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Objective: This brief report examines differences in step- versus biological family support between White, Black, and Hispanic families in the United States. Background: The increasing share of stepfamilies reflects a potential shift in family relationships. Although research finds that stepfamilies are generally less likely to engage in instrumental support than biological families, recent work suggests that the relationship between family structure and family behaviors may vary across racial/ethnic groups. Method: Using data from the 2015-2017 Add Health Parent Study, this report examines racial/ethnic differences in step- versus biological family support between parents and adult children. Specifically, parents' likelihood of and hours of providing instrumental support to adult children are assessed. Results: Findings from this report indicate for Black and White families, stepfamilies are less likely to provide instrumental support to their adult children than biological families. Among Hispanic families, however, stepfamilies are not more or less likely to provide support than biological families. When hours of instrumental support are examined, White stepfamilies provide fewer hours of support than biological families, whereas no difference is found for Black or Hispanic families. Conclusion: Findings from this study contribute to broader work that calls for more nuanced understanding of the differential effects of family structure across social groups. Future research should consider applying within-race/ethnicity analyses when examining the association between family structure and intergenerational support.

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Introduction: Throughout the COVID-19 pandemic, the need to address digital inclusion and social well-being for older adults was particularly apparent for those from disadvantaged communities. This pilot program provided access to technology and intergenerational mentorship to older adult participants interested in receiving and learning how to utilize an iPad. Pre/post-changes were examined for social well-being in the areas of quality of life, social isolation, and loneliness. Methods: This study conducted pre- and post-surveys with older participants (n = 145) from five disadvantaged communities in the United States utilizing standardized measures. One-on-one interviews were conducted post-program (n = 98) to examine participants' perceptions of the program and evaluate its impact on social measures. Results: The study sample included older adults (Mean age = 72.3) who were mostly lower income (82.3%) and self-reported as Black (13.6%), Hispanic (21.7%), and White (56.5%). Significant differences were identified in participant pre/post-survey scores for social isolation, loneliness, and a global measure of quality of life. Qualitative analyses suggest improvements in various aspects of social well-being. Themes showed that participants believed the program contributed to (1) enhanced mood and mental health, (2) improved quality of life, (3) sense of purpose and feelings of being less alone, (4) ability to use video calling to connect with others; and (5) ability to more freely use email, texting, and messaging to communicate with others. Discussion: This research demonstrates that this pilot program seemed to contribute to reduced social isolation and loneliness for participants, and participants stated more positive social well-being following program participation. However, future research with larger samples is needed to expand upon these findings. Future studies will examine the pathways between technology improvements and social well-being and examine group differences.

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OBJECTIVES: Adult child socioeconomic status (SES) has been identified as a predictor of older parents' cognitive aging. However, studies have primarily relied on educational attainment as the sole measure of adult child SES. We evaluated the relationship between adult children's financial disadvantage and cognitive outcomes of older parents in the United States. METHODS: We used data from U.S. Health and Retirement Study (2000-2014, n = 15,053 respondents ≥51 years with at least 1 adult child). Adult child financial disadvantage was measured with 3 indicators of extremely low income, unemployment, and lack of homeownership. We used linear mixed models to estimate the association between adult child financial disadvantage and the rate of decline in verbal memory scores, controlling for respondents' sociodemographic characteristics. RESULTS: Having at least 1 adult child (vs no adult children) with extremely low income was found to be associated with lower verbal memory (b = -0.041, 95% confidence interval [CI]: -0.043, -0.039) at baseline. There was a small but significant association with the rate of decline in verbal memory z-scores (b = 0.004, 95% CI: 0.000, 0.008) and some evidence of heterogeneity by parent gender, marital status, and SES. DISCUSSION: Offspring financial disadvantage may be influential for older parents' initial level of memory function, although evidence of associations with memory decline was weak. Public policy interventions aimed at improving the economic conditions of adult children may indirectly benefit the cognitive performance of disadvantaged parents in their later life.

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ACADEMIC ABSTRACT: We articulate an intergenerational model of positive psychosocial development that centers storytelling in an ecological framework and is motivated by an orientation toward social justice. We bring together diverse literature (e.g., racial-ethnic socialization, family storytelling, narrative psychology) to argue that the intergenerational transmission of stories about one's group is equally important for elders and youth, and especially important for groups who are marginalized, because stories provide a developmental resource for resistance and resilience in the face of injustice. We describe how storytelling activities can support positive psychosocial development in culturally dynamic contexts and illustrate our model with a case study involving LGBTQ+ communities, arguing that intergenerational storytelling is uniquely important for this group given issues of access to stories. We argue that harnessing the power of intergenerational storytelling could provide a culturally safe and sustaining practice for fostering psychosocial development among LGBTQ+ people and other equity-seeking populations. PUBLIC ABSTRACT: Understanding one's identity as part of a group with shared history and culture that has existed through time is important for positive psychological functioning. This is especially true for marginalized communities for whom identity-relevant knowledge is often erased, silenced, or distorted in mainstream public discourses (e.g., school curricula, news media, television, and film). To compensate for these limitations around access, one channel for the transmission of this knowledge is through oral storytelling between generations of elders and youth. Contemporary psychological science has often assumed that such storytelling occurs within families, but when families cannot or would not share such knowledge, youth suffer. We present a model of intergenerational storytelling that expands our ideas around who counts as "family" and how knowledge can be transmitted through alternative channels, using LGBTQ+ communities as a case example.

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OBJECTIVE: A plethora of studies have unequivocally established the profound significance of harmonious familial relationships on the psychological well-being of the elderly. In this study, we elucidate the intergenerational relationships, probing the association between frequent interactions or encounters with their children and the incidence of depression in old age. METHODOLOGY: We employed a retrospective cross-sectional study design, sourcing our data from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). To identify cases of depression, we utilized the 10-item Center for Epidemiologic Studies Depression Scale (CESD). Employing a five-fold cross-validation methodology, we endeavored to fashion five distinct machine learning models. Subsequently, we crafted learning curves to facilitate the refinement of hyperparameters, assessing model classification performance through metrics such as accuracy and the Area Under the Receiver Operating Characteristic (AUROC) curve. To further elucidate the relationship between variables and geriatric depression, logistic regression was subsequently applied. RESULTS: Our findings accentuated that sleep patterns emerged as the paramount determinants influencing the onset of depression in the elderly. Relationships with offspring ranked as the second most significant determinant, only surpassed by sleep habits. A negative correlation was observed between sleep patterns (Odds Ratio [OR]: 0.78, 95 % Confidence Interval [CI]: 0.75-0.81, P < 0.01), communication with offspring (OR: 0.86, 95 % CI: 0.82-0.90, P < 0.01), and the prevalence of depressive symptoms. Among the evaluated models, the k-Near Neighbor algorithm demonstrated commendable discriminative power. However, it was the Random Forest algorithm that manifested unparalleled discriminative prowess and precision, establishing itself as the most efficacious classifier. CONCLUSION: Prolonging the duration of nocturnal sleep, and elevating the frequency of communication with offspring have been identified as measures conducive to mitigating the onset of geriatric depression.

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Objective: This study investigates longitudinal associations between providing care to grandchildren and cognitive functioning. It also examines heterogeneity in these relationships. Background: Grandchild caregiving may support older adults' cognitive functioning by providing social engagement and emotional meaning. However, studies caution that time- intensive or custodial grandchild caregiving can take a toll on grandparents. The cognitive health implications of grandchild caregiving may thus depend on contexts including time spent providing care and living arrangements. They may also vary across sociodemographic groups and have greater effects on older adults who are more vulnerable to cognitive decline. Method: Data came from the 1998-2016 waves of the Health and Retirement Study (HRS) and represented over 11,000 U.S. adults age 50+. Using linear growth curve and dynamic panel models, the analysis explored relationships between level of grandchild care and cognitive functioning over time and across sociodemographic, family, work and health characteristics. Results: Those providing 100-199, 200-499 or 500+ hours of care to grandchildren had better cognitive functioning than non-caregivers regardless of whether they lived with grandchildren. Positive links between grandchild caregiving and cognition were stronger for lower income, non-working, and unpartnered adults and grew with age and functional limitations. Conclusion: These findings suggest that providing care to minor grandchildren may help support cognitive functioning as adults age. They also support the hypothesis that more vulnerable or isolated groups of older adults may benefit the most from grandchild caregiving.

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Intergenerational relationships have been established as a critical locus of psychosocial development, meeting needs of identity development for youth, generativity for elders, and connection and belonging for both. However, intergenerational relationships are both rare in the LGBTQ+ community and sorely needed as a buffer to the discrimination and harm that those within the community experience from systemic and structural oppression. Focusing on sexual identity, and employing a letter writing paradigm, we investigated the content of wisdom that LGB elders have to share with youth. In a descriptive, exploratory, mixed-methods, and pre-registered study, 94 adults ranging in age 50 to 79 years (M = 55.98; SD = 6.30) wrote letters to a fictional youth, Sam, as well as completed surveys of psychosocial development and well-being. Letters were content coded for themes, as well as for emotional tone and subjective perspective. The most common themes of wisdom shared included knowing and celebrating oneself, negotiating an oppressive society, and finding one's community. Those who wrote more emotionally positive letters scored higher on measures of wisdom and generativity, and lower on embitterment. Results are discussed in terms of the importance of cultivating opportunities for wisdom-sharing within LGBTQ+ communities to promote flourishing across the lifespan.

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Amidst population ageing trends and epidemiological transitions, there has been a growing emergence of young family caregivers, about whom most studies have been conducted in Western countries. Their subjective experiences and perceptions toward caregiving remain underexplored in Asia. This qualitative study explored the lived experiences of caregiving for older family members by young caregivers in Singapore. Interpretative phenomenological analysis was employed to collect and analyse data from semi-structured, in-depth interviews with six young adult caregivers aged between 23 and 29. Interviews were supplemented with photo-elicitation techniques to deepen interview discussions and uncover experiential significance. Findings illustrated transitions into caregiving, challenges across role conflicts and expectations amidst developmental tasks and transitions, and navigation of intergenerational conflicts and ambivalence. Although no definitive conclusions can be reached from this small-scale study, the findings offer important insights into the convergence and intensity of young caregivers' experiences. Given that caregiving challenges are likely to continue amidst Singapore's rapidly ageing population, these necessitate further in-depth research efforts. Implications for policy and practice across multiple stakeholders interfacing with youth and older adults are presented. A whole-of-society approach is called for to enable young caregivers to realise their full potential while contributing to their ageing families and nation.

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BACKGROUND: Late-life internal migration is frequently associated with a higher risk of depression in older parents. This research delves into the impact of intergenerational emotional cohesion (IEC) on depression in older internal migrants and the underlying mechanisms within the contemporary Chinese context. METHODS: Obtained from a cross-sectional survey in Nanjing, China, the research involved 654 older internal migrants (66.97% female; mean age = 66.05 years; SD = 4.67). Variables were assessed using the Intergenerational Solidarity Inventory, 3-item R-UCLA Loneliness Scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire (PHQ-9). For mediation exploration, a serial mediation model was utilized, and the Bootstrap method was employed to test the signifcance of these mediation effects. RESULTS: IEC demonstrates a negative correlation with depression. Through IEC, three significant mediation pathways were identified that directly affect depression: (1) loneliness (ß=-0.06; Ratio=17.14%), (2) perceived stress (ß=-0.09; Ratio=25.71%), and (3) loneliness and perceived stress (ß=-0.03; Ratio=8.57%). CONCLUSIONS: IEC can impact the depression of older internal migrants by mitigating negative psychological emotions during the migration process. This finding provides valuable theoretical insights for the prevention of mental health problems among this demographic.

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Intergenerational contact is important to older adults' quality of life, but less is known about within-family differences in older parents' contact between sons and daughters, especially in countries with patrilineal traditions. Applying latent profile analysis to data on 3,228 Korean older adults' frequency of meeting and communication with each of their children, this study identified within-family patterns of intergenerational contact. Nearly half of parents exhibited gender-balanced patterns of meeting across children, while 13% reported "more frequent contact with daughters" and 39% reported "more frequent contact with sons." On the other hand, "equally high contact" (77%) was the most common pattern for communication. Multinomial regression results showed that the derived patterns were differentiated by parents' education, marital status, region, economic satisfaction, health, and depressive symptoms. The results highlighted the enduring nature of patrilineal traditions as well as the differing patterns of contact that Korean older adults have with their children.

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Ageism includes discrimination toward both younger and older individuals. Discrimination based on generational cohorts can serve as a proxy for discrimination based on age and, therefore, can be argued as a form of ageism. This study examined the occurrence of generational ageism and its relationship to internalized and relational ageism. This cross-sectional study surveyed 913 individuals recruited through ResearchMatch. Analyses found that those in the Millennial and Gen Z groups reported experiencing the highest levels of discrimination based on generational cohort and reported feeling that their generational groups were viewed as less capable, more opinionated, and more selfish than other generations. Millennial and Gen Z groups also reported experiencing higher internalized and relational ageing anxiety levels than older cohorts. As our collective understanding of the manifestation and perpetuation of ageism grows, it is imperative to explore the impact and consequences of generational bias as a form of ageism.

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BACKGROUND AND OBJECTIVES: Family caregiving-providing emotional and physical health care for a family member or friend with an illness or disability-can result in many outcomes, including stress and beneficial experiences. Both romantic and caregiving relationships are complex and varied. Nevertheless, little research has examined how caregiving and romantic relationships influence one another. The purpose of this study was to understand ways romantic partners who care for a family member outside of their romantic relationship perceive that their romantic relationship and caregiving experiences influence one another. RESEARCH DESIGN AND METHODS: A qualitative study using thematic analysis was conducted. A sample of 5 couples where one or both partners were caring for a relative with dementia participated in interviews about their experiences in family caregiving and in their romantic relationship, as well as how the 2 roles interacted with each other. Couple members were interviewed separately and together. RESULTS: From these interviews, themes reflecting ways that caregiving influences romantic relationships, as well as ways romantic relationships influence caregiving emerged. Themes about caregiving influencing romantic relationships were caregiver stress interacting in the romantic relationship, the romantic relationship becoming less of a priority, and benefits experienced in the romantic relationship due to caregiving. Themes about romantic relationships influencing caregiving were partners improving the caregiving experience, and workload inequality. DISCUSSION AND IMPLICATIONS: These findings broaden our understanding of how dyadic coping affects family caregiving and may suggest ways that the mutual influences caregivers experience between romantic relationships and caregiving benefits and challenges.

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LGBTQ+ people continue to be threatened by systemic censorship and erasure in public spaces and discourses, making community-based resources for positive development crucial. In this study, we examined one such developmental resource-LGBTQ+ intergenerational storytelling about cultural-historical events. LGBTQ+ adults (N = 495) ranging in age from 17 to 80 years (M = 39.22, SD = 19.89) responded to an online survey about LGBTQ+ intergenerational storytelling and relationships. Results showed that although LGBTQ+ intergenerational storytelling was reported to occur infrequently, sharing stories across generations was considered important, and LGBTQ+ people desired even greater intergenerational connection. Intergenerational narratives reported by participants were primarily about cultural-historical events involving adversity and oppression (e.g. AIDS crisis), policy and legislation (e.g. marriage equality), and protest, resistance, and activism (e.g. Stonewall uprising). Stories were mostly told by older friends in private or social settings for the purpose of passing on LGBTQ+ history. Lessons learned through storytelling were diverse but tended to focus on appreciation and affirmation. Valuing intergenerational storytelling was associated with positive psychosocial identity. This study suggests that intergenerational storytelling may be an important developmental resource for LGBTQ+ people and other marginalized communities.

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AIMS: To explore the relationships between adult offspring's socioeconomic resources and the development of stroke and survival after stroke among older adults in Denmark and Sweden. METHODS: The study included 1,464,740 Swedes and 835,488 Danes who had turned 65 years old between 2000 and 2015. Multivariable Cox proportional hazard regression models were used to analyse incident stroke and survival after stroke until 2020. RESULTS: Lower level of offspring's education, occupation and income were associated with higher hazards of stroke among both men and women in Sweden and Denmark. Associations with offspring's education, occupation and income were most consistent for death after the acute phase and for educational level. From one to five years after stroke and compared with a high educational level of offspring, low and medium educational level were associated with 1.34 (95% confidence interval (CI): 1.11; 1.62) and 1.18 (95% CI: 1.10; 1.27) as well as 1.26 (95% CI: 1.06; 1.48) and 1.14 (1.07; 1.21) times higher hazard of death in Swedish women and men, respectively. The corresponding estimates in the Danish population were 1.36 (1.20; 1.53) and 1.10 (1.01; 1.20) for women and 1.23 (95% CI: 1.11; 1.32) and 1.13 (95% CI: 1.05; 1.21) for men. CONCLUSIONS: Adult offspring socioeconomic resources are, independently of how we measure them and of individual socioeconomic characteristics, associated with development of stroke in old age in both Denmark and Sweden. The relationships between offspring socioeconomic resources and death after stroke are present especially after the acute phase and most pronounced for educational level as a measure of offspring socioeconomic resources.

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Resumo Objetivo Discutir sobre a promoção da saúde da pessoa idosa por meio da intergeracionalidade, com ênfase na educação intergeracional nos Programas Intergeracionais, como uma proposta de educação para o protagonismo da pessoa idosa e o envelhecimento bem-sucedido. Método Ensaio teórico, de cunho reflexivo com abordagem qualitativa. Embasando-se na leitura de documentos que reforçam o aumento da longevidade e a preocupação com a promoção da saúde para a pessoa idosa no Brasil, a fim de refletir sobre a intergeracionalidade na promoção da saúde e a utilização da educação intergeracional para promover o envelhecimento bem-sucedido, por meio dos Programas Intergeracionais. Resultados Organizaram-se em três tópicos: Promoção da saúde da pessoa idosa: desafios para o seu protagonismo; Compreensão sobre envelhecimento para a aprendizagem intergeracional; Programa intergeracional: protagonismo para a promoção da saúde da pessoa idosa. Conclusão Experiências exitosas na saúde, especificamente nos espaços ocupados pela Atenção Primária à Saúde ainda se mostram restritas ou pouco visualizadas para a construção de uma educação transformadora para a promoção da saúde da pessoa idosa. O desafio é fomentar pesquisas científicas, para que os profissionais, a partir da educação permanente, possam potencializar os momentos de educação em saúde a partir da educação intergeracional, sendo assim, a construção e implementação de Programas Intergeracionais podem representar essa possibilidade.

Abstract Objective To discuss the promotion of health for older adults through intergenerationality, with an emphasis on intergenerational education within Intergenerational Programs, as a proposal for education fostering the protagonism of older adults and successful aging. Method Theoretical essay, reflective in nature with a qualitative approach. Grounded in the examination of documents emphasizing the increase in longevity and the concern for health promotion among older adults in Brazil, the aim is to contemplate intergenerationality in health promotion and the utilization of intergenerational education to foster successful aging through Intergenerational Programs. Results Organized into three topics: Health promotion for older adults: challenges for their protagonism; Understanding aging for intergenerational learning; Intergenerational program: protagonism for the health promotion of older adults. Conclusion Successful experiences in health, specifically within the realms of Primary Health Care, still appear to be limited or insufficiently recognized for the development of transformative education in health promotion for older adults. The challenge lies in fostering scientific research so that professionals, through continuous education, can enhance health education moments through intergenerational education. Thus, the establishment and implementation of Intergenerational Programs may represent this promising possibility.

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Objective: The purpose of this article is to examine the relationship between mother-youth closeness and stigma stemming from police contact. Background: Research increasingly indicates that stigma stemming from police-youth encounters links police contact to compromised outcomes among youth, though less is known about the correlates of stigma stemming from this criminal legal contact. Close mother-youth relationships, commonly understood to be protective for youth outcomes, may be one factor that buffers against stop-related stigma, especially the anticipation of stigma. Method: We use data from the Fragile Families and Child Wellbeing Study, a sample of youth born in urban areas around the turn of the 21st century, to examine the relationship between mother-youth closeness and stop-related stigma. Results: We find that mother-youth closeness is negatively associated with stop-related anticipated stigma but not stop-related experienced stigma. We also find that the relationship between mother-youth closeness and stop-related anticipated stigma is concentrated among youth experiencing a non-intrusive stop. Conclusion: Close mother-youth relationships may protect against stigma stemming from criminal legal contact.

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Objective: This study examined changes in geographic proximity to family members among race and income groups in the United States from 1981 to 2017. Background: Close geographic proximity to family members can facilitate mutual support and strengthen family bonds. Some scholars argue that institutional sources of support have replaced many core family functions, which might mean that households are likely to live increasingly farther away from family. Advancing technology and changing labor market opportunities might reinforce this pattern. Yet, the ongoing cultural and emotional salience of family might curtail the effects of these factors on the increasing distance to family. Method: We conducted a quantitative analysis of longitudinal data from the Panel Study of Income Dynamics (PSID). We utilized the multigenerational structure of the PSID and restricted-use geocodes to map kin proximity at every interview from 1981 to 2017. We cross-classified our sample by race and income, focusing on Black and White respondents across income quartiles (n = 171,501 person-periods). Results: High-income White respondents showed the greatest increases in distance from kin over time, whereas proximity to kin among other race-income groups was relatively stable. Conclusion: Proximate kin has become less central in the lives of high-income White households over time, whereas close proximity to kin has been the norm over time for other racial and income groups. These results have implications for racial and income differences in kin relations over time.

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Objective: We examined the acculturation processes involving intergenerational consonance and dissonance in parent-child relationships in U.S. immigrant families. Background: This study is important because we lack national studies that examine the association between acculturation processes and intergenerational relationships among diverse racial/ethnic groups in immigrant families. Method: Using national data from Add Health with diverse race/ethnicity, we measured acculturation levels by immigrant generation, age of arrival, and length of time. Intergenerational consonance (the degree to which children and parents share the same values and activities) was measured by family cohesion and sharing meals (specifically dinners) with parents. Intergenerational dissonance (the degree to which parents and children differ in expected norms and parents lose authority over their children) was measured by parent-child conflict and parental control. Ordinary least square, binary logistic, ordered logistic, and Poisson regressions were conducted depending on the nature of the four dependent variables. Results: We found robust evidence that adolescents of the second immigrant generation acculturate more rapidly than those of the first generation and their immigrant parents creating a "gap" in intergenerational relationships. Thus, second-generation adolescents experience lower levels of family cohesion, less frequency of sharing weekly dinners with parents, less parental control of adolescents' activities, and more serious arguments about their behaviors with their parents than their first-generation counterparts. Conclusion: This is the new evidence that is based on national data, across multiple measures of intergenerational relationships, and holds for diverse racial and ethnic groups. Implications: The findings underscore the importance of developing culturally informed interventions supporting healthy parent-child relationships in immigrant families.

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This study aimed to examine the association of workplace-based ageism with (a) ageism in non-work contexts and (b) workplace-based sexism. Data came from an online survey of workers in South Korea, with a sample stratified by gender and age group (N = 600; mean age = 43.6 years, range 20-74). Workplace-based ageism was measured using the Workplace Intergenerational Climate Scale (WICS). Other measures included the Fraboni Ageism Scale (FAS) and the Workplace Sexism Culture Scale (WSCS). A series of logistic regression models for endorsing the most workplace ageism (i.e., scoring in WICS bottom quartile) were estimated. Results showed that with each unit increase in FAS scores, the probability of belonging to the WICS bottom quartile increased by 7% while controlling for sociodemographic characteristics [odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.04-1.10, p < 0.01]. Likewise, when WSCS scores increased by one unit, the probability of belonging to the WICS bottom quartile increased by 8% while controlling for sociodemographic characteristics (OR = 1.08, 95% CI = 1.04-1.12, p < 0.01). Findings suggest that ageism and sexism may be intertwined across workplace and non-work contexts.

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OBJECTIVE: Socioeconomic resources and family support have been shown to improve adherence to treatment in people with type 2 diabetes (T2D) and are associated with a lower risk of diabetes-related complications and death. We investigated the associations of having children and their educational level with diabetes-related complications and death among older adults with T2D. METHODS: We included 74,588 adults who were at least 65 years of age at the time of T2D diagnosis over the period from 2000 to 2018 in Denmark and grouped them based on having children (yes [reference]/no), and their children's highest educational level (low/medium/high [reference]). Multistate models were performed with 3 states: T2D diagnosis, diabetes-related complications, and death. All models were stratified by other chronic diseases at baseline (yes/no). RESULTS: During follow-up (mean, 5.5 years), 14.6% of the adults developed a complication and 24.8% died with or without complications. Not having children was associated with a higher hazard of death without complications among adults without (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.17 to 1.33) and with (HR, 1.10; 95% CI, 1.02 to 1.18) other chronic diseases and after complications among adults without other chronic diseases (HR, 1.25; 95% CI, 1.12 to 1.38). Having children with a lower educational level was associated with a higher hazard of complications (HRlow, 1.14; 95% CI, 1.05 to 1.24; HRmedium, 1.11; 95% CI, 1.05 to 1.17), death without complications (HRlow, 1.26; 95% CI, 1.17 to 1.36; HRmedium, 1.07; 95% CI, 1.02 to 1.14), and after complications (HRlow, 1.22; 95% CI, 1.07 to 1.39) among adults without other chronic diseases. CONCLUSIONS: Among adults without other chronic diseases, having no children or having children with lower educational levels was associated with a higher hazard of death. Among these adults, having children with lower educational levels was also associated with a higher hazard of diabetes-related complications.

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