability) and depressive symptoms in older Chinese and Korean Americans. Using harmonized data (N =... more
In the present study, we examined self-rated health as a mediator between physical health conditions (chronic diseases and functional disability) and depressive symptoms in older Chinese and Korean Americans. Using harmonized data (N = 5,063) from the Population Study of Chinese Elderly (PINE) and the Study of Older Korean Americans (SOKA), we tested direct and indirect effect models. In both groups, chronic diseases and functional disability were closely associated with negative ratings of health and symptoms of depression. Analyses with the PROCESS macro showed that the effect of chronic diseases and functional disability on depressive symptoms was mediated by self-rated health in both groups; the indirect effect was greater in the Korean American sample than in the Chinese American sample. These findings contribute to the understanding of the psychological mechanisms that underlie the mind–body connection and highlight the potential importance of subjective health assessment as a...
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OBJECTIVES The present study examined the factors associated with social isolation in Asian Americans. Three types of social isolation (social isolation from family, social isolation from friends, and overall social isolation), identified... more
OBJECTIVES The present study examined the factors associated with social isolation in Asian Americans. Three types of social isolation (social isolation from family, social isolation from friends, and overall social isolation), identified by the Lubben Social Network Scale-6, were examined with a sample of Asian Americans representing diverse ethnic groups (Chinese, Asian Indian, Korean, Vietnamese, Filipino, and other Asians) and a broad age range (18-98). DESIGN Using data from the 2015 Asian American Quality of Life Survey (N = 2609), logistic regression models examined how each type of social isolation was predicted by sociodemographic (age, gender, ethnic origin, marital status, education, and perceived financial status), health-related (chronic medical conditions and self-rated health), and immigration-related (proportion of life in the United States and English proficiency) variables. RESULTS The percentage of the sample that fell into the category of social isolation from family, social isolation from friends, and overall isolation ranged from 18.2% to 19.3%. At 36% in the friend category and 33% in the overall category, the Vietnamese sample showed a heightened risk of social isolation. Regression analyses indicated that, for both family and friend categories, individuals who were in the middle-aged group (40-59 years old) and who had limited English proficiency demonstrated higher odds of being isolated. Reflecting relational differences in family and friend networks, the risk associated with unmarried status was specific to social isolation from family, whereas having unmet financial needs was only associated with social isolation from friends. CONCLUSIONS The study findings expand our understanding of the multiple domains of social isolation in an understudied population and emphasize the importance of developing prevention and intervention programs to foster social connectedness among Asian Americans. Our findings on risk factors and ethnic variations help identify the groups to be prioritized in intervention efforts and suggest ways to approach them.
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Using data from surveys with Korean Americans aged 60 years or above ( n = 2,150), the level of healthcare navigation self-sufficiency was assessed, and its related factors were explored. The overall status of self-sufficiency was low;... more
Using data from surveys with Korean Americans aged 60 years or above ( n = 2,150), the level of healthcare navigation self-sufficiency was assessed, and its related factors were explored. The overall status of self-sufficiency was low; for example, over half of the sample needed assistance with reading and filling out medical documents, and nearly half needed someone to interpret during medical visits. Diminished self-sufficiency in healthcare navigation was associated with disadvantaged social status (e.g., advanced age, female gender, and low education), early stages of immigration (short length of stay in the U.S. and low English proficiency), and lack of personal health resources (e.g., poor health condition and lack of health insurance). The findings shed light on older immigrants’ challenges in the use of health services in a broad sense and help identify areas of patient burden and avenues for interventions.
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Objectives: This study examined gender variations in the effect of education and acculturation on cognitive function in a group of older immigrants. Methods: Data were from the Study of Older Korean Americans, a multistate survey of... more
Objectives: This study examined gender variations in the effect of education and acculturation on cognitive function in a group of older immigrants. Methods: Data were from the Study of Older Korean Americans, a multistate survey of Korean Americans aged 60 years and older ( N = 2061). Multivariate linear regression models of cognitive function, measured with the Mini-Mental State Examination, were tested to examine the independent and interactive effects of education, acculturation, and gender. We hypothesized that gender would be a moderator in the relationships of education and acculturation with cognitive function. Results: Supporting the hypothesis, the positive effect of both education and acculturation was greater among women than men. Furthermore, the positive association of education with cognitive function was pronounced among women with low acculturation. Discussion: Our findings suggest that gender plays a critical role in determining the cognitive health benefit arising...
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The purpose of this study was to investigate intergenerational differences in the associations of social capital attributes (family network, friend network, community cohesion) and perceived family support (instrumental, informational,... more
The purpose of this study was to investigate intergenerational differences in the associations of social capital attributes (family network, friend network, community cohesion) and perceived family support (instrumental, informational, emotional) with loneliness among Korean adults. Interview data were collected from participants aged 18+ in South Korea during 2017 (Ng= 1,017), classified by three age groups (18–44, 45–64, 65+). In regression models, greater loneliness was associated with smaller friend networks and lower community cohesion for the younger group, lower information support and higher instrumental support for the middle-aged group, and lower informational and emotional support for the older group.
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The purpose of this study was to examine the correlates of depressive symptoms among older Korean adults in three geographic locations with varying densities of the Korean population: mainland Korea (mostly Koreans), New York metropolitan... more
The purpose of this study was to examine the correlates of depressive symptoms among older Korean adults in three geographic locations with varying densities of the Korean population: mainland Korea (mostly Koreans), New York metropolitan area (high Korean density), and west central Florida (low Korean density). The study focused on the role of family and friend networks. Data were drawn from three sources: (1) a multistage national sample of Koreans in South Korea ( n = 403); (2) a survey conducted in the western/central Florida area that used a variety of culturally sensitive sampling strategies ( n = 672); and (3) a survey in the New York metropolitan area ( n = 420) that replicated the Florida study. For those living in Korea, living alone and lower perceived financial status were independently associated with higher levels of depressive symptoms. For the New York and Florida samples, fair or poor self-rating of health, lower levels of acculturation, and weaker ties with family ...
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ABSTRACT
Evaluated time is a dimension of time perspective which has received minimal attention from researchers; it subsumes those constructs dealing with the affective tone, or feelings, placed upon different points of the life cycle. Using data... more
Evaluated time is a dimension of time perspective which has received minimal attention from researchers; it subsumes those constructs dealing with the affective tone, or feelings, placed upon different points of the life cycle. Using data from a cross-sectional study of 216 men and women aged 16 to 67, a variety of approaches to the study of evaluated time were examined. Evaluations were found to differ by the respondents' stage of life and by sex, with older respondents and women generally being more optimistic in their perceptions of later life. For example, while all the younger respondents viewed old age more negatively than other periods, older respondents drew a distinction between the young old and the old old. The former period was protrayed as a time of continued satisfaction.
Research Interests: Psychology, Gerontology, Aging, Adolescent, Medicine, and 10 moreTime Perspective, TIME, Humans, Female, Male, Aged, Middle Aged, Adult, Time, and Personal Satisfaction(Time Perspective, TIME, Humans, Female, Male, Aged, Middle Aged, Adult, Time, and Personal Satisfaction)
(Time Perspective, TIME, Humans, Female, Male, Aged, Middle Aged, Adult, Time, and Personal Satisfaction)
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Research Interests: Psychology, Nursing, Medicine, Humans, Nursing Homes, and 15 moreFemale, Florida, Male, Mental Disorders, Mental Health Care, Health Status, Nursing Home, Clinical Sciences, Aged, Online survey, Geriatric Assessment, Polypharmacy, Ethnic Difference, Homes for the Aged, and Health services for the aged
... Much of the information is presented within the context of a case study which was excerpted from an interactive videodisc program (Murphy & Sweeney, 1995). In the CD-ROM program, the importance of formulating an advanced directive... more
... Much of the information is presented within the context of a case study which was excerpted from an interactive videodisc program (Murphy & Sweeney, 1995). In the CD-ROM program, the importance of formulating an advanced directive is Page 6. ...