Embed Size (px)
Citation preview
This article was downloaded by: [Adams State University]On: 09 October 2014, At: 08:37Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK
Journal of IntergenerationalRelationshipsPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/wjir20
The Joint Effect of PoorPhysical Function andChildcare on PsychologicalDistress Among Elderly LatinosDiane Weis Farone DSW JD a , Thanh V. Tran PhD b ,Tanya R. Fitzpatrick PhD MSW RN a & Phu Phan PhDMSW ca Social Work Department , Arizona State UniversityWest , PO Box 37100, Phoenix, AZ, 85069, USAb Social Work Department , California StateUniversity , 5151 State University Drive, LosAngeles, CA, 90032, USAc Department of Social Work , California StateUniversity , East Bay, Hayward, CA, 94542, USAPublished online: 26 Sep 2008.
To cite this article: Diane Weis Farone DSW JD , Thanh V. Tran PhD , Tanya R.Fitzpatrick PhD MSW RN & Phu Phan PhD MSW (2007) The Joint Effect of Poor PhysicalFunction and Childcare on Psychological Distress Among Elderly Latinos, Journal ofIntergenerational Relationships, 5:1, 21-38, DOI: 10.1300/J194v05n01_03
To link to this article: http://dx.doi.org/10.1300/J194v05n01_03
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,
or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.
This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
The Joint Effect of Poor Physical Functionand Childcare on Psychological Distress
Among Elderly Latinos
Diane Weis Farone, DSW, JDThanh V. Tran, PhD
Tanya R. Fitzpatrick, PhD, MSW, RNPhu Phan, PhD, MSW
ABSTRACT. This study is based on the double jeopardy hypothesisthat elderly people who have poor physical function and who providechildcare for their families are more likely to experience a greater senseof psychological distress than those with poor physical function whohave no childcare responsibilities. We used a sample of 2160 elderly(age 65 or over) Latinos (including Puerto Ricans and those of Mexican,Cuban, or other Latin American origin or descent) from the NationalSurvey of Hispanic Elderly People to test this hypothesis. Regressionanalysis was used, and the findings confirm that after controlling for age,gender, marital status, and education, the joint effect of physical func-tion and childcare on psychological distress remains statistically signifi-cant. We further performed a sub-group analysis, also using regressionanalysis, to clarify the effect of poor physical function on psychological
Diane Weis Farone is affiliated with Social Work Department, Arizona State Uni-versity West, PO Box 37100, Phoenix, AZ 85069 (E-mail: [email protected]).
Thanh V. Tran is affiliated with Social Work Department, California State Univer-sity, 5151 State University Drive, Los Angeles, CA 90032 (E-mail: [email protected]).
Tanya R. Fitzpatrick is affiliated with Social Work Department, Arizona State Uni-versity West, PO Box 37100, Phoenix, AZ 85069 (E-mail: [email protected]).
Phu Phan is affiliated with Department of Social Work, California State University,East Bay, Hayward, CA 94542 (E-mail: [email protected]).
Address correspondence to Tanya R. Fitzpatrick.
Journal of Intergenerational Relationships, Vol. 5(1) 2007Available online at http://jir.haworthpress.com
© 2007 by The Haworth Press, Inc. All rights reserved.doi:10.1300/J194v05n01_03 21
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
distress in the sample of those who did provide and those who didnot provide childcare. The findings clearly indicate that poor physi-cal functioning has a greater effect on psychological distress in thegroup who provided childcare than in the group that did not. Implica-tions for intergenerational practice and further research are discussed.doi:10.1300/J194v05n01_03 [Article copies available for a fee from The HaworthDocument Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2007 by TheHaworth Press, Inc. All rights reserved.]
KEYWORDS. Latino elders, double jeopardy, elders providingchildcare
Grandparents accepting responsibility for care of their grandchil-dren constitute a significant population in the United States. Nationally5,800,000 grandparents live in a household with one or more grandchil-dren. Of this number, 2.5 million are responsible for most of the basicneeds of at least one grandchild under the age of 18 (U.S. Census Bu-reau, 2004). The number would be much larger if grandparents whoprovide significant, but not the primary, care for their grandchildrenwere included. Child welfare policies have become increasingly recep-tive to kinship care for abused and dependent children (Ainsworth &Maluccio, 1998; Leos-Urbel, Bess, & Geen, 2002). It is important toexplore what effects such care, especially when combined with poorphysical function, may have on the well-being of the elders who arefulfilling these roles.
Latinos tend to place, as a cultural characteristic, a high value onfamily solidarity and obligations to help extended family members(Sabogal et al., 1987). Also, as a population group, Latinos are morelikely to have such chronic or disabling health conditions as obesity, di-abetes, and high blood pressure than non-Latinos (U.S. Department ofHealth and Human Services, 2002) and less likely to have access tomedical help (Angel & Angel, 2003). A person who has physical limita-tions would find the tasks involved in caring for grandchildren or otherchild members of the extended family particularly taxing. Stretching ca-pacities in order to fulfill responsibilities could serve both to call moreattention to the functional difficulties and to lead to worsened health(Burnette & Mui, 1994; Kendig, Browning, & Young, 2000; Mitchell,Mathews, & Yesavage, 1993; Preville et al., 2002). Juxtaposition ofhealth risks associated with aging and familial expectations presents a
22 JOURNAL OF INTERGENERATIONAL RELATIONSHIPS
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
high likelihood of the joint occurrence of functional limitations andchildcare responsibility among Latino elders.
Prior research that has explored the effects of providing childcare onelders’ psychological well-being or distress has presented mixed results.Caring for grandchildren presents opportunities for both positive andnegative effects on psychological well-being. For people with problems inphysical functioning, the burdens of childcare may simultaneously im-pair the ability to enjoy its potential rewards and increase vulnerabilityto stress that severely strains their capacities to cope. The purpose ofthis study is to examine the joint effects of poor physical function andtaking care of children on the level of psychological distress among apopulation of Latino elders.
LITERATURE REVIEW
Functional Limitations and Psychological Distress
Empirical results show that psychological and physical well-being,or lack thereof, appear to reciprocally affect each other in complex ways.Cross-sectional survey research has demonstrated an association be-tween poor health and symptoms of psychological distress, includinganxiety, depression, and loneliness (Burnette, 1999b; Burnette & Mui,1994; Kendig et al., 2000; Mitchell et al., 1993; Mui, 1996; Previlleet al., 2002). Loss of physical function could precipitate feelings of griefand loss, fears of having to depend on others, damage to one’s self-esteem, and sense of mastery or competence. Latino elders who carefor grandchildren are particularly vulnerable to a frustrating lack of fi-nancial, medical, and social resources to fulfill their responsibilities(Burnette, 1999a).
Evidence that psychological distress affects physical health also ex-ists. Meeks and Murrell (2001) found that the presence of negative af-fect predicts poor health outcomes and mediates the positive associationbetween education and health. In a longitudinal study Ostir, Markides,Black, and Goodwin (2000) found in a sample of older MexicanAmericans that those who had a presence of high positive affect at base-line were less likely to have impaired physical function or to have diedduring a two-year follow-up period than those with lower positive affectscores.
Research 23
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
Childcare and Psychological Distress
Having caretaking responsibilities for grandchildren can provideboth rewards and burdens. Waldrop and Weber (2001) conducted aqualitative study of 54 grandparents who had primary physical and fi-nancial responsibility for raising one or more grandchildren. Theyfound that the grandparents reported experiencing joy from sharing achild’s life and activities and from performing the tasks of child rearing,as well as feeling a sense of purpose and direction in their lives. In addi-tion to the positives described, the participants reported stressful factorsassociated with raising their grandchildren. Such stressors includedproblems with the grandchild’s parent, concerns about the grandchild’swell-being, shifts in the grandparents’ marital relationships, and legal,financial, and health problems. Specific income and educational infor-mation was not given in the study, but the participants were primarilyCaucasian, married residents of suburban areas, or small towns. Theywere recruited as participants primarily through a caregivers conferenceor caregivers support groups. These characteristics suggest a populationthat has access to social resources to support their caretaking roles, un-like many minority elders.
Several factors have been found to affect the levels of benefitsand burdens for grandparents associated with raising their grandchil-dren. Some variables that are significantly associated with negative ex-periences are problematic child behaviors (Emick & Hayslip, 1999;Pruchno & McKenney, 2002; Sands & Goldberg-Glenn, 2000), prob-lem behaviors of the grandchild’s natural parent (Giarrusso et al., 2000),and grandparents being in poor physical health (Kelley et al., 2000;Pruchno & McKenney, 2002). Some negative effects shown to be asso-ciated with caregiver grandparents are psychological distress (Emick &Hayslip, 1999; Fuller-Thompson & Minkler, 2000; Kelley, 1993; Kelleyet al., 2000; Minkler & Fuller-Thompson, 2001; Minkler et al., 1997),poorer physical health (Giarrusso et al., 1996; Gibbons, 2003; Kelleyet al., 2000; Pruchno & McKenney, 2002; Strawbridge, Wallhagen,Shema, & Kaplan, 1997; Szinovacz, DeViney, & Atkinson, 1999),more impairment affecting activities of daily living (Minkler & Fuller-Thompson, 1999, 2001), more social isolation (Kelley, 1993; Kelley et al.,2000), and feeling burdened (Pruchno & McKenney, 2002; Strawbridgeet al., 1997).
Elements associated with positive effects for grandparents from theirchildcare activities include perceived ability to choose one’s level ofinvolvement with grandchildren (Giarrusso et al., 1996) and belief in
24 JOURNAL OF INTERGENERATIONAL RELATIONSHIPS
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
cultural role expectations of family solidarity (Giarrusso, Silverstein, &Feng, 2000).
The studies summarized above came from many sources, but none in-cluded any significant Latino representation. The only study located thatexamined a Latino population was by Burnette (1999a,b,c). Her study in-cluded 74 Puerto Rican and Dominican grandparents in New York Citywho were raising their grandchildren. In that population she found highlevels of unmet need, in spite of some support from extended family andconnections with the system of formal help (Burnette, 1999a). Barriers togetting needs met included lack of knowledge, low levels of education,poor health, high stress levels, and lack of reliable help. With respectto familial values and expectations, Burnette (1999b) found the grand-parents endorsed the value of extended family but did not think it was bestto rely on help from one’s family. Because of the magnitude of needs,families were stretched very thin in trying to meet them. Burnette (1999c)further found the poverty rate in her sample was three times that in thegeneral population, and the rate of poor health and depression was twotimes the general rate. Correlates of depression included poor health andrearing grandchildren with special needs, such as ADHD, HIV/AIDS,and developmental disabilities/mental retardation.
A cultural belief in family solidarity and mutuality, known as familism,is common among Latino populations. Sabogal et al. (1987) included intheir list of elements of familism strong identification and attachmentamong nuclear and extended family members and strong feelings ofloyalty, reciprocity, and solidarity. They found that feelings of beingsupported by family continued among Latinos of varying ethnicity andacross levels of acculturation. The rate of agreement about feeling sup-ported by family among even highly acculturated Latinos was higherthan that among non-Hispanic Whites. However, Markides and Krause(1985) found, in a Mexican American population, a significant associa-tion between elders having more contact with their adult children andgreater depression. The authors tested whether the higher depressionlevels might be due to a role reversal and increased dependency of theelders on their children, but further analysis did not bear out this expla-nation. Another possibility for their findings could be that more contactwith adult children is, to some extent, a function of the adult children’sproblematic lives. Perceived affection with grandchildren was associ-ated with well-being in the Markides and Krause (1985) study. Forpurposes of this study, grandparents taking care of children of familymembers included a wide range of possible involvement, from baby-sitting to primary responsibility. Clearly, for those who assume primary
Research 25
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
responsibility for raising their grandchildren, a strong parental role func-tion remains. For those with lesser involvement with childcare some re-versal of roles could be a factor, especially for elders with functionalimpairments.
Latino Health and Welfare
Of 30,700,000 foreign born people in the 2000 U.S. census, 51.8%were born in Latin American countries (U.S. Census, 2002). The Latinopopulation of 37.4 million constituted 13.3% of the national non-insti-tutional population. Latinos tend to have lower income (U.S. Census,2002) and less access to health insurance, health care, and other socialresources (Angel & Angel, 2003). They are less likely to have com-pleted high school (U.S. Census, 2002), and education is a factor thathas shown a positive association with better health (Meeks & Murrell,2001). Poor health in the Latino population has been found to be associ-ated with psychological distress (Mui, 1996). Tran, Fitzpatrick, Berg,and Wright (1996) also found some direct effect of poor health onpsychological distress and an indirect effect because of its contributionto social and family stresses, which were the two largest predictorsof psychological distress. Beyene, Becker, and Mayen (2002) foundthat Latinos who reported unsatisfactory family relations also reportedpoorer health. One would expect that care for grandchildren or other mi-nor children from the extended family, with its strong potential for con-tributing to family stress coupled with its demands made on physicalavailability and endurance, would have potent effects on psychologicaldistress among those elders who have impairments in functioning.
Hypotheses and Rationale
The focus of this study is on the joint effect of poor physical functionand providing childcare on psychological distress among Latino elders.The presumption is that each increases vulnerability to psychologicaldistress; thus, the Latino elders who experience both elements wouldexperience greater psychological distress than those with only poor phys-ical function or those who provide childcare but do not have functionalimpairment.
Exchange theory (Dowd, 1975) provides a basis for predicting stressand strain for elders taking on childcare roles. Exchange theory is basedon the idea that people are motivated to expend resources if the rewardsfor doing so are sufficient. The children who are being taken care of
26 JOURNAL OF INTERGENERATIONAL RELATIONSHIPS
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
may not be appreciative and they may generally exhibit problematic be-haviors. Even under the most positive of circumstances, relationshipsbetween minor children and adults are not balanced in terms of ex-change, except to the extent that the adults derive satisfaction fromperforming the parenting role. The children’s parents often are not ap-preciative either, due to problems of their own, or possibly due to overtconflict with the elder caregivers.
Based on prior research, we would expect lack of education and lackof ability to speak English, which are prevalent in the study sample, tocontribute to stress levels and limit access to resources to meet one’sphysical and emotional needs. Poor physical function contributes tovulnerability and fears about being able to cope or manage. The need tobe in good physical condition becomes more important when one is re-sponsible for another person, so health problems would have a strongimpact. Although caring for children could act as both a source of satis-faction and a distraction from other problems and pain, the cumulativeeffects of lack of resources, poor physical health, and caring for childrenare expected to impair the ability to benefit from potential positiveeffects. In this study population more than half of the households havevery low income, 79% have less than a high school education, and 53%do not speak English, presenting a good opportunity to test how pro-viding childcare is experienced by elders who live in difficult socio-cultural conditions.
Specifically we hypothesized that the interaction of poor physicalfunction and childcare would have a significant relationship to psycho-logical distress among Latino elders. In addition, through sub-sampleanalyses we address the question of whether there is a difference inthe effects of poor physical function on psychological distress amongthose Latino elders who did and who did not provide childcare.
METHODS
Data and Sample
This study was conducted using data from the 1988 National Survey ofHispanic Elderly People (Davis & Commonwealth Fund, 1997). Datawere collected through telephonic interviews with 2,299 respondents,conducted by bilingual interviewers. Respondents for the study wereidentified through screening 48,000 households in areas with a high den-sity of Latino (Mexican American, Puerto Rican, Cuban American, or
Research 27
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
other Latino ethnicity) population to locate ones containing a memberover age 65 years. The purpose of the original survey was to gain a betterunderstanding of the economic, health, and social status of this group.Questions included demographic information and questions about activi-ties, worries or concerns, disabilities, needed help, sources of assistanceused, and questions about feelings and mood. For purposes of our studythe sample size was 2160. The average age was 73. A little less than half(47%) were married. Women constituted over 64% of the sample. Over31% of the respondents provided childcare. Table 1 presents demo-graphic information and mean scores for the study variables.
Measurement
Dependent Variable. The dependent variable of psychological distresswas measured using a five-item scale that contains self-ratings on five di-mensions of psychological discomfort. Respondents were asked if eachof the following feelings occurred “in the last few weeks”: (1) “So rest-less you couldn’t sit still,” (2) “very lonely or remote from other people,”(3) “bored,” (4) “depressed or very unhappy,” and (5) “upset becausesomeone criticized you.” These questions are the negative affect portionof the Bradburn Balanced Affect Scale, developed and validated byBradburn (1969) for use in large surveys as indicators of the negative
28 JOURNAL OF INTERGENERATIONAL RELATIONSHIPS
TABLE 1. Descriptive statistics of variables used in overall analysis (N = 2160).
Variables Mean (SD) or Percentage
Psychological distress* 1.206 (1.453)
Physical health: ADLa 2.188 (3.077)
Childcare 31.39%
ADL � childcareb .406 (1.275)
Gender (male) 36.06%
Marital status (married) 47.41%
Age 73.150 (6.656)
Education 6.270 (4.298)
* Internal consistency reliability = .722.a Activities of daily living (physical function).b Interaction effect or combined effect of ADL and childcare.
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
affect aspect of psychological well-being. Bradburn was interested indeveloping measures of psychological well-being in normal populationsas fluctuating responses to environmental events, rather than as indicatorsof personality traits or mental health status. This emphasis fits the pur-poses of our study, as we were interested in the effects of the providingchildcare on elders who reported difficulties in physical functioning. Inour study the five items as a single scale representing negative affect hadan acceptable internal consistency reliability of .72. The mean score in thestudy population was 1.2, on a scale of 0 to 5.
Independent Variables. Physical function was measured by self-re-ported “difficulties” in 13 areas of daily functioning, such as mobility,personal care, and household tasks. The survey questions used the word“difficulties,” a word that has led to reporting a greater prevalence offunctional impairment than what is found when the phrase “needs assis-tance with” is used (Jette, 1994). However, in our study we are interestedin co-variation of the amount of impairment with psychological distressand how that relationship is affected by providing childcare, not preva-lence of functional difficulties in the population. The mean number of re-ported difficulties among the respondents is 2.188, as shown on Table 1.
Provision of childcare was measured using one question, which camefrom a set of questions in the survey that addressed “how family mem-bers help each other.” The responses were coded as a dummy variable(1 = Yes, 0 = No). Specifically participants were asked, “Do you pro-vide babysitting services for your family?”
Control Variables. Several demographic variables that have a logicaland/or empirical association with psychological distress were usedin the analyses as a means of clarifying further the relationships of themajor variables in the study. These control variables were coded as gen-der (1 = Male, 0 = Female), marital status (1 = Married, 0 = Not mar-ried), age as a continuous variable, and education (in 18 ascendinglevels). The 6.3 mean educational level for the sample is the equivalentof grade 5 through 7 plus some technical or vocational training.
Data Analysis
To examine the joint effect of physical function and childcare onpsychological distress we used ordinary least squares regression (OLS)analysis applying four separate models. Model 1 examines the directeffect of physical function on psychological distress. Model 2 examinesthe direct effects of both physical function and providing childcare onpsychological distress. Model 3 tests for an interaction effect between
Research 29
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
physical function and provision of childcare by adding the variable phys-ical function � childcare into the regression equation. Finally, Model4 enters physical function, childcare, the interaction term, and thecontrol variables of age, sex, marital status, and education into the re-gression equation. We then performed separate regression analysesof the effect of physical function on psychological distress for the sub-sample who provided childcare and the sub-sample who did not providechildcare to assess differences, if any, between the two groups. To con-duct these analyses, we used OLS regression with the variables enteredsimultaneously.
RESULTS
Table 2 presents results from the regression analyses for the fourmodels. Model 1 tested the independent effect of physical functioning onpsychological distress, showing physical functioning to be a significant
30 JOURNAL OF INTERGENERATIONAL RELATIONSHIPS
TABLE 2. Testing the double jeopardy hypothesis of ADL and childcare onpsychological distress.
Variables Model 1 Model 2 Model 3 Model 4
b(SE) Beta b(SE) Beta b(SE) Beta b(SE) Beta
ADLa .157(.009)
.336*** .156(.010)
.335*** .142(.010)
.305*** .151(.011)
.320***
Childcare .008(.064)
.002 �.147(.076)
�.047* �.163(.077)
�.052**
Interactioneffect (ADL*childcare)
.106(.028)
.092*** .086(.028)
.076**
Gender (male) �.242(.067)
�.080***
Marital status(married)
�.083(.066)
�.029
Age �.028(.005)
�.127***
Education �.019(.007)
�.057**
R square .113 .112 .117 .139
a Activities of daily living (physical function).* p < .05, ** p < .01, *** p < .001.
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
predictor of psychological distress (b = .157, p � .001), suggestinga positive relationship between poor physical function and psycho-logical distress. Model 1 explained 11.3% of the variance. Childcareresponsibility was included in Model 2 to see if it would modify the ef-fect of physical functioning on psychological distress (mediating ef-fect). There was no support for a finding of mediation effects, asminimal change occurred in the relationship between impaired functionand psychological distress between Model 1 and Model 2. Further, theresults show that childcare had no significant effect on psychologicaldistress (b = .008, NS) in this model. Model 2 explained 11.2% of thevariance. Model 3 tested the interaction effect of physical function andchildcare on psychological distress. The interaction effect is significant(b = .106, p � .001). The psychological distress of the Latino elders hasbeen moderated (made more severe) by the addition of providing child-care to the stress of poor physical function, supporting our hypothesis.Model 3 explained 11.7 % of the variance. Model 4 included the two in-dependent variables, the interaction variable and demographic controlvariables of age, sex, marital status, and education. The interaction effectbetween poor physical function and childcare remains statistically signif-icant (b = .086, p � .01) in Model 4, a finding that continues to supportour hypothesis. Model 4 explained 13.9% of the variance. It should benoted that age, sex, and education each had a significant effect on psy-chological distress in this model and that marital status did not. Consis-tent with prior research men reported a lower level of psychologicaldistress (b = �.242, p � .001) than women (Desai & Jann, 2000) andpeople with higher levels of education reported lower feelings of psy-chological distress (b = .019, p � .01) (Meeks & Murrell, 2001). Olderparticipants reported lower levels of psychological distress (b = �.028,p � .001).
It is interesting to note associations between providing childcare andpsychological distress across Models 2, 3, and 4. In Model 2, childcareis not a significant predictor of psychological distress (b = .008, NS), al-though the direction of the association is positive. With the inclusion ofthe interaction effect between poor physical function and childcare inModels 3 (b = �.147, p � .05) and 4 (b = �.163, p � .05) childcare is asignificant predictor of distress and the direction is negative. Thatmeans Latino elders who do provide childcare but have no functionalimpairments showed a lower level of psychological distress.
To further examine the relationship among the variables shownin Table 2 we performed a sub-group analysis to see if the effects weredifferent between the two groups. The sample was divided into two
Research 31
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
groups, those who provided childcare and those who did not. A regres-sion analysis was performed separately in each sub-group to highlightthe differential effect of poor physical function on psychological distressbetween the two groups. Table 3 presents descriptive statistics for thevariables used in the sub-group analyses.
Even though the non-childcare group had more functional impair-ment, the association with distress was less severe for them (b = .152,p � .001) than for those without childcare responsibility (b = .238, p �.001). The regression models explain 14.3% of the variance for thechildcare group and 13.3% of the variance for the non-childcare group.The conclusion we can draw is that poor physical function associateswith greater risk of psychological distress among elder Latinos; how-ever, its effect is even greater among elderly who have childcare re-sponsibility. Table 4 reports the results of the regression analysis.
DISCUSSION
The study results indicate that Latino elders who had poorer physi-cal functions experienced higher levels of psychological distress. The
32 JOURNAL OF INTERGENERATIONAL RELATIONSHIPS
TABLE 3. Descriptive statistics of variables use in sub-group analysis.
Variables Childcare (n = 678) No childcare (n = 1482)
Psychological distress
Mean (SD) 1.072 (1.417) 1.268 (1.466)
ADLa
Mean (SD) 1.295 (2.009) 2.597 (3.381)
Gender (male)
Percentage 42 33
Marital status (married)
Percentage 56 43
Age
Mean (SD) 70.940 (5.305) 74.160 (6.961)
Education
Mean (SD) 6.480 (4.492) 6.180 (4.174)a Activities of daily living (physical function).
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
association between physical function and distress level was greaterfor those elders who provided childcare services to their families. Forthose who had fewer or no difficulties with their physical function-ing, providing childcare was associated with lower levels of distress.Thus, providing care to minor children of the family appears to improvethe quality of life for the Latino elders if they are relatively physicallyhealthy. These results will be interpreted within the context of the studydesign and of what the literature suggests about explanations.
Although the study is based on secondary data, the strong statisticalfindings in a large, randomly drawn sample of Latino elders provideconvincing evidence that the risks and rewards inherent in grandparentsproviding care for grandchildren do affect psychological well-being inpredictable ways. However, some questions that could have increased ourunderstanding of the relationship between providing childcare and psy-chological distress were not asked. We only know whether the eldersdid or did not provide babysitting services for their families. Therecould have been wide variation from occasional babysitting to full timeresponsibility for rearing a minor grandchild. We don’t have informa-tion about the relationships between the elders and the parents of thechildren they cared for. More detailed study of the effects of time spentand levels of authority, responsibility, and compatibility of child rearingbeliefs between the generations would be helpful for designing mean-ingful intervention strategies.
The measures of distress in our study are general, and questions withmore direct links to the demands and rewards of caring for the children
Research 33
TABLE 4. Testing the double jeopardy hypothesis of ADL and childcare onpsychological distress: Sub-group analysis.
Variables Childcare (n = 678) b(SE) No childcare (n = 1482) b(SE)
ADLa .238(.026)*** .152(.011)***
Gender (male) �.285(.121)* �.232(.081)**
Marital status (married) .017(.122) �.123(.079)
Age �.023(.010)* �.029(.006)***
Education �.019(.012) �.019(.009)*
R square .143 .133
a Activities of daily living (physical function).* p � .05, ** p � .01, *** p � .001.
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
were not asked. The measure we used involved five elements, four ofwhich have elements of social disconnection: loneliness, depression,boredom, and feeling criticized. The double jeopardy of disabilities thataffect mobility and childcare responsibilities that reduce opportunitiesfor social contacts with other adults may be contributing factors to ourfindings. To the extent that is the case, culturally relevant and appealingintergenerational programs and activities at community centers or seniorcenters might mediate the effects we found.
Physical function and psychological distress are features of humanexistence that are not time bound. Thus, that the data are not currentdoes not lessen the relevance of an association of the two within thecontext of providing or not providing childcare. What would vary, andwhat needs further study, is the socio-cultural context of explanatoryfactors that contribute to the associations found.
One element that is sensitive to time involves the rapid rate of cul-tural change. This creates some social distance between generations andhas been studied within a theoretical framework of cohort effects andthe effects of modernization (Wallace & Facio, 1987). For people livingthe immigration experience, social distancing due to cultural changes ismagnified. People moving from one culture to another, with a differentlanguage, different opportunity structure, and different role expecta-tions are asked to learn and change. When one comes to a new countryat an older age, such changes may be more difficult and the motivationto make them may be less intense. There is a difference in exposure tothe new culture, as well as differences in what priority acculturationmay assume for those who may not have to adapt to educational andeconomic structural expectations. Silverstein and Chen (1999) examinedthe impact of acculturation on intergenerational relationships amongMexican American families living in San Antonio. They found grand-children felt declines in interaction with and affection toward theirgrandparents as they became more acculturated, but the grandparentsdid not experience a lessening of affection with respect to their grand-children. Additional study of the effects of differential acculturationon intergenerational relationships could increase our understanding ofthe grandparenting experience, as it intersects with migration patternsunder current conditions.
A second important contextual factor with Latino families is theeffect of socio-economic status. Finding resources to address care forminor children and one’s health can be quite challenging, especially forpeople with lower levels of income, education, and social connec-tions. In general the Latino population in the United States has lower
34 JOURNAL OF INTERGENERATIONAL RELATIONSHIPS
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
educational levels, lower-income levels, and lower access to social re-sources, relative to non-Hispanic Whites. As Burnette’s (1999a) study in-dicated, Latino grandparents caring for their grandchildren are stretchedto locate resources within the family to meet the needs. Further explora-tion needs to be done in at least two areas concerning resources. Howdoes the availability or lack of resources for assistance in carrying outchildcare roles contribute to distress and poorer health outcomes? Whatkinds of assistance would be viewed as relevant and helpful? Burnette’s(1999a) research is an example of such study. Its respondents were lim-ited to people of Puerto Rican and Dominican origin who are living inNew York.
Finally, another area for fruitful research would be to increase our un-derstanding of the complexity of Latino family values and expectations.The phenomenon of familism among Latino families contains multipleelements highly relevant to intergenerational relations. The work ofGiarrusso et al. (2000) shows greater satisfaction for grandparents rearinggrandchildren if they value family solidarity. Research with Latino fami-lies indicates family solidarity is valued, even among more highly accul-turated Latinos (Sabogal et al., 1987). Burnette (1999c) found Latinograndparents value family solidarity, but not necessarily reliance on fam-ily for help. Others have questioned whether familism is really a culturalfactor or, rather, a phenomenon based more in a response to economicneed or oppression (Gratton, 1987; Mendez-Negrete, 2000).
Clearly public policy that relies too heavily on grandparent kinshipcare may overlook confounding issues, such as the health status ofelders providing care and levels of coping resources within the ex-tended family and the community. Prior research has indicated that el-ders who can choose their level of involvement with childcare havemore positive experiences (Giarrusso et al., 2000), which suggeststhat strategies that increase opportunities for such choice might reducedistress.
In spite of what is not known, the results of our study have implica-tions for social services for aging Latinos, especially those with poorphysical function. The double jeopardy findings highlight the impor-tance of supports that help minority families with the physical, finan-cial, and adaptive demands of intergenerational family life. Servicesneed to be designed in ways that reduce the impact of burdens, increasecoping resource capacities, and support the positive aspects of sustain-ing intergenerational connections.
Research 35
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
REFERENCES
Ainsworth, F. & Maluccio, A. N. (1998). Kinship care: False dawn or new hope?Australian Social Work, 51, 3-8.
Angel, J. L. & Angel, R. J. (2003). Hispanic diversity and health care coverage. PublicPolicy and Aging Report, 13, 8-12.
Beyene, Y., Becker, G., & Mayen, N. (2002). Perception of aging and sense of wellbeing among Latino elderly. Journal of Cross Cultural Gerontology, 17, 155-172.
Bradburn, N. M. (1969). The structure of psychological well-being. Chicago, IL:Aldine Publishing Company.
Burnette, D. (1999a). Custodial grandparents in Latino families: Patterns of service useand predictors of unmet needs. Social Work, 44, 22-34.
Burnette, D. (1999b). Physical and emotional well-being of custodial grandparents inLatino families. American Journal of Orthopsychiatry, 69, 305-318.
Burnette, D. (1999c). Social relationships of Latino grandparent caregivers: A role the-ory perspective. Gerontologist, 39, 49-58.
Burnette, D. & Mui, A. C. (1994). Determinants of self-reported depressive symptomsby frail elderly persons living alone. Journal of Gerontological Social Work, 22,3-19.
Davis, K. & Commonwealth Fund Commission on Elderly People Living Alone.(1997). National survey of Hispanic elderly people, 1988 (Computer file). Con-ducted by Westat, Inc. 2nd ICPSR ed. Ann Arbor, MI: Inter-university Consortiumfor Political and Social Research (producer and distributor).
Desai, H. D. & Jann, M. W. (2000). Major depression in women: A review of the litera-ture. Journal of the American Pharmaceutical Association, 40, 525-537.
Dowd, J. J. (1975). Aging as exchange: A preface to a theory. Journal of Gerontology,30, 584-594.
Emick, M. A. & Hayslip, B., Jr. (1999). Custodial grandparenting: Stresses, copingskills, and relationships with grandchildren. International Journal on Aging andHuman Development, 48, 35-61.
Fuller-Thomson, E. & Minkler, M. (2000). The mental and physical health of grand-mothers who are raising their grandchildren. Journal of Mental Health and Aging,6, 311-323.
Giarrusso, R., Feng, D., Silverstein, M., & Marenco, A. (2000). Primary and secondarystressors of grandparents raising grandchildren: Evidence from a national survey.Journal of Mental Health and Aging, 6, 291-310.
Giarrusso, R., Feng, D., Wang, Q., & Silverstein, M. (1996). Parenting and co-parenting of grandchildren: Effects on grandparents’ well-being and family solidar-ity. International Journal of Sociology and Social Policy, 16, 124-154.
Giarrusso, R., Silverstein, M., & Feng, D. (2000). Psychological costs and benefits ofraising grandchildren: Evidence from a national survey. In C. B. Cox (Ed.), Tograndmother’s house we go and stay: Perspectives on custodial grandparents.(pp. 71-90). New York, NY: Springer Publishing.
Gibbons, C. (2003). Kinship care: Health profile of grandparents raising their grand-children. Journal of Family Social Work, 7, 1-14.
36 JOURNAL OF INTERGENERATIONAL RELATIONSHIPS
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
Gratton, B. (1987). Familism among the Black and Mexican-American elderly: Mythor reality? Journal of Aging Studies, 1, 19-32.
Jette, A. M. (1994). How measurement techniques influence estimates of disability inolder populations. Social Science and Medicine, 38, 937-942.
Kelley, S. J. (1993). Caregiver stress in grandparents raising grandchildren. Image:Journal of Nursing Scholarship, 25, 331-337.
Kelley, S. J., Whitley, D. M., Sipe, T. A., & Yorker, B. C. (2000). Psychological dis-tress in grandmother kinship care providers: The role of resources, social supportand physical health. Child Abuse & Neglect, 24, 311-321.
Kendig, H., Browning, C. J., & Young, A. E. (2000) Impacts of illness and disability onthe well-being of older people. Disability and Rehabilitation, 22, 15-22.
Leos-Urbel, J., Bess, R., & Geen, R. (2002). The evolution of federal and state policiesfor assessing and supporting kinship caregivers. Children and Youth Services Re-view, 24, 37-52.
Markides, K. S. & Krause, N. (1985). Intergenerational solidarity and psychologicalwell being among older Mexican Americans: A three generation study. Journal ofGerontology, 40, 390-392.
Meeks, S. & Murrell, S. A. (2001). Contribution of education to health and life satisfac-tion in older adults mediated by negative affect. Journal of Aging and Health, 13,92-119.
Mendez-Negrete, J. (2000). “Dime con quien andas”: Notions of Chicano and MexicanAmerican families. Families in Society, 81, 42-48.
Minkler, M. & Fuller-Thomson, E. (1999). The health of grandparents raising grand-children: Results of national study. American Journal of Public Health, 89, 1-6.
Minkler, M. & Fuller-Thomson, E. (2001). Physical and mental health status ofAmerican grandparents providing extensive child care to their grandchildren.Journal of the American Medical Women’s Association, 56, 199-205.
Minkler, M., Fuller-Thomson, E., Miller, D., & Driver, D. (1997). Depression ingrandparents raising grandchildren. Archives of Family Medicine, 6, 445-452.
Mitchell, J., Mathews, H. F., & Yesavage, J. A. (1993). Multidimensional examinationof depression among the elderly. Research on Aging, 15, 198-219.
Mui, A. C. (1996). Correlates of psychological distress among Mexican, Cuban, andPuerto Rican elders living in the USA. Journal of Cross-Cultural Gerontology, 11,131-147.
Ostir, G. V., Markides, K. S., Black, S. A., & Goodwin, J. S. (2000). Emotionalwell-being predicts subsequent functional independence and survival. Journal ofthe American Geriatrics Society, 48, 473-478.
Preville, M., Hebert, R., Bravo, G., & Boyer, R. (2002). Predisposing and facilitatingfactors of severe psychological distress among frail elderly adults. Canadian Jour-nal on Aging, 21, 195-204.
Pruchno, R. A. & McKenney, D. (2002). Psychological well-being of black and whitegrandmothers raising grandchildren: Examination of a two factor model. Journalsof Gerontology: Series B: Psychological Sciences, 57B, P444-P452.
Sabogal, F., Marín, G., Otero-Sabogal, R., Marín, B. V. & Perez-Stable, E. J. (1987).Hispanic familism and acculturation: What changes and what doesn’t? HispanicJournal of Behavioral Sciences, 9, 397-412.
Research 37
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
Sands, R. G. & Goldberg-Glen, R. S. (2000). Factors associated with stress amonggrandparents raising their grandchildren. Family Relations, 49, 97-105.
Silverstein, M. & Chen, X. (1999). Impact of acculturation in Mexican American fami-lies on the quality of adult grandchild-grandparent relationships. Journal of Mar-riage and the Family, 61, 188-198.
Strawbridge, W. J., Wallhagen, M. I., Shema, S. J., & Kaplan, G. A. (1997). New bur-dens or more of the same? Comparing grandparent, spouse, and adult-child care-givers. Gerontologist, 37, 505-510.
Szinovacz, M. E., DeViney, S., & Atkinson, M. P. (1999). Effects of surrogateparenting on grandparents’ well-being. Journal of Gerontology: Social Sciences,54B, S376-S388.
Tran, T. V., Fitzpatrick, T. R., Berg, W. R. & Wright, R., Jr. (1996). Acculturation,health, stress, and psychological distress among elderly Hispanics. Journal ofCross-Cultural Gerontology, 11, 149-165.
U.S. Census Bureau (2002). Hispanic population in the United States 2002 March CPS.Retrieved August 25, 1004, from http://www.census.gov/population/www/socdemo/hispanic/ho02.html
U.S. Census Bureau (2004). Facts for Grandparents Day 2004: September 12.Retrieved August 25, 2004, from http://www.census.gov/Press-Release/www/releases/archives/facts_for_features_special_editions/002319.html
U.S. Department of Health and Human Services (2002). Healthy people 2010.Washington, DC: Government Printing office.
Waldrop, D. & Weber, J. A. (2001). From grandparent to caregiver: The stress and sat-isfaction of raising grandchildren. Families in Society: The Journal of Contempo-rary Human Services, 82, 461-472.
Wallace, S. P. & Facio, E. L. (1987). Moving beyond familism: Potential contributionsof gerontological theory to studies of Chicano/Latino aging. Journal of Aging Stud-ies, 1, 337-354.
Received: 04/15/05Revised: 06/15/05
Accepted: 08/20/05
doi:10.1300/J194v05n01_03
38 JOURNAL OF INTERGENERATIONAL RELATIONSHIPS
Dow
nloa
ded
by [
Ada
ms
Stat
e U
nive
rsity
] at
08:
37 0
9 O
ctob
er 2
014
