The Propagation of Disorder in Later Life: Neighbourhood, Home, and Body

The Propagation of Disorder in Later Life: Neighbourhood, Home, and Body University of Toronto Institute for Life Course and Aging April 6 2017 Markus H. Schafer Department of Sociology University of Toronto James Iveniuk Dalla Lana School of Public Health University of Toronto Laura Upenieks Department of Sociology University of Toronto

Does household disorder moderate the effect of disablement on social disconnectedness? 5 Core network size 4.8 4.6 4.4 4.2-1 S.D. Household disorder Mean Household disorder +1 S.D. Household disorder 4 3.8 Not disabled Became disabled Schafer, Markus H. 2017. (Where) is Functional Decline Isolating? Disordered Environments and the Onset of Disability. Journal of Health and Social Behavior, forthcoming.

Is household disorder associated with less sexual interest among coupled seniors? Pr. prob. of lacking interest in sex.2.3.4.5.6.7-1 -.5 0.5 1 Household disorder Husbands Wives Schafer, Markus H., Laura Upenieks, and James Iveniuk. 2017. Putting Sex into Context in Later Life: Environmental Disorder and Sexual Interest among Partnered Seniors. The Gerontologist, forthcoming.

Is disorderly self-presentation associated with risk of mortality, net of the usual predictors? Schafer, Markus H., Laura Upenieks, and Andie MacNeil. 2017. Environmental Disorder and Mortality among Older Adults. Paper in progress.

Motivating question for the current study: Does environmental disorder propagate over time across levels of sociophysical and embodied space?

Why should we care about socio-spatial disorder among older adults? (1) Aging reduces physiological and cognitive competence and makes seniors more susceptible to stressors in their environments (2) Order and disorder emerge as tools of social control and as specimens of the medical gaze in later life (3) The line between order and disorder directly intersects with social stratification and the unequal experience of aging

Conceptualizing physical disorder Elements Chicago School Tradition Environmental Gerontology Embodiment Role of Disorder in the Theoretical Perspective a) Disorder as an outcome b) Disorder as a cause Mismatch between environment demands and personal competence (low P-E fit) Dimension of selfpresentation; signal of deviance What is the cause of disorder? Poverty, racial exclusion, disinvestment Unspecified; proactivity in shaping environment not originally part of the P-E model but recognized in later work Unspecified How is disorder measured? Residents perceptions of local conditions; objective measures; active means of data-gathering through systematic social observation Not disorder per se; measures of press, which covers a wide range of issues, from hazardous conditions and homebased hazards (e.g., inadequate lighting, slippery floors, loose rugs, poor lighting, unstable furniture) Changes in physical appearance and function (self-report or independent observation) Context Studied Primarily neighbourhood Primarily home, also neighbourhood Body

Interconnected environments and the propagation of disorder Ecological systems theory: the environments consequential for people s life course trajectories are multi-leveled and interconnected much like a set of nested structures [or] a set of Russian dolls (Bronfrenbrenner 1979, pg. 3). Social stress mechanisms Disorder propagates through loss of control, distress Social bonds and social control Disorder propagates due to inadequate social support and control

Charting the propagation process Hypothesis 1. Neighbourhood disorder increases household disorder. Hypothesis 2. Neighbourhood disorder increases embodied disorder. Hypothesis 3. Household disorder and embodied disorder are reciprocally related over time. Hypothesis 4. The association between neighbourhood disorder and embodied disorder (H2) is mediated by household disorder. Hypothesis 5. Household disorder leads to more embodied disorder over time, but not vice versa (in contrast to H3). Fully propagative model

Data Panel data from the nationally representative National Social Life, Health, and Aging Project (NSHAP) Wave 1: 2005-2006 (3005 respondents aged 57-85) Wave 2: 2010-2011 (75.2% of the W1 sample) Analytic sample consists of respondents who participated at both waves (n=2261) The full scope of neighbourhood observation was conducted only at W2 (W1 had single item) Selected longitudinal analyses use the single neighbourhood variable used consistently at both waves.

Key measures: Socio-spatial disorder Neighbourhood, household, and bodily disorder were measured by trained members of the NSHAP research staff Field Interviewer Questionnaire based on the principles of systematic social observation (first developed in the Project on Human Development in Chicago neighborhoods conducted by Robert Sampson) Scores standardized within interviewers in order to account for between-interviewer differences in disorder perceptions.

Neighbourhood disorder (Cornwell and Cagney 2014) Measures How well kept are most of the buildings on the street? [1=very well kept, 2=fairly well kept, 3=poorly kept, 4=very poorly kept] Describe street (one block, both sides): Clean vs. full litter of rubble [1-5] Quiet vs. noisy [1-5] No traffic vs. heavy traffic [1-5] No smell or air pollution vs. strong smell or pollution [1-5] Waves W1, W2 W2 W2 W2 W2 As a scale at W2, the five items load on a single factor and manifest good inter-item reliability (alpha = 0.82). Unless otherwise noted, neighbourhood disorder will refer to the single item, available at both waves.

Household disorder (Cornwell 2014) Measures How well kept is building in which respondent lives? [1=very well kept, 2=fairly well kept, 4=very poorly kept] Describe room where interview was conducted: Clean vs. dirty [1-5] Neat and tidy vs. messy [1-5] Quiet vs. noisy [1-5] No smell/pleasant smell vs. strong smell [1-5] Waves W1, W2 W1, W2 W1, W2 W1, W2 W1, W2 The five items load on a single factor and manifest good inter-item reliability (alpha = 0.83).

Embodied disorder Measures Describe the respondent: Well-dressed vs. poorly dressed [1-5] Hygienic vs. not hygienic [1-5] Waves W1, W2 W1, W2 The two items load on a single factor and manifest good inter-item reliability (alpha = 0.71).

Distribution of disorder scales at wave one and wave two (kernel density estimation).

Contextual covariates Census Measures: 2000 U.S. Census (for W1) and the 2005-2009 American Community Survey five-year estimates (for W2) Concentrated disadvantage: scale composed of tract proportion poor, on public assistance, femaleheaded households, unemployed, below 18 years old, and non-white Census tract density Neighborhood Collective Efficacy (W2) (1) Reciprocated exchange: 3-item scale (α =0.76) with questions about the local area such as How often do you visit each other s homes? (2) Social cohesion: a 5-item scale (α =0.67) with agree-disagree questions about the local area such as This is a close-knit neighborhood.

Individual-level covariates Health Covariates Self-reported physical health (poor, fair, good, very good, excellent) Psychological Covariates Psychological Distress (11 item CES-D scale) Cognitive Functioning (Chicago Cognitive Functional Measures) Social Covariates Network size (number of confidants with whom respondent can discuss important matters ) Average closeness to network members Number of people living in respondent s household Support from family (how often they could open up to, or rely on, their family, α = 0.63) Support from friends (how often they could open up to, or rely on, their friends α = 0.73).

Demographic covariates Self-reported Race/Ethnicity (White, Black, Latino/a, Other) Education (less than high school, high school, some college/vocational certification/associate s degree, Bachelors degree and higher) Total household assets (property, cars, businesses, financial assets, with midpoint value assigned for those who do not know their exact net worth) Gender Age (years)

Analysis: testing hypothesis 1, 2, and 4 H1. Neighbourhood disorder increases household disorder. H2. Neighbourhood disorder increases embodied disorder. H3. Household disorder and embodied disorder are reciprocally related over time. H4. The association between neighbourhood disorder and embodied disorder (H2) is mediated by household disorder. H5. Household disorder leads to more embodied disorder over time, but not vice versa (in contrast to H3). Lagged Dependent Variable (LDV) linear regression model: used to test the full propagative process A given Y variable measured at W2 lagged (W1) version Disorder independent variables are assessed as both lagged and as contemporaneous predictors, while all other covariates are measured at W1 Full Information Maximum Likelihood (FIML) used to deal with missing data

LDV models The propagation of disorder across two waves of NSHAP (lagged dependent variable models; N=2261) Outcome: Household disorder Embodied disorder M1 M2 M3 M4 M5 M6 M7 Household disorder W2 0.54*** 0.51*** W1 0.22*** 0.01 0.01 Neigh. Disorder W2 0.22*** 0.05* 0.31*** W1 0.07** -0.01 0.08** 0.03 0.00 LDV 0.38*** 0.34*** 0.28*** 0.26*** 0.21*** 0.19*** 0.19*** R-squared 0.31 0.44 0.22 0.27 0.23 0.38 0.39 Note: Models control for all covariates mentioned earlier. Note: * <.05; ** <.01; *** <.001 Note: Regression estimates weighted for unequal probability of selection and attrition. Estimates apply robust standard errors to adjust for complex survey design.

Is there evidence for mediation? Formal tests of mediation, based on possible cases of mediation observed in prior table Mediation process Test of mediation from model... NeighW1 NeighW2 HouseW2 NeighW1 NeighW2 BodyW2 HouseW1 HouseW2 BodyW2 2 4 6 7 NeighW2 HouseW2 BodyW2 Direct effect -0.01 0.03 0.01 0.05 Indirect effect 0.08*** 0.06*** 0.22*** 0.16*** Total effect 0.07** 0.09*** 0.23*** 0.21*** Note: Models control for all other controls in prior table. Note: * <.05; ** <.01; *** <.001 Note: Regression estimates weighted for unequal probability of selection and attrition. Estimates apply robust standard errors to adjust for complex survey design.

Summary of LDV and mediation models Support for Hypothesis 1: Neighbourhood disorder increases household disorder Support for Hypothesis 2: Neighbourhood disorder increases embodied disorder. Support for Hypothesis 4: The association between neighbourhood disorder and embodied disorder (H2) is mediated by household disorder.

Analysis: testing hypothesis 3 and 5 H1. Neighbourhood disorder increases household disorder. H2. Neighbourhood disorder increases embodied disorder. H3. Household disorder and embodied disorder are reciprocally related over time. H4. The association between neighbourhood disorder and embodied disorder (H2) is mediated by household disorder. H5. Household disorder leads to more embodied disorder over time, but not vice versa (in contrast to H3). Cross-lagged dependent variable (CLDV): attempts to ascertain temporal ordering in the longitudinal association between home and body; Models assessed in Stata s Structural Equation Modeling (SEM) framework FIML used to deal with missing data

CLDV models R-squared for household equation:.31 R-squared for embodied equation:.23 Note: Models control for all other covariates listed above. Note: * <.05; ** <.01; *** <.001 Note: Regression estimates weighted for unequal probability of selection and attrition. Estimates apply robust standard errors to adjust for complex survey design.

Summary of CLDV models Support for Hypothesis 5: Household disorder leads to more embodied disorder over time, but not vice versa No support for Hypothesis 3: Household disorder and embodied disorder reciprocally related over time.

Additional analyses (1) Models among only those who had not moved between W1 and W2: consistent with main findings Change-score models: consistent with LDV models Reverse direction of propagation (body home neighbourhood): no evidence for reverse propagation

Examining the reversed propagation process. Process (X M Y) Body Household Neigh. Indirect effect 0.00 Direct effect 0.02 Total effect 0.03 Controls for... Background YES Social YES Psych YES Health YES Lagged dep. Variables YES Note: * <.05; ** <.01; *** <.001 Note: Regression estimates weighted for unequal probability of selection and attrition. Estimates apply robust standard errors to adjust for complex survey design.

Additional analyses (2) Tested interactions between forms of disorder and gender, educational attainment, race, and network size, household size, social support, and neighbourhood collective efficacy

Note: interactions use W2 disorder variables and hold constant all covariates used in earlier tables

Discussion: Propagation of physical disorder in later life? Evidence for stepwise progression: neighbourhood home body No evidence of mediation by stress processes or social bonds Moderation patterns Those with few confidants and those who live in tight-knit neighborhoods seem most susceptible to neighborhooddriven household decline No moderation in link from home to body

Limitations Validity of physical disorder measures? Full neighbourhood disorder scale available only at W2 Only 2 NSHAP waves currently available

Towards a tighter integration between urban sociology and social gerontology Long debate over whether physical disorder erodes social trust and increases crime. But insights of social disorganization theory and broken windows debates have not been applied to the phenomena seniors of aging-in-place. version of broken windows applied to preservation of physical conditions broken windows to dirty kitchens, dirty kitchens to rumpled clothes? Person-environment fit models in gerontology emphasize the home. But they seldom account for what happens outside the front door.

Extending the sociology of embodiment in late life Existing research asks whether neighbourhood conditions get under the skin. But disorder also comes to be expressed upon the body. Future qualitative work needed: how do seniors negotiate appearance amidst disorder? succumb to or resist physical surroundings when performing self-care? Failure to sustain bodily order threaten[s] a person s capacity to remain part of mainstream society (Twigg 2007:295)

Acknowledgements Thanks to my co-authors, James Iveniuk and Laura Upenieks, both at University of Toronto. Thanks also go to Social Sciences and Humanities Research Council of Canada for grant support. NSHAP data were collected by NORC at the University of Chicago and made available by the Inter-university Consortium for Political and Social Research, Ann Arbor, MI. Neither the collector of the original data nor the Consortium bears any responsibility for the analyses or interpretations presented here.

Note: interactions use W2 disorder variables and hold constant all covariates used in earlier tables

Does inclusion of covariates explain some of the propagative process? (1) Associations between household disorder and neighbourhood disorder, with and without controls for social factors, psychological factors, and physical health (lagged dependent variable models). Outcome: household disorder W2 Neigh. Disorder W1 0.08** 0.07** 0.08** 0.08** LDV 0.41*** 0.39*** 0.41*** 0.41*** Controls Background YES YES YES YES Social YES Psych YES Health YES R-Squared 0.29 0.30 0.30 0.30 Note: * <.05; ** <.01; *** <.001 Note: Regression estimates weighted for unequal probability of selection and attrition. Estimates apply robust standard errors to adjust for complex survey design. Background covariates: household assets, home ownership, working for pay, education, race/ethnicity, gender, age, Census Tract concentrated disadvantage, Census Tract population density Social covariates: married, network size, network closeness, perceived support from family, perceived support from friends, household size Psychological covariates: depressive symptoms, cognitive status Health covariates: self-rated health

Does inclusion of covariates explain some of the propagative process? (2) Associations between embodied disorder and other forms of disorder across waves of NSHAP, with and without controls for social factors, psychological factors, and physical health (lagged dependent variable models). Outcome: embodied disorder W2 Household disorder W1 0.22*** 0.21*** 0.22*** 0.22*** Neigh. Disorder W1 0.10** 0.09** 0.10** 0.09** 0.05 0.05 0.05 0.05 LDV 0.31*** 0.30*** 0.31*** 0.29*** 0.22*** 0.22*** 0.22*** 0.21*** Controls Background YES YES YES YES YES YES YES YES Social YES YES Psych YES YES Health YES YES R-squared 0.19 0.21 0.19 0.20 0.21 0.22 0.21 0.22 Note: * <.05; ** <.01; *** <.001 Note: Regression estimates weighted for unequal probability of selection and attrition. Estimates apply robust standard errors to adjust for complex survey design.