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Social Networks, Host Resistance, and Mortality: A Nine-Year Follow-Up Study of Alameda County Residents
Abstract
The relationship between social and community ties and mortality was assessed using the 1965 Human Population Laboratory survey of a random sample of 6928 adults in Alameda County, California and a subsequent nine-year mortality follow-up. The findings show that people who lacked social and community ties were more likely to die in the follow-up period than those with more extensive contacts. The age-adjusted relative risks for those most isolated when compared to those with the most social contacts were 2.3 for men and 2.8 for women. The association between social ties and mortality was found to be independent of self-reported physical health status at the time of the 1965 survey, year of death, socioeconomic status, and health practices such as smoking, alcoholic beverage consumption, obesity, physical activity, and utilization of preventive health services as well as a cumulative index of health practices.
... Additional social determinants of health questions were included in this survey to evaluate financial strain (Kahn and Pearlin, 2006;Puterman et al., 2012), stress (Elo et al., 2003), social isolation (Berkman and Syme, 1979;Ford et al., 2006;Pantell et al., 2013), and transportation accessibility (De Marchis et al., 2020). These questions have been utilized, scored, and validated in prior studies in the general population (Chagin et al., 2021). ...
Healthcare systems and providers have increasingly acknowledged the role and impact of social determinants in overall health. However, gender-diverse individuals face persistent health disparities due to their identities. There is limited research on the impact of clinical and sociodemographic characteristics on mood and quality of life (QoL) for transgender (TG) individuals. Our study aims to understand and better elucidate social and clinical characteristics of transmasculine (TM) and transfeminine (TF) individuals and their impact on quality of life and depressive symptoms. In this cross-sectional study, 298 TF and TM individuals on gender-affirming hormone therapy (GAHT) were surveyed about their demographic characteristics (age, gender identity, body mass index (BMI), and education), social needs, mood, and quality of life. Multivariable regression modelling was performed to assess the effect of each variable listed above on three domains of QoL (psychological, environmental, and physical) as well as depressive symptoms. We find that QoL scores are similar between TM and TF individuals, with scores in the psychological domain particularly low in both cohorts. TM individuals report higher rates of stress and restroom avoidance than TF individuals. In particular, psychological well-being (measured by the psychological domain of QoL and depressive symptoms) is significantly associated with increased BMI, financial instability, and stress in TM individuals while for TF individuals, psychological well-being is associated with stress and social integration. These data suggest that social circumstances are key drivers of QoL and psychological well-being among gender-diverse individuals receiving GAHT with specific differences between TF and TM individuals. This information may be utilized by healthcare providers and policymakers to address and improve clinical care and social policies to improve health equity for gender-diverse individuals.
... We defined SNs using 5 measures based on the definition of social connection and ties from the Berkman and Syme Social Networks Index (SNI): marital status, number of close friends, number of close relatives, number of friends or relatives visited monthly, and belonging to social groups. 18 For instance, participants were asked: How many relatives do you feel you are close to? How many of these friends or relatives do you see at least once per month? ...
Background
Cardiovascular disease (CVD) disproportionately affects Black adults. Greater social networks (SNs), or social connectedness, may lower the risk of CVD events. This study determined the association of SNs and incident CVD and tested mediation by depressive symptoms, hypertension control, and diabetes control.
Methods and Results
We used the Social Network Index at exam 1 (2000–2004) to develop a continuous standardized SN score and binary categories (high versus low) among participants in the Jackson Heart Study (n=4686; mean age, 54.8 years). Surveillance of coronary heart disease, stroke, and heart failure events occurred after exam 1 (2005 for HF) until 2016. Using Cox proportional hazards regression, we estimated the association of SNs and CVD events by sex and tested the mediation of depressive symptoms, hypertension control, and diabetes control. Models adjusted for age, education, health behaviors, CVD comorbidities, and depressive symptoms. Among women, the SN score was associated with a lower hazard of stroke, coronary heart disease, and heart failure after full adjustment (hazard ratio [HR], 0.78 [95% CI, 0.64–0.95]; HR, 0.79 [95% CI, 0.71–0.88]; and HR, 0.78 [95% CI, 0.66–0.92], respectively). SN scores were also associated with a lower hazard of coronary heart disease in men (HR, 0.84 [95% CI, 0.75–0.94]) after full adjustment. High versus low SNs were associated with a lower hazard of coronary heart disease and heart failure among women after full adjustment. There was no evidence of mediation by depressive symptoms, diabetes control, and hypertension control.
Conclusions
Higher SNs may lower the risk of CVD events, especially in women.
The concepts of disease, illness, and sickness, included in Twaddle triad, capture fundamentally different aspects of human health including medical, personal, anthropological, and social related phenomena. All the aforementioned scientific disciplines offer a variety of valuable insights, but they are not strongly connected to each other to describe a unique vision of health phenomena, and this represents a gap in the current literature. This article provides a review of the theoretical discussions on the Twaddle Triad, considering critiques and elements of interest, analyzing its connections with the concepts and the processes of recovery. The concept of recovery has been fully linked to Twaddle triad by means of its three main processes, curing, healing, and habilitating, in order to arrive to a new framework proposal that is able, connecting variables and attributes of each framing concept, to better describe and deepen multifaceted elements around different types of health problems.
Background: Ambient air pollution, detrimental built and social environments, social isolation (SI), low socioeconomic status (SES), and rural (versus urban) residence have been associated with cognitive decline and risk of Alzheimer’s disease and related dementias (ADRD). Research is needed to investigate the influence of ambient air pollution and built and social environments on SI and cognitive decline among rural, disadvantaged, ethnic minority communities. To address this gap, this cohort study will recruit an ethnoracially diverse, rural Florida sample in geographic proximity to seasonal agricultural burning. We will (1) examine contributions of smoke-related fine particulate matter (PM2.5) exposures to SI and cognitive function; (2) determine effects of built and social environments on SI and cognitive function; and (3) contextualize SI and cognitive function among residents from different ethnoracial groups during burn and non-burn seasons.
Methods: We will recruit 1,087 community-dwelling, dementia-free, >=45-year-olds from five communities in Florida’s Lake Okeechobee region. Over 36 months, participants will complete baseline visits to collect demographics, health history, and health measurements (e.g., blood pressure, body mass index) and 6-month follow-ups assessing cognitive function and social isolation at each visit. A subsample of 120 participants representative of each community will wear smartwatches to collect sensor data (e.g., heart rate) and daily routine and predefined activities (e.g., GPS-captured travel, frequent destinations) over two months. Ecological momentary assessments (EMA) (e.g., whether smoke has bothered participant in last 30 minutes) will occur over two months during agricultural burning and non-burning months. PurpleAir monitors (36 total) will be installed in each community to continuously monitor outdoor PM2.5 levels.
Ethics and expected impact: This study received Florida Atlantic University’s Institutional Review Board approval and will require participant informed consent. We expect to identify individual- and community-level factors that increase the risk for SI and cognitive decline in a vulnerable rural population.
This study was designed to identify the relationship between perceived social sup port and the mental health status of persons receiving psychiatric care as out-patients.The purpose was to contribute to the theoretical understanding of the relationship between these two concepts and eventually to the enhancement of theoretically directed nursing care.The subjets for this study were 54 patients receiving treatment for mental illness in an out-patient clinic or out-patient rehabilitation program at one of three general hospitals, a private clinic, or a social welfare institute.The data were collected from sept.2 to 20, 1991.Perceived social support was measured by the Social Support Scale developed by Bak, Ji-Won. A questionnare developed by Derogatis, et al (1976) and modified by lee (1986) was used to measure mental health status.The data were analyzed by desciptive statistics and t-test, ANOVA, and pearson coorelation coefficients, using an S.P.S.S, program. The results of this study can be summerized as follows :1. The mean perceived social support was 2.52 in a possible range of 0 to 4, and the major source of social support was the mother(83.3%). The major type ctf support was emotional(44.7%), and the frequency of contact with the supportive person ranged from once a week to once a week to once a month.2. The mean mental health status was 0. 9456 in possible range of 0 to 4. The severity of the subscales ranged down in the following order : obscession, depression, somatization, phobic anxiety, anxiety, hostility, paranoid ideation, interpersonal sensitivity, and psychosis.3. The relationship bewteen preceived social support and mental health status was not significant(r= 0.2124, p>0.05), but there were relationship between certain subscales of the independent and dependent variables.Variables related to appraisal support were the total mental health status (r= -0.2756, P<0.05), hostility(r=-0.2305, p<0.05), interpersonal sensitivity(r=-0. 2546, p<0.05). and psychosis(r= -0.3034, p<0.05).Psychosis was related to emotional support (r= -0.2332, p<0.05) and to total social supprot(r= -0.2300, p<0.05).For this sample, some subscales dimensions of social support may have and affect on some aspects of mental health status.Future research of these conceptual relationships is essential to the development of theoretical nursing to give direction to the planning of scientifically sound nursing care.
Background
Neighborhood factors of social isolation have been understudied, hindering efforts to reduce social isolation at the neighborhood level. This study aims to investigate the longitudinal effects of neighborhood social cohesion and physical disorder on social isolation in community-dwelling older adults, as well as to examine whether race/ethnicity moderates the neighborhood-isolation relationship.
Methods
We used 11-year data from the National Health and Aging Trend Study, a longitudinal national study of Medicare beneficiaries aged 65 and older. Social isolation was measured through a summary score across four domains: marital/partner status, family and friend contact, religious attendance, and club participation. A series of weighted mixed-effects logistic regression models were performed to test the study aims. Sample sizes ranged from 7,303 to 7,291 across individual domains of social isolation.
Results
Approximately 20% of participants reported social isolation. Findings indicated a negative association between neighborhood social cohesion and social isolation. Higher levels of neighborhood social cohesion were longitudinally associated with lower odds of social isolation (odds ratio [OR] = 0.52, 95% CI: 0.47–0.58). Yet, the presence of neighborhood physical disorder was associated with an increased risk of overall social isolation ([OR] = 1.2, 95% CI: 1.00, 1.44). Race/ethnicity significantly moderated the effects of neighborhood social cohesion and physical disorder on social isolation. The odds of no in-person visits associated with neighborhood social cohesion are smaller among Black adults compared to White adults. Black adults had constantly lower odds of isolation from religious attendance compared to White adults regardless of the level of neighborhood social cohesion. Hispanic adults had decreased odds of having no friends associated with signs of physical disorder, while no associations were found among older White adults. White adults had higher odds of isolation from in-person visits when living in neighborhoods with signs of physical disorder, whereas no association was observed among older Black and Hispanic adults.
Conclusions
This study elucidates the role of neighborhood characteristics in shaping social isolation dynamics among older adults. Furthermore, the observed moderation effects of race/ethnicity suggest the need for culturally sensitive interventions tailored to address social isolation within specific neighborhood and racial contexts.
Background
Social isolation is a well-known risk factor for poor health outcomes, including incident dementia, yet its associations with outcomes among persons living with dementia is understudied. We examined the association between social isolation and hospitalization among a nationally representative sample of older adults with and without dementia.
Methods
This observational cohort study included 5,533 community-dwelling Medicare beneficiaries from the 2015 and 2016 National Health and Aging Trends Study (NHATS). Using multivariable logistic regression analyses, we examined associations between social isolation and hospitalization in the following year, examining differences by dementia status. Social isolation was measured using a 4-item typology. Dementia was identified using a pre-specified classification in NHATS.
Results
20.7% of older adults were socially isolated. Social isolation was more prevalent among persons with dementia (35.4%) than among those without dementia (19.0%) (p < .001). Among persons with dementia, social isolation was associated with 1.68 greater odds of hospitalization (CI: 1.23‒2.28), translating into a 9% average increase in the predicted probability of hospitalization for persons with dementia who were socially isolated compared to those who were not (p = 0.001). In the combined sample that included persons with and without dementia, there was a significant moderation effect of dementia on the association between social isolation and hospitalization (OR: 1.70; CI: 1.19‒2.43).
Conclusions
For persons with dementia, social isolation is prevalent and associated with greater odds of subsequent hospitalization. Efforts to reduce acute healthcare utilization should explore ways to bolster social connection to improve health outcomes among persons with dementia.
Both physical activity and social network size decline as people age. However, limited research has examined if social network size and contact frequency differentially influence physical activity across the adult lifespan. This study aimed to assess if these social network characteristics moderated the relationship between age and physical activity level across adulthood. Multiple regression analyses were conducted to examine the main-effect association between age, past-week physical activity, and past-year physical activity, as well as the moderating effect of social network characteristics (i.e., friend network size, friend contact frequency, relative network size, and relative contact frequency) on age-physical activity associations. The results revealed that friend network size had moderated associations between age and past-week physical activity (β = −7.03; p = .025, f² = 0.13) and past-year physical activity (β = −585.52; p = .017, f² = 0.15). Specifically, adults who were older and had smaller friend networks performed more minutes of moderate–vigorous physical activity (MVPA) over the past week and past year; on the other hand, adults who were younger and had larger friend networks performed more minutes of MVPA over the past week and past year. Relative network size, friend contact frequency, and relative contact frequency did not moderate the relationship between age and past-week physical activity and past-year physical activity. These findings suggested that building friend networks throughout adulthood may help promote active living across the adult lifespan.
Objective
To identify the defining attributes, antecedents, consequences and empirical referents to form an operational definition of social isolation in people with type 2 diabetes.
Design
The Walker and Avant approach.
Data source
An electronic search of the literature using China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, Web of Science, CINAHL, and PsycINFO informed the analysis. The search included both quantitative and qualitative studies related to social isolation in people with type 2 diabetes published in Chinese and English.
Results
Of the 2918 articles identified, 21 ultimately met the inclusion criteria. The analysis identified the defining attributes of social isolation in people with type 2 diabetes as objective and subjective. Antecedents included five aspects: personal characteristics, disease-related physiological factors, and psychological, behavioral, and social factors. Consequences were identified as physiological, psychological, behavioral aspects and quality of life.
Conclusions
The operational definition of social isolation in people with type 2 diabetes is that due to personal characteristics, disease-related physiological factors, and psychological, behavioral, and social factors, people with type 2 diabetes will have limited social networks and social support, reduced social contact and social involvement, and/or negative feelings of disconnection from the outside world, which lead to adverse physiological, psychological, and behavioral outcomes and poor quality of life. Clinicians can further develop tools to measure social isolation in people with type 2 diabetes and analyze the path of the antecedents to social isolation to investigate the interplay between them in order to develop target interventions.
As health and health care systems continue to face massive challenges from local to global well-being, understanding the processes that lead to improvement or deterioration in human health has embraced a broad range of forces from genes to national cultures. Despite the many efforts to deploy a common framework that captures diverse drivers at scale, the common missing element is the absence of a flexible mechanism that can guide research within and across levels. This hinders both the cumulation of knowledge and the development of a scientific foundation for multiplex interventions. However, studies across disciplines using a wide variety of methods and measures have converged on “connectedness” as crucial to understanding how factors operate in the health space. More formally, a focus on the critical role of the network structure and content of key elements and how they interact, rather than just on the elements themselves, offers both a generalized theory of active factors within levels and the potential to theorize interactions across levels. One critical contemporary health crisis, suicide, is deployed to illustrate the Network Embedded Symbiome Framework. The wide range of health and health care research where networks have been implicated supports its potential but also cautions against inevitable limits that will require creative theorizing and data harmonization to move forward.
Background
Loneliness and social isolation have been found to be associated with various health-related outcomes. Our study aimed to evaluate the association of loneliness and social isolation with the risk of glaucoma.
Methods
A total of 373,330 participants from the UK Biobank without glaucoma at recruitment were included in this study. Self-reported questionnaires were used to define loneliness and social isolation. Incident glaucoma events were identified by hospital inpatient admissions and self-reported data. COX proportional hazards models adjusted for sociodemographic, lifestyle, and health-related factors were used to estimate hazard ratios (HRs) and 95% CIs.
Results
During a median follow-up of 13.1 (interquartile range: 12.3–13.9) years, 6,489 participants developed glaucoma. After adjusting for confounding factors, loneliness (yes vs. no: adjusted HR: 1.16; 95% CI: 1.04–1.30; P = 0.009) and social isolation (yes vs. no: adjusted HR: 1.08; 95% CI: 1.01–1.16; P = 0.033) were associated with an increased risk of glaucoma.
Conclusions
In this population-based prospective cohort study, loneliness and social isolation were associated with a higher risk of glaucoma.
Importance
Understanding how attachment to pets can alleviate depression and anxiety offers valuable insights for developing preventive and therapeutic strategies, particularly for those with insecure attachment styles from childhood trauma.
Objective
To determine if a close bond with a pet is associated with reduced depression and anxiety, especially among women who experienced childhood abuse.
Design, Setting, and Participants
This cross-sectional study involved women who voluntarily enrolled in the Mind Body Study (MBS), a substudy of the Nurses’ Health Study II (NHS2) focusing on psychosocial factors. Women reporting childhood abuse were oversampled to capture their psychosocial distress in adulthood. MBS participants were invited to complete comprehensive online questionnaires, which were administered twice (March 2013 and February 2014).
Exposure
Pet attachment measured by Lexington Attachment to Pets Scale (LAPS).
Main Outcomes and Measures
Levels of depression and anxiety (10-item Centre for Epidemiologic Studies Depression Scale [CESD-10]; Kessler Psychological Distress Scale [K6]; 7-item Generalized Anxiety Disorder scale [GAD-7]; Crown Crisp Experiential Index phobic anxiety subscale [CCI]), considered individually and combined into an overall z -score measure of anxiety and depression symptoms.
Results
A total of 214 women (mean [SD] age, 60.8 [3.9] years) were included; 156 women (72.6%) reported a history of childhood abuse. Of 688 invited MBS participants in 2013, 293 (42.6%) expressed interest; there were 228 completed questionnaires (response rate, 77.8%) in 2013 and 208 questionnaires (response rate, 71.0%) in 2014. LAPS scores were provided by 140 participants (65.4%), 78 (55.7%) for dogs and 46 (32.9%) for cats. Overall higher pet attachment on the LAPS score was significantly associated with lower GAD-7 scores (β = −0.17; 95% CI, −0.29 to −0.06), but there was no association for phobic anxiety or depression. There were no statistically significant associations between cat attachment and depression or anxiety. Higher dog attachment was associated with significantly lower scores in depression (CESD-10: β, −0.47; 95% CI, −0.68 to −0.26; K6: β = −0.42; 95% CI, −0.54 to −0.31), generalized anxiety (GAD-7: β = −0.47; 95% CI, −0.65 to −0.3), and the overall measure of anxiety and depression ( z score: β = −0.12; 95% CI, −0.17 to −0.08), but there was no association between dog attachment and phobic anxiety (CCI: β = −0.08; 95% CI, −0.24 to 0.09). All effect sizes for associations were higher when analyses were restricted to women with a history of childhood abuse.
Conclusions and relevance
In this explorative cross-sectional study, strong attachment to pets, especially dogs, was associated with lower anxiety and depression symptoms. The favorable association was particularly apparent in women with a history of childhood abuse.
Background: Midlife residential exposure to greenspace may slow cognitive decline by increasing opportunities for physical activity and social connection, restoring attention, or reducing stress or adverse environmental exposures. However, prospective studies on the association between greenness and cognitive decline are sparse.
Objective: We investigated the prospective association between greenness at midlife and cognitive decline later in life. We explored effect measure modification by apolipoprotein E (APOE)-ɛ4 carrier status, neighborhood socioeconomic status (NSES), and rural/urban regions.
Methods: The Nurses’ Health Study (𝑁=121,700) started in 1976 with married female nurses, 30–55 years of age, located across 11 US states. We examined 16,962 nurses who were enrolled in a substudy starting in 1995–2001 (mean age=74y) through 2008. We assessed average summer residential greenness in a 270-m buffer using Landsat Normalized Difference Vegetation Index data from 1986–1994. Starting in 1995–2001, participants underwent up to four repeated measures of five cognitive tests. A global composite score was calculated as the average of all 𝑧-scores for each task to evaluate overall cognition. We used linear mixed models to evaluate the association of average greenness exposure at midlife with cognitive decline in later life, adjusted for age, education, NSES, and depression.
Results: In adjusted models, higher midlife greenness exposure [per interquartile range (IQR): 0.18] was associated with a 0.004-unit (95% CI: 0.001, 0.006) slower annual rate of cognitive decline. For comparison, we found that 1 year of age is related to a −0.006 mean annual difference for global cognition in the full sample; thus, higher midlife greenness appeared equivalent to slowing cognitive decline by ∼8 months. In analysis exploring gene–environment interactions, we found that among APOE-ɛ4 carriers, an IQR increase in greenness was associated with a rate of decline that was slower by 0.01 units of global composite score (95% CI: 0.0004, 0.02). This association was attenuated among APOE-ɛ4 noncarriers. We did not observe associations between greenness and baseline or annual rate of cognitive decline of verbal memory.
Discussion: Higher midlife greenness exposure is associated with slower cognitive decline later in life. Future research is necessary to confirm these findings. https://doi.org/10.1289/EHP13588
Background
Social support is associated with improved clinical outcomes but is understudied among US immigrants. We examined two types of social support, perceived health provider support and community support, and characterized perceptions of social support among US immigrants compared with nonimmigrants.
Methods
We conducted cross-sectional data analysis on self-reported data from Health Information National Trends Survey 5, Cycle 2. Population-level estimates were obtained using jack-knife replicate weights.
Results
Immigrant status was not associated with perceived health care provider support or community support. However, compared with nonimmigrants, US immigrants were more likely to report rarely (adjusted odds ratio [aOR]=3.07) or never (aOR=3.18) having access to emotional support.
Conclusions
Further research that incorporates nuanced factors (eg, time since arrival) that may influence social support in diverse US immigrant groups is needed to determine the impact of social support on health outcomes in an underserved and often overlooked population.
Importance
There are limited data on whether the vulnerabilities and impacts of social isolation vary across populations.
Objective
To explore the association between social isolation and mortality due to all causes, cardiovascular diseases (CVD), and malignant neoplasms focusing on heterogeneity by sociodemographic factors.
Design, Setting, and Participants
This cohort study used a moderator-wide approach to examine the heterogeneity in the association of social isolation with all-cause, CVD, and malignant neoplasm mortality using baseline data from the Japan Gerontological Evaluation Study in 2010 and 2011. Eligible participants were adults aged 65 years or older without heart disease, stroke, cancer, or impaired activity of daily living across 12 Japanese municipalities. Follow-up continued until December 31, 2017, identifying 6-year all-cause, cardiovascular disease (CVD), and malignant neoplasm mortality. Logistic regression assessed effect modification by age, gender, education, income, population density, marital status, and employment on mortality associations. Data analysis was performed from September 13, 2023, to March 17, 2024.
Exposure
Social isolation, determined by a 3-item scale (scores of 2 or 3 indicating isolation) was the primary exposure variable.
Main Outcomes and Measures
Six-year all-cause, CVD, and malignant neoplasms mortality.
Results
This study included 37 604 older adults, with a mean (SD) age of 73.5 (5.9) years (21 073 women [56.0%]). A total of 10 094 participants (26.8%) were classified as experiencing social isolation. Social isolation was associated with increased all-cause (odds ratio [OR], 1.20 [95% CI, 1.09-1.32]), CVD (OR, 1.22 [95% CI, 0.98-1.52]), and malignant neoplasm mortality (OR, 1.14 [95% CI, 1.01-1.28]). Stratified analysis showed associations of social isolation with all-cause and malignant neoplasm mortality among people with high income (highest tertile all cause: OR, 1.27 [95% CI, 1.06-1.53]; malignant neoplasm: OR, 1.27 [95% CI, 1.02-1.60]), living in areas with high population density (highest tertile all cause: OR, 1.47 [95% CI, 1.26-1.72]; malignant neoplasm: OR, 1.38 [95% CI, 1.11-1.70]), not married (all cause: OR, 1.33 [95% CI, 1.15-1.53]; malignant neoplasm: OR, 1.25 [95% CI, 1.02-1.52]), and retirees (all cause: OR, 1.27 [95% CI, 1.14-1.43]; malignant neoplasm: OR, 1.27 [95% CI, 1.10-1.48]). Formal testing for effect modification indicated modification by population density and employment for all-cause mortality and by household income and employment for neoplasm mortality.
Conclusions and Relevance
Social isolation was associated with increased risks of all-cause, CVD, and malignant neoplasm mortality, with associations varying across populations. This study fills an important gap in research on social isolation, emphasizing its varied associations across demographic and socioeconomic groups.
Background
Erectile dysfunction (ED) is a prevalent condition that affects middle-aged and older men, impacting their sexual health and overall wellbeing. We aimed to investigate the relationship between social support and ED among this specific population.
Methods
Data were collected from the National Health and Nutrition Examination Survey. Social support was assessed through various dimensions, including emotional support, material support, and network support. Multivariate logistic regression was performed to examine the association between social support and ED, and a propensity-score-matched (PSM) analysis was further conducted.
Results
Among 1938 middle-aged and older males in the United States, 49.9% had a history of ED. ED was more prevalent in older individuals and those with comorbidities such as hypertension, prostate disease, higher serum creatinine level, and mental problems. Males with lower social support scores had a higher weighted rate of ED (P < 0.001). After adjusting for multiple variables in logistic regression analysis, a higher social support score was associated with a 19% lower likelihood of ED (weighted odds ratio [OR] 0.81, 95% confidence interval [CI] 0.66–0.98, P = 0.032). The association remained consistent after propensity score matching (OR 0.80, 95% CI 0.66–0.98, P = 0.028).
Conclusion
Social support appears to be associated with a reduced risk of ED in middle-aged and older men. Further research is needed to better understand this relationship and explore interventions that enhance social support, potentially leading to improved sexual health outcomes.
From the perspective of sociologists involved in various project activities in the field of health, the affirmation of medical sociology in BiH society is undoubtedly necessary. It is not only about strengthening its theoretical and educational components, it is also about its development as an applied discipline, which has the capacity to solve complex social issues in the field of health, and to be recognized as such by health professionals. The potential of qualitative methodology is underutilized in research studies and public policy analysis. The paper seeks to point out the contribution of applied medical sociology to the creation of public health policies and to the affirmation of a qualitative approach to conducting research in this field.
Community cohesion plays a critical role in the determination of an individual’s health in social science. Intriguingly, a community structure of gene networks indicates that the concept of community cohesion could be applied between the genes as well to overcome the limitations of single gene-based biomarkers for precision oncology. Here, we develop community cohesion scores which precisely quantify the community ability to retain the interactions between the genes and their cellular functions in each individualized gene network. Using breast cancer as a proof-of-concept study, we measure the community cohesion score profiles of 950 case samples and predict the individualized therapeutic targets in 2-fold. First, we prioritize them by finding druggable genes present in the community with the most and relatively decreased scores in each individual. Then, we pinpoint more individualized therapeutic targets by discovering the genes which greatly contribute to the community cohesion looseness in each individualized gene network. Compared with the previous approaches, the community cohesion scores show at least four times higher performance in predicting effective individualized chemotherapy targets based on drug sensitivity data. Furthermore, the community cohesion scores successfully discover the known breast cancer subtypes and we suggest new targeted therapy targets for triple negative breast cancer (e.g. KIT and GABRP). Lastly, we demonstrate that the community cohesion scores can predict tamoxifen responses in ER+ breast cancer and suggest potential combination therapies (e.g. NAMPT and RXRA inhibitors) to reduce endocrine therapy resistance based on individualized characteristics. Our method opens new perspectives for the biomarker development in precision oncology.
Background
Individuals’ sense of belonging (SoB) to their neighborhood is an understudied psychosocial factor that may influence the association between neighborhood characteristics, health, and disparities across socio-demographic groups.
Methods
Using 2014–2016 data from the Survey of the Health of Wisconsin (SHOW, N = 1,706), we conduct a detailed analysis of SoB and health in an American context. We construct OLS and logistic regressions estimating belonging’s association with general, physical, and mental health. We explore geographic, racial, and socioeconomic variation to understand both the differential distribution of SoB and its heterogeneous relationship with health.
Results
A higher SoB is positively associated with better physical, mental, and general health. White participants report higher SoB than Black participants, yet the association between SoB and mental health is strongest among participants of color and urban residents.
Conclusion
Sense of belonging to neighborhood significantly predicts many facets of health, with place and individual characteristics appearing to moderate this relationship. Racial, geographic, and socioeconomic disparities in belonging-health associations raise important questions about who benefits from the social, economic, and physical aspects of local communities.
Introduction
The population of older adults is growing disproportionately, constituting 13% of the global population in 2022, and is expected to double by 2050. One of public health’s priorities is healthy aging, the maintenance of functional ability aligned with well-being. As many as 50% of older adults report poor sleep quality, leading to an increased risk of morbidity and mortality. The quality and quantity of social relationships may broadly benefit sleep in older adults. However, the concept of socially-supported sleep is underdeveloped as a basis for intervention.
Methods
Existing literature was searched without time restriction in PubMed, CINAHL, PsycINFO, and Scopus ending in August 2022. Thematic analysis was used to determine the defining attributes, antecedents, and consequences of socially-supported sleep guided by Rodgers’ evolutionary concept analysis.
Results
Twenty-nine articles written in English, peer-reviewed, and examined social support and sleep in participants aged ≥50 were included. The defining attributes reflect dimensions of sleep quality. The antecedents are safe and secure, belonging and connection, and warmth and comfort. The consequences of socially-supported sleep include improved regulatory capabilities, physical and emotional well-being, and quality of life.
Conclusion
Socially-supported sleep has the potential to inform interventions that promote sleep in older adults. Ongoing research is needed to address the antecedents and mechanisms through which socially-supported sleep may promote sleep quality for healthy aging.
During the start of the COVID-19 pandemic in 2020, lockdowns and movement restrictions were thought to negatively impact population mental health, since depression and anxiety symptoms were frequently reported. This study investigates the effect of COVID-19 mitigation measures on mental health across the United States, at county and state levels using difference-in-differences analysis. It examines the effect on mental health facility usage and the prevalence of mental illnesses, drawing on large-scale medical claims data for mental health patients joined with publicly available state- and county-specific COVID-19 cases and lockdown information. For consistency, the main focus is on two types of social distancing policies, stay-at-home and school closure orders. Results show that lockdown has significantly and causally increased the usage of mental health facilities in regions with lockdowns in comparison to regions without such lockdowns. Particularly, resource usage increased by 18% in regions with a lockdown compared to 1% decline in regions without a lockdown. Also, female populations have been exposed to a larger lockdown effect on their mental health. Diagnosis of panic disorders and reaction to severe stress significantly increased by the lockdown. Mental health was more sensitive to lockdowns than to the presence of the pandemic itself. The effects of the lockdown increased over an extended time to the end of December 2020.
Objectives
More frequent engagement in social activity is often associated with better physical health outcomes. Yet, less is known about whether engagement in a greater variety of social activities such as a mix of volunteering and attending club meetings (social activity variety) is important for health. The current study assessed whether social activity variety relates to mortality risk after adjusting for social activity frequency, non-social activity frequency and variety, and sociodemographic covariates, and how this relationship varies depending on age.
Method
Using data from the Health and Retirement Study (HRS), we included 5,017 adults aged 51 and older who completed questions about social activity participation in 2008 and whose mortality status was recorded up to 2019. We also examined whether age moderated the relationship between social activity variety and mortality risk.
Results
Cox proportional hazard model analyses revealed that those with higher activity variety in social activities were more likely to survive over the following 11 years than those with low social activity variety. Moreover, age moderation indicated that the association between social activity variety with mortality risk was stronger among the oldest adults.
Discussion
Findings suggest that a greater variety of social activities is linked to mortality risk even after adjusting for social activity frequency, non-social activities, and health status across adulthood.
We propose a psychologically-informed concept of social health to join physical and mental components in a more comprehensive assessment of human health. Although there is an extensive literature on the importance of social relationships to health, a theoretical framework is needed to coalesce this work into a codified conceptualisation of social health, defined here as adequate quantity and quality of relationships in a particular context to meet an individual’s need for meaningful human connection. Informing this novel conceptualisation, we outline eight key propositions to guide future research and theory on social health, including five propositions focused on the conceptualisation of social health and three focused on its population patterning. The former five propositions include that social health is an outcome in its own right, that health interventions can have divergent effects on social versus physical and mental aspects of health, that social health has independent effects on quality of life, that it is a dynamic and contextual construct, and that it is embedded and encoded in the human body (and mind). The utility of the social health concept is further revealed in its significance for understanding and addressing population health concerns, such as health inequalities experienced by marginalised groups.
Objective
Social relationships have been extensively researched as having compelling health benefits. Nevertheless, these issues are understudied in low-income countries like India. This study investigates whether intergenerational solidarity or the social relationship developed in the household context and social participation or the social relationships developed in the community context are the critical determinants of subjective wellbeing (SWB) of older adults in India. In addition, this study also investigates whether gender moderates the association between social relationships and subjective wellbeing (SWB).
Methods
This study utilises a latent variable approach to investigate the association between social relationships and SWB among older adults (aged 60 or older, N = 9,852) based on a cross-sectional analysis of data from Building a Knowledge Base on Population Ageing in India (BKPAI) (2011). I tested the moderating effect of gender by employing a multigroup analysis in structural equation modelling that incorporated social relationships and other predictors of SWB.
Results
The study suggests that social participation has a significant protective impact on elderlies’ SWB, and gender doesn’t moderate the relation. Intergenerational solidarity has a significant health protective impact on older adults’ SWB; there is a significant moderating impact of gender. Specifically, functional and consensual solidarity have significant moderating effects of gender. Affectional solidarity, although a significant predictor of older adults’ SWB, and gender don’t moderate the relation.
Conclusion
The study suggests taking into account a variety of social relationships as well as gender roles when attempting to understand SWB at a later age. The results are discussed in terms of how gender roles impact social relationships and how men and women evaluate SWB differently based on those relationships.
Background:
Multimorbidity is associated with increased rate of cognitive decline with age. It is unknown whether social engagement, which is associated with reduced risk of dementia, modifies associations between multimorbidity and cognitive decline.
Objective:
To examine the associations of multimorbidity with longitudinal cognitive test performance among community-dwelling older adults, and to determine whether associations differed by levels of social engagement.
Methods:
We used data from the Rancho Bernardo Study of Healthy Aging, a community-based prospective cohort study. Starting in 1992-1996, participants completed a battery of cognitive function tests at up to 6 study visits over 23.7 (mean = 7.2) years. Multimorbidity was defined as≥2 of 14 chronic diseases. Social engagement was assessed using items based on the Berkman-Syme Social Network Index. Multivariable linear mixed-effects models were used to test associations of multimorbidity and cognitive performance trajectories. Effect measure modification by social engagement was evaluated.
Results:
Among 1,381 participants (mean age = 74.5 years; 60.8% women; 98.8% non-Hispanic White), 37.1% had multimorbidity and 35.1% had low social engagement. Multimorbidity was associated with faster declines in Mini-Mental State Examination (MMSE; β= -0.20; 95% CI -0.35, -0.04), Trail-Making Test Part B (β= 10.02; 95% CI 5.77, 14.27), and Category Fluency (β= -0.42; 95% CI -0.72, -0.13) after adjustment for socio-demographic and health-related characteristics. Multimorbidity was associated with faster declines in MMSE among those with low compared to medium and high social engagement (p-interaction < 0.01).
Conclusions:
Multimorbidity was associated with faster declines in cognition among community-dwelling older adults. Higher social engagement may mitigate multimorbidity-associated cognitive decline.
Background
Integrative oncology [IO] is sought-after by patients, endorsed by clinical guidelines, and valued within National Cancer Institute Centers. Shared Medical Appointments [SMA] leverage health education and social connection to deliver enhanced patient experience, population health, cost-reduction, and clinician well-being. Integrative Oncology Shared Medical Appointments increase access to integrative medicine but delivering these services via telehealth have not been evaluated.
Objective
We created, and pilot tested a Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) to assess its feasibility, acceptability, and efficacy at an urban academic teaching hospital.
Methods
The 7-session hour-long Living Well with and after Cancer series included didactics, multi-disciplinary experiential sessions, and group discussion. Topics included (1) Introduction, (2) Herbs/Botanicals/Fungi, (3) Mindful Movement, (4) Acupuncture, (5) Narratives and Nature, (6) Diet and Culinary Medicine, and (7) Vitamins/Supplements. Virtual visits via telehealth were offered to enhance patient participation during the pandemic. Outcome measures included recruitment, retention, pre/post-series patient survey and qualitative clinician feedback.
Results
Between 9/2021 and 4/2023, 72 unique patients were recruited to 5 cohorts and had a total of 332 VIOSMAS visits. A total of 50 patients (69%) attended 4 or more of the 7-session series; 60 (83% were women); patients ranged in age from 28 to 93 years (median 66); 36 (50%) lived outside the city center; the most common cancer diagnoses were breast, lymphoma, and lung cancer. Patients were from diverse demographics. Pre-program, patients reported desiring assistance in addressing diverse symptoms including fatigue, insomnia, pain, gastrointestinal (GI) symptoms, anxiety, and depression. Post-series, patients reported that the VIOSMAS addressed their goals and symptoms; they also reported incorporating recommended lifestyle changes in diet, exercise, sleep, and stress management; they were satisfied with the number of sessions and telehealth format. The participating clinicians reported high levels of satisfaction with VIOSMAS. Revenue to the institution from VIOSMAS exceeded the revenue potential of equivalent time spent for individual visits while supporting extended physician-patient contact.
Conclusion
VIOSMAS is feasible for patients and clinicians, addresses patients’ symptoms and questions about lifestyle and complementary therapies, and generates more revenue than individual visits. Larger implementation trials with appropriate comparison groups are recommended.
Background
Elevated psychosocial stress has been linked with accelerated biological aging, including composite DNA methylation (DNAm) markers that predict aging‐related outcomes (“epigenetic age”). However, no study has examined whether stressful life events (SLEs) are associated with epigenetic age acceleration in postmenopausal women, an aging population characterized by increased stress burden and disease risk.
Methods
We leveraged the Women's Health Initiative, a large muti‐ancestry cohort of postmenopausal women with available psychosocial stress measures over the past year and epigenomic data. SLEs and social support were ascertained via self‐report questionnaires. Whole blood DNAm array (450 K) data were used to calculate five DNAm‐based predictors of chronological age, health span and life span, and telomere length (HorvathAge, HannumAge, PhenoAge, GrimAge, DNAmTL).
Results
After controlling for potential confounders, higher SLE burden was significantly associated with accelerated epigenetic aging, as measured by GrimAge (β: 0.34, 95% CI: 0.08, 0.59) and DNAmTL (β: −0.016, 95% CI: −0.028, −0.004). Exploratory analyses showed that SLEs‐GrimAge associations were stronger in Black women as compared to other races/ethnicities and in those with lower social support levels. In women with lower social support, SLEs‐DNAmTL associations showed opposite association in Hispanic women as compared to other race/ethnicity groups.
Conclusions
Our findings suggest that elevated stress burden is associated with accelerated epigenetic aging in postmenopausal women. Lower social support and/or self‐reported race/ethnicity may modify the association of stress with epigenetic age acceleration. These findings advance understanding of how stress may contribute to aging‐related outcomes and have important implications for disease prevention and treatment in aging women.
Background
Individuals’ relationships are characterized by multidimensional aspects and the unique make-up of different features is more or less supportive of physical and mental health. The current study derived social network types based on an extended set of indicators reflecting the structure, function, and quality of relationships, then examined their associations with diverse physical and mental health outcomes separately for men and women.
Methods
Using samples of 620 South Korean adults (Mage = 53.52), Latent Profile Analysis (LPA) was used to uncover distinct social network types, and multiple regression analyses were conducted to examine the link between network types and health outcomes.
Results
LPA analysis derived four network types: diversified, family-(un)supported, friend- based, and restricted. The prevalence and configuration of network types differed between men and women: the family-unsupported type was more prevalent in women than in men whereas the restricted type was more prevalent in men than in women. An individual’s network type membership was significantly associated with one’s physical and mental health and the positive effects of an optimal network type and the negative effects of a non-optimal network type on mental health were much greater for women than they were for men.
Discussion
The findings suggest that women benefit more from supportive networks but that they are also more vulnerable to a lack of supportive (or the presence of conflict-filled) relationships, and highlight that having diversified and greater quality relationships, and avoiding conflicts are critical for women to have enhanced health.
INTRODUCTION
Social connectedness is associated with slower cognitive decline among older adults. Recent research suggests that distinct aspects of social networks may have differential effects on cognitive resilience, but few studies analyze brain structure.
METHODS
This study includes 117 cognitively impaired and 59 unimpaired older adults. The effects of social network characteristics (bridging/bonding) on brain regions of interests were analyzed using linear regressions and voxel‐wise multiple linear regressions of gray matter density.
RESULTS
Increased social bridging was associated with greater bilateral amygdala volume and insular thickness, and left frontal lobe thickness, putamen, and thalamic volumes. Increased social bonding was associated with greater bilateral medial orbitofrontal and caudal anterior cingulate thickness, as well as right frontal lobe thickness, putamen, and amygdala volumes.
DISCUSSION
The associations between social connectedness and brain structure vary depending on the types of social enrichment accessible through social networks, suggesting that psychosocial interventions could mitigate neurodegeneration.
Highlights
Distinct forms of social capital are uniquely linked to gray matter density (GMD).
Bridging is associated with preserved GMD in limbic system structures.
Bonding is associated with preserved GMD in frontal lobe regions.
Bridging is associated with increased brain reserve in sensory processing regions.
Bonding is associated with increased brain reserve in regions of stress modulation.
Quality of relationship between partners is associated with a wide range of physical and psychological outcomes like anxiety and depression. There are relatively few longitudinal studies with detailed and repeated measures for quality of relationship, particularly in both partners. The Avon Longitudinal Study of Parents and Children (ALSPAC) is a large birth cohort study in the UK with five post-partum repeated measures of quality of relationship between mothers and their partners assessed using the Intimate Bond Measure (IBM). The Measure includes two subscales named “Care” and “Control”. These were measured at 2.75, 6, 9, 12, and 18 years post-partum (baseline N for mothers: 8675; baseline N for partners: 5499). The aims of this data note are to provide a comprehensive overview on the existing IBM data in ALSPAC and to describe both its strengths and limitations for future users. The internal consistency of the subscales were high (Cronbach's alpha 0.95 and 0.88 for the Care and Control subscales) in both mothers and their partners at the baseline. In the Care subscale, all 12 items were highly correlated with the overall score (r>0.62) at the baseline, but in the Control subscale there were three items that had relatively low correlations with the total subscale (r<0.46). This should be taken into account in future research. The longitudinal nature of this data on both mothers and partners will enable detailed explorations of the causes and consequences of differences in quality of relationship.
Cancer has become a major public health issue, as it leads to increased mortality and disability worldwide (Cheatley et al., 2021; Huang et al., 2023). In 2020, there were almost 19.3 million new cancer cases around the world (Sung et al., 2021); however, recent years have seen a rapid rise in the number of cured cancer patients (Miller et al., 2022), which leads to a concomitant upsurge in rehabilitation efforts (Weis, 2003). Rehabilitation is defined as “a process aimed at enabling persons with disabilities to reach and maintain their optimal functional capacity…”, while cancer rehabilitation aims at enabling cancer patients to restore their optimal physical, sensory, intellectual, psychiatric, psychological, and/or social function levels (Mikkelsen et al., 2008). Furthermore, psychosocial rehabilitation of cancer patients focuses on how to restore the psychosocial function of cancer populations. It has been proposed that cancer psychosocial rehabilitation should be an integral part of the care plan and that it should enjoy a status equal to that of surgery, radiation, and chemotherapy (Cheville, 2005). The current Research Topic entitled “Psychosocial rehabilitation for cancer patients” examined various facets related to the psychosocial rehabilitation for cancer patients, including psychosocial issues of cancer patients, conceptualization of psychosocial issues, early detection of psychosocial issues, potential mechanisms of psychosocial issues, and effective intervention for psychosocial issues.
Social isolation has been found associated with multiple sleep traits in conventional observational studies. However, whether this association is causal and if so, its direction, is uncertain. We analyzed the association between social isolation and multiple sleep traits in 30,430 participants from the Guangzhou Biobank Cohort Study (GBCS). In bidirectional Mendelian randomization, we used 6, 17 and 11 single nucleotide polymorphisms (SNPs) associated with attendance at sports club/gym, religious group and pub/social club from the UK Biobank (n=452,302), respectively, and 152 SNPs associated with insomnia from the combination of UK Biobank and 23andme (n=1,331,010). Observationally in GBCS, insomnia (yes/no) (beta=0.12, 95% confidence interval (CI) 0.10-0.16) and poor sleep quality (yes/no) (beta=0.12, CI:0.08-0.15), but not sleep duration and chronotype, were associated with higher social isolation score (severe social isolation). In bidirectional MR, genetically predicted insomnia decreases the odds of attendance at sports club/gym (beta=0.98, CI: 0.98-0.99) and religious group (beta=0.99, CI: 0.98-0.99), but not pub/social club. However, these three types of social activity were not associated with insomnia. Our results support the causal effects of insomnia on social activity. Further clinical investigations into the utility of insomnia treatment in alleviating social isolation are needed.
Social isolation and disability are established risk factors for poor nutrition. We aimed to assess whether social isolation is associated with diet quality specifically among adults with disabilities.
This cross-sectional analysis used data from the National Health and Nutrition Examination Survey, 2013–2018. Adults with a disability, who were not pregnant, breastfeeding, or missing dietary intake data were included (n = 5,167). Disability was defined as a physical functioning limitation based on difficulty with any activities of daily living, instrumental activities of daily living, lower extremity mobility activities, or general physical activities. The Healthy Eating Index (HEI)-2015 measured diet quality; higher scores correspond to higher diet quality. We computed a social isolation index by summing single status, living alone, and two social engagement difficulty measures (one point for each component met; maximum 4 points). Multivariable linear regression, controlling for demographic and health covariates, estimated differences in HEI scores for dietary intake data, by social isolation score.
Over half of HEI scores were < 51, corresponding to “poor” diet quality. Higher social isolation score was associated with lower vegetable and seafood/plant proteins intake. Single status and one of two social engagement measures were associated with lower scores on certain adequacy components. Differences were modest. There was little evidence of effect modification by age or gender.
Adults with disabilities are not meeting national dietary standards; improving diet quality is a priority. Whether social isolation is associated with specific dietary components in this population requires further investigation. Further research is also needed among younger adults.
Introduction
Social isolation has been found to be a significant risk factor for health outcomes, on par with traditional risk factors. This isolation is characterised by reduced social interactions, which can be detected acoustically. To accomplish this, we created a machine learning algorithm called SocialBit. SocialBit runs on a smartwatch and detects minutes of social interaction based on vocal features from ambient audio samples without natural language processing.
Methods and analysis
In this study, we aim to validate the accuracy of SocialBit in stroke survivors with varying speech, cognitive and physical deficits. Training and testing on persons with diverse neurological abilities allows SocialBit to be a universally accessible social sensor. We are recruiting 200 patients and following them for up to 8 days during hospitalisation and rehabilitation, while they wear a SocialBit-equipped smartwatch and engage in naturalistic daily interactions. Human observers tally the interactions via a video livestream (ground truth) to analyse the performance of SocialBit against it. We also examine the association of social interaction time with stroke characteristics and outcomes. If successful, SocialBit would be the first social sensor available on commercial devices for persons with diverse abilities.
Ethics and dissemination
This study has received ethical approval from the Institutional Review Board of Mass General Brigham (Protocol #2020P003739). The results of this study will be published in a peer-reviewed journal.
While parental behaviors during the ‘first thousand days’ are critical for child health, little is known about fathers during this time. We examined prenatal patterns of health behaviors, social-emotional wellbeing, and infant care intentions among expectant fathers, both overall and compared to expectant mothers. Among 227 mother-father dyads enrolling in a randomized controlled trial of a perinatal obesity prevention program in Boston, Massachusetts (July 2020–July 2022), participants independently completed baseline surveys addressing (1) health behaviors, (2) social emotional wellbeing, and (3) infant care intentions. We compared paternal and maternal responses to survey items within each of these domains. Further, we conducted a latent class analysis of paternal responses and examined their associations with sociodemographic characteristics. Compared to expectant mothers, fathers were more likely to report increased body mass index, less fruit intake, decreased sleep, increased physical activity, and no recent primary care visit. Latent class analysis revealed four distinct groups of paternal health behaviors and infant care intentions: (1) more health behaviors with less infant care; (2) less health behaviors with less infant care; (3) less health behaviors with more infant care; and (4) more health behaviors with more infant care. Fathers with increased health behaviors were more likely to have higher education and income. Fathers with decreased health behaviors were more likely to endorse food insecurity, housing insecurity, and social isolation. Our findings identify potential areas for targeting expectant fathers in health promotion initiatives and suggest that social needs may impact the capacity to adopt healthy lifestyle behaviors.
Background
Decentralized, digital health studies can provide real-world evidence of the lasting effects of COVID-19 on physical, socioeconomic, psychological, and social determinant factors of health in India. Existing research cohorts, however, are small and were not designed for longitudinal collection of comprehensive data from India’s diverse population. Data4Life is a nationwide, digitally enabled, health research initiative to examine the post-acute sequelae of COVID-19 across individuals, communities, and regions. Data4Life seeks to build an ethnically and geographically diverse population of at least 100,000 participants in India.
Methods
Here we discuss the feasibility of developing a completely decentralized COVID-19 cohort in India through qualitative analysis of data collection procedures, participant characteristics, participant perspectives on recruitment and reported study motivation.
Results
As of June 13th, 2022, more than 6,000 participants from 17 Indian states completed baseline surveys. Friend and family referral were identified as the most common recruitment method (64.8%) across all demographic groups. Helping family and friends was the primary reason reported for joining the study (61.5%).
Conclusions
Preliminary findings support the use of digital technology for rapid enrollment and data collection to develop large health research cohorts in India. This demonstrates the potential for expansion of digitally enabled health research in India. These findings also outline the value of person-to-person recruitment strategies when conducting digital health research in modern-day India. Qualitative analysis reveals opportunities to increase diversity and retention in real time. It also informs strategies for improving participant experiences in the current Data4Life initiative and future studies.
Social support has repeatedly been linked to a host of diverse social, economic, and health outcomes, including mortality (Berkman & Syme 1994), depression (Wethington & Kessler 1986), a variety of physical health problems, including heart disease (Kristenson et al. 1998), rheumatoid arthritis (Krol et al. 1993), and educational attainment and success (Hagan et al. 1996).
Increasing evidence suggests that intact social bonds are protective against age-related morbidity, while bond disruption and social isolation increase the risk for multiple age-related diseases. Social attachments, the enduring, selective bonds formed between individuals, are thus essential to human health. Socially monogamous species like the prairie vole (M. ochrogaster) form long-term pair bonds, allowing us to investigate the mechanisms underlying attachment and the poorly understood connection between social bonds and health. In this review, we explore several potential areas of focus emerging from data in humans and other species associating attachment and healthy aging, and evidence from prairie voles that may clarify this link. We examine gaps in our understanding of social cognition and pair bond behavior. Finally, we discuss physiologic pathways related to pair bonding that promote resilience to the processes of aging and age-related disease. Advances in the development of molecular genetic tools in monogamous species will allow us to bridge the mechanistic gaps presented and identify conserved research and therapeutic targets relevant to human health and aging.
More than 1 in 5 pregnant people in the United States experience depressive symptoms. Although treatments exist, many people remain under- or un-treated due to concerns about stigma, side effects, and costs of medications or psychotherapy, particularly those who are marginalized (defined as those who are minoritized, low-income, or with low-educational attainment). Further, the standard depression treatments do not address social connectedness, which is a potentially modifiable factor involved in depressive symptom etiology. This protocol presents the rationale, design, and status of the two-arm longitudinal parallel group randomized controlled trial - the Mindful Moms Study - which aims to evaluate the effects and mechanisms of a group-based mindful physical activity (yoga) intervention in marginalized pregnant people with depressive symptoms (n = 200) compared to a prenatal education control group. The primary aim is to evaluate effects of group assignment on depressive symptom severity, anxiety, and perceived stress over time from baseline to six weeks postpartum. Secondary aims include understanding the role of social connectedness as a moderator of the effects and to identify genome-wide DNA methylation patterns associated with depressive symptoms and perceived social connectedness at postpartum. A focus on adequate symptom management through non-pharmacologic, accessible therapies that address social connectedness during pregnancy in marginalized women is an urgent clinical and research priority. The successful completion of this study will provide important insights into social connectedness as a mechanism to decrease depressive symptoms in a largely understudied population. Trial registration: NCT04886856.
Background
The southern India state of Kerala has among the highest proportion of older adults in its population in the country. An increase in chronic age-related diseases such as dementia is expected in the older Kerala population. Identifying older individuals early in the course of cognitive decline offers the best hope of introducing preventive measures early and planning management. However, the epidemiology and pathogenesis of predementia syndromes at the early stages of cognitive decline in older adults are not well established in India.
Objective
The Kerala Einstein Study (KES) is a community-based cohort study that was established in 2008 and is based in the Kozhikode district in Kerala state. KES aims to establish risk factors and brain substrates of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of slow gait and subjective cognitive concerns in individuals without dementia or disability. This protocol describes the study design and procedures for this KES project.
MethodsKES is proposing to enroll a sample of 1000 adults ≥60 years old from urban and rural areas in the Kozhikode district of Kerala state: 200 recruited in the previous phase of KES and 800 new participants to be recruited in this project. MCR is the cognitive phenotype of primary interest. The associations between previously established risk factors for dementia as well as novel risk factors (apathy and traumatic brain injury) and MCR will be examined in KES. Risk factor profiles for MCR will be compared between urban and rural residents as well as with individuals who meet the criteria for mild cognitive impairment (MCI). Cognitive and physical function, medical history and medications, sociodemographic characteristics, lifestyle patterns, and activities of daily living will be evaluated. Participants will also undergo magnetic resonance imaging and electrocardiogram investigations. Longitudinal follow-up is planned in a subset of participants as a prelude to future longitudinal studies.
ResultsKES (2R01AG039330-07) was funded by the US National Institutes of Health in September 2019 and received approval from the Indian Medical Council of Research to start the study in June 2021. We had recruited 433 new participants from urban and rural sites in Kozhikode as of May 2023: 41.1% (178/433) women, 67.7% (293/433) rural residents, and 13.4% (58/433) MCR cases. Enrollment is actively ongoing at all the KES recruitment sites.
ConclusionsKES will provide new insights into risk factors and brain substrates associated with MCR in India and will help guide future development of regionally specific preventive interventions for dementia.
International Registered Report Identifier (IRRID)DERR1-10.2196/49933
Objective:
This study examined whether social activity diversity, a novel concept indicating an active social lifestyle, is associated with lower subsequent loneliness, and decreased loneliness is further associated with less chronic pain over time.
Methods:
2528 adults from the Midlife in the United States Study (Mage = 54 yrs) provided data at baseline (2004-2009) and 9 years later. Social activity diversity was operationalized by Shannon's entropy that captures the variety and evenness of engagement across 13 social activities (0-1). Participants reported feelings of loneliness (1-5), presence of any chronic pain (yes/no), the degree of chronic pain-related interference (0-10), and the number of chronic pain locations. Indirect associations of social activity diversity with chronic pain through loneliness were evaluated, adjusting for sociodemographics, living alone, and chronic conditions.
Results:
Higher social activity diversity at baseline (B = -0.21, 95%CI = [-0.41, -0.02]) and an increase in social activity diversity over time (B = -0.24, 95%CI = [-0.42, -0.06]) were associated with lower loneliness 9 years later. An increase in loneliness was associated with 24% higher risk of any chronic pain (95%CI = [1.11, 1.38]), greater chronic pain-related interference (B = 0.36, 95%CI = [0.14, 0.58]), and 17% increase in the number of chronic pain locations (95%CI = [1.10, 1.25]) at the follow-up, after controlling for corresponding chronic pain at baseline and covariates. Social activity diversity was not directly was associated with chronic pain, but there were indirect associations through its association with loneliness.
Conclusion:
Diversity in social life may be associated with decreased loneliness, which in turn, may be associated with less chronic pain, two of the prevalent concerns in adulthood.
Background:
Poor diet quality is an important risk factor for increased asthma prevalence and poor asthma control. To address the question of whether adults with asthma can benefit from following a healthy diet, this trial will test the efficacy and mechanisms of action of a behavioral intervention promoting the Dietary Approaches to Stop Hypertension (DASH) dietary pattern with sodium reduction among patients with uncontrolled asthma.
Methods:
In this 2-arm randomized clinical trial, 320 racially/ethnically and socioeconomically diverse adults with uncontrolled asthma on standard controller therapy will be randomized to either a control or an intervention group and assessed at baseline, 3, 6 and 12 months. Control and intervention participants will receive education on lung health, asthma, and other general health topics; additionally, the intervention group will receive DASH behavioral counseling over 12 months. The primary hypothesis is that the DASH behavioral intervention, compared with the education-only control, will lead to significantly more participants with minimum clinically important improvement (responders) in asthma-specific quality of life at 12 months. Secondary hypotheses will test the intervention effects on other asthma (e.g., asthma control, lung function) and non-asthma outcomes (e.g., quality of life). Additionally, therapeutic (e.g., short chain fatty acids, cytokines) and nutritional biomarkers (e.g., dietary inflammatory index, carotenoids) will be assessed to understand the mechanisms of the intervention effect.
Conclusion:
This trial can substantially advance asthma care by providing rigorous evidence on the benefits of a behavioral dietary intervention and mechanistic insights into the role of diet quality in asthma.
Clinicaltrials:
gov #: NCT05251402.
Objectives: Social relationships are widely regarded as salubrious, but do they mediate the influence of childhood experiences on frailty in later life? Drawing from cumulative inequality theory, we assess the influence of childhood experiences and adult relationships on frailty trajectories. Methods: We analyzed data from the Health and Retirement Study to examine the influence of six domains of childhood experiences and social relationships on frailty trajectories over 8 years. Mediation analyses were completed with structural equation models. Results: Risky adolescent behavior, chronic disease, and impairments during childhood are associated directly with higher risk of initial frailty, but not over time. More social roles and higher social support mediate the relationship between childhood experiences and frailty, and the effect of more social roles continues over time. Discussion: This study provides compelling evidence that supportive social relationships mediate the risk and severity of frailty in later life associated with noxious childhood experiences.
The associations between social isolation, loneliness and the risk of mortality from all causes, cardiovascular disease (CVD) and cancer are controversial. We systematically reviewed prospective studies on the association between social isolation, loneliness and mortality outcomes in adults aged 18 years or older, as well as studies on these relationships in individuals with CVD or cancer, and conducted a meta-analysis. The study protocol was registered with PROSPERO (reg. no. CRD42022299959). A total of 90 prospective cohort studies including 2,205,199 individuals were included. Here we show that, in the general population, both social isolation and loneliness were significantly associated with an increased risk of all-cause mortality (pooled effect size for social isolation, 1.32; 95% confidence interval (CI), 1.26 to 1.39; P < 0.001; pooled effect size for loneliness, 1.14; 95% CI, 1.08 to 1.20; P < 0.001) and cancer mortality (pooled effect size for social isolation, 1.24; 95% CI, 1.19 to 1.28; P < 0.001; pooled effect size for loneliness, 1.09; 95% CI, 1.01 to 1.17; P = 0.030). Social isolation also increased the risk of CVD mortality (1.34; 95% CI, 1.25 to 1.44; P < 0.001). There was an increased risk of all-cause mortality in socially isolated individuals with CVD (1.28; 95% CI, 1.10 to 1.48; P = 0.001) or breast cancer (1.51; 95% CI, 1.34 to 1.70; P < 0.001), and individuals with breast cancer had a higher cancer-specific mortality owing to social isolation (1.33; 95% CI, 1.02 to 1.75; P = 0.038). Greater focus on social isolation and loneliness may help improve people’s well-being and mortality risk.
Background:
Few modifiable risk factors for epithelial ovarian cancer have been identified. We and other investigators have found that individual psychosocial factors related to distress are associated with higher risk of ovarian cancer. The present study examined whether co-occurring distress-related factors are associated with ovarian cancer risk.
Methods:
Five distress-related factors were measured repeatedly over 21 years of follow-up: depression, anxiety, social isolation, widowhood, and, in a subset or women, posttraumatic stress disorder (PTSD). Cox proportional hazards models estimate relative risks (RR) and 95% confidence intervals (CI) of ovarian cancer for a time-updated count of distress-related factors, in age-adjusted models, then further adjusted for ovarian cancer risk factors and behavior-related health risk factors.
Results:
Across 1,193,927 person-years of follow-up, 526 incident ovarian cancers occurred. Women with ≥3 versus no distress-related psychosocial factors demonstrated increased ovarian cancer risk (HRage-adjusted = 1.71; 95% CI = 1.16, 2.52). No significant difference in ovarian cancer risk was observed in women with one or two versus no distress-related psychosocial factors. In the subsample with PTSD assessed, ≥3 versus no distress-related psychosocial factors was associated with twofold greater ovarian cancer risk (HRage-adjusted = 2.08, 95% CI = 1.01, 4.29). Further analysis suggested that women at highest ovarian cancer risk had PTSD co-occurring with any other distress-related factor (HR = 2.19, 95% CI = 1.20, 4.01). Adjusting for cancer risk factors and health behaviors minimally impacted risk estimates.
Conclusions:
Presence of multiple indicators of distress was associated with risk of ovarian cancer. When including PTSD as an indicator of distress, the association was strengthened.
This article elaborates on the utilization of social media for practices of interaction in the city during the COVID-19 pandemic and discusses its potential in providing for the wellbeing of urban communities. During the early periods of the pandemic when preventative measures were taken intensively to decrease contamination, communities lacked physical relationships with and within cities. Interactions realized in physical spaces in normal conditions were compensated with practices in social media. While such shift can be perceived to have decreased the meaning of cities in the pursuit of daily life and interactions, efforts which were localized upon physical human settlements yet were realized in the digital realm seem to have opened alternative paths for connection among residents. Within this context, we explore Twitter data through three hashtags which were promoted by the local government of Ankara and used densely by the residents in the early periods of the pandemic. Considering that social connection is one of the fundamental enablers of wellbeing, we aim to provide insights into the strive for wellbeing in times of crises where ruptures in physical interaction prevail. The patterns we observe in the expressions that gather around the selected hashtags shed a light on the ways the cities, their people and local governments are positioned in the struggles pursued in digital realm. Our findings support our arguments that social media has significant potential in contributing to the wellbeing of people especially in times of crisis, local governments can increase the quality of life of their citizens with modest actions, and the cities hold significant meanings for people as loci of communities and thus of wellbeing. Through the discussions we pursue, we seek to contribute to the stimulation of research, policies, and community actions that aim at the enhancement of wellbeing of urban individuals and communities.
Among men of Japanese ancestry, there is a gradient in the occurrence of coronary heart disease (CHD). It is lowest in Japan, intermediate in Hawaii, and highest in California. This gradient appears not to be completely explained by differences in dietary intake, serum cholesterol, blood pressure or smoking. To test the hypothesis that social and cultural differences may account for the CHD differences between Japan and the United States, 3809 Japanese-Americans in California were classified according to the degree to which they retained a traditional Japanese culture. The most traditional group of Japanese-Americans had a CHD prevalence as low as that observed in Japan. The group that was most acculturated to Western culture had a three- to five-fold excess in CHD prevalence. This difference in CHD rate between most and least acculturated groups could not be accounted for by differences in the major coronary risk factors.
The relationship between deaths during 1959-61 from nine leading causes and socioeconomic status was examined in the city of Hartford, Conn. Socioeconomic status was determined according to social rank areas, and mortality was measured by expected deaths and excess deaths. The measure of expected deaths shows how deaths from each cause in each of four social rank areas differ from those that would have occurred if age-specific death rates by cause for the total city had prevailed. The comparative measure of excess deaths approximates the assumption that age-specific death rates for each cause of death in the highest social rank area would be applied to the age composition of the three lower socioeconomic areas. The major difference between the measurements of observed and expected deaths and excess deaths is that the measure of excess deaths yielded slightly larger relative differences in mortality among the four social rank areas by cause of death. A more important observation, however, is that, with minor exceptions, both measures of mortality demonstrated a clear inverse association between socioeconomic status and mortality from all nine causes. The extent of the association was strongest for infectious and parasitic diseases, respiratory and digestive diseases, diabetes, and accidents. An inverse relationship between mortality from heart diseases, cancer, and genitourinary diseases was also ascertained, but the strength of the association was less apparent. Excess deaths (deaths which can be prevented) result mainly from chronic diseases, especially from heart disease. Therefore, in order to reduce the overall level of mortality of the lower socioeconomic group to a level closer to that of the higher socioeconomic groups, early diagnosis and better treatment should be provided for persons at lower socioeconomic levels.
Much has been written during the past decade about the mortality and morbidity which may follow conjugal bereavement [1–4]. Existing studies of morbidity do not however enable us to draw any substantial conclusions about the prevalence of such consequences in widows and widowers. Either the population of bereaved persons has been a highly selected one, commonly available for study because they have been referred for psychiatric treatment, or there has been no utilization of a non-bereaved control group, the desirability of which is heightened by the tendency towards some deterioration in physical and mental health in middle age [5].This present study developed as one segment of a major research endeavour, aimed ultimately at the identification in advance of those widows most likely to suffer untoward physical and/or psychological consequences following conjugal bereavement [6]. Our major focus has been on the subject's interaction with her social network during the three months immediately following the bereavement [7], the whole study being conceptualized within the framework of crisis theory [8]. Our findings on the health of widows, however, were of such interest that it seemed worthwhile to examine suitably matched control groups in order to determine more truly the prevalence of health deterioration following bereavement. As well as information about the overall prevalence of health deterioration in two samples of widows, one in Boston, Massachusetts and the other in Sydney, Australia, our techniques also enabled us to gather information about the specific symptoms and syndromes manifested by the subjects and the matched controls.
In their concern with etiological questions, medical and behavioral scientists alike have overwhelmingly focused on the etiology of diseases. It is the thesis of this paper that the time has come to add to—though not to supplant—this focus by the serious consideration of the etiology of disease, in the singular. In order to avoid confusion, I propose to substitute the term “breakdown” to refer to the global entity which might be called disease.‡ I argue that clarification and use of the breakdown concept will have fruitful implications for understanding the etiology of all those departures from the social norm we call health, for therapeutic purposes, for a more adequate structuring of the health professions, and for research in medical sociology. The concept of breakdown, I suggest, must be adopted as a fourth major step in the thinking of modern medicine.
Thesis (Ph. D.)--University of North Carolina at Chapel Hill. Microfilm (negative) of typescript.
The authors emphasized the importance of social support as protective of health. They have also begun to ascertain the key questions that should be addressed; initiated a new synthesis of the great variety of types of support; suggested some synthesizing criteria of social support, and finally, have commented on the policy implications of the social support hypothesis.
Social support is defined as information leading the subject to believe that he is cared for and loved, esteemed, and a member of a network of mutual obligations. The evidence that supportive interactions among people are protective against the health consequences of life stress is reviewed. It appears that social support can protect people in crisis from a wide variety of pathological states: from low birth weight to death, from arthritis through tuberculosis to depression, alcoholism, and the social breakdown syndrome. Furthermore, social support may reduce the amount of medication required, accelerate recovery, and facilitate compliance with prescribed medical regimens.
This paper explores the relationship of a number of personal health practices and mortality in the years after a survey made in Alameda County, California in 1965. Age-adjusted mortality rates were higher for men, for persons reporting disability, and for those with inadequate incomes.The individual health practices, smoking, weight in relation to desirable standards for height, drinking, hours of sleep, regularity of meals, and physical activity, were related to mortality in the expected direction. When accumulated to form a health practice score from 0 to 7, the number of health practices showed a striking inverse relationship with mortality rates, especially for men. This relationship was independent of income level and physical health status.The age-specific death rates by number of health practices were used to develop a life table. The average life expectancy of men aged 45 who reported six or seven “good” practices was more than 11 years more than that of men reporting fewer than four. For women the relationship between health practices and mortality was less strong, and the difference between the life expectancy at age 45 for those who reported six or seven, and those who reported fewer than four, was 7 years.
The epidemiological method and findings have identified and emphasized the research potential of studying migrants within the U.S., for specific causes of death.The study has demonstrated the marked differences in cancer mortality which become manifest for the nonwhite and native-born white when resident male and female deaths of a state are subclassified by region of birth and state of residence, which would not otherwise be apparent in the comparisons by broad classifications as currently coded in vital records.The age adjusted rates for all cancers (ages 35–69) for the nonwhite males born in the South were 363.67 vs 180.43 for those born in Ohio. The same ratio among the white males born in the South was 225.73, and for those born in Ohio, 197.14.For cancer of the lung and other specific cancer sites, the nonwhite males showed a higher rate for those born in the South compared to those born in Ohio. The excess for the white males was most notable for cancer of the lung.Statistical evidence is presented for the conclusion that the observed differences in cancer mortality among the nonwhite are not due to race per se.The importance of endemic factors associated with place of birth in the U.S. and the influences of the early years of life, particularly in the South in the development of social and biological imprints, and following migration the subsequent exposure to industrial environments, has been considered.
A technique for following a survey population by computer, and matching items from the survey with the State file of death records is described. Two computer programs were used--one in which the primary match was on name, sex, and color, the other in which month and day of birth, birthplace, sex, and first letter of first name were the only matching variables. Final verification of computer linked records was made by a comparison of items not coded from the death certificates, such as address, name of spouse, occupation, and name of relative or persons to contact. The name-match method produced more verified deaths than the birth-date method, but the birth-date method added 5 percent to the total. An estimate was made of the number of deaths to be expected in the survey population. Following adjustment for deaths in longterm care facilities (not included in the survey) and for persons moving from the State, it was found that the computer record linkage had located records of 90 percent of these deaths.
Our concept and measurement of health has generally focused on ill health. This focus on pathology probably arose from the fact that for most of human existence the health problem facing society, and medicine in particular, has been overcoming disease. By mid-twentieth century, however, already for some of mankind and hopefully soon for the rest, the health picture had changed—people as a whole were not disease-ridden and ideas of so-called positive health emerged. This emboldened the WHO to define health in a new way as ‘physical, mental and social well-being, not merely the absence of disease or infirmity’.
To absorb this concept and use it in medical science has not been easy for those trained to approach health through pathology. The Human Population Laboratory of Alameda County, California, have been trying to apply the WHO idea in the measurement of health and in ascertaining how to improve health. This paper discusses the various aspects of and approaches to this subject and describes a trial of their method of measurement and the preparations for another survey in 1973.
For an individual or a community it appears possible to measure health status through questions that only individuals can answer about themselves, as in the Human Population Laboratory, and through testing by physical means the extent of functional reserves, as in multiphasic screening. Medicine would then focus on improving health in the sense of (i) moving people toward the favorable end of the health spectrum, as determined subjectively by responses to questions, and (ii) enhancing the bodily reserves, as determined by screening tests.
1.1. Blood pressure does appear to vary with ‘socioecological niches’ or combinations of sex, race and residence, which reflect social class position as well as degree of social stressor conditions. Black High Stress males had higher adjusted levels than Black Low Stress males, while White High Stress females had higher adjusted pressures than White Low Stress females. Black High Stress females had significantly higher observed levels than Black Low Stress females.2.2. Black High Stress males had a significantly higher per cent of Borderline and Hypertensive blood pressure than other male race-area groups; White Low Stress females had the lowest of all eight sex-race-stress area groups.3.3. For Black males, the younger, overweight High Stress residents had significantly higher Borderline and Hypertensive levels than did a similar Black Low Stress subgroup. Further, for both groups, being raised in Detroit and not migrating from elsewhere was related to higher readings. Tests for age-stress area interaction, however, were not significant.
Nuckolls, K. B. (Yale University School of Nursing, New Haven, Conn. 06510), J. Cassel and B. H. Kaplan. Psychological assets, life crisis and the prognosis of pregnancy. Am J Epidemiol 95: 431-441, 1972.-This is a study of the relationships between psychosocial assets, social stresses as measured by a cumulative life change score and the prognosis of pregnancy. Psychosocial assets were measured early in pregnancy by a questionnaire (TAPPS) designed to assess the adaptive potential for pregnancy. At 32 weeks, subjects completed the Schedule of Recent Experience from which scores were calculated for life change during pregnancy and for the two years preceding it. Following delivery, the medical record was used to score each pregnancy as "normal" or "complicated." Complete data were obtained on 170 subjects. Taken alone, neither life change nor TAPPS scores were significantly related to complications. However, when these variables were considered conjointly, it was found that if the life change score was high both before and during pregnancy, women with high TAPPS scores (favorable psychosocial assets) had only one third the complication rate of women with low TAPPS scores. In the absence of high cumulative life change, there was no significant relationship between psychosocial assets and complications.
This paper continues the analysis previously reported of physical health status in an adult population and its relationship to various independent variables. Data for the study were gathered by questionnaires completed by a probability-based sample of adult residents of Alameda County, California, in 1965.Physical health is measured along a spectrum ranging from severe disability to high energy level with absence of chronic conditions or symptoms. The “ridit” which places each individual along the spectrum can be averaged for comparison of groups, and can be adjusted for differences due to age and sex.This paper examines the relation between common health practices, including hours of sleep, regularity of meals, physical activity, smoking and drinking, and physical health status. Good practices are shown to be associated with positive health, and the relationship of these activities was cumulative; those who followed all of the good practices being in better health, even though older, than those who failed to do so. This association was found to be independent of age, sex, and economic status.
A total of 4,486 widowers of 55 years of age and older have been followed up for nine years since the death of their wives in 1957. Of these 213 died during the first six months of bereavement, 40% above the expected rate for married men of the same age. Thereafter the mortality rate fell gradually to that of married men and remained at about the same leveLThe greatest increase in mortality during the first six months was found in the widowers dying from coronary thrombosis and other arteriosclerotic and degenerative heart disease. There was also evidence of a true increase in mortality from other diseases, though the numbers in individual categories were too small for statistical analysis.In the first six months 22.5% of the deaths were from the same diagnostic group as the wife's death. Some evidence suggests that this may be a larger proportion than would be expected by chance association, but there is no evidence suggesting that the proportion is any different among widows and widowers who have been bereaved for more than six months.
1.1. Death rates from coronary heart disease in white males aged 55–64 who are rural residents of North Carolina increased with increasing urbanization of their county of residence in the years 1951–1953 and also in 1959–1961.2.2. It was shown that these differences in mortality could not in all likelihood be explained by differences in diagnostic custom.3.3. This gradient of mortality was predicted in advance of the study on the basis of postulated incongruities between the culture of rural residents and the demands and expectations of increasing urbanization.4.4. The data suggest that whatever deleterious influences accompany urbanism as far as coronary heart disease is concerned, they have, by 1960. in this age, race, and sex group in North Carolina, reached a plateau for urban residents but are continuing to exert their effects on the less adapted rural residents.
Data from a study of coronary heart disease in six counties of northeastern North Dakota were examined to determine how certain socio-cultural variables relate to the incidence of coronary heart disease. Information on all cases occurring in this area in a one-year period in white men age 35 and over was compared to that obtained from a sample of white men age 35 and over who were representative of the population from which the cases emerged. 1.1. It was found that subjects of urban American background had a ratio of observed to expected number of cases three times that for subjects of rural or urban European background.2.2. While white-collar workers in general had a higher ratio than blue-collar or agricultural workers, white-collar workers of rural background had a ratio two to three times higher than agricultural or blue-collar workers of rural background.3.3. Data on occupational and geographic mobility were examined to explore the possibility that discontinuities between present social situation and background might be helpful in interpreting these findings. It was found that geographically mobile subjects had a ratio twice that of geographically stable subjects; occupationally mobile men had a ratio three times higher than that of occupationally stable men.4.4. These socio-cultural factors were related to coronary heart disease independently of such other factors as diet, relative body weight, blood pressure, cigarette smoking, and parental longevity.5.5. The interaction between these socio-cultural and other factors yields greater differences between cases and controls than does any one of them alone.
Marital status and risk factors for coronary heart disease
- Weiss
Weiss NS: Marital status and risk factors for coronary heart disease. Br J Prev Soc Med 27:41-43, 1973
A multiple adjustment method for combining J x 2 contingency tables for prospective and survival study analysis
- Rj Brand
- Sholtz
Brand RJ, Sholtz RI: A multiple adjustment method for combining J x 2 contingency tables for prospective and survival study analysis. Presented at Biometrics Society Meeting, March, 1976
Changing frequency of arteriosclerosis in mammals and birds at the Philadelphia Zoological Garden
- Hl Ratcliffe
- Cronin
Ratcliffe HL, Cronin MIT: Changing frequency of arteriosclerosis in mammals and birds at the Philadelphia Zoological Garden. Circulation 18:41-52, 1958
Social dis-organization and Btroke mortality in the black populations of North Carolina
- Wb Nesser
- Ha Tyroler
- Cassel
Nesser WB, Tyroler HA, Cassel JC: Social dis-organization and Btroke mortality in the black populations of North Carolina. Am J Epidemiol 93:166-175, 197
In The Community as an Epidemiological Laboratory
- Ml Levin
AJameda County Population Laboratory. Edited
by II Kessler, ML Levin. In The Community as
an Epidemiological Laboratory. Baltimore,
Johns Hopkins University Press, 1970, pp
149-176.
Cancer Epidemiology: Methods of Study
- Am Lilienfeld
- E Pedersen
- Je Dowd
Lilienfeld AM, Pedersen E, Dowd JE: Cancer
Epidemiology: Methods of Study. Baltimore,
Johns Hopkins University Press, 1967