AFRICAN AMERICAN GRANDPARENTS RAISING GRANDCHILDREN: A National Profile of Demographic and Health Characteristics.

AFRICAN AMERICAN GRANDPARENTS RAISING GRANDCHILDREN: A National Profile of Demographic and Health Characteristics. Social workers are seeing, in health care settings, an increasingnumber of grandparent caregivers among their clients. A disproportionatenumber of these are African American African AmericanMulticulture A person having origins in any of the black racial groups of Africa.See Race. . This article compares thedemographic and physical and mental health characteristics of AfricanAmerican grandparents who are raising their grandchildren withnoncaregiving African American grandparents, using the National Surveyof Families and Households (1992-94). Caregivers reported significantlyhigher levels of limitations in four of five activities of daily living(ADL) and were almost twice as likely as their peers to reportclinically relevant levels of depression. Key words African Americans caregiving grandparents health kinship care Social workers, health care providers, and mental health careproviders working in large inner-city clinics in the late 1980s reporteda marked increase in the number of missed appointments, stress-relatedconditions, and exacerbation of previously controlled hypertension anddiabetes among their middle-age and older female patients (Davis, 1993;Miller, 1991; Minkler & Roe, 1993). On further investigation itbecame apparent that many of these patients had recently assumed custodyof grandchildren or greatgrandchildren. The 1990 census revealed thatwhat social workers and services providers were finding mirrored a muchlarger national trend. The 1980s indeed saw a 44 percent increase in thenumber of children living with grandparents or other relatives. In athird of these homes, neither parent was present (Saluter, 1992),typically making the grandparent the sole or primary caregiver. Although grandparent caregiving includes all racial and ethnicminority groups, it is particularly prevalent in African Americanfamilies. By the mid-1990s, 13.5 percent of African American childrenwere living with grandparents or other relatives (Lugaila, 1998),compared with 6.5 percent of Hispanic children and 4.1 percent of whitechildren. Almost 30 percent of African American grandmothers and about14 percent of African American grandfathers reported having had primaryresponsibility for raising a grandchild for at least six months at somepoint in their lives (Szinovacz, 1998), compared with 10.9 percent ofall grandparents (Fuller-Thomson, Minkier, & Driver, 1997). This article examines differences in physical and mental healthstatus between African American grandparents raising grandchildren andthose who are not involved in this caregiving role. This discussionbuilds on our earlier study of grandparent caregivers, using a nationaldata set, but it is unique in that it explores the physical and mentalhealth of the growing subpopulation sub��pop��u��la��tion?n.A part or subdivision of a population, especially one originating from some other population: microbial subpopulations.Noun 1. of African American grandparents whoare raising grandchildren. REVIEW OF THE LITERATURE Increase in Grandparent-Headed Households The rapid growth in the number of children formally placed withrelatives can be traced in part to federal and state laws and policies,beginning in 1979, which had the effect of encouraging or requiring thata preference be given to next-of-kin in the placement of fosterchildren. In many of the most populated parts of the United States United States,officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. ,fully one-half of the children in out-of-home placements are in"kinship care" or formal placements with relatives (Brooks,Webster, Berrick, & Barth, 1998). But policies promoting kinshipcare do not explain the concomitant increase social workers also haveseen in the number of children who have been informally "going tolive with grandma"-a trend that has continued into the late 1990s(Harden, Clark, & Maguire, 1997; Minkler, 1999). A variety of socialfactors have contributed to the increase. Prominent among these are drugabuse (particularly the epidemic of cocaine use in the 1980s), the risein households headed by single parents, teenage pregnancy teenage pregnancyAdolescent pregnancy, teen pregnancy Social medicine Pregnancy by a ♀, age 13 to 19; TP is usually understood to occur in a ♀ who has not completed her core education–secondary school, has few or no marketable skills, is and youthunemployme nt (Burnette, 1997; Harden et al., 1997), HIV/ AIDS (Joslin& Harrison, 1998), and a sixfold increase in the rate of femaleincarceration Confinement in a jail or prison; imprisonment.Police officers and other law enforcement officers are authorized by federal, state, and local lawmakers to arrest and confine persons suspected of crimes. The judicial system is authorized to confine persons convicted of crimes. from 1980 to 1995 (U.S. Department of Justice, 1997). Grandparent Caregiving among African Americans Several factors help explain the disproportionate number of AfricanAmerican children living in the care of grandparents. Historically, theextended family was the primary West African West AfricaA region of western Africa between the Sahara Desert and the Gulf of Guinea. It was largely controlled by colonial powers until the 20th century.West African adj. & n. family structure at thetime of slavery (Scannapieco & Jackson, 1996). The immediate needsof children who were separated from their parents during slaverypromoted continued reliance on extended family caregiving (Sudarkasa,1981; Wilson, 1989). In the United States, during the first half of the20th century, poverty, oppression, racism, and the consequent lack ofopportunity in the South led to great migration of African Americans tothe North in pursuit of employment. It was commonplace for grandparentsto remain in the South to care for children while the middle generationestablished themselves in Northern cities (Sudarkasa, 1981; Wilson,1989). Subsequently and continuing through the 1960s, urban parentsoften would send their children in summer to grandparents and otherextended family in the South. These visits allowed the new generation toremain closely connected with their grandparents and other relatives inthe South and to be exposed to cultural traditions. In contrast, as Burton and Dilworth-Anderson (1991) have noted,contemporary grandparent caregiving often occurs in response to crisessuch as incarceration of children's mothers, HIV/AIDS, andsubstance abuse. These reasons for caregiving frequently carry with thema stigma for the whole family, including grandparent caregivers.Extended families, churches, and other supports that historically havehelped African Americans cope with racism and other adversities (Gibbs,1991) are in place for many grandparent caregivers and will be discussedlater; however, the stigma attached to AIDS and drug abuse also has ledto social isolation from peers and not infrequently from churches in theAfrican American community (Generations United, 1998; Poe, 1992). Health Problems Associated with Grandparent Caregiving Although caring for one's grandchildren brings many rewards,including "keeping the family together" (Burton, 1992;Jendrek, 1994; Minkier & Roe, 1993; Poe, 1992), it also has beenassociated with potentially serious physical and mental health problems.Key among these is depression, which, as Walker and Pomeroy (1996)noted, is one of "the more enduring effects of caregiving"(p.247). Recent analysis of the National Survey of Families andHouseholds (NSFH NSFH National Survey of Families and HouseholdsNSFH Not Safe For Humanity ) multicultural sample found that 25 percent of allgrandparent caregivers had clinically relevant levels of depression(Minider, Fuller-Thomson, Miller, & Driver, 1997). Depression maydevelop because of difficulties in balancing multiple work, family, andsocial responsibilities at a time when many grandparents had hoped tohave more time to themselves. The increased demands on caregivers'time and finances may be particularly disheartening dis��heart��en?tr.v. dis��heart��ened, dis��heart��en��ing, dis��heart��ensTo shake or destroy the courage or resolution of; dispirit. See Synonyms at discourage. when contrasted withnoncaregiving grandparents' increasing freedom and leisure time. Earlier qualitative studies among African American grandparentsraising grandchildren (Burton, 1992; Minkler & Roe, 1993; Poe, 1992)have suggested that such depression also may be triggered by sorrow thatresults from distressing circumstances surrounding the onset of care(such as the substance abuse, incarceration, or death of the adultchild). Walker and Pomeroy (1996) suggested that symptoms of depression,in fact, may reflect the caregivers' "normal distress"and grief (p. 248). Whether depression or grief, however, the elevatedrates of psychological distress psychological distressThe end result of factors–eg, psychogenic pain, internal conflicts, and external stress that prevent a person from self-actualization and connecting with 'significant others'. See Humanistic psychology. reported among African Americangrandparent caregivers are noteworthy. Adverse physical health outcomes and functional health limitationsalso have been associated with primary caregiving for a grandchild,including exacerbation of pre-existing chronic conditions, comorbidity,declines in self-assessed health, and limitations in one or moreactivities of daily living (Burnette, 1999b; Miller, 1991; Minkler &Fuller-Thomson, 1999a; Minkler & Roe, 1993; Strawbridge, Wallhagen,Shema, & Kaplan, 1997). To untangle the unique effects of caregivingon health, it is essential to take into account the fact that olderAfrican Americans have, on average, more physical health problemsbecause of, in part, racism, oppression, and poverty. In fact, AfricanAmerican women experience greater morbidity and mortality Morbidity and Mortality can refer to: Morbidity & Mortality, a term used in medicine Morbidity and Mortality Weekly Report, a medical publication See alsoMorbidity, a medical term Mortality, a medical term than all othergroups of women (Gaston, Barrett, Johnson, & Epstein, 1998).Consequently, African American caregivers must be compared withnoncaregiving African Americans, rather than with the general populationof noncaregivers. The great majority of studies on grandparent caregivers to datehave used small nonrepresentative samples, and hence their resultscannot be generalized (for example, Burnette, 1999b; Burton, 1992;Minkler & Roe, 1993; Shore & Hayslip, 1994). Studies that haveused representative data sets (for example, Chalfie, 1994;Fuller-Thomson et al., 1997; Minkler & Fuller-Thomson, 1999a, 1999b;Minkler et al., 1997; Szinovacz, 1998) have not focused their researchon African American grandparent caregivers. With the use of a nationallyrepresentative subsample sub��sam��ple?n.A sample drawn from a larger sample.tr.v. sub��sam��pled, sub��sam��pling, sub��sam��plesTo take a subsample from (a larger sample). of African Americans, we sought to address thisgap and answer the question, "How do African American caregivinggrandparents differ with respect to demographic and physical and mentalhealth characteristics from African American grandparents who are notraising a grandchild?" METHODS Two cycles of the NSFH were conducted, the first from 1987 through1988 and the second from 1992 through 1994. In the first cycle 13,008people were interviewed, 2,390 of whom were African American. AfricanAmericans and other ethnic minority groups were oversampled in the NSFHto allow subanalysis by race. To adjust for this oversampling Creating a more accurate digital representation of an analog signal. In order to work with real-world signals in the computer, analog signals are sampled some number of times per second (frequency) and converted into digital code. , as wellas oversampling related to nontraditional families and recently marriedpeople and to deal with the problem of nonresponse, a weighting variablewas constructed by the NSFH. This weighting represents a sample that isdemographically representative of the continental United States. (For amore in-depth discussion of the NSFH, see Sweet, Bumpass, & Call,1988.) In the second cycle 10,008 people were reinterviewed, including1,723 or 72 percent of the original African American respondents. Theanalyses reported here are based on the second cycle of data collection. The original multiracial NSFH sample had 3,477 grandparents in thesecond cycle of data collection, 173 of whom were caregivers. (Fordetailed discussions of custodial caregiving in the general population,see Fuller-Thomson et al., 1997; Minkler & Fuller-Thomson, 1999a;Minider et al., 1997). The subsample here is restricted to AfricanAmerican grandparents who were raising a grandchild during the 1990s (n=78) and a comparison sample of African American grandparents who hadnever been primary caregivers for a grandchild (n = 485). Custodialgrandparents were defined as those who replied in the affirmative to thequestion "For various reasons, grandparents sometimes take on theprimary responsibility for raising a grandchild. Have you ever had theprimary responsibility for any of your grandchildren for six months ormore?" Grandparents who reported that they had begun or endedcaregiving during the 1990s were the subgroup of primary interest inthis investigation. To avoid confounding confoundingwhen the effects of two, or more, processes on results cannot be separated, the results are said to be confounded, a cause of bias in disease studies.confounding factor the analysis, grandpa rents whopreviously had provided care but who were no longer doing so during the1990s were excluded. Because we restricted the analyses to the African Americansubsample of the original survey, the weighting variable requiredmodification. To allow for appropriately weighted comparisons in theAfrican American subsample, we divided the weighting variable by themean value of that variable for this group (Statistics Canada, 1996).This technique allows the overall sample size of African Americans toremain constant, but it "takes into account the unequalprobabilities of selection" (p. 28). Caregivers and noncaregiverswere then compared and contrasted on demographic and physical health andmental health characteristics. Chi-square tests were used for nominaland ordinal (mathematics) ordinal - An isomorphism class of well-ordered sets. variables, and independent t tests were used for interval-and ratio-level variables. Depression was measured using a modified 12-item version of theCenter for Epidemiological Studies Depression Scale (CES-D) (Radloff,1977). The full CES-D is a self-report measure of current symptoms ofdepression, developed for use in large-scale community-based studies.The CES-D scale has excellent concurrent validity concurrent validity,n the degree to which results from one test agree with results from other, different tests. , good internalconsistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. , and acceptable test-retest reliability (Devins & Orme,1985; Radloff, 1977). The correlation between the full CES-D and the12-item CES-D is 0.88 (Fuller-Thomson, 1995). The traditional cut-pointthat suggests clinically relevant levels of depressive de��pres��siveadj.1. Tending to depress or lower.2. Depressing; gloomy.3. Of or relating to psychological depression.n.A person suffering from psychological depression. symptoms in thefull CESD CESDcholesteryl ester storage disease. is a score of 16 or higher. Although the 12-item CES-D used inthis study has a much smaller range (0-36) than the full 20-item CES-D(0-60), we conservatively chose to retain the full CES-D cut-point of16. Because we retained this cut-point, the possibility of identifyingrespondents as depressed when they would not be so identified on thefull CES-D was minimized (false positives), but th e true level ofdepression may have been underestimated (false negatives). RESULTS African American custodial grandparents of the 1990s tended tobegin caregiving when the grandchildren were very young. More than half(53.6 percent) began when the grandchildren were younger than one yearold, and an additional 20.5 percent undertook care when thegrandchildren were between the ages of one and five; 17.5 percent begancaregiving when the child was between five and 10 years old, and theremaining 8.4 percent undertook care when the child was 11 years old orolder. The findings of this study indicate that there are markeddifferences between caregiving grandparents and noncaregivinggrandparents in the African American community (Table 1). Three-fourthsof caregiving grandparents were widowed, divorced, separated, or nevermarried, compared with one-half of noncaregivers. Caregivers were alsomore likely to be female (77 percent compared with 55 percent), to havemore grandchildren (on average, 8.2 grandchildren compared with 5.3grandchildren), and to be poorer. Almost half lived below the povertyline, compared with one-quarter of noncaregiving grandparents. African American caregivers were significantly more likely thantheir noncaregiving peers to have limitations in four of the fiveactivities of daily living (ADL) investigated (Table 2). Caregivers hadmore problems moving around inside the house and doing day-to-day tasks.The levels of limitation were quite substantial, with 29 percent ofcaregivers reporting "a lot of limitation" climbing a flightof stairs Noun 1. flight of stairs - a stairway (set of steps) between one floor or landing and the nextflight of steps, flightstaircase, stairway - a way of access (upward and downward) consisting of a set of steps and two of five caregivers indicating that they had a lot oflimitation walking six blocks. Approximately two-thirds of caregivershad at least one limitation, and the mean number of limitations was two.No significant differences were found between African Americancaregivers and noncaregivers with respect to self-reported health statusor with their reported ability to bathe, dress, and provide otherpersonal care. African American caregivers also had more symptoms of depressioncompared with their noncaregiving peers, with more than one-third ofcaregivers reporting clinically relevant levels of depression, comparedwith one-fifth of noncaregivers. DISCUSSION There are several limitations to this study. First, the relativelysmall sample size of African American grandparent caregivers in the NSFHprohibited us from taking advantage of the longitudinal character of thedata and explore causation. As a result, we were able to report only onassociations and had no information on whether these factors werecausally related to grandparent caregiving status and, if so, in whichdirection the relationship flowed. Second, the NSFH did not allow us todistinguish between caregivers raising one grandchild and those raisingtwo or more grandchildren. Smaller, nonrandom studies in New York New York, state, United StatesNew York,Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of (Joslin & Brouard, 1995), Oakland, California (Minkler & Roe,1993), and elsewhere have suggested that many African Americangrandparents may be raising more than one grandchild, particularly ininner-city neighborhoods. Because the financial, emotional, and physicalconsequences of raising several children may be even more substantialthan those associated with raising one, further study in this area iswarranted. Third, the NSFH did not provide information on whethergrandparents had legal custody of the grandchildren. This information iscritical because grandparents raising grandchildren in the formal fostercare system are eligible for significantly greater benefits than thosewithout the "kinship care" designation. Furthermore, somegrandparents without legal custody may avoid obtaining any governmentassistance because they fear that the child will be taken intononfamilial foster care. Finally, the NSFH data set did not enable an examination of whyindividuals become grandparent caregivers, and it did not allow us tounderstand the reason for the elevated risk for depression and illhealth among African American grandparents compared with theirnoncaregiving peers. IMPLICATIONS FOR SOCIAL WORK RESEARCH AND PRACTICE Despite these limitations our study was able to outline a healthprofile of African American grandparents raising grandchildren, and thatprofile was troubling. Caregivers had, on average, two limitations oftheir ADL, twice as many as were experienced by noncaregivinggrandparents. More than 50 percent had trouble climbing stairs orwalking six blocks. Because 75 percent of the grandparents undertookcustodial care Custodial CareNon-medical care that helps individuals with his or her activities of daily living, preparation of special diets and self-administration of medication not requiring constant attention of medical personnel. when the child was younger than five years old, when thephysical aspects of child-rearing typically are most strenuous, theconsequences of these limitations may be particularly problematic. The extent of physical limitations among African Americancaregiving grandparents has a number of implications for social workpractice and research. Social workers who have caregiving grandparentsas clients need to be attentive particularly to current health problemsand the possibility that the extensive demands of caregiving mayexacerbate these conditions. Devices for assistance, home modifications,and in-home support services support servicesPsychology Non-health care-related ancillary services–eg, transportation, financial aid, support groups, homemaker services, respite services, and other services should be made easily accessible tograndparent caregivers in need. Similarly, respite services should bemade far more available to grandparents, and their child care componentshould include relief from some of the more physically demanding tasksof caregiving, such as bathing young children and taking them onoutings. Grandparents who are in the poorest health and those raisingchildren they perceive as having physical or behavioral problems may beamong the least likely to seek and receive counseling and other help forthemselves (Burnette, 1999a; Shore & Hayslip, 1994). More targetedoutreach to such grandparents and the creation of "one-stopshopping" centers, where grandparents can receive mental andphysical health care and services for their grandchildren andthemselves, may be critical for effective service delivery (GenerationsUnited, 1998; Minkler, 1999). An Afrocentric neighborhood-based healthpromotion center (Elliott Brown, Jemmott, Mitchell, & Walton, 1998)holds considerable promise for this population of older AfricanAmericans. These holistic services agencies could offer direct services,information, and referral for mental and physical health needs ofcaregiving grandparents, support groups, exercise and wellnessworkshops; coordinate babysitting exchanges; and provide legal advice oncustody and acces s issues. African American grandparents'willingness to use social services social servicesNoun, plwelfare services provided by local authorities or a state agency for people with particular social needssocial servicesnpl → servicios mpl socialesand health centers and the culturalappropriateness of services they receive are enhanced by hiring staffwho live in the community (Harvey & Rauch, 1997). The high levels of depressive symptoms for African Americangrandparent caregivers in this study (37 percent) underscores the needfor high-quality and culturally sensitive psychotherapeutic psy��cho��ther��a��py?n. pl. psy��cho��ther��a��piesThe treatment of mental and emotional disorders through the use of psychological techniques designed to encourage communication of conflicts and insight into problems, with the goal being interventions, including support groups designed to reinforce and buildon the strengths of African American grandparents and to address theirunmet needs. Detroit's Project GUIDE ("AssistingIntergenerational in��ter��gen��er��a��tion��al?adj.Being or occurring between generations: "These social-insurance programs are intergenerational and all Famiies," 1993), a comprehensive program ofservices, support, and cultural enrichment for African Americangrandparents and the grandchildren in their care, which grew out of thedrug epidemic, provides an excellent example of an intervention thatmeets many of these criteria. Social workers assisting grandparent-headed households also shouldstay abreast of pre-existing resources such as the grandparentinformation center (GIG) of the American Association of Retired Persons(AARP). The GIG, for example, maintains a database of approximately 500grandparent caregiver support groups in all 50 states (personalcommunication with M. Hollidge, director, AARP GIG, June 4, 1999) andcan put social work professionals and grandparents themselves in touchwith programs and services in their geographic areas. If furtherresearch indicates that the grandparents' depression is primarily agrief reaction from loss associated with caregiving, the focus of socialwork interventions should be on coping with grief rather than managinglong-term depression (Walker & Pomeroy, 1996). More effectiveinvolvement of African American churches in the provision of support andassistance to grandparents raising grandchildren also is needed. Asseveral observers have noted, the shame often associated with tw o majorcauses of the increase in grandparent caregiving--substance abuse andHIY/AIDS--has resulted in the tendency for many African Americanchurches to shy away from Verb 1. shy away from - avoid having to deal with some unpleasant task; "I shy away from this task"avoid - stay clear from; keep away from; keep out of the way of someone or something; "Her former friends now avoid her" greater involvement in this area (GenerationsUnited, 1998). Social workers can play an important role in bringingvisibility to the work of churches that have helped address the needs ofgrandparent caregivers in these situations and in helping to findculturally appropriate and comfortable ways for other churches to followtheir example. The fact that fully half of the grandparent caregivers in thisstudy were living below the poverty line underscores the importance ofstudying and responding to grandparent caregiving within a broadsociostructural framework. Indeed, many of the causes of the increase ingrandparent caregiving nationally (for example, incarceration of one orboth parents, the rise in single parentheaded households, and theepidemics of substance abuse and AIDS) are tied in fundamental ways tothe continued and often interconnected problems of poverty and racism inour society (Gibbs, 1991). The rapid increase in incarceration rates ofwomen, for example, has affected disproportionately low-income AfricanAmerican women and their families (Dressel & Barnhill, 1994).Similarly, the disproportionate rates of single parent-headed householdsamong African Americans reflect, in part, the continued loss ofmen's relative economic advantage as breadwinners--a loss that hasbeen far more pronounced in the African American community a s a resultof institutionalized in��sti��tu��tion��al��ize?tr.v. in��sti��tu��tion��al��ized, in��sti��tu��tion��al��iz��ing, in��sti��tu��tion��al��iz��es1. a. To make into, treat as, or give the character of an institution to.b. racism and oppression (Ozawa, 1994). Seriousefforts to address the factors contributing to the rise inintergenerational households headed by grandparents cannot be madewithout a concomitant commitment to confronting these underlyingproblems. Of immediate salience sa��li��ence? also sa��li��en��cyn. pl. sa��li��en��ces also sa��li��en��cies1. The quality or condition of being salient.2. A pronounced feature or part; a highlight.Noun 1. in this regard are the potential effects ofthe 1996 welfare reform legislation on low-income grandparents raisinggrandchildren. As Mullen (1997) has pointed out, the legislative changesincorporated in the Personal Responsibility and Work OpportunityReconciliation Act of 1996 (P.L. 104-193) (which removed the entitlementstatus of Aid to Families with Dependent Children Aid to Families with Dependent Children (AFDC) was the name of a federal assistance program in effect from 1935 to 1997,[1] which was administered by the United States Department of Health and Human Services. and replaced thelatter with the Temporary Assistance to Needy Families [TANF TANF Temporary Assistance for Needy Families (previously known as AFDC)] program),"were never designed with grandparent-headed households inmind]' Despite this oversight, a growing proportion of TANFrecipients are grandparents and other relatives, particularly in theinner city. TANF regulations that establish five-year lifetime benefitlimits, impose a work requirement after two years, and require teenagemothers to live at home as a condition of receiving aid may have theeffect of increasing the number of grandparents who become primarycaregivers to their grandchildren (Minkler, Berrick, & Needell,1999; Mullen, 1997). As frontline workers, social workers are among thefirst professionals to become aware of the ramifications ramificationsnpl → Auswirkungen plof TANF fortheir clients. Policymakers need to be apprised of these ramifications,with suggestions on how to improve the policies so they take less of atoll on our nation's grandparents. Social workers also are wellsituated to alert researchers of the need for further investigation intoand data collection on neglected caregiving issues (Gaston et al.,1998). Both qualitative and quantitative longitudinal studies longitudinal studies,n.pl the epidemiologic studies that record data from a respresentative sample at repeated intervals over an extended span of time rather than at a single or limited number over a short period. on theeffect of TANF on African American grandparents are critical as weattempt to assess the consequences of welfare reform for the growingnumber of intergenerational households headed by grandparents. As suggested earlier, further social work research should attemptto examine also the legal custody status of the children being providedcare by African American grandparents and its effect (mediated throughdifferential access to resources and so forth) on grandparents'health and well-being. Finally, studies are needed to determine theextent to which the elevated depression rates found in grandparentcaregivers may in fact be a function of grief as has been found withother forms of caregiving (Walker & Pomeroy, 1996). Taking a cuefrom Walker and Pomeroy's study of the experience of caregivers ofpeople with dementia, instruments (for example, The Grief ExperienceInventory [Sanders, Mauger, & Strong, 1985] and the Beck DepressionInventory Beck Depression InventoryA trademark for a standardized questionnaire used to diagnose depression.Beck Depression Inventory[Beck, Steer, & Garbin, 1988]) that enable the delineationof the role of grief in influencing depression scores should be used. CONCLUSION In focusing on grandparents as surrogate parents to theirgrandchildren, this study inadvertently may have reinforced the commonmisconception mis��con��cep��tion?n.A mistaken thought, idea, or notion; a misunderstanding: had many misconceptions about the new tax program. that grandparent caregiving is "a black issue"and that this role is in fact common in the African American community.As Hunter and Taylor (1998) pointed out, "research on blackgrandparents has historically been couched within the public discourseon black families and social policy" (p. 70). In contrast to themajority of research on white grandparents, studies of blackgrandparent-hood tend to stress the roles of grandparents within acontext of family crisis. Much further research is needed on the 71percent of African American grandmothers and 86 percent of grandfathers(Szinovacz, 1998) who never serve as surrogate parents to theirgrandchildren. The results should be publicized widely to help counterthese misconceptions. At the same time, however, the needs of thoseAfrican American grandparents raising grandchildren are deserving ofcontinued attention from r esearchers and increased attention frompolicymakers and social work practitioners. As Gibbs (1991) explained,issues such as grandparent caregiving in African American communities"can be better understood if they are conceptualized as aninteraction between historical patterns of adaptation, current socialpolicies, environmental stress, and coping strategies The German Freudian psychoanalyst Karen Horney defined four so-called coping strategies to define interpersonal relations, one describing psychologically healthy individuals, the others describing neurotic states. utilized by blackfamily members" (p. 328). Davis, Aguilar, and Jackson (1998)suggested that social workers can play a key role in "raisingsubstantive questions about social justice" (p. 83) and inadvocating for change in policies that may adversely affect women whomake low wages and their families. As the findings of this study makeclear, such advocacy should include work with and on behalf of thegrowing number of grandparents, many of them African American, who areraising their grandchildren. ABOUT THE AUTHORS Esme Fuller-Thomson, PhD, is I. Anson Assistant Professor, Facultyof Social Work, University of Toronto Research at the University of Toronto has been responsible for the world's first electronic heart pacemaker, artificial larynx, single-lung transplant, nerve transplant, artificial pancreas, chemical laser, G-suit, the first practical electron microscope, the first cloning of T-cells, , Toronto, Canada M5S 1A1; e-mail:esme.fuller.thomson@utoronto.ca. Meredith Minkler, DrPH, is professor,Health and Social Behavior In biology, psychology and sociology social behavior is behavior directed towards, or taking place between, members of the same species. Behavior such as predation which involves members of different species is not social. , School of Public Health, University ofCalifornia, Berkeley The University of California, Berkeley is a public research university located in Berkeley, California, United States. Commonly referred to as UC Berkeley, Berkeley and Cal . The authors gratefully acknowledge theCommonwealth Fund of New York for its support of this research. Theauthors thank Joan Brooks and the reviewers of this article for theirhelpful comments and suggestions on an earlier draft. 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Comparative Demographic Profile of African Custodial Grandparents versus African American Noncustodial Grandparents of the 1990s % NoncaregivingVariable Grandparents (n = 495)Marital status in 1993 Widowed, divorced, separated, or never married 51.7 Married 48.3Mean age in 1993 55.6Gender Male 45.1 Female 54.9Education level in 1993 Grade 11 or less 45.6 Grade 12 or higher 54.4Geographic region in 1988 South 56.6 Elsewhere 43.4Urban or rural status in 1988 Nonstandard metropolitan area (rural) 19 Standard metropolitan area (urban) 81.0Income in 1988 Median income $27,889 Families below poverty line 25.4 Families above poverty line 74.6Mean number of grandchildren 5.3 % CaregivingVariable Grandparents (n = 78)Marital status in 1993 Widowed, divorced, separated, or never married 76.9 [***] Married 23.1Mean age in 1993 58.3 [+]Gender Male 23.1 [***] Female 76.9Education level in 1993 Grade 11 or less 50 Grade 12 or higher 50Geographic region in 1988 South 50.0 Elsewhere 50.0Urban or rural status in 1988 Nonstandard metropolitan area (rural) 20.5 Standard metropolitan area (urban) 79.5Income in 1988 Median income $21,163 [*] Families below poverty line 47.1 [***] Families above poverty line 52.9Mean number of grandchildren 8.2 [**]NOTE: Chi-square tests were used for nominal variables,and independent t tests were used for ratio-level variables.(+.)p[less than].10.(*.)p[less than].05.(**.)p[less than].01.(***.)p[less than].001. Comparative Profile of Health-Related Variables for African American Custodial Grandparents Compared with African American Noncustodial Grandparents in the 1990s % NoncaregivingVariable Grandparents (n = 495)Physical or mental conditions limit respondent's ability to care for personal needs such as bathing, dressing, eating, or going to the bathroom Does not limit at all 84.4 Limits a little 9.6 Limits a lot 6Move about inside the house? Does not limit at all 81.1 Limits a little 12.2 Limits a lot 6.7Do day-to-day tasks? Does not limit at all 75.1 Limits a little 15.6 Limits a lot 9.4Climb a flight of stairs? Does not limit at all 68.4 Limits a little 19.6 Limits a lot 12.0Walk six blocks? Does not limit at all 66.8 Limits a little 16.8 Limits a lot 16.4Limitation of at least one ADL No limitations 57.3 Some limitation of at least one ADL 42.7Mean number of ADL limitations (n=525) 1.2Health status Very poor or poor 9.2 Fair 25.1 Good or excellent 65.7Depression Categorized as depressed using modified CES-D 20.8 Not depressed 79.2 Mean score on CES-D 9.0 % CaregivingVariable Grandparents (n = 78)Physical or mental conditions limit respondent's ability to care for personal needs such as bathing, dressing, eating, or going to the bathroom Does not limit at all 78.7 Limits a little 10.7 Limits a lot 10.6Move about inside the house? Does not limit at all 65.8 [*] Limits a little 20.5 Limits a lot 13.7Do day-to-day tasks? Does not limit at all 54.8 [**] Limits a little 27.4 Limits a lot 17.8Climb a flight of stairs? Does not limit at all 47.2 [***] Limits a little 23.6 Limits a lot 29.2Walk six blocks? Does not limit at all 44.6 [***] Limits a little 16.2 Limits a lot 39.2Limitation of at least one ADL No limitations 36.5 [***] Some limitation of at least one ADL 63.5Mean number of ADL limitations (n=525) 2.1 [***]Health status Very poor or poor 8.1 [+] Fair 36.5 Good or excellent 55.4Depression Categorized as depressed using modified CES-D 36.8 Not depressed 63.2 [**] Mean score on CES-D 11.5 [*] NOTES: ADL = activities of daily living. CES-D = Center forEpidemiological Studies Depression Scale (Radloff, 1977). Chi-squaretests were used for nominal and ordinal-level variables. Independent ttests were used for interval and ratio-level variables. (+.)p[less than].10. (*.)p[less than].05. (**.)p[less than].01. (***.)p[less than].001.