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. 2023 Nov 30;18(11):e0294887. doi: 10.1371/journal.pone.0294887

Definitions of successful aging among middle-aged Latinas residing in a rural agricultural community

Elizabeth Ambriz 1,*, Camila De Pierola 2, Norma M Calderon 3, Lucia Calderon 1, Katherine Kogut 2, Julianna Deardorff 2, Jacqueline M Torres 1
Editor: Frank Kyei-Arthur4
PMCID: PMC10688629  PMID: 38032988

Abstract

Introduction

Latinos are the fastest growing aging population in the U.S. However, there has been limited attention to conceptualizing successful aging among Latinos, especially those residing in rural communities. Latinos are the largest racial or ethnic group residing in rural underserved communities and rural Latinos experience significant structural barriers to access the conditions they need to age well. The goal of this study is to make unique contributions to the successful aging literature by describing what successful aging means for middle-aged Latinas residing in a rural community.

Methods

This qualitative paper used inductive thematic content analysis to examine definitions of successful aging among Latina women (n = 40) residing in an underserved agricultural community and entering mid-life (mean = 49 years old; age range 40–64).

Results

With regards to definitions of successful aging, four themes emerged: 1) Having good health; 2) maintaining an active lifestyle; 3) the wellbeing of one’s children; and 4) being independent.

Discussion

Participants’ definitions of successful aging aligned to some extent with existing frameworks, specifically related to health and independence. However, middle-aged Latina participants’ unique definitions of successful aging also diverged from existing frameworks, especially around the wellbeing of their children and the importance of work as a way of maintaining an active lifestyle. More research is needed to understand the unique social context and circumstances of middle-aged Latinos residing in rural communities and how they influence their aging journeys. This can provide important information for the development of culturally sensitive services, interventions, and policies to help Latinos age well.

Background

Rowe and Kahn’s framework for successful aging has been widely adopted in research and defines successful aging as the absence of disease and disability, maintenance of a high degree of physical and cognitive functioning, and meaningful engagement in life [1, 2]. However, this framework has been criticized by the academic community mainly because of its lack of in-depth attention to individuals’ and groups’ multiple social locations and a narrow conceptualization of “successful aging” that does not capture the diversity in the aging populating itself [3–6]. In particular, there has been limited attention to conceptualizing successful aging among Latinos, the fastest growing aging population in the U.S. [7] and especially Latinos residing in rural communities. As the largest racial or ethnic group residing in rural underserved communities [8], rural Latinos experience more structural barriers to access the conditions they need to age well. In addition, there is limited attention to successful aging among middle-aged adults, although middle age is increasingly understood as a critical window for anticipating and laying the foundation for successful aging through later life [6, 9, 10].

Latinos, especially rural Latinos, in the United States disproportionately lack access to the conditions that support health and its social determinants, including affordable housing, living wages, financial resources, transportation, quality education, and health care access [11]. The health inequities that result from these conditions affect Latinos’ ability to age successfully [3]. The health and aging of Latinos may be further compromised by “weathering”, or the cumulative wear and tear on the body in response to chronic stressors [12–15]. These structural conditions and their biological impacts put Latinos at elevated risk for high morbidity and mortality attributed to preventable chronic conditions such as diabetes, obesity, high blood pressure, cancer, and mental health conditions [16–18]. These conditions may impact both subjective and objective measures of successful aging including both their physical and cognitive aging patterns.

The few existing studies on successful aging among older Latinos demonstrate that their definitions of successful aging go beyond traditional definitions rooted largely in health and functional outcomes [18–21]. A qualitative study of perceptions on successful aging among a sample of older adults aged 62–88 years in Zapopan, Mexico found that participants’ definition of successful aging included acceptance and adaptation to life transitions and health conditions, strong involvement with family and friends, being close to God, the achievement of personal goals, and aging in place [22]. Other qualitative studies about the perceptions of successful aging among Latinos aged 50 or older in the US found similar themes as the study in Mexico; despite having an illness, Latinos focus on maintaining a positive outlook, living in the present, enjoying a sense of community, and finding comfort and meaning in spirituality and family as they age [19–21]. Finally, a quantitative study analyzing cross-sectional data from 9,798 individuals age 60 and above from the Health and Retirement Study (HRS) study found that although older Latino immigrants had lower socioeconomic status as compared to other older adults in the United States, they were the most satisfied with their lives [23]. To our knowledge, Latinos residing in rural communities are not represented in the current aging literature–including literature on successful aging—which is a critical gap give that rural Latinos experience chronic exposure to stressors stemming from structural barriers to access the conditions they need to thrive, and ultimately resulting in poor health outcomes [8, 24].

Furthermore, research on successful aging has prioritized the perspectives of older adults, which is typically thought to be individuals 65 years and over [25], and has not sought to understand the perspectives of middle-aged individuals. Middle-age could be a critical window for understanding what successful aging means for rural Latinos and the development of effective prevention and intervention strategies [6, 9, 10] since Latinos suffer relatively high levels of functional impairment and greater morbidity and mortality associated with preventable chronic diseases such as diabetes [18, 26]. This is particularly important because foreign-born Latina females have a longer total life expectancies at age 50 (36.3 years) compared to White females (33.6 years) and higher prevalence rates of cognitive impairment and dementia, which contributes to fewer number of years spent in a cognitively normal state [27]. Understanding how mid-life Latinas define successful aging gives voice to their unique lived experiences during the critical time of mid-life when people still can redirect and reflect on their own aging journeys. Midlife also represents an excellent opportunity to intervene and design community conditions to support health, prevent disease and disability, and plan for the future [9, 28].

The goal of this study is to make unique contributions to the successful aging literature by describing what successful aging means for middle-aged Latinas residing in a rural community, a group that has not been well represented in research. To do this, we collected qualitative data using focus groups to examine definitions of successful aging among Latina women residing in an underserved agricultural community and entering mid-life (mean = 49 years old).

Methods

Participants

Focus group participants were part of the ongoing Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS) Study (UCB IRB current protocol: 2016-08-9072), based in a farmworker community in California. Details of the CHAMACOS study have been published elsewhere [29]. Briefly, participants were originally recruited in 1999/2000 as part of a birth cohort study; an additional group of demographically similar women and children were recruited in 2009 to refresh the sample. While CHAMACOS mothers were in early- to mid-adulthood at the start of the study, they are now primarily in mid-life (mean age for overall study = 47). Follow-up visits with these women and their children have been conducted approximately every two years, with additional quantitative data collected related to the impacts of the COVID-19 pandemic. As of 2021, a total of 594 maternal participants were still part of the CHAMACOS cohort. We included participants in our qualitative study who spoke Spanish (88% of the cohort) and who continued to live in or near the Salinas Valley.

We recruited participants in two ways. First, we recruited participants via the support of the CHAMACOS field staff who distributed recruitment postcards to CHAMACOS mothers attending in person visits as part of the ongoing cohort study. The postcard invited women to contact the first author or share their contact information to be contacted if interested in participating. Second, we sent a recruitment text message to a list of all potentially eligible Spanish speaking CHAMACOS mothers who had participated in any recent aspect of CHAMACOS research (n = 467). Among those participants who requested to be contacted or replied that they were interested in participating (n = 202), the research team followed up via phone call to a subset (n = 70) to schedule focus groups. Of those contacted via phone, a subset (n = 30) were not available to participate, were not reachable, or were not able to make it to the focus group. We recruited participants until saturation was reached and referred the other (n = 128) who were interested in participating to another ongoing qualitative research study led by the first author. All participants in the focus groups (n = 40) were female, had children, spoke Spanish, had an age range of 40–64, and more than half of participants worked in agriculture. Please see Table 1. For demographic characteristics of the sample.

Table 1. Demographic characteristics of middle-aged Latina women in a qualitative study of definitions of successful aging (N = 40).

n (%)
Ethnicity
    Mexican 38 (92.5)
    Salvadoran 3 (7.5)
Age  
    40–49 24 (60)
    50–59 14 (35)
    60+ 2(5)
Employment  
    Unemployed 12 (30)
    Agriculture 22 (55)
    Non-agriculture 6 (15)
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Data collection

Data were collected from seven focus groups including (n = 40) participants or an average of 5.7 participants per group, at which point saturation was reached. Data collection started in November 2021 and ended in February 2022. The Committee of Human Research of the [REDACTED FOR SUBMISSION] approved the study (21–34842). The overall goal of the focus groups was to examine definitions of successful aging among middle-aged Latina women. The focus groups were organized by age with participants in similar age categories (40s vs. 50s to early 60s) participating in a focus group together. The focus groups were organized by age to elucidate differences in definitions of successful aging by age. Focus groups were conducted in Spanish by the first author, who is a bilingual and bicultural Latina researcher, were designed to last about 120 minutes, and were audio recorded and professionally transcribed. Focus groups were held in person in the CHAMACOS field office or at a local park conveniently located for participants. Participants received a $75 gift card for their time. Focus groups began with the facilitator obtaining informed written consent. The facilitator then began posing questions from the focus group guide starting with probing participants’ own definitions of successful aging. Then, participants were asked to describe someone who they thought was aging successfully. Next, the facilitator asked if they thought they were aging successfully and what barriers they experience to age successfully. Finally, participants were asked what would make them satisfied in old age, and their worries about aging (S1 Appendix). The facilitator took field notes during and after the focus groups.

Data analysis

Transcripts of focus groups were entered into MAXQDA software. The first author and a research assistant analyzed the transcripts with inductive thematic content analysis (Angel, 2009) [3]. Transcripts were analyzed in Spanish line by line [30] to examine definitions of successful aging among middle-aged Latina women. First, we focused on identifying themes and subthemes [31]. Next, we compared themes from each focus group to assess whether they corroborated, negated, or expanded one another, which adds depth to the analysis [32]. To validate the data, we used collaborative coding, the first author and a research assistant independently coded each transcript using an iterative process [33]. First, we individually read transcripts to generate an initial list of key concepts and group repeated concepts into patterns or themes. Then we met, discussed, and came to consensus about the code structure before re-reading additional transcripts searching for these or other new themes. We analyzed focus group data in an iterative process reviewing and refining themes until no new concepts emerged from subsequent focus groups and resulting themes are deemed “saturated” by the analytic team [34] This study is reported as per the Consolidated Framework for Reporting Qualitative Research (COREQ) guideline (S1 Checklist) [35]. Finally, the first author translated quotes used to summarize each theme and subtheme.

Results

With regards to definitions of successful aging, four themes and various subthemes emerged under each theme: 1) Having good health and accepting changes in physical body; 2) maintaining an active lifestyle; 3) the wellbeing of one’s children; and 4) being independent.

Having good health

Participants across focus groups defined successful aging as having “good health,” while the theme of accepting the physical changes in their bodies with age as key to being happy was more common among the 50s-early 60s focus groups. One participant summarized her definition of successful aging as, “Yes, I’m aging successfully because one has good health and, when I go to the doctor, well, everything is good with my health” (Participant in the 40s focus group).

Participants expressed that they value their health, even though some said that they are currently not healthy and are afraid of developing chronic conditions such Alzheimer’s dementia because they are already forgetting things. One said, “I’d like to have health, have health like others are saying here, have health even though I don’t, I don’t because lately I’ve been very sick from depression, I’ve suffered many years with depression, and I’m afraid that with time, because sometimes I forget things, that with time, I’ll forget everything completely. Yes, I’m afraid and I think, I don’t think it’s because of age, because I’m only 53, but I’m afraid that with the passing of time I won’t remember anything” (Participant in 50s-early 60s focus group).

Being happy despite having an illness

Some participants shared that they are happy, despite having an illness, because they accept and acknowledge the physical changes in their bodies with age. This was illustrated by a participant in the 50s-early 60s focus group when they shared, “Well, I feel well even though I have diabetes. I feel happy with my white hair, I’ve always been overweight… when I was younger, I was thin, but I continued to gain weight once married, but I am happy like this with my husband and my family.”

Accepting changes in physical body

Additionally, physical changes in the body were discussed as part of the “natural” aging process and acceptance as key to being happy and satisfied with one’s aging. One participant summarized this as, “I am [laughs] I am aging successfully, even though I sometimes ask myself why I’m overweight? I’ve always been thin but after 40 I’ve gained some pounds despite taking care of my diet. I tell myself, I’m going to accept myself, and I accept that when one is older our metabolism is slower and is not going to be the same as when one is 20. I say I am going to accept it and be happy about how I’m aging, at my stage, I’m happy, at my age that I have I’m happy, I don’t feel old” (Participant in the 50s to early 60s focus group).

Participants consider health and accepting the physical changes to their bodies with age as essential for successful aging.

Maintaining an active lifestyle

For participants, successful aging also meant continuing one’s active lifestyle whether it be through work, household demands, walks, and caring for their children.

Exercise and everyday activities

This theme was agreed upon by the women and summarized when one added, “For me aging successfully would be aging healthily, that I don’t have any disease, that I continue to have the same energy to continue doing everyday tasks, working, and taking care of my children and my home” (Participant in the 40s focus group). In this group, an active lifestyle was deemed as essential to maintain health and therefore successful aging of the mind and body. This was summarized by a participant as follows, “I am. I feel like I’m aging satisfactorily because I’m healthy. I can walk. I can come and go. Do things for myself. I can still run after my children, a bit slowly, but I can reach them” (Participant in the 40s focus group). For this group, being active through exercise and everyday activities was essential to support health and successful aging.

Work

Interestingly, while exercise was discussed through traditional methods such as walking, for this group it also encompassed the physical demands of work. One participant supported this idea when stating, “I want to at least work because I don’t like to exercise, one job and another, but don’t stop because I don’t want to stay and be shut in more than I already I am.” (Participant in the 50s-early 60s focus group).

Participants described others who they thought were aging successfully as being active in their everyday lives and continuing to work. This is shown through an example given by one of the participants when discussing their own father, “he still comes, he does not stop working here [in US], or there [Mexico]. We tell him, “don’t work anymore,” “don’t go there anymore,” “retire already,” and he says, “Ay, my daughter, I can still do it” (Participant in 40s focus group).

Another participant described her uncle as an example of someone aging successfully: “he is now with a hunched back, but he is still helping my cousin to clean his yards, he goes out and says he’s looking for a girlfriend [laughs]. They had Banda music for his 100th birthday two weeks ago and he was dancing with his granddaughters, it was beautiful because he already is 100 years” (Participant in 50s-early 60s focus group).

Overall, participants hoped to maintain their health and wellbeing into old age and continue their active way of living for a satisfying aging process.

The wellbeing of their children

The overwhelming majority (96%) of women in the study defined successful aging in terms of their children. To them, aging successfully means that their children are self-sufficient, independent, have a good job and financial stability to live well, and practice family values. Their children played a significant role when determining their own successful aging, ultimately utilizing their children’s success as a measurement for themselves.

Self-sufficiency

Of all factors discussed in the focus groups, their children’s self-sufficiency to live independently was most important. The women felt that preparing their children to live independently from them and taking advantage of the opportunities in the U.S. indicated their success. The push for their children to follow their goals and support themselves was described as, “Like I tell you, my phase of raising, caring, and educating my children is over. Now it is up to them what they want to achieve, but I’ve helped them as much as I could, my children are all grownups, and thanks to God they can support themselves” (Participant in 50s-early 60s focus group).

Live well

While children’s higher education was important to the mothers, many understood that it was beyond the interest of some of their children and therefore prioritized financial stability through employment. The mothers were flexible in terms of their expectations for their children, often citing that being good people and building their career based on their interests was a proud accomplishment. One woman summarizes the importance of her children’s independence for her own aging, “I want my children to be fulfilled, yes. That they have their job, maybe someone will not like school, but if I see they live well, for me that would be aging with dignity for myself, because I will be at peace seeing that my children are well. And then I could focus on myself, my husband, and that’s it” (Participant in 40s focus group).

Practice family values

Practicing family values or being good people was described as not being involved in gangs or drug use and, and instead striving to achieve their goals. This sentiment was summarized by a woman, “As a person, as a mother, you feel fulfilled seeing that your children didn’t get into trouble. That they’re doing something good for themselves. Because I tell them, maybe mom and dad cannot leave you an inheritance, but the only inheritance you will have, I tell them, is going to be your education. What do you want to achieve?” (Participant in 40s focus group).

In all, the women in this study prioritized their children and their wellness, both economically and health-wise, as determinants of their success. Raising their children is seen as an accomplishment and milestone for the mothers, ultimately defining their progression through life.

Independence

Independence was a key component of successful aging for all participants in the study. When imagining themselves as older, many participants explained the sadness and worry of not being able to take care of themselves. This lack of self-sufficiency and capability was viewed as unsuccessful aging because they would depend on others for basic needs to continue their lifestyle. One participant describes this dependence as, “If you reach a certain age is like becoming a child again because you’ll need a diaper, that someone feeds you in the mouth, and that they help you sit. Then, yes, that would be very difficult” (Participant in 40s focus group).

Preparing now to be independent in old age

With independence, conversation also diverged to feelings of freedom and ability to do what they wanted without external pressure. Additionally, they shared that one could plan to be independent in old age and saw what they were doing today linked to their future independence. “Liberty is, being worry-free, I can go out to walk, sleep, visit someone, I don’t have anything to pressure me. But it has a lot to do with what I’m doing today to prepare, right?” (Participant in 50s-early 60s focus group).

Not depending on their children

Additionally, most of the mothers added that independence would be exemplified through not depending on their children as they prepared for later life. On the one hand, mothers believed that their children were not obligated to care for them in old age, therefore withholding that expectation. On the other hand, they also revealed that their children’s independence and ability to live their own life raised concerns in terms of their motivation to care for them. For this reason, mothers spoke about not relying on their children because of instances where children focused on their own lives and put their parents aside. Interestingly, some mothers also added that they did not want to be a burden on their children and their families, ultimately deciding that being independent was best for all parties to avoid conflict. This concern was illustrated when one participant stated, “For me, like the fellow friend said, I would not like to reach an age when I have to depend on anyone, because when one becomes dependent on children, I have seen cases when the siblings fight because no one wants to care for their parents” (Participant in 40s focus group).

Maintaining family unity and relationships

Family unity and cohesion were noted to be of importance among participants as they considered the uncertainty of their future and need for independent preparedness. While there were mixed sentiments regarding the caring for future grandchildren, the women agreed they wanted future interactions with their children and grandchildren. One participant highlights this goal when stating, “I would like that my son gets married and gives me grandchildren because I can still help take care of them” (Participant in 40s focus group). However, some participants shared that they did not want to care for their grandchildren full time because they had already taken care of their own children and now wanted to focus on themselves. This was illustrated by one participant as, “I visualize myself with my husband [laughs]. Just the two of us, maybe with our grandchildren sometimes, but not taking care of them all the time. I imagine myself traveling, going to Mexico in seasons. That’s all” (Participant in the 40s focus group).

Above all, the women wished to age autonomously due to their familial concerns and ability to be self-sufficient.

Table 2. Summary of themes and subthemes.

Table 2. Themes/sub themes.

Exemplar Quotes
Having good health
    Being happy despite having an illness “Well, I feel well even though I have diabetes. I feel happy with my white hair, I’ve always been overweight… when I was younger, I was thin, but I continued to gain weight once married, but I am happy like this with my husband and my family” (participant in the 50s-early 60s focus group).
    Accepting changes in physical body “I am [laughs] I am aging successfully, even though I sometimes ask myself why I’m overweight? I’ve always been thin but after 40 I’ve gained some pounds despite taking care of my diet. I tell myself, I’m going to accept myself, and I accept that when one is older our metabolism is slower and is not going to be the same as when one is 20. I say I am going to accept it and be happy about how I’m aging, at my stage, I’m happy, at my age that I have I’m happy, I don’t feel old” (Participant in the 50s to early 60s focus group).
Maintaining an active lifestyle
    Exercise and everyday activities “I am. I feel like I’m aging satisfactorily because I’m healthy. I can walk. I can come and go. Do things for myself. I can still run after my children, a bit slowly, but I can reach them” (Participant in the 40s focus group).
    Work “He still comes, he does not stop working here [in US], or there [Mexico]. We tell him, “don’t work anymore,” “don’t go there anymore,” “retire already,” and he says, “Ay, my daughter, I can still do it” (Participant in 40s focus group).
The wellbeing of one’s children
    Self-sufficiency “Like I tell you, my phase of raising, caring, and educating my children is over. Now it is up to them what they want to achieve, but I’ve helped them as much as I could, my children are all grownups, and thanks to God they can support themselves” (Participant in 50s-early 60s focus group).
    Live well “I want my children to be fulfilled, yes. That they have their job, maybe someone will not like school, but if I see they live well, for me that would be aging with dignity for myself, because I will be at peace seeing that my children are well. And then I could focus on myself, my husband, and that’s it” (Participant in 40s focus group).
    Practice family values “As a person, as a mother, you feel fulfilled seeing that your children didn’t get into trouble. That they’re doing something good for themselves. Because I tell them, maybe mom and dad cannot leave you an inheritance, but the only inheritance you will have, I tell them, is going to be your education. What do you want to achieve?” (Participant in 40s focus group).
Independence
    Preparing now to be independent in old age “Liberty is, being worry-free, I can go out to walk, sleep, visit someone, I don’t have anything to pressure me. But it has a lot to do with what I’m doing today to prepare, right?” (Participant in 50s-early 60s focus group).
    Not depending on their children “For me, like the fellow friend said, I would not like to reach an age when I have to depend on anyone, because when one becomes dependent on children, I have seen cases when the siblings fight because no one wants to care for their parents” (Participant in 40s focus group).
    Maintaining family unity and relationships “I would like that my son gets married and gives me grandchildren because I can still help take care of them” (Participant in 40s focus group)
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Discussion

Middle aged Latinos residing in rural communities have been severely underrepresented in the successful aging literature. Latinos suffer from high morbidity and mortality due to preventive chronic conditions such as diabetes, high blood pressure, obesity, and cancer–and middle age is a crucial window of opportunity to prevent and manage these conditions. Therefore, it is important to capture Latino perspectives on successful aging in mid-life as this is a critical period during which to develop prevention and intervention strategies for later life.

Participants’ definitions of successful aging align to some extent with existing frameworks developed primarily among white participants over 60 years old [6, 9], specifically related to health and independence. They value health and share that accepting the physical changes in their bodies as part of a natural process is key to being happy. This is similar to a qualitative study of 30 Korean, Vietnamese, and Latino older adults, which found that Latinos participants were more likely than their Korean and Vietnamese counterparts to have a positive outlook and being happy despite having an illness [21]. This study found that while participants across focus groups value their health as key to aging successfully, older participants in the 50s- early 60s focus groups also defined successful aging as accepting the physical changes in their bodies with age as key to being happy. Participants’ independence or ability to maintain an active lifestyle without depending on their children or other people to do their activities of daily living is of extreme importance. Many shared that while they are still currently independent, they are fearful of the future if they cannot do many essential things without help. It was important for this group to not rely on their children to provide practical or financial help but that they maintain relationships with and proximity to children and grandchildren. Participants placed more emphasis on anticipating a desire for emotional support from their children than on other forms of assistance. This finding is similar to a qualitative study on positive aging among 101 Latino adults ages 60 and older, which found that Latino older adults value self-sufficiency while at the same time want to maintain strong relationships and connections with their children and extended networks [36].

Middle-aged Latina participants’ unique definitions of successful aging also align with prior findings including Chinese immigrants to a Western country, which found that participants saw their children’s success and wellbeing as essential to their own sense of aging well [37]. This group defined their own successful aging in terms of the success and wellbeing of their children in many aspects, including having a good job, accomplishing their goals, being good people and practicing family values. They reiterated that they would feel fulfilled and accomplished if their children were doing well. The strong focus on their children might be because all participants in the study have children, and the importance of familism as a cultural value creating a sense of obligation to take care of one’s family by providing the necessary emotional and instrumental social support when needed [38]. This finding reinforces previous findings including Chinese immigrants about the role of children on parental wellbeing and their own definitions of successful aging. This is also consistent with findings from other research on the interconnectedness between the wellbeing of aging parents and their children. For example, a quantitative study including 633 middle aged adults found that having even one child suffering from psychosocial problems was associated with poor parental wellbeing [39].

However, one aspect where our results diverge from existing successful aging frameworks is that in this group, maintaining an active lifestyle through work, household chores, and exercise was deemed as essential to maintain health and therefore successful aging of the mind and body. Interestingly, while exercise was discussed through traditional methods such as walking, for this group it also encompassed the physical demands of work. Participants also described others, mainly parents and family members, who they thought were aging successfully as being active and continuing to work until old age. This group also hoped to continue to work until old age in part because they wanted to continue an active lifestyle and in part because they want to be financially independent in old age and see the need to continue working after 65 to be able to accomplish this goal. This may be because Latino and Black workers have lower participation and contributions in employer sponsored retirement plans than do white workers, one of the factors contributing to them reaching the later years of life with substantially fewer economic resources [40]. Furthermore, participants in this study are employed mostly in low-wage jobs in the agriculture or service sectors, and struggle to afford the high cost of living in the Salinas Valley [41].

Newer successful aging frameworks include a consideration of the social context and social determinants of health. This is crucial because rural Latino neighborhoods in the United States possess limited access to health care, internet, transportation, and recreation infrastructure, which negatively impacts health outcomes and behaviors [11, 24]. The socioeconomic position for Latinos matters because overall, they have fewer resources to deal with preventable chronic conditions since they are overrepresented in low-wage jobs with no benefits such as health insurance. Health insurance instability has been associated with worse health outcomes including poor diabetes control among Latinos [26]. Insights from this study can help us better consider how to tailor interventions and preventive models for Latinas that center the wellbeing of the whole family, especially of children, as inseparable from the well-being and successful aging of Latina mothers.

It is important to examine successful aging among this group through a biopsychosocial perspective, which helps us understand the development of illness and health through the complex interaction of biological factors (genetic, biochemical, etc.), psychological factors (mood, personality, behaviour, etc.) and social factors (cultural, familial, socioeconomic, etc.) [42]. For participants in this study, accepting physical changes in their body, maintaining an active lifestyle through work, and the wellbeing of their children was critical for their own health and successful aging. Findings from this research highlight the interconnections between individual and group perceptions of successful aging and the underlying biology of health and disease. Furthermore, these findings align with existing research that shows a two-way relation between physical health and subjective wellbeing; poor health leads to reduced subjective wellbeing, while high subjective wellbeing can reduce physical health impairments [43]. Furthermore, a recent investigation from the Multi-Ethnic Study of Atherosclerosis (MESA) comprising 1036 participants of Black, Chinese-American, Hispanic and White origin showed that it is not race/ethnicity but cardiovascular risk factors such as age, smoking, hypertension, diabetes and socio-economic status, that determine the outcome on cognitive decline [44]. More research is needed to understand the complex interactions of biopsychosocial factors and their influence on Latino’s aging journeys in order to develop tailored prevention and intervention strategies for latter life.

Strengths and limitations

This study provides unique contributions to the successful aging literature because it includes a group that, to our knowledge, has not been included in successful aging studies, middle-aged Latina women residing in a rural agricultural community. Additionally, the study provides unique perspectives from a sample including more than half of participants who worked in agriculture across seven focus groups.

Although the data saturation was considered to have been achieved with the current participants, a larger number of participants from a wider range of Latino backgrounds residing in rural communities might have fully captured the perspectives of this diverse group. Furthermore, because we recruited participants from a long-term cohort study, we might have only attracted female participants who have been exposed to health-related messages, through educational events, informative newsletters, and other community events tailored to this cohort of women, some of whom have participated in the study for more than twenty years.

Conclusion

Participants’ definitions of successful aging align to some extent with existing frameworks, specifically related to health and independence. However, middle-aged Latina participants’ unique definitions of successful aging also diverged from existing frameworks, especially around the wellbeing of their children and the importance of work as a way of maintaining an active lifestyle. More research is needed to understand gender differences in similar research including mixed gender focus groups and the unique social context and circumstances of middle-aged Latinos and their families residing in rural communities and how it influences their aging journeys. Centering on the experiences of the whole family and taking a life course perspective on successful aging can provide important information for the development of culturally sensitive services, interventions, and policies to help Latinos age well. Middle age also represents an opportunity for practitioners and policymakers to support the successful aging of Latinos as they define it by creating the community conditions to support health, prevent disease and disability, and plan for the future.

Supporting information

S1 Checklist. COREQ (COnsolidated criteria for REporting Qualitative research) checklist.

(PDF)

Click here for additional data file. (347.1KB, pdf)
S1 Appendix. Focus group guide.

(DOCX)

Click here for additional data file. (18.3KB, docx)

Acknowledgments

We thank the participants who have helped us make this research possible. We are grateful to the CHAMACOS program and its staff for their assistance in recruiting focus groups participants and planning the focus groups.

Data Availability

The focus group data hold potentially identifying sensitive information regarding the participants, and it would therefore be unethical to make this public and would undermine the minimal risk ethical committee agreement and consent process. Please contact the University of California, San Francisco Institutional Review Board (IRB) to request anonymized focus group data access at CHR@ucsf.edu.

Funding Statement

All authors are supported by the National Institute on Aging R01069090. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Decision Letter 0

Callam Davidson

19 Dec 2022

PONE-D-22-28508Definitions of Successful Aging among Middle-Aged Latinas residing in a Rural Agricultural CommunityPLOS ONE

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Reviewer #1: I enjoyed reading this well-written manuscript, and found the results to be interesting and insightful. The study methods sound appropriate, and the findings provide new insights into Latino perspectives on successful ageing. I would very much like to see this work published, although I do think that there are a few issues that the authors should consider before the manuscript is ready for publication. I outline these below.

Main points

1. Insufficient attention is currently paid to the fact that the study only includes female participants. At the very least, this should be explained and justified in the introduction section. It is also something that could be worth exploring in the discussion section – especially when considering how the current findings differ to those of previous work in Latino populations e.g. what proportion of previous samples were female, and could the smaller proportions of female participants (or, indeed, the method of data collection e.g. if mixed gender focus groups were used) account for the differences in key themes that emerged? Based on these reflections, do you feel that gender differences should be explored further in similar research?

2. Your description of the analytical procedure is a little unclear, and lacks important detail. For instance:

a. What kind of coding did you use (and might you consider adding a table with some examples of the initial codes that you applied to some of the quotes from each theme?)?

b. What do you mean by ‘narratives’ and how do these differ from your themes?

c. More detail is needed to explain how you did your collaborative coding, and how you used the Consolidated Framework.

3. There is a fair bit of overlap between your first two themes, in that Theme 1 (‘Having Good Health and Accepting Changes in the Physical Body’) includes details of participants wanting to maintain active lifestyles, and to continue to take part in valued activities, and Theme 2 (‘Maintaining an Active Lifestyle’) then ends by mentioning participants’ desires to maintain their health and wellbeing. Whilst these two themes are logically related to one another, I felt that the content and narratives could be better organised so that there is a clearer distinction between the focus of each.

4. Whilst the introduction and discussion do a great job of considering what is known about Latino peoples’ perspectives on successful ageing, I think that the paper could be much improved by also considering how these findings compare to findings from other cultures and groups. For instance, which of the findings seem to be somewhat universal across cultures/groups, and which are more specific to Latinos, or to other groups with shared characteristics? For instance, work in this area conducted with Chinese immigrants to a Western country by Teh et al (2020: DOI: 10.1111/ajag.12677) found that participants saw their offspring’s success and wellbeing as integral to their own sense of ageing well. The work also highlights a similar tension between participants wanting their children to be independent, whilst also feeling concern at them not being there to take care of them as they age. It would therefore be useful to situate the current findings within this broader literature base so that such similarities and differences are highlighted.

5. In relation to the previous point, your argument in the discussion about the ‘unique contribution’ of ‘the important role of children’ that this work makes to ‘successful ageing frameworks’ is not accurate, as these points have already been made by authors such as Teh and colleagues.

Minor points

6. There are a couple of missing bits of text in the version of the manuscript that I saw. In particular:

a. The introduction paragraph of the abstract contains a question mark in place of a word (‘..rural Latinos experience more structural barriers than ? to access the conditions…’)

b. The penultimate sentence of the results section ends with empty quotation marks (‘This was illustrated by one participant as ‘’ ‘).

7. It would be useful to state the overall age range of the participants, rather than just the mean age, in the abstract, introduction, and methods section.

8. The first sentence of the second paragraph of the Background section (starting: ‘Latinos, especially rural Latinos, in the United States…’) should be supported with a citation.

9. It would be useful to know in the methods section how and why the particular subset of 70 responders were chosen from the 202 that contacted the research team.

10. The final couple of sentences of text in the ‘participants section’ (that describe the size of the focus groups, the dates of data collection, and the means of ethical approval) would seem better placed in the ‘data collection’ section.

11. I would suggest providing a more complete description of the topic guide in the main manuscript, as many readers will download the paper without the appendix, and so will not have access to this when reading the paper.

12. Could you explain why you chose to organise focus groups by age?

13. Some of the information in the demographics table is not useful. In particular, as you explain elsewhere that all of the participants were female, and that they all spoke Spanish, it doesn’t seem necessary to report the %s of these characteristics. I also felt that these demographic details of your sample might be better placed in your participants section, than your results, as they are descriptions of your sample rather than ‘findings’.

14. In the discussion section you mention that all of the participants had children. If this information was formally collected as part of the study, then it would be useful to report this when describing the characteristics of the sample.

15. It is not clear what you mean in the ‘strengths and limitations section by your sample being ‘robust’.

16. If word count is an issue, then I think that much of the first paragraph of the discussion could be omitted, as it repeats many points from the introduction. Other parts of the discussion also reiterate parts of the results section that are not needed. Some of your quotes could also be cut down.

Reviewer #2: This is a well-written paper on successful aging in Latinas in a rural community. This paper contributes to the literature by providing the perspectives of a unique population. I have some minor comments below for the authors to consider in revising their manuscript.

Introduction: The authors build a strong case for investigating successful aging in middle-aged Latinos. However, the introduction is missing some context as it pertains to women specifically, and related to the life expectancy of Latinas. These pieces are need to provide a rationale for the sample, and to provide context to the results.

Line 160: How did the researchers decide which participants to follow-up with? Why didn’t they follow-up with all participants? Some explanation is required here to provide more understanding of bias in the sample selection.

Line 163: How was it established that saturation was reached?

Table 1: Since only women were recruited, gender can be removed from the table. Also, did the authors ask about gender, or are they using biological sex?

Results: Since the focus groups were done in age-groups, can the authors address age differences in the findings? This comparison would help elucidate some of the issues or gaps that were identified in the introduction of the paper.

Results: Quotes should be pulled out from the paragraphs to improve readability and to highlight them.

Results: The high-level themes appear to have several sub-themes that are not clearly addressed. For example, it appears that weight came up on more than on occasion. Is there a sub-theme related to weight that might need to be highlighted? Similarly, some of the quotes suggest that perhaps the women had low self-esteem or were depressed. But perhaps there is a cultural component pertaining to humility that is being captured in these quotes instead. It would be nice to see a more thorough breakdown of the data. A table or figure could clearly provide the themes and sub-themes. This would also help with highlighting the novelty in the discussion as well i.e. cultural differences, age differences, etc.

Introduction and Discussion: Given that the age of the sample was much younger than samples who are typically included in studies regarding successful aging, it is important for the authors to highlight the sample of the age in the studies being used for comparison. Are there other studies that have asked about successful aging in middle-aged adults that can be used for direct comparison? It is also worth addressing the fact that the probing questions used across studies can vary significantly. For example, the current study included a question asking for examples of people who were aging successfully. Other studies may not have asked this directly, and therefore it may not have arisen as a theme. Comparison to previous literature needs to be put in the context of the age of the sample and the probing questions used.

Line 366: Did all of the women in the sample have children? If such a dimension is added to a framework, will it be inclusive of such women? I’m not sure I agree with the suggestion being made in this line.

Discussion: The rural aspect of the sample did not appear to come through in the discussion, other than in the section on physical demands of work. This is a novel aspect of the work, and might need to be better highlighted in the discussion.

Line 386: typo

Line 57: Typo

Reviewer #3: The authors studied what successful aging means among 40 middle-aged Latinas who participated in focus groups conducted within the context of the CHAMACOS Study in the Salinas Valley of California in 2021-2022.

In the Introduction, the authors provided an adequate summary of the state of the field of successful aging research based on relevant published work, highlighted gaps in knowledge about Latino populations, and articulated the rationale for their work. In the Methods, the authors provided adequate description of participant recruitment, conduct of focus groups, and thematic content analysis of the qualitative data. As reported in the Results, the authors observed four salient themes in participants’ personal definitions of successful aging: 1) good health & accepting physical changes; 2) active lifestyle; 3) children’s wellbeing; and 4) independence. In the Discussion/Conclusion, the authors asserted that the evidence supports some unique views of successful aging for this Latina population relative to other populations, for example the importance of children doing well in life.

I do not have any major comments for improvement. The paper was well-organized and contained all necessary information to be a valuable contribution to the successful aging literature. I have only some minor comments below.

MINOR COMMENTS:

1. Abstract: In the Abstract Introduction paragraph, there appears to be an incomplete sentence with a question mark in the middle.

2. Results/Discussion/Conclusion: The statement of the four identified themes appeared at least three times – first paragraph of Results, first paragraph of Discussion, last paragraph of Discussion (Conclusion). As I reader, I felt this was redundant. Consider stating the list of four themes only once (in the Results), and then omit the list from the Discussion paragraphs but rather use the Discussion paragraphs to explore implications of the four themes.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Evan L. Thacker, PhD

**********

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Decision Letter 1

Frank Kyei-Arthur

6 Apr 2023

PONE-D-22-28508R1Definitions of successful aging among middle-aged Latinas residing in a rural agricultural communityPLOS ONE

Dear Dr. Ambriz,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by May 21 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Frank Kyei-Arthur, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

I suggest the authors adequately address the comments of the reviewers to enhance their manuscript.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

Reviewer #4: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: No

Reviewer #4: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: As stated to the editor, i have no further comments for the authors. Not sure why there is a minimum word count for this box.

Reviewer #4: Please see attached file.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #2: No

Reviewer #4: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.<quillbot-extension-portal></quillbot-extension-portal>

Attachment

Submitted filename: Report on Ambriz et al_Resubm.pdf

Click here for additional data file. (228.2KB, pdf)
PLoS One. 2023 Nov 30;18(11):e0294887. doi: 10.1371/journal.pone.0294887.r004

Author response to Decision Letter 1

1 May 2023

We appreciate this comment and have explicitly addressed the connection between individual/group perceptions of wellbeing/successful aging and the underlying biology of health and disease in the discussion section. This recognition strengthens our paper and the complexity of the topic of successful aging.

Attachment

Submitted filename: Response to Reviewers_2.docx

Click here for additional data file. (14.6KB, docx)

Decision Letter 2

Frank Kyei-Arthur

14 Jun 2023

PONE-D-22-28508R2Definitions of successful aging among middle-aged Latinas residing in a rural agricultural communityPLOS ONE

Dear Dr. Ambriz,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

 Thank you for addressing the previous comments of reviewers. However, you still need to address the comments raised in the previous round relating to individual/group perceptions of successful aging and the underlying biology of health and disease. Addressing this comment will strengthen your manuscript. A copy of the previous comments is provided below and is included as an attachment.

Please submit your revised manuscript by Jul 28 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Frank Kyei-Arthur, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

The authors need to address the reviewer comment on the interconnections between individual/group perceptions of successful aging and the underlying biology of health and disease.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Ambritz and colleagues present a qualitative study on ‘successful aging’ from the perspective of

Latina women residing in a rural community. The group under study demographically

corresponds to 40 Latina women from a rural agricultural community, ethnically predominant

Mexican, within a middle age range of 40-49 (60%) and 50-59 (35%), 70% of them employed and

30% unemployed. The goal of the study was to investigate the perspectives on ‘successful aging’

by this group of Spanish speaking women, methodologically conducted by a facilitator in focus

groups, organized by age, using as a guide a questionnaire of 7 major questions about ‘successful

aging’, and contextual variations around each one of them, aiming at developing a more

complete picture of the viewpoints and perceptions on the topic by the group under

investigation. The conversations, lasting 2hs in each focus group were recorded and later

transcribed.

Good health and acceptance of body changes associated with aging, active lifestyle, children

wellbeing and independence were the major components of successful aging, as perceived by

the women group investigated.

Major comment

The premise of the study of highlighting the role played by psycho-social-cultural factors involved

in the perceptions of ‘successful aging’, and its findings as potential tools to promote and guide

policies leading to achieve healthy aging, are valuable complements of the biological perspective

on aging.

Although the present study raises an important point, for instance, the impact on the quality of

life of the participating women exerted by their children wellbeing, it is also true that if something

aggravating happens to a child it will be followed by an impact on mothers’ biology, e.g., immune

system, making them more prone to disease and degradation of life quality. The lack of explicit

recognition of the tight interconnections between individual/group perceptions of successful

aging and the underlying biology of health and disease is what this paper is missing. This

recognition strengthen rather than weakening the premise of the study while recognizing the

complexity of the topic, i.e., ‘successful aging’, that this paper approaches. This is why this

Reviewer notes that the approach utilized in this study is a ‘valuable complement’ of the

biological perspective on aging.

In regard of this, a recent investigation on cognitive decline and dementia in the Multi-Ethnic

Study of Atherosclerosis (MESA) comprising 1036 participants of Black, Chinese-American,

Hispanic and White origin, of which 53% were women, showed that it is not race/ethnicity but

cardiovascular risk factors such as age, smoking, hypertension, diabetes and socio-economic

status, that determine the outcome on cognitive decline (Austin, T.R. et al., 2022. JAHA).

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

<quillbot-extension-portal></quillbot-extension-portal>

PLoS One. 2023 Nov 30;18(11):e0294887. doi: 10.1371/journal.pone.0294887.r006

Author response to Decision Letter 2

11 Oct 2023

We appreciate this comment and have explicitly addressed the connection between individual/group perceptions of wellbeing/successful aging and the underlying biology of health and disease in the discussion section. We have also highlighted existing research that highlights the connection between biopsychosocial factors and health. This recognition strengthens our paper and our depth of understanding of the complexity of the topic of successful aging.

Attachment

Submitted filename: Response to Reviewers_10.10.23.docx

Click here for additional data file. (14.6KB, docx)

Decision Letter 3

Frank Kyei-Arthur

13 Nov 2023

Definitions of successful aging among middle-aged Latinas residing in a rural agricultural community

PONE-D-22-28508R3

Dear Dr. Ambriz,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Frank Kyei-Arthur, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

Reviewer #4: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #4: (No Response)

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: N/A

Reviewer #4: (No Response)

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: (No Response)

Reviewer #4: (No Response)

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #4: (No Response)

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: No further comments

No further comments

No further comments

No further comments

No further comments

No further comments

Reviewer #4: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

Reviewer #4: No

**********

Acceptance letter

Frank Kyei-Arthur

20 Nov 2023

PONE-D-22-28508R3

Definitions of successful aging among middle-aged Latinas residing in a rural agricultural community

Dear Dr. Ambriz:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Frank Kyei-Arthur

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Checklist. COREQ (COnsolidated criteria for REporting Qualitative research) checklist.

    (PDF)

    Click here for additional data file. (347.1KB, pdf)
    S1 Appendix. Focus group guide.

    (DOCX)

    Click here for additional data file. (18.3KB, docx)
    Attachment

    Submitted filename: Response to Reviewers.docx

    Click here for additional data file. (27.3KB, docx)
    Attachment

    Submitted filename: Report on Ambriz et al_Resubm.pdf

    Click here for additional data file. (228.2KB, pdf)
    Attachment

    Submitted filename: Response to Reviewers_2.docx

    Click here for additional data file. (14.6KB, docx)
    Attachment

    Submitted filename: Response to Reviewers_10.10.23.docx

    Click here for additional data file. (14.6KB, docx)

    Data Availability Statement

    The focus group data hold potentially identifying sensitive information regarding the participants, and it would therefore be unethical to make this public and would undermine the minimal risk ethical committee agreement and consent process. Please contact the University of California, San Francisco Institutional Review Board (IRB) to request anonymized focus group data access at CHR@ucsf.edu.

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