Life and Times

IMAO.

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New Year Resolutions

Happy New Year! I had an amazing 2013: found someone special in my life and enjoy everyday with him; took many road trips, and learned so much from school. 

In 2014, I need to:

1. Work out on a regular basis;

2. Eat healthy; 

3. Write more;

4. Listen more;

5. And be less stressed. 

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Child Poverty in South Africa

This is one of my paper for my courses. I spent a lot of efforts into doing research about the Child Support Grant in South Africa. I grew so much in developing the techniques and skills in writing policy memo. Even though child welfare is not one of my major focus in my career development, I'm delighted to see how it turns out. Enjoy reading!

Executive Summary

Child poverty in South Africa is more pervasive than for the population as a whole. Children constitute 37% of the total population, and 58% of them live below the national poverty line. Three primary factors have led to child poverty in South Africa: racial disparities, high unemployment rate, and the HIV/AIDS epidemic. 

The Child Support Grant was introduced in 1998 to alleviate child poverty. Due to the means test, almost 25% of children who would be eligible for the grant are being excluded (SASSA & UNICEF, 2013b). Key barriers to receiving benefits include high levels of confusion regarding the means test and eligibility criterion, complicated application processes, and problems with retrieving the needed documents (DSD, SASSA & UNICEF 2012; Zembe-Mkabile et al., 2012). Children are the future of South Africa and their benefits should be prioritized. A rights-based universal Child Support Grant is proposed, wherein all South African children under 18 would be eligible for the benefits regardless of their household income. A universal Child Support Grant is economically, politically, and administratively feasible.

Child Poverty in South Africa

In mid-2010, South Africa had a total population of 50 million, of whom 18.5 million were children (i.e., those under 18 years old) (Meintjes et al., 2010). Although children constitute 37% of the total population, nearly 12 million children were considered to be poor (UNICEF, 2010). Child poverty (65.5%) remains more pervasive than in the population as a whole (52.9%) and poverty among adults (45.2%).

Poverty has created barriers for South African children in terms of access to nutritious food, education, and even causes child mortality. 21.7% of children lived in households where some level of child hunger was reported; six out of ten non-poor children started school by the age of 6, as compared with 53.8% of poor children (SASSA & UNICEF, 2013a). 

Causes of Child Poverty

Racial disparities, high unemployment rates, and the prevalence of HIV/AIDS are three major causes of child poverty in South Africa. South Africa stands out as a country with one of the largest racial divisions in the world due to European colonization and the Apartheid regime that followed independence, which officially ended in 1994 (Gradin, 2011). Racial dimensions persist within child poverty, and poverty is the highest among African and Colored children (UNICEF, 2010). 84.8% of Black African children were in poverty, while only 5.3% of White children lived in poverty between 2008 and 2009 (SASSA &UNICEF, 2013a). 

Child poverty in South Africa is highly associated with household unemployment. In 2011, over 65 million children in South Africa (35%) lived in households where no adults were employed. According to Meintjes and Hall (2013), 40% of African children do not live with an employed adult, whereas only 3% of white children do not live with an employed adult. Living with employed adults is significant to a child’s well-being, as it can provide financial stability and security to children. Additionally, children are more likely to have access to education and health care. 

HIV/AIDS prevalence is another factor contributing to child poverty in South Africa. According to UNICEF (2010), South Africa has the highest incidence proportion of HIV/AIDS in the world. Even though South Africa has less than 1% of the world’s population, South Africa is home to 17% of all people living with HIV globally. Many adults have died due to the effects of HIV/AIDS, leaving many children without any primary caregivers. In 2011, roughly 3.6 million children were orphaned, which is approximately 1 in 5 children. Parental deaths also result in household economic shock (Kua & Operario, 2010). 

Current Policies

The Child Support Grant (CSG) was introduced in 1998 and is an important tool in alleviating child poverty in South Africa, reaching 10 million children each month (DSD, SASSA & UNICEF, 2012). The CSG is a cash transfer paid to the caregiver of a child under 18 years old who qualifies based on a means test. In 2011, the CSG reached the largest number of beneficiaries (68%) compared to other social grants in South Africa (DSD, SASSA & UNICEF, 2012). The grant is a publicly funded social assistance program, supervised by the Department of Social Development, accounting for 3.5% of GDP. 

 Criteria to access the CSG

Three sets of criteria determine eligibility for the CSG: an income-based means test, age thresholds (children have to be under 18 years old), and citizenship. The means test evaluates the income of the CSG applicant (i.e., the child’s biological parent or primary caregiver), the income of their spouse or partner, and the income of the beneficiary (i.e., the dependent child). In order for an applicant to be eligible, the sums of these three incomes must fall below a threshold which is adjusted annually. In 2011, the means test threshold for the CSG was set at R2, 500 (US dollars 242.5) per month for a single caregiver, and R5, 000 (US dollars 485) per month for a couple. Children are being excluded

Even though the CSG has helped many children out of poverty (DSD, SASSA & UNICEF, 2012), a total of 2.3 million children are being excluded (Zembe-Mkabile, 2012). The take-up rate peak for children was ages 7 to 10 years old, with the enrollment rate lowest among infants and adolescents (DSD, SASSA & UNICEF, 2012).  It is troubling that children who are at the greatest risk of exclusion from the program are also the children often identified as the most vulnerable. Research suggested that early receipt of the grant is associated with improved health care and better school performance (DSD, SASSA &UNICEF, 2012).  

Such a gap was created by three factors: the means test, confusion and misunderstanding among applicants about the income threshold, and difficulties in obtaining significant legal documents. 

1. The means test

The CSG was designed as means-tested benefit targeting the poor. However, targeting the most vulnerable does not necessarily translate into effectively reaching this population. The means test of the Child Support Grant created one major exclusion group — the youngest caregivers — because teenage mothers cannot simultaneously be a caregiver applicant (on behalf on her own children) and a beneficiary (in terms of her own mother’s application). In addition, the CSG eligibility criteria also limit the benefits to applicants (e.g., the primary caregivers of children) who are citizens or permanent residents of South Africa, regardless of the status of the beneficiary child. Since caregivers apply on behalf of the child, it is the status of the caregiver, not the child or spouse that determines eligibility — another major exclusion error. 

Exclusion from the CSG is highly impacted by racial disparity (SASSA & UNICEF, 2013b). Only 4% of eligible white children, compared to 43% Indian, 63% Colored, and 78% Black children, receive the CSG. However, the number of excluded white children is small (94,500), compared to the almost 2 million excluded Black children. 

2. Confusion and misunderstanding about the income threshold

Research (UNICEF, DSD & UNICEF, 2012) found that more than one out of 10 poor eligible caregivers who did not apply for the grant believed that their income was too high, even though their incomes actually fell below the threshold. For instance, employed caregivers frequently believed that any employment rules out eligibility for the grant, without understanding that the current income threshold enables millions of workers in South Africa to be eligible for the grant. 

3. Problems with documents

The inability to acquire the required legal documents is the number one reason why eligible applicants not to apply for the grant. Likewise, problems with obtaining the correct documentation were the number one reason why applicants for the CSG were delayed. The core documents required for the CSG application include parents’ ID, child’s birth certificate, clinic (immunization or “Road to Health”) card, marriage certificate, and proof of address.

Policy Proposal

A rights-based universal Child Support Grant can be more cost effective reaching all South African children under age of 18 regardless of their household income. The government spends a lot of money to determine whether a household falls below the income threshold. A universal Child Support Grant can also mitigate the confusing issues of eligibility criteria; reduce inequality in terms of acquiring the grant due to applicants’ educational background and race; and reduce the stigma associated with receiving benefits. South African government can obtain funding for the universal Child Support Grant by reallocating public expenditure and increasing tax revenue. Universal Benefits vs. Means-tested Benefits

Compared to universal benefits, means-tested benefits can come with some inefficiency and are more costly. In order to apply the means-tested benefits, the government has to determine an indicator to measure child poverty. However, governments often have inaccurate information about the true welfare level of households (Notten et al., 2008). Moreover, child poverty is a multi-dimensional concept and there are various ways to measure each dimension (Notten et al., 2008). As a result, nearly 25% of the eligible children are being excluded (SSASA & UNICEF, 2013b). Additionally, screenings costs can be high to implement means-tested benefits. Many money and resources have to be put into determine whether a household is eligible, and the application process is very time-consuming due to the complex paper work (SASSA & UNICEF, 2013b). When screening costs are high and there are inefficiencies caused by exclusion errors, universal benefits become more attractive as a benefit allocation mechanism (Notten et al., 2008). 

Children should be Prioritized

According to UNICEF (2012), investing in children and supporting children’s development can offer critical opportunities that will yield lasting returns. Because childhood is a crucial time period in terms of physical, cognitive, and psychological growth, investing in children can ensure their well-being and help them grow into their full potential. With South Africa’s high rate of parental death due to the HIV/AIDS epidemic, children are the future. On the other hand, losses due to malnutrition or missed schooling can be difficult to recover from in terms of adult productivity and earnings (UNICEF, 2012). For example, the impact of a child in South Africa receiving the CSG can translate into gains in monthly wages of 5-7 percent. By expanding the current means-tested benefits into a universal benefit, many more children can be reached, delivering higher return rates. 

Offering social support for children’s development can last beyond childhood, increase adult productivity, and contribute to breaking the intergenerational cycle of poverty. UNICEF supports investing in children because investing in children and offer social protection can result in positive immediate and long-term economic and social returns (UNICEF, 2012). Social protection can also have positive impacts on the economic activities of homes with potential multiplier effects (UNICEF, 2012).

Feasibility Analysis 

Economic

UNICEF (2012) argued that social protection is affordable even in budget-constrained settings and needs to be seen as an investment in human capital accumulation and household resilience, as well as risk management strategy. Allocating funds within the existing national budget and raising more tax revenue are two major principles in financing increased expenditure on cash transfers (UNICEF 2012, Arnold et al., 2011). Affordability of financing social benefits programs is about where and how resources should be spent to maximize benefits and what long-term financing strategies are feasible for progressive expansions of coverage (UNICEF, 2012). Eventually, affordability depends on a society’s willingness to finance social policies to support population.

Re-allocating current expenditures can be an efficient option, which includes assessing ongoing dulcet allocation through public expenditure, and replacing high-cost, low-impact investment and those with larger socio-economic impacts, eliminating spending inefficiencies and/or reducing corruption (UNICEF, 2012). Successful examples include Indonesia and Mozambique, which scaled down regressive fuel subsidies to finance social protection efforts. 

Altering tax rates to increase tax revenue is also an efficient option in financing universal benefits for South African children. According to UNICEF (2012), taxes are one of the key sources of domestic revenue available to governments, so growing tax revenues, expanding the tax base, and increasing tax compliance to mobilize possible resources for social protection without necessarily sacrificing other spending priorities. For example, Holmqvist (2010, cited in UNICEF, 2012) found that raising tax revenue by just one percentage point - from 13 to 14 percent of GDP in Burkina Faso would be enough to finance a universal pension for those aged 65 and over. 

Political

The South African government, in its Constitution, has already entered into a social contract with its people to provide social assistance and to protect children. As recognized by the 2007 Convention on the Rights of the Child, children have a right to social security, including social insurance, and to an adequate standard of living (UNICEF, 2007). A universal Child Support Grant can guarantee that no child is left behind, and the rights of children are met. In fact, the South African government has already commissioned a feasibility study of a universal Child Support Grant (Samson, 2009).

Administrative 

According to UNICEF (2012), cash transfer programs are easy to administer and are more cost-effective. South Africa has already developed a means-tested system under the Department of Social Development. Changing from the means-tested benefits to universal benefits can actually help the government save money in paperwork and manpower to determine whether applicants fall under the income thresholds. The application process can also be simplified and more efficient. 

Reference

Arnold, C., Conway, T. & Greenslade, M. (2011). Cash Transfers: Literature Review. UK Department  for International Dvelopment. Glasgow, UK. Retrieved from http://r4d.dfid.gov.uk/PDF/Articles/cash-transfers-literature-review.pdf

DSD, SASSA, and UNICEF. 2012. The South African Child Support Grant Impact Assessment: Evidence from a survey of children, adolescents, and their households. Pretoria: UNICEF South Africa.

Gradín, C. (2011). Race, Poverty and Deprivation in South Africa. Journal of African Economies, 22(2), 187-238.

Kua, C. & Operario, D. (2010). Caring for AIDS-orphaned children: An exploratory study of challenges faced by carers in KwaZulu-Natal, South Africa. Vulnerable Child Youth Studies, 5(4), 344-352.

Meintjes, H. & Hall, K. (2010). Demography of South Africa’s children. In: Berry L, Biersteker L, Dawes A, Lake L & Smith C (eds) South Africa Child Gauge 2013. Cape Town: Children’s Institute, University of Cape Town.

Notten, G. & Gassmann, F. (2008). Size matters: Targeting efficiency and poverty reduction effects of means-tested and universal child benefits in Russia. Journal of European Social Policy, 18(3), 260-274.

Samson, M.(2009). Social cash transfers and pro-poor growth. OECD. Retrieved from http://www.oecd/org/development/povertyreduction/43280571.pdf

UNICEF. (2007). Law reform and implementation of the convention on the rights of child. Florence, Italy. Retrieved from http://www.unicef irc.org/publications/pdf/law_reform_crc_imp.pdf

UNICEF.(2010). Inequities in the fulfillment of children’s rights in South Africa: A statistical Review. Pretoria, South Africa, Retrieved from http://www.unicef.org/southafrica/SAF_resources_smrstatsrev.pdf

UNICEF. (2012). Integrated Social Protection System: Enhancing Equity for Children. New York, NY. Retrieved from http://www.unicef.org/socialpolicy/files/UNICEF_Social_Protection_Strategic_Framework_full_doc_std.pdf

SASSA and UNICEF. (2013a). Men, Women and Children: Findings of the Living Conditions Survey 2008/2009. Pretoria, South Africa. Retrieved from http://www.statssa.gov.za/Publications/Report-03-10-02/Report-03-10-022009.pdf

SASSA and UNICEF. (2013b). Preventing Exclusion form the Child Support Grant: A study of Exclusion Errors in Accessing CSG Benefits. Pretoria: UNICEF South Africa

Zembe-Mkabile, W., Doherty, T., Sander, D., Jackson, D., Chopra, M., Swanevelder, S., Lombard, C. & Surender, R. (2012). Why do families still not receive the child support grant in South Africa? A longitudinal analysis of a cohort of families across South Africa. BIMC International Health and Human Rights, 12:24.

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Back in the fall.

To me, trees are very elegant and I like to capture their beautiful shapes. 

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Times House in Jim Thorpe

Such a cute B&B. Love the vintage and cozy feeling of it. The owners are very friendly and highly recumbent for stay during your visit to Jim Thorpe. 

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Train Ride in Jim Thorpe

Please try the train ride when you visit Jim Thorpe. it's worthwhile to spend a little more money for the 1st class. It was absolutely an amazing experience to see the nature in PA. The sofa in the first class is very comfy, and the ride is an hour long. 

Check the schedule in advance. 

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Jim Thorpe

Perfect place for a romantic weekend gateway. Love the European atmosphere in the town. People call it the "Switzerland in America" and I agree. The town has a lot to offer: museum, plays & performance in the opera house, exquisite boutiques, hiking in the summer time, and skiing & snowboarding in the winter. 

Moya is a great restaurant to try. Recommend the curry cat fish, very yum! Don't forget to make reservation in advance during weekends and holidays seasons. We tried to get back before we left and we were told that no tables were available. 

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Merry Christmas!

So much love this Christmas: decorated a Christmas tree with Jay for the very first time & shopped for different ornaments.

Embrace the holiday atmosphere with people you love is what it matters. :)

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Day & Night, Manhattan

If you want to see the City from up there, either you can take the tour with the helicopter, or you can go the top of the Rock or the Empire State Building. It's quite expensive to take the helicopter even though you can always find discount from the Groupon, so I chose to go up to the Rock and the Empire State Building. I went to the Rock during the daytime, and I went up to the Empire State building during night. Both were breath-taking experiences. 

So much glam and fame, along with the lights...the City is so amazing, while it is also easy for you feel lost in the middle. 

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Pieces in the west village. 

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Chelsea Market and the High Line.

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“年轻黑人男性”的沉重意义

这几天我继续阅读sue教授的书，有一些章节想要分享一下。

书中第三章有谈到发生在1999年的案件。一名无辜的23岁黑人男子Amadou Diallo被三名纽约便衣警察开枪被杀。Diallo是一名移民。事情的缘由是警察拦下Diallo要求查看身份证明，Diallo想要掏出其皮夹却被警察误以为其要掏出枪械，警察随即将其枪毙。

书中p45-46谈到一个黑人女性妈妈就其事件的描述：

Directly after that incident, I (Derald Wing Sue) recalled a professional forum on "Racial Realities and Worldviews" during which a Black female psychologist started off her address to a primarily White audience by asking the following question: "Do any of you know what every Black mother with a teenage son experienced right the shooting of Amadou Diallo? Do you know that every morning I rehearse with my teenage son possible scenarios of the day? Do you know I frequently ask him, when (not if) you are stopped by the police when driving, what will you do? Do you know that I tell him he must be polite, say "yes sir no sir" when responding to questions, not make any sudden moves, and to keep his hands in clear sight? Do you know that on weekends, when he is going to hang out with friends at the shopping mall, I grill and drill him with the same questions and advice about mall security guards? Do you know that as a Black mother, I live in constant fear for the safety of my own son? Can you truly understand what it is like to be Black in this society? As White parents, this is not your reality, but it is mine!

上文的主旨翻译：事情发生后，我（书的作者）回顾一次在关于种族讨论上，一名黑人母亲回应在场的一名白人听众。她说：“请问你们当中谁知道作为一名年轻黑人的妈妈，我对于Diallo被枪毙的回应？你们知道我每天早上都会和我的孩子一起排练当天可能发生的情形。你是否知道我反复提问他，当（而不是假若）一名警察把你拦下来，你应该怎么做？你们是否知道我告诉他他一定要保持礼貌，用”yes sir no sir“来回答警察的提问，不要作出突然的身体移动，并且将手放在警察视觉可看到的地方？你们是否知道当他周末与朋友在百货公司逛街的时候，我也会提醒和训练他如何应对商场的警卫。你们是否知道作为一名黑人母亲，我每天都活在恐慌之中。你们是否理解作为一名黑人，我们在这个社会当中的处境？作为白人父母，这都不是你们面临的现实，而是我们的。

YOUNG BLACK MALE - 年轻 黑人 男子

这几个字加在一起在美国这个环境下有着特殊的意义。请看一下这些数据后面的意义：

1. 每4名黑人小孩在他们18岁之前就会有1个小孩的父母曾经被监禁。

2. 黑人高中生有着非常高的高中辍学率。比起有一份工作，当前有更多高中辍学的黑人在监狱。比起进入4年的全日制大学和参军，年轻黑人男性更有可能进监狱。

［来源： http://www.nytimes.com/2012/10/28/sunday-review/how-prisoners-make-data-look-good.html ］

sue教授反复在他的书里提到说很多制造种族微侵略的人本身并不意识到其对于有色人种的偏见。这些偏见和歧视都是无意识的，可是很多数据确也让人害怕。一个出生在美国的黑人男性，如果他没有顺利高中毕业，他有40%的可能性进监狱。许多人可能会说这些无意识的种族歧视是非常难完全消除的，难道我们就不可以当作没有发生吗？我觉得当然不可以。尤其在美国这个被许多人认为“机会面前人人平等”的国家，肤色是一个人无法选择的，可是肤色确很大程度上代表了一个人的命运。

可是我们又应该怎么做呢？

＊本文纯粹个人观点。博文中提及的书是：

Sue, D. W. (2010). Microaggressions in everyday life: Race, gender, and sexual orientation. John Wiley & Sons.

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我们被贴的标签

＊本文纯属个人观点。我的经历只能代表我个人。

我最近在读Sue教授的书－－Microagressions in Everyday Life: Race, Gender, and Sexual Orientation. 种族歧视是这本书的一种一个主题，这也是是一个很沉重的话题。最近在美国因为Trayvon案件的审理 （http://www.economist.com/news/united-states/21581998-when-it-legal-shoot-unarmed-black-teenager-trayvons-legacy），似乎这个对于这个话题的讨论又变得更加激烈。作为一个外国人在美国，在来美国之前对于这个问题是没有多少理解的。我可以结合我自己一年在美国的各种经历，跟我读这本书的一些看法，写一点东西。

According to Sue et al. (2007), racial microagressions are brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color. 

sue教授将racial micro agression （种族微侵略）定义为发生在日常生活中的简短的平通的，言语上行为上，或者是环境上的侮辱；这种侮辱可能是有意的，也可能是无意的，其使得沟通产生敌意或不敬，或是针对有色种族消极的种族轻视和侮辱。

简单地说，sue教授的观点是公开的显然的种族歧视在美国已经很少见了，可是发生在每天生活当中的确实这种细微的“侮辱”，有些时候这些侮辱甚至是处于好意的。sue教授在书里面列了一些例子，比如说一个美国白人对一个在美国出生成长的华人称赞其英文很好。那个华人可能就会感到这种称赞带有侮辱性，即使那个白人的出发点是好的。

我觉得在美国社会上存在一种对于中国人的固定想法：英语不好，害羞，数学好，等等。我第一天搬进我住的大楼的时候，我的邻居是一名法国博士在读生。我上前打了声招呼，然后和她聊了几句。她称赞我说，”你的英文真好！中国学生一般英文都不是很流利。” 类似的情形还发生过许多次，我总是感到不是很滋味，可是确不知道如何去形容这种感受。更何况，我相信称赞我英文好的人都是出乎好意的，可是为什么我心里就是开心不起来呢。

我觉得社会，普遍社会，不仅仅限于美国社会，都倾向于将人们分组，然后每个组都会有一个标签，组里的每个人都带着这个标签。不管这个标签是好是坏，这个标签就会跟着我们一辈子。这种固定想法或者标签，多多少少让我们有复杂的感受。当我们经历这种微侵略的时候，心里多少会感到不滋味，感到被打击。

我会继续阅读sue博士的书，然后会继续将感受分享到这里来。

* Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: implications for clinical practice. American Psychologist, 62(4), 271.

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With every good bye you learn

I finished my internship this week, and my supervisor shared this with me. I would like to pass it here.

After a while you learn the subtle difference

Between holding a hand and chasing a soul

And you learn that love doesn't mean leaning

And company doesn't mean security.

And you begin to learn that kisses aren't contracts 

And presents aren't promises

And you begin to accept your defeats

With your head up and your eyes open.

With the grace of a women,

Not the grief of a child

And you learn to build all your roads on today,

Because tomorrow's ground is too uncertain for plans

and futures have a way of falling down in mid-flight

After awhile you learn that even sunshine

Burns if you get too much

So you plant your own garden and decorate your own soul

Instead of waiting for someone to bring you flowers

And you learn that you really can endure...

That you really are strong

And you really do have worth,

and you learn and learn...

With every good bye you learn.

- Anonymous

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Photos taken in Cloisters, MET.

Camera: Canon 600D

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I went to Newport RI for my July 4th weekend, there I saw the beautiful ocean. I did not want to go back to the city, it was nice to stay away from the crowd. 

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A Case Integration Paper (final draft)

Abstract

An interview has been conducted with Peter and this paper is about the development of his life course over his 66 years. Peter described that his life trajectory is mainly about three women (his mother, his first teacher and his wife) and three countries(China, Hong Kong and the US). Born as an infant living in extreme poverty in 1947, Peter fled to Hong Kong in search of a better life around 1956-1957, where he was offered the opportunity to receive an education and found his religious belief with the help of his first teacher; and he met his life partner--his wife. When his wife determined to move to the US for her master degree in 1984, Peter decided that the whole family would move to the US to support his wife, which has become his home now. The theoretical framework used in this paper is the developmental life course theory. Major themes, such as the interplay of human lives and historical times, linked lives, diversity in life course trajectory, human agency and timing of lives will be explored to analyze Peter’s life trajectory. In addition, the protective factor of resilience can be found within Peter’s life journey: from a poor infant born during war to him becoming a Pastor. Spirituality/religion as a vital protective factor will also be examined.

Narrative and Analysis

1. China, Peter’s mother and his adverse childhood

Peter was born in 1947 in a remote village in Taishan, Gruandong Province, China. He has four siblings (i.e., an older brother, a younger brother and two younger sisters); he is the second child in his family.  From 1945 to 1947, China was experiencing the Civil War between Kuomintang and the Chinese Communist Party (“Party”). In 1947, Kuomintang retreated to Taiwan and the Party took power over the country with the People’s Republic of China (“PRC”) being established in 1949 (Mui & Shibusawa, 2008).

Land in China was privately owned and could be legally transferred based on mutual agreement before PRC was established. In 1946, three years before PRC’s establishment, the Party implemented a series of land reforms in rural areas within its administrative control by expropriating the land from the landlords and transferring it to the peasant tenants (Qin, 2010). Peter’s father was working in the US and sent them money regularly so that the family could afford to buy land and build a house. However, due to the Land Reform, their house was expropriated and Peter’s family fell into complete poverty. In addition, their family became a major target and their lives were threatened because they had family members working abroad, which was against the principles of the Party.

According to Mui and Shibusawa (2008), the life course perspective examines human development and aging as a lifelong process and emphasizes the significance of understanding the historical and social context that shapes the course of individuals‘lives in accordance with the timing of these events. Likewise, Elder Jr., Johnson and Crosnoe (2003) pointed out that the principle of time and place is one of the major principles of life course theory. The historical times and places that one experiences embed and shape an individual’s life trajectory over his/her life time. Peter’s life course is heavily influenced by the time in which he was born and his birth place, which caused Peter to face enormous adversity in his childhood. Historical events, including the Chinese Civil War and Land Reform, are the primary reasons why Peter experienced immense difficulties during his childhood.

Peter’s mother was pregnant during the Civil War. He described that his mother, along with other family members, had to constantly escape from one village to another during the war. The pregnancy was in fact an additional burden to the family. Peter’s mother could have relinquished Peter when he was a fetus, but she did not. Peter’s mother tried her best to protect Peter and successfully gave birth to him. Peter described his mother as a strong woman and she is one of the three significant women in his life as she did not abandon him and gave him life during the war. The life course perspective highlights the influence of linked lives--the ways in which relationships both support and control an individual’s behavior. Family is often considered as the primary source of support in one’s life and certainly parent’s and children’s lives are linked (Hutchison, 2005). His mother’s decision not to relinquish him during war can explain Peter’s gratitude of his mother.

Peter’s family had some relatives living in Hong Kong and he followed her mother and fled to Hong Kong when he was around 10 years old. Peter, along with his brothers left Guangzhou to Macau by passing through many villages and climbing over many mountains. After staying in Macau for approximately half-a-year, Peter went to Hong Kong by paying fishermen to carry them with ships. The life course perspective emphasizes the diversity in life course trajectory. Not everyone from the same cohort falls into the same developmental pathways (Hutchison, 2005). Between the 1950s and 1970s, there was a considerable amount of mainlanders who fled to seek a better life in Hong Kong, which at that time was a British colony, however, it was not easy for mainlanders to flee to Hong Kong and many people lost their lives (Qin, 2010). Not every mainlander who wished to seek a better life made it to Hong Kong as Peter did.

2. Hong Kong, Peter’s teacher and his adolescence/adulthood

Fleeing from mainland China to Hong Kong and meeting his first teacher were definitely major turning points for Peter. Hutchison (2005) defined a turning point as a particular life event which produces a lasting shift, not simply a temporary detour in the life course trajectory. Similarly, Elder Jr. et al. (2003) explained that turning points involve a substantial change in the direction of one’s life. After Peter’s arrival in Hong Kong, he was offered the opportunity to receive an education and in doing so he found his religious belief, which would have been impossible if Peter had stayed in mainland China.

During his first few years settling down in Hong Kong, Peter no longer needed to worry about war and he had more freedom; however, it did not change the fact that they were living in extreme poverty. The whole family was still living in a small room because they could not afford the rent. Peter was about 10 years old and due to his low socioeconomic status, he could not afford to go to school regardless of his strong desire for receiving an education. At that point, he encountered the second significant woman in his life - his first teacher, the president of a church school. Peter’s first teacher had several influences on him: offering him an education, changing his point of view regarding human kindness, and helping him find his spiritual belief.

The teacher noticed that Peter spent a lot of time wandering around the school and found that he was eager to go to school even though he could not afford it. Peter described how the teacher was very kind to him; she offered him the opportunity to study in the school without charging him any tuition. Apart from that, she provided him financial aid in return for asking him to work part time in the school. Despite being over-aged, he joined the first grade when he was approximately 10 years old. (There were certain rules which required schools not to accept over-aged students.)

Peter described that he cherished such a precious opportunity of receiving an education and he devoted himself entirely to his studies to catch up to his counterparts. “I caught up with the other people within only one year.”  He finished his study in that elementary school and graduated with honors. Peter then enrolled in a great public school and he was the only student to make it that far in his class. According to Hutchison (2005), human agency is one of the major themes in the life course perspective. The use of human agency refers to the use of personal competence to achieve one’s goals. Peter was very thankful to the opportunity and he studied very hard to catch up with his counterparts and accomplished enormous academic success at school.

Nevertheless, his academic success also came from the support of his teacher. The life course perspective also emphasizes the interdependence of human lives in terms of individual’s links with the people outside of the family and the ways in which relationships both support and control an individual’s behavior. Social support refers to the help rendered by others that benefits an individual (Troits, as cited in Hutchison, 2005). Elder et al. (2003) offered consistent opinions in addressing the principles of the life course perspective, which indicated that lives are lived interdependently and social-historical influences are expressed through this network of shared relationships. They indicated that the initiation of new relationships can shape lives as well, by fostering turning points that lead to a change in behavior or by fostering behavioral continuity.

The establishment of supportive relationships between Peter and his first teacher foster one of his major turning points in life: he was offered the opportunity to receive an education and he was able to finish middle school and high school, and accomplished his college degree. The opportunity of receiving an education helped him out of poverty and changed his life journey completely. The supportive relationship with his teacher also changed Peter’s point of view toward human interaction according to the linked lives perspective - he acknowledged for the first time in his life that people would offer help to him.

Having experienced dramatic adversities in his early childhood (war, poverty and refuge in Hong Kong), he had found it difficult to believe in people’s kindness. “Even the fishermen that helped us to flee to Hong Kong, they would not let us go until we paid them; otherwise they would have thrown us into the ocean. Those people did not want to help us; they just wanted to make money out of us. They were simply looking for money.” Peter described the teacher as his “mother of school.” “Before meeting my teacher, I did not believe that people would reach out to you while you are in difficulty.” Peter explained his gratitude to his teacher as she offered him the opportunity of education, which served as a solid foundation and opened the door of higher education to him later in his life.

In addition, the impact that his first teacher had on Peter can also be demonstrated by his opinions regarding offering help to others. In our interview, he mentioned many times that helping others is very significant in his life, as he was fortunate enough to have his teacher's help while he was poor. Peter is devoted to offering help to others in achieving their dreams. Apart from nurturing Peter with knowledge, the teacher also introduced him to Christianity. Since then, his religious belief has become a major protective factor in promoting his resilience.

3. Peter’s wife and moving to the US

After graduating from college, Peter reached a marriageable age, but he still did not have a girlfriend. “I was very picky,” Peter explained. Since Peter was determined to serve God with his whole life, he wished to find someone with similar values. With perfect timing, Peter met his wife Rachel at a church event, when he went to her church to teach. They met each other in 1973. Peter discovered that his wife was also very devoted to God and she shared similar values with Peter - serving God with their life. She was very supportive of Peter’s passion to become a Pastor. Then they applied to study in a seminary school together. After their graduation from the divinity institute, they got married in 1975.

“She is the third important woman in my life,” Peter described. The principle of linked lives in developmental life course perspective emphasizes that because lives are lived interdependently, the transition of one person’s life can also foster transition for another person as well. Rachel had been a social worker working in different hospitals in Hong Kong for nearly a decade when she decided to improve her skills and knowledge by going to the US for a master’s degree in social work. Rachel’s move from Hong Kong to the US also fostered Peter’s life transition as he decided to support Rachel and moved to the US with her. Peter explained that he noticed Rachel’s incredible talents in social work. He agreed that Rachel should go back to school to further maximize her talents, so that she would be able to help more people. Therefore, they moved to the US in 1984, but they never expected that they would stay in the US.

The transition from Hong Kong to the US was not easy for Peter and Rachel. They had to adapt to a new culture, a new accent (even though they both spoke English fluently). For Peter, in particular, he had to balance his various roles: a husband, a father, a Pastor and a teacher. With Rachel being a full-time student at school, Peter became the primary care-giver to their 8-year-old son. At the same time, he was very supportive to his wife: he drove her to school or her internship; he prayed for her while she was experiencing frustration or stress from school; and he was also a full-time teacher in order to support his family. According to the developmental life course perspective, Peter’s efforts in supporting his family as a major caregiver and a bread-winner are consistent with the human agency perspective. Peter had many roles to balance in his life when he first arrived in the US, but he focused on building his competence and ability to support his family.

Apart from his own competence, religion/spirituality has played a key role in helping Peter to remain positive when he was faced with the tremendous challenges of moving to a new country. Peres, Moreira-Almeida, Nasello and Koenig (2007) stated that religiousness and spirituality are strongly based on a personal quest for understanding of questions about life and meaning. Similarly, Raghallaigh and Gilligan (2010) combined several coping strategies among people of resilience and found that religious faith plays an important role in many participants’ coping mechanisms. Religion facilitated the adoption of a positive attitude as they found that many participants expressed hope in their future influenced by God. “I employed a different approach when looking at the challenges that we faced. Instead of complaining, I was grateful that my wife was enrolled in a great institution and she was offered the opportunity to grow to become a better social worker; I was thankful that I was able to find jobs and support my family; most importantly, I was thankful to God that the whole family was still together and we support each other,” Peter said. His religious belief offered him a positive coping mechanism when faced with the challenges of moving to a new country.

Peres et al. (2007) also stated that the concept of religious coping involves several cognitive aspects, such as seeking spiritual connection (i.e., thinking about how life is part of a large spiritual force) and seeking spiritual direction (praying to find a new reason to live). Peter believes that helping other people is the calling from God and he found the connection with God when helping others. Both Peter and Rachel are dedicated themselves to offer better training to the younger generation. “We both used to be very poor; we did not have the money to go to school. We both recognize that knowledge can change our life, so we wish to offer the young generation with the best knowledge; and their life can be changed as well,” Peter said. By doing so, they can respond to the calling from God and remain their connection with God.

With the passion to offer better training to the younger generation in social work education, Rachel decided to go for a PhD program. Again, Peter was completely supportive of his wife’s decision as they both were planning to go back to Hong Kong after Rachel obtained her degree. To become a professor in a fine institution, a PhD degree is essential; therefore, Rachel enrolled in a PhD program in Social Work.

Resilience is an important theme in Peter’s older adulthood and his religion/spirituality, along with the supportive relationship that he has with his wife are the two major protective factors in promoting his resilience in his late life. Rutter (2007) defined resilience as the phenomenon where certain individuals have a relatively good outcome despite suffering risky experiences that would be expected to bring about serious outcomes. Likewise, Hutchison (2005) defined resilience as the capacity for positive adaptation in the face of serious adversity. Rutter (2007) stated that it is essential to examine individual’s resilience from a life course perspective as overcoming stress or adversity may depend on experiences following the risk exposure.

Physical disease can be considered a major life event in late life. Hutchison (2005) described a life event as an important occurrence involving a relatively abrupt change that may produce serious and long-lasting effects. Life events may produce adaptation and may produce stress. Rachel was informed by her doctor that she might lose her vision in about 7 years due to a disease in one of her eyes after living in New York City for two years. Peter experienced six surgeries due to a hernia. Peter is worried about his wife and he is also worried that he may have to face surgery again. “I worry that I may not be able to wake up again.” However, Peter emphasized how religion/spirituality mediates the current difficulties. “I could have died many times. When I was a fetus, my mother could have abandoned me; but thank God, my wife still has limited vision after 14 years and I am still alive. We are both very grateful to God and we pray for each other and support each other.”

Peter’s resilience not only showed in his early adulthood, but also can be found in his late adulthood, which was promoted by his positive religious beliefs and the supportive relationships that he has had with his wife. The fact that his wife may lose her vision and he may die of surgeries does not change his positive attitudes of life and he remains thankful to God. Instead of complaining to God with regard to the diseases that he and Rachel are exposed to, Peter is still thankful to God that they still have maintained their health.

On the other hand, Fuller-Iglesias, Sellars and Antonucci (2008) have found that social relations can be a significant protective factor in strengthening resilience in late life. They found that older adults’ network is highly associated with their well-being and they emphasized that spousal relationships are definitely one of the most important protective factors in addressing resilience. Their findings indicated that spousal relationships continue to have a pervasive influence on the individual’s competence to meet and cope with adversity throughout adulthood. Peter described Rachel as his life partner and they support each other throughout their life trajectories in achieving their life goals. Rachel supported Peter’s decision of being a Pastor and Peter supported Rachel’s decision in pursuing further education in a different country. Therefore, no matter what the challenges they faced during their first decade after arriving in the US (i.e., adaptation to a new culture and Rachel’s stress at school), or the adversity they have faced as they reach their late life (i.e., both having physical diseases), they remain supportive to each other and accompany each other in their life course.

Both Peter and Rachel are still actively involved with helping China and the Chinese communities in the US. According to the linked lives perspective of the developmental life course theory, Peter’s overall identity of himself is linked with 3 women in his life. He identifies “offering help to others” as the most important motto in his life. His dedication in helping others can represent what was given to him by his mother, and his first teacher and the spiritual service he now shares with his wife. Peter said “I want to continue helping people because just as I believe that you reach your life’s goals with other people’s help, you should also help others to achieve their goals.” Examining how Peter’s religious belief influenced his life attitude, it is easy to conclude that it offered him a sense of direction. He devoted himself to serve Chinese communities as his means of serving God. He chose to become a Pastor working in different churches. Even after he and his family moved to the US, he is still positively engaged in the Chinese communities and offers support to the Chinese younger generation in the US as he described this is where his roots are.

Resilience is a major theme throughout Peter’s life course. The accumulation of risk factors in Peter’s life course include the exposure to several major political incidents in mainland China during his early childhood; losing family support during his stay in Guangzhou (i.e., he had to beg for food on the street because he did not have the citizenship of Guangzhou), and poverty. Schoon and Bynner (2003) pointed out that it is the acculturation of protective factors that can strengthen resilience. In Peter’s case, these protective factors can be identified as the supportive relationships with his mother, his teacher and his wife, along with his positive religious beliefs.

Conclusion

In brief, in looking at Peter’s life from the life course perspective, his story represents that of many Chinese from his generation. What Peter has experienced is similar to many other Chinese born during the Chinese Civil War. Cohort effect is one of the major themes in the life course theory, which refers to how historical time and events influence one cohort differently than other cohorts. For Peter, several major life events dramatically shaped his life trajectory: Chinese Civil War and Land Reform created enormous adversity in his early childhood; he lived in poverty and was not able to receive an education. Not every individual from the same cohort has the same life trajectories, some have achieved better life outcome, while some have not. Peter has demonstrated strong human agency throughout his life course--achieving academic success at school and adaptation to a new culture when moving to the US. Three major “linked--lives” relationships also promoted his resilience and transferred him from a poor infant to a well-educated Pastor: the supportive relationships with his mother, his first teacher and his wife. Peter is grateful that his mother did not relinquish him during the war and gave him life. He was offered the opportunity to obtain an education by his first teacher and he found his religious belief with the help of his teacher. His wife provides him support and company in achieving his life goals and the support he got from his wife also promoted resilience in his late life when faced with diseases. Religion/spirituality is also a major protective factor in his resilience, which offered him life direction and a positive stress coping mechanism, and enhanced his resilience even in his late life.

Reference:

Elder Jr., G. H., Johnson, M. K. & Crosnoe, R. (2003). The Emergence and Development of Life Course Theory. In Mortimer, J. T. Editor & Shanahan, M. J. Editor (Eds.), Handbook of the Life Course (3-19). Hingham, MA, USA: Kluwer Academic Publishers.

Fuller-Iglesias, H., Sellars, B. & Antonucci, T. C. (2008). Resilience in old age: social relationships as a protective factor. Research in Human Development, 5(3), 181-193.

Hutchison, E.D. (2005). The life course perspective: a promising approach for bridging the micro and macro worlds for social workers. Families in Society, 86, 143-153.

Mui, A. C., Shibusawa, T. (2008). Asian American elders in the twenty-first century: Key indicators of well-being. New York, NY: Columbia University Press.

Peres, J. F. P., Moreira-Almeida, A., Nasello, A. G., Koenig, H.G. (2007). Spirituality and resilience in trauma victims. Journal of Religious Health, 46, 343-350.

Qin, X. (2010). The impact of political forces on urban land ownership reform in transitional China. International Journal of Law in the Built Environment, 2, 206-217.

Raghallaigh, M. N. and Gilligan, R. (2010). Active survival in the lives of unaccompanied minors: coping strategies, resilience, and the relevance of religion. Child and Family Social Work, 15, 226-237.

Rutter, M. (2007). Resilience, competence, and coping. Child Abuse and Neglect, 31, 205-209.

Schoon, J. and Bynner, J. (2003). Risk and resilience in the life course: implications for interventions and social policies. Journal of Youth Studies, 6, 22 - 31.

[kayla-ling]

Literature Review on Educational and Recreational Programs for Older Adults

This literature review will examine the NORC program as well  as the therapeutic recreation model upon which the Educational and Recreational Program is based. In addition, there will be a discussion with regard to how educational and recreational programs prevent the aging population, (the Asian immigrant elderly in particular), from the risk of social isolation. Enormous research gaps in terms of NORC, as well as educaitonal and recreational programs serving Chinese immigrant elderly exisit; therefore, the articles cited in this paper are mostly concentrated on the general aging population. Future studies about Chinese immigrant elderly are needed.

a) Evaluation of NORC

According to Elbert and Neufeld (2010), a naturally occurring retirement community (NORC) refers to a community which offers an opportunity to provide supportive services and programs in a coordinated and cost-efficient way to enable seniors age in place. “Age in place” can be defined as individuals  growing older without having to move from one’s present residence in order to secure necessary support services in response to seniors’ changing needs (Kunstler, 2002). A national survey (AARP, 2005) also indicated that 89% of Americans aged 50+ want to stay in their current residence for as long as long as possible and 85% want to stay in their community as they age. Elbert and Neufeld stated that NORCs can reduce the costs to society regarding aging concerns by maintaining the elderly’s health and ability to live within their homes instead of institutions. Such findings are consistent with Menec’s (2003) argument, which emphasized that the benefits of social networks and community support can promote healthy aging.

When it comes to evaluating NORC’s benefits, Elbert and Neufeld (2010) found that NORCs have incorporated a wide range of topics and activities to engage and empower senior residents to be active and involved in their community. They emphasized that socialization is crucial in all NORC activities; these activities are designed to offer the maximum opportunities for residents to interact with one another and to help them develop relationships. Researchers also found that NORC activities enhanced residents’ awareness of available services and the benefits deprived from them. Many seniors from the study supported the existence of NORCs because they can access services when they need them even though they may not be involved in the NORC program at present.

b) Therapeutic Recreation Model

Many NORC programs conduct Educational and Recreational Programs on site as many seniors  choose to become residents of NORC. This trend has promoted the development and delivery of therapeutic recreation servics to the elderly who continue to live in their own homes (Kunstler, 2002). Educational and Recreational Program resembles the therapeutic recreation model. Therapeutic recreation is a service that can enhance healthy lifestyles by employing the therapeutic recreation process. Therapeutic recreation in the NORC is designed as a viable service that can stimulate participants’ interaction (Kunstler, 2002). Similarly, Johnson (2008) defined therapeutic recreation as the specialized application of recreation and experimental activities or interventions that assist in maintaining or improving health status, functional competence and quality of life. Interventions used in the therapeutic recreation process include games, arts and crafts, tai chi, music, poetry and many more. Theraupeutic recreation utilizes an indivdidual’s exisiting skills and interests, as well as facilitates the development of  new skills for daily living and community functioning (Operational Outlook Handbook, as cited in Johnson, 2008). Johnson emphasized that therapeutic recreation should be offered by professionals with academic and practical training in therapeutic recreation delivery. Austin and Crawford (2001) also emphasized that therapeutic recreation can provide opportunities for the elderly to engage in activities based on their own choices, with a minimum of external pressure, therefore enhancing the elderly’s feelings of competence and control.

c) Possitive Impact of  Educational and Recreational Program

i. To The General Aging Population

Mehrotra (2003) found that education promotes sustained mental function: individuals with more years of school education are more likely to retain high cognitive functioning. In order to promote seniors’ sustained cognitive functioning, there exists a continuing need to offer various educational programs, which offer senior participants new opportunities to practice their cognitive functioning and to enhance their continuing engagement in life. Meanwhile, Mehrotra also indicated that participation in educational programs can maintain the elderly’s self-efficacy. Self-efficacy refers to a person’s belief in his or her own competence to cope with various situations. It refers to the belief that one is able to solve specific problems in a given area and meet different challenges. Participating in challenging educational programs reinforces older adults’ underlying sense of self-efficacy, such as learning a new language or mastering a new technology.

Educational programs can also promote older adult’s interactions (Mehrotra, 2003). The researcher indicated that conversation, touching and relating to others are significant to our well-being. Close relationships with others involve supportive behaviors, and the exercises of being supportive to others can bring positive effects on health. Mehrotra found that older adults established many new friendships during the participation of educational programs and these friendships continue to last long after the termination of the program.

Regardless of the benefits of educational programs mentioned beforehand, Mehrotra (2003) also indicated potential difficulties in conducting educational programs among older adults. There are many subgroups within the aging population and their level of prior education received varies. Those with higher education tend to need less encouragement to participate and can work with any teaching method. However, for those with less education, they are far less likely to participate in educational programs and have a higher need for guidelines. In addition, literacy is a serious problem in some subgroups, such as Hispanics and African Americans (Mehrotra, 2003). Therefore, the research highlights that such diversity should be considered when designing educational programs.

ii. To The Asian Immigrant Elderly

When it comes to the impact that these programs have on the Asian immigrant elderly, Kim et al. (2011) pointed out the challenges that the Asian immigrant elderly are faced with in terms of participating in educational and recreational programs because of cultural differences (i.e., language barriers, limited social networks, different family roles and lack of leisure resources). In order to address these constraints, Kim et al. suggested developing leisure services that include leisure education, recreational activities originating from Asian cultures, and multicultural recreation events.

By offering leisure education to Asian immigrant elderly, they will be able to identify various leisure opportunities as encompassing situations which promote social involvement (Kim et al., 2011). Leisure education can be defined as an individual in a contextualized process by which the individual can develop an understanding of self and leisure education, along with acknowledging and learning essential skills to participate in freely chosen activities, which promote a healthy life (Bullock & Mahon, as cited in Kim et al., 2011). Leisure service providers can educate the Asian immigrant elderly about the significance of leisure in their lives and how they can utilize a variety of leisure services and resources. Meanwhile, Asian immigrant elders will be able to acquire an appreciation for the benefits related to leisure participation by attending different leisure education classes.

As for recreational activities related to Asian cultures, Kim et al. (2011) pointed out that such activities offer older Asian immigrants the opportunity to experience leisure and develop social relationships, which create a familar context, so that they can easily make social connections with other participants. Such social connection can lead to development of valuable friendships, which may reduce the risks of anxiety, depression and loneliness among the Asian immigrant elderly, so that older Asian immigrant can achieve better psychological and social well-being by participating in these activities (Kim et al., 2011). In addition, researchers highlights that recreational activities associated with Asian culture can enable the Asian immigrant elderly to adapt to their new culture. Researchers stressed that when the Asian immigrant elderly interact with other participants from their home country but with different cultural and ethnic backgrounds, they may face challenges in establishing social relationships with them due to the differences associated with customs and language. Being exposed to differences with peers from their home country offers the Asian immigrant elderly the opportunity to practice understanding cultural and ethnic differences, so that they will be able to benefit from circumstances that encourage them to develop social inclusion within their diverse community (Kim et al., 2011).

    Reference:

AARP. (2005) The state of 50+ America-2005. Retrieved March 10, 2013, from http://assets.aarp.org/rgcenter/econ/fifty_plus_2005.pdf

Austin, D., Crawford, M. (2001). Therapeutic recreation: An introduction. Needham Heights, MA: Allyn & Bacon.

Elbert, K.B., Neufeld, P.S. (2010). Indicators of a successful naturally occurring retirement community: a case study. Journal of Housing for The Elderly, 24, 322-334.

Johnson, C.D. (2008). Therapeutic recreation treats depression in the elderly. Home Health Care Services Quarterly, 18:2, 79-90.

Kim, J., Dattilo, J., Heo, J. (1996). Education and recreation activities of older Asian immigrants. Educational Gerontology, 37, 336-350.

Kunstler, R. (2002). Therapeutic recreation in the naturally occurring retirement community (NORC): benefiting “aging in place”. Therapeutic Recreation Journal, 36:2, 186-202.

Mehrotra, C.M. (2003). In defense of offering educational program for older adults. Educational Gerontology, 29, 645-655.

Menec, V. (2003). The relation between everyday activities and successful aging: A 6-year longitudinal study. Journal of Gerontology, 58B, S74-S82.