Sense of Community among Chinese Older Adults in the Greater Chicago Area : Findings from the PINE Study

Background: Sense of community is a concept th at has significant implications cross multiple disciplines, particularly in public health practice. However, there exists a knowledge gap in utilizing the sense of comm unity in investiga ting the health of older imm igrant populations. Objective: This study aim ed to expl ore the perception of the sense of community among community-dwelling U.S. Chinese older adults. Methods: Data were from the PINE study , a population-based survey of U.S. Chinese older adults aged 60 years and above in the greater Chicago area. We administered the Sense of Community Index to m easure the levels of sense of comm unity. Socio-demographic information was also collected. Results: Our results suggest that Chinese older adults in this study sample reported a strong sense of community. In total, 86.7% of the participants reported satisfaction with the cu rrent neighborhood, and 78.4% expresse d their desire to continue living in the community as long as possible. In addition, o lder age (r = 0.11), having higher levels of income (r = 0.08), being female (r = 0.08), being unmarried (r = –0.06), living with fewer people (r = –0.22), having more children (r = 0.11), having been in the U.S. for more years (r = 0.12), longer residency in the community (r = 0.15), higher overall health status (r = 0.18), better quality of life (r = 0.23), and improved health status in the past year (r = 0.11) were significantly correlated with the higher levels of the sense of the comm unity. Conclusions: The study investigation provided the ba sis for generating em pirical knowledge for understanding the sense of community among U.S. Chinese older adults. Future research is needed to delineate the m echanisms underlying sense of comm unity and health in the increasingly diverse aging population.


Introduction
Sense of community, or som etimes referred to as "psychological s ense of community", is "a feeling that members have a belonging, a feeling that members matters to one another and to the group, and a shared faith th at members' needs will be m et through their co mmitment to be together" [1].Four factors, including the sens e of m embership, influence, integration, shared emotional connection, form ulate the sense of comm unity and have been extensively explored in qualitative and quantitative studies in community psychology [2][3][4][5].Length of community residence was also found as a predictor to the actual sense of community [6].
Studies report that people with a high sense of community are likely to have increas ed ties to other individuals, and conversely , people with a lo w sense of community are likely to be social isolated and has fewer ties to ot her individuals [2,3].W ith respect to its im pact on health and well-being, a strong sense of community contribut e to positive outcomes, including empowerment, sense of efficacy, life satisfaction, improved well-being, and happiness [7,8], whereas lowered levels of the sense of community may induce feelings of loneliness, depression, and suicide [9].
In addition, empirical work has suggested that the salience of community is particularly critical for older adults [10, 1 1].Where one lives at olde r age m ay often provide opportunities for social integration and engagement.Therefore, the impact of the community on health is likely to be greater for older adults because they often have de creasing mobility and likely depend m ore on the community resources [12,13].Li mited but growing atte ntion has been paid to dif ferent racial/ethnic minorities including K orean older adults and Latino o lder adults [13,14].However, given the heterogeneity of the Asi an populations, the presen t assessment focused on Chinese Am erican older adults-one of the fastest growing aging populations in the U.S.
Chinese American community is the oldest and largest Asian population in the U.S. [15,16].It is also amongst the fastest growing U.S. Asia n population.From 2000 to 2010, Chinese aging population aged 65 and over has experienced a growth rate almost four times higher than the general U.S. aging population [17].Similar growth trend is reflected in the segment of older adults.Currently, Chinese older adults aged 60 and over account for 14% of the total Chinese population in the U.S. As the population is Chinese older adults is increasing, Chicago has one of the largest Chinese American communities in the co untry.The rapid ly expanding community m ay bring an opportunity for community creation an d a deepened psycholo gical sense of community wh ich can be a critical component of successful aging.T o expand upo n existing literature, the curre nt study aimed to 1) examine the sense of comm unity among community-d welling Chinese older ad ults in the greater Chicago area; 2) investigate the correlations be tween socio-demographic factors and sense of community in a U.S. Chinese aging population.

Population and settings
Data were drawn from the Population Study of Chinese Elderly in Chicago (PINE) study, which surveyed approximately 3,159 older adults aged 60 and over in the greater Chicago area.Participants were interviewed via in-person face-to-face between 2012 and 2014.The response rate was 91.9 %.Briefly, the purpose of the PINE study is to collect com munity-level data of U.S. Chinese older adults to ex amine the key cultu ral determinants of health and well-being [18] .The project was initiated by a syner gistic community-academic collaboration between Rush Institute for Healthy Aging, Northwestern University , and m any community-based social se rvices agencies and organizations throughout the greater Chicago area.
In order to ensure study relevance to the we ll-being of the Chinese community and enhance community participation, the PINE study implem ented extensive cultura lly and linguistically appropriate community recru itment strategies strictly guided by com munity-based participatory research (CBPR) approach.With over twenty soci al services agencies, community centers, health advocacy agencies, faith-based organizations, senior apartments and social clubs serving as the basis of study recruitment sites, eligible participants were approached th rough routine social services and outreach efforts serving Chinese Americans fam ilies in the Chicago city and suburban areas.Out of 3,542 eligible participants, 3,159 agreed to participate in the study, yielding a response rate of 91.9%.
Based on the available census data drawn from U.S. Census 2010 and a random block census project conducted in th e Chinese comm unity in Chicago, the PINE study is representative of the Chinese aging population in the greater Chicago area with respective to key demographic attributes including age, sex, income, education, number of children, and country of origin [19].The study was approved by the institutional review boards of the Rush University Medical Center.

Overall health status, quality of life and health changes over the last year
Overall health status was measured by "In general, how would you rate your health?" on a four point scale (1 = poor , 2 = fair, 3 = good, 4 = very good).Quality of life was assessed by asking "In general, how would you rate you r quality of life?" also on a four poi nt scale, ranging from 1 = poor to 4 = very good.Health changes over the last y ear was measured by "Com pared to one year ago, how would you rate your now?" on a three point scale (1 = worsened, 2 = same, 3 = improved).

Sense of Community Index
We used the 12-item Sense of Community Index (SCI) instrum ent to m easure the sense of community.SCI is am ong the most widely used a nd broadly validated measure of the psychological sense of community [20]; it was de veloped concurrently with the psychological sense of community theory that stated that a sense of community was a perception the following four components: (a) membership, feelings of emotional security, belonging, and identification; (b) influence, by which the community inf luences the indi vidual and the indi vidual influences the community , in turn; (c) integration and fulfillment of needs, physical and psychological needs met, thereby reinforcing one's commitment to the group; and (d) shared em otional connection, positive af fect and shared history related to community membership [1].
Participants rated their agreement (1 = Strongly disagree, 5 = Strongly agree) with the following 12 statements: 1.I think m y neighborhood is a good place for m e to live; 2. People in this neighborhood do not share the sam e values; 3. My ne ighbors and I want the sam e things from this neighborhood; 4. I can recognize m ost of the people who live in my neighborhood; 5.I feel hom e at this neighborhood;

Sense of Community Index reliability and content validity
In our cohort, the alpha coefficient of reliability for the SCI was 0.69.If question "People in this neighborhood do not share the same values", "V ery few of m y neighbors know me", and "I have almost no influence what this ne ighborhood is like" were removed fr om the scale, the alpha would be improved although marginally to 0.70 (Table 2).
With respect to inter-item correlation coefficients, "I can recognize most of the people who live in my neighborhood" and "V ery few of m y neighbors know m e" showed the highest inter -item correlation coefficients (0.56), followed by "I e xpect to live in this neighborhood for a long tim e" and "It is very im portant to me to live in this particular neighborhood" (0.49).All co rrelations were significant at the 0.001 level.
Several measures were done to inspect content validity of the SCI.The bilingu al research team first translated the original English version of SCI into Chinese.Due to the vast linguistic diversity of our study p opulation, the Chinese version was then back translated by bilingual and bicultural investigators fluent in dialects including Mandarin and Cantonese to confirm consistency in the meaning of the Chinese version with the orig inal English v ersion.Both written s cripts (traditional and simplified Chinese characters) were subsequently examined.A group of community stakeholders led by an experienced bilingual and bicultural geriatrician then went over the wording of the Chinese versions to ascertain that the m eanings of the item s in Chinese conveyed the m eanings to Chinese older adults and to ensure validity.

Endorsement of Sense of Community Index
With respect to specific endorsement to the SCI, 86.7% felt that their neighborhood was a good place to live, 81.9% reported th at they felt hom e at the current neighborhood, 78.4% of the participants expected to live in this neighborhood for a long tim e, and 73.2% felt that the people in this neighborhood generally got along with each o ther (Table 3).In add ition, 61.9% o f the participants felt that their neighbors and themselves wanted the same thing from the neighborhood, 58.9% reported that if there was a problem in the neighborhood, peopl e who lived there could get it solved, and 56.9% of the participants reported that neighbors knew them.
I feel home at this neighborhood 41 ( 78.4% expressed their desire to continue living in the community as long as possible, and 86.7% of the participants reported satisfaction with the current neighborhood.In addition, previous study on minority older adults also suggest that immigrant older adults who had a shorter stay in the U.S. had more negative perception of health and th e community [14].Conversely , in a community -dwelling sample of Italian adults and olde r adults, the y ears of residence was pos itively correlated with the sense of community ( r = 0.09, P < 0.05) [8].Building on previous findings, our study support the notion that Chinese o lder adults' longer length of residence in the community were signif icantly correlated (r = 0.15) wit h stronger sense of community .Taken together, our findings contribute t o searching for ways to strengthen the social fabric within developm ent of sense of comm unity, and that the sense of community can be utilized as a tool for fostering greater social bonding [21].Where community means more than the residency outside of a geographic boundary , strategies can be introduced to allow ther apeutic benefits of community to allow empowerment among Chinese older adults.
Consistent with previous studies, our results further suggest that there exist positive correlations between sense of community and self -reported health.Existing studies among older adults suggest that the sense of community belongingness influen ce older adults self-perce ived health, including aspects in both physical and m ental health [12,22,23] .With respect to racial /ethnic older adults, a study with Korean American olde r adults in New Y ork City poi nted out that the subjective perceptions of t he community environment affected older adults' self-reported physical and ment al health, and that older adults w ho are less satisfied with their neighborhood environm ent were more likely to have negative perceptions of health a nd depressive sym ptoms [14].The results of the present study am ong U.S. Chinese older adults c onfirm earlier findings th at the older adults' psychological sense of community was clos ely correlated with three subjective self-reported health variables, among which correlation with the quality of variable showed strongest correlation strength (r = 0.23).In -depth investigations are n eeded not only to understand the m echanisms underlying sense of community and health, but also disentangl e associations with dif ferent aspects of physical, mental, and social well-being of U.S. Chinese older adults.
Although the present study contribute s to the nascent literature on the sense of community , the result of this study should be interpreted with lim itations.First, the PINE study sam ple is representative of Chinese older adu lts in the gr eater Chicago.Caution is advised when generalizing from these findings to other Chinese American older populations in the country or in Asian societies.In addition, the present study used quantitativ e methodology and cannot explore the subjectiv e experiences of the sense of community among community-dwelling older adults.Future research employing mixed-method approach is needed to enlighte n the cultural conceptualization of community among U.S. Chinese older adults.Third, this study is cross -sectional designed, and we could not postulate on the potential temporal relationships.Future longitudinal studies are called for to examine the risk/p rotective factors and ou tcomes associated with the sense of community in Chinese older adults.
Our study has several practice implications.First, community has the potential to enhance older adults' overall health and well-being.Our study results suggest th at neighborhood characteristics should be taken into consideration in developing community -based policies for racially/ethnically diverse populations.In addition, further em pirical research should explore racial/ethnic-specific mechanisms, including cultural beliefs and values , that may help illu minate how community is associated with specific components of self-perceived health.
Second, previous studies have id entified the important role that neighborhood context may play in the development of the sense of the community.Evidence suggests that a commonly held sense of community may occur within a specific urban neighbor hood and specific contexts [3,5].However, to date we know very little regarding the relation ship between an imm igrant neighborhood and the psychological sense of community in the Chines e communities in Chi cago.The present study suggests that relationship between the sense of community and health merits greater theoretical and empirical attention.
Third, from the perspectives of comm unity empowerment, involving older adults in community-based participatory research design and coll aboration may not only contribute to a sense of community co-ownership, but also help foster the sense of membership and influence, in which both are the core elem ents of the sense of comm unity.We further postulate this novel research module may have the potential to call for a paradigm shift in designing and im plementing population-based aging research pertaini ng to the racially/ethnically diverse populations, and m ay contribute to a new generation of population-based study design [24,25].

Conclusions
The study investigation provided the basi s for generating em pirical knowledge for understanding the sense of community am ong U.S. Chinese older adults.Future longitudinal studies are needed to explore th e risk/protective factors and health outcom es associated with the sense of community in the increasing diverse aging populations.
6. Very few of my neighbors know me; 7. I care about what m y neighbors think

Table 3 . Endorsement of sense of community index.
I can recognize most of the people who live in my neighborhood 160