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Frndak S, Cudjoe T, Thorpe RJ, Deng Z, Ward-Caviness CK, Clarke KA, Dickerson AS. Social cohesion as a modifier of joint air pollution exposure and incident dementia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 949:175149. [PMID: 39084376 DOI: 10.1016/j.scitotenv.2024.175149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/19/2024] [Accepted: 07/28/2024] [Indexed: 08/02/2024]
Abstract
Social cohesion can reduce stress, increase social interaction, and improve cognitive reserve. These social mechanisms may modify the effects of air pollution on dementia risk. This cohort study examines the potential moderating effect of social cohesion on associations between joint air pollution exposure and incident dementia leveraging data from 5112 community-dwelling adults ≥65 years of age enrolled in the National Health and Aging Trends Study (NHATS). Study participants were enrolled in 2011 and followed through 2018. We assigned 2010 residential census tract-level exposures to five air pollutants, particulate matter (PM) ≤ 10 μm in diameter, PM ≤ 2.5 μm in diameter, carbon monoxide, nitric oxide, and nitrogen dioxide, using the US Environmental Protection Agency's Community Multiscale Air Quality Modeling System. Dementia status was determined based on self- or proxy-reported dementia diagnosis or "probable dementia" according to NHATS cognitive screening tools. Participants' self-rated neighborhood social cohesion was evaluated based on three questions: neighbors knowing each other, being helpful, and being trustworthy. Social cohesion was dichotomized at the median into high vs low social cohesion. Associations between air pollutants and incident dementia were assessed using quantile g-computation Cox proportional hazard models and stratified by high vs low social cohesion, adjusting for age, sex, education, partner status, urbanicity, annual income, race and ethnicity, years lived at current residence, neighborhood disadvantage index, and tract segregation. High social cohesion (HR = 1.20, 95 % CI = 0.98, 1.47) and air pollution (HR = 1.08, 95 % CI = 0.92, 1.28) were not associated with incident dementia alone. However, when stratified, greater joint air pollution exposure increased dementia risk among participants at low (HR = 1.34, 95 % CI = 1.04, 1.72), but not high (HR = 1.00, 95 % CI = 0.93, 1.06) social cohesion. Air pollution was a risk factor for dementia only when reported social cohesion was low, suggesting that social interaction may play a protective role, mitigating dementia risk via air pollution exposure.
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Affiliation(s)
- Seth Frndak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Thomas Cudjoe
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, United States of America
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States of America; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, United States of America; Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, United States of America
| | - Zhengyi Deng
- Department of Urology, Stanford School of Medicine, United States of America
| | - Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, United States of America
| | - Kayan A Clarke
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States of America; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, United States of America; Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, United States of America.
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Hajek A, Sutin A, Luchetti M, Peltzer K, Veronese N, Gyasi RM, Soysal P, Stephan Y, Terracciano A, König HH. Perception of one's social environment and loneliness: results of the nationally representative "Old age in Germany (D80+)" study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02774-3. [PMID: 39354148 DOI: 10.1007/s00127-024-02774-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 09/20/2024] [Indexed: 10/03/2024]
Abstract
OBJECTIVES To examine the association between perception of one's social environment (in terms of residential attachment and neighborhood trust) and loneliness among the oldest old and whether these associations differ by living arrangement. METHODS We used data from the nationally representative "Old Age in Germany (D80+)" study that included individuals residing in private households and institutionalized settings. The analytic sample was 9,621 individuals (average age: 85.5 years, SD: 4.1 years; 62% female). Data collection took place from November 2020 to April 2021. Multiple linear regressions were conducted with adjustment for relevant covariates. RESULTS Higher residential attachment (β=-0.02, p < .05) and higher neighborhood trust (β=-0.12, p < .001) were associated with less loneliness. The latter association was moderated by living arrangement (β=-0.09, p = .04) such that the association between neighborhood trust and loneliness was stronger among individuals living in institutionalized settings compared to individuals in private households. CONCLUSION Greater residential attachment and neighborhood trust, particularly among individuals living in institutionalized settings, are associated with less loneliness among the oldest old. Finding ways to improve perceived attachment and trust may assist in avoiding loneliness among older individuals.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany.
| | - Angelina Sutin
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Martina Luchetti
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya
- Faculty of Health, National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
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Qin W, Nicklett EJ, Yu J, Nguyen AW. Neighborhood social cohesion and physical disorder in relation to social isolation in older adults: racial and ethnic differences. BMC Public Health 2024; 24:2574. [PMID: 39304855 PMCID: PMC11414110 DOI: 10.1186/s12889-024-20112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 09/17/2024] [Indexed: 09/22/2024] Open
Abstract
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.
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Affiliation(s)
- Weidi Qin
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, 1350 University Ave, Madison, WI, 53706, USA.
| | - Emily J Nicklett
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Jiao Yu
- School of Public Health, Yale University, New Haven, CT, USA
| | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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Mohd Tohit NF, Haque M. Preparing the Younger Generation for an Aging Society: Strategies, Challenges, and Opportunities. Cureus 2024; 16:e64121. [PMID: 38983672 PMCID: PMC11231670 DOI: 10.7759/cureus.64121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 07/11/2024] Open
Abstract
The global demographic landscape is experiencing a monumental shift as populations age, driven by advances in healthcare and declining birth rates. This transition underscores the need to prepare the younger generation to navigate and contribute effectively to an aging society. This manuscript comprehensively reviews strategies to equip younger generations with the requisite knowledge, skills, and empathy to support an aging population. This study identifies critical challenges and opportunities in fostering intergenerational solidarity and understanding through an extensive analysis of existing literature and innovative educational programs. The review highlights the importance of early education, community engagement, and policy interventions in bridging the generational divide. Additionally, it explores the role of technology and digital media in facilitating awareness and empathy among young people. Key findings suggest that incorporating aging-related content into educational curricula, promoting volunteerism, and implementing supportive policies can significantly enhance the younger generation's readiness to support an aging society. The manuscript concludes with recommendations for future research and practical steps for educators, policymakers, and community leaders to foster a more inclusive and age-friendly environment. By preparing the younger generation today, we can build a more cohesive and supportive society for tomorrow.
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Affiliation(s)
- Nor Faiza Mohd Tohit
- Department of Community Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
| | - Mainul Haque
- Karnavati Scientific Research Center (KSRC), School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
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Yang Y, Sims KD, Lane NE, Duchowny KA, Torres JM. Perceived Neighborhood Characteristics and Later-Life Pain Outcomes: Evidence From the Health and Retirement Study. J Aging Health 2024; 36:246-256. [PMID: 37349863 PMCID: PMC10739572 DOI: 10.1177/08982643231185382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Objectives: This study examines whether perceived neighborhood characteristics relate to pain outcomes among middle-aged and older adults. Methods: Data were from the Health and Retirement Study (2006-2014; n = 18,814). Perceived neighborhood characteristics were physical disorder, social cohesion, safety, and social ties. We fitted adjusted generalized estimating equation models to evaluate prevalence, incidence, and recovery of moderate-to-severe limiting pain 2 years later. Results: The mean age of our sample was 65.3 years; 54.6% were female and 24.2% reported moderate-to-severe limiting pain at baseline. Positive neighborhood characteristics were associated with low prevalence (e.g., prevalence ratio [PR]: .71 for disorder) and reduced incidence (e.g., PR: .63 for disorder) of moderate-to-severe limiting pain. Positive neighborhood characteristics were associated with a high recovery rate from moderate-to-severe limiting pain (e.g., PR = 1.15 for safety), though the 95% CIs for disorder and cohesion crossed the null. Discussion: Neighborhood characteristics may be important determinants in predicting pain in later life.
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Affiliation(s)
- Yulin Yang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kendra D. Sims
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Nancy E. Lane
- Center for Musculoskeletal Health, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kate A. Duchowny
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Baek J, Kim B, Park S, Ryu B. Loneliness Among Low-Income Older Immigrants Living in Subsidized Senior Housing: Does Perceived Social Cohesion Matter? JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:80-95. [PMID: 37246421 DOI: 10.1080/01634372.2023.2216741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
This study compared the level of loneliness among older immigrants residing in subsidized senior housing with that of non-immigrant residents. The study also sought to examine the differential influence of perceived social cohesion on loneliness among these groups. 231 study participants were recruited from subsidized senior housing in St. Louis and the Chicago area. Multiple regression analyses showed that there was a significant difference in loneliness between immigrants and non-immigrants (b = .3, SE = 0.150, p < .05). Also, perceived social cohesion was negatively associated with loneliness (b=-.102, SE = .022, p < .001). Furthermore, immigration status moderated the relationship (b=-.147, SE = .043, p < .01), showing immigrants may benefit more from higher perceived social cohesion in terms of loneliness. The results suggest that perceived social cohesion may act as an important community-level protective factor against loneliness, particularly for older immigrants residing in subsidized senior housing. Creating socially cohesive environments, particularly for this subgroup, could be a crucial strategy for mitigating loneliness. .
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Affiliation(s)
- Jihye Baek
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - BoRin Kim
- Department of Social Work, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire, USA
| | - Sojung Park
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Byeongju Ryu
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
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Li J, Guo B, Lu M, Zhang W. Who are the convoys of the happiness of Chinese urban residents? Research on social relations and subjective well-being based on the convoy model. Front Psychol 2023; 14:1260754. [PMID: 37731884 PMCID: PMC10508955 DOI: 10.3389/fpsyg.2023.1260754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction While the rapid advancement of urbanization has driven the improvement of material living standards, it has also brought about rapid social changes and intensified competition. In this "involutive" environment characterized by highly competitive and strong pressure, urban residents tend to fall into a state of "mental exhaustion." Anxiety, depression, sleep disorders, and other mental illnesses have seriously threatened public health in Chinese cities. Support from social relations is crucial for enhancing residents' subjective well-being (SWB) and promoting their mental health, especially in China's highly contextualized collectivist culture. Methods According to the social structure of China's "difference sequence pattern," this paper constructs a theoretical framework of the relationship between social relations and SWB based on the convoy model and uses CGSS2018 data to verify the applicability of the theoretical framework. Results Kinship and friendship positively relate to SWB, and their interaction effect is significantly negative. There is no necessary correlation between neighborhood and SWB. The relationship between social relations and SWB of different age groups is heterogeneous. In addition, the moderating effects of relative income and social class are significantly negative. Discussion Kinship and friendship are Chinese urban residents' SWB convoys, and these two factors have an obvious substitution effect. The neighborhood has withdrawn from the convoy orbit of Chinese urban residents' SWB, which may be related to neighborhood indifference caused by China's housing system reform. From the life course perspective, the SWB convoys of young and middle-aged groups consist of kinship and friendship, while those of elderly people include kinship and neighborhood. In addition, for poor individuals living at the bottom of society, support from kinship is the most important source of social capital. These findings provide new insights into the relationship between social relations and the welfare of Chinese urban residents.
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Affiliation(s)
- Jianna Li
- Department of Management Science and Engineering, School of Management, Xi'an University of Architecture and Technology, Xi'an, China
| | - Bin Guo
- Department of Public Administration, School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
| | - Mengyuan Lu
- Department of Management Science and Engineering, School of Management, Xi'an University of Architecture and Technology, Xi'an, China
| | - Wen Zhang
- Department of Management Science and Engineering, School of Management, Xi'an University of Architecture and Technology, Xi'an, China
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Hajek A, Kretzler B, Walther C, Aarabi G, Zwar L, König HH. Neighbourhood cohesion, loneliness and perceived social isolation prior and during the COVID-19 pandemic. Longitudinal evidence from the German Ageing Survey. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1411-1420. [PMID: 36914882 PMCID: PMC10010637 DOI: 10.1007/s00127-023-02447-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE To investigate the longitudinal association between neighbourhood cohesion and loneliness as well as perceived social isolation prior and during the COVID-19 pandemic (stratified by sex). METHODS Longitudinal data were taken from a nationally representative sample (German Ageing Survey) of inhabitants aged 40 years and over in Germany prior (wave 6: year 2017) and during the COVID-19 pandemic (wave 8: November 2020 until February 2021; n = 6688 observations, mean age was 67.4 years). The De Jong Gierveld tool was used to measure loneliness and the Bude and Lantermann tool was used to measure perceived social isolation. Neighbourhood cohesion was assessed based on different items. RESULTS FE regressions showed that decreases in closeness of contact with neighbours were associated with increases in loneliness and perceived social isolation levels among men, but not women. In contrast, decreases in different indicators of involvement in neighbourhood activities were associated with increases in loneliness and perceived social isolation levels among women, but not men. CONCLUSION Changes in neighbourhood factors are differently associated with loneliness and perceived social isolation among middle-aged and older women and men. Gender-specific efforts to avoid loneliness and social isolation are, therefore, needed.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany.
| | - Benedikt Kretzler
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
| | - Carolin Walther
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Larissa Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
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Massihzadegan S, Stokes JE. Neighborhood Social Cohesion and Loneliness in Mid- and Later Life: Are Benefits Contingent on Race/Ethnicity or Neighborhood Disorder? J Gerontol B Psychol Sci Soc Sci 2023; 78:1581-1590. [PMID: 37218292 DOI: 10.1093/geronb/gbad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVES Connections between social integration and health throughout the life span are well established, including at the neighborhood level and among older adults. Less explored is how pathways between neighborhood social cohesion and well-being may differ by race/ethnicity or by neighborhood disorder. This study investigates whether perceived neighborhood social cohesion is associated with loneliness in adults aged 50 and older, and whether this association is moderated by race/ethnicity or perceived neighborhood disorder. METHODS We used pooled cross-sectional data from the 2016 and 2018 waves of the Health and Retirement Study and respondents to the Leave-behind Questionnaire age 50 and older, living in the community (N = 10,713). Data were analyzed using multivariate ordinary least squares regression. RESULTS Perceived social cohesion was negatively associated with loneliness (B = -0.13, p < .001); however, this effect was strongest among White respondents, and significantly weaker for respondents who were Black (B = 0.02, p < .05), Hispanic (B = 0.03, p < .05), or of another race/ethnicity (B = 0.03, p < .05). Further, neighborhood disorder moderated the association between social cohesion and loneliness (B = 0.02, p < .001), reducing the strength of relationship for those in areas of high disorder. Inclusion of this interaction also attenuated the interaction between neighborhood cohesion and race for Black older adults. DISCUSSION Findings show that neighborhood social cohesion matters for midlife and older adults' loneliness, but that this relationship varies by race/ethnicity and neighborhood disorder. As such, neighborhood racial/ethnic makeup and both social and objective neighborhood characteristics should be considered when designing interventions to reduce loneliness.
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Affiliation(s)
- Setarreh Massihzadegan
- Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Jeffrey E Stokes
- Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
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Akhter-Khan SC, Prina M, Wong GHY, Mayston R, Li L. Understanding and Addressing Older Adults' Loneliness: The Social Relationship Expectations Framework. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:762-777. [PMID: 36322145 PMCID: PMC10336618 DOI: 10.1177/17456916221127218] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Loneliness is an experience resulting from a perceived discrepancy between expected and actual social relationships. Although this discrepancy is widely considered the "core mechanism" of loneliness, previous research and interventions have not sufficiently addressed what older adults specifically expect from their social relationships. To address this gap and to help situate research on older adults' loneliness within broader life span developmental theories, we propose a theoretical framework that outlines six key social relationship expectations of older adults based on research from psychology, gerontology, and anthropology: availability of social contacts, receiving care and support, intimacy and understanding, enjoyment and shared interests, generativity and contribution, and being respected and valued. We further argue that a complete understanding of loneliness across the life span requires attention to the powerful impacts of contextual factors (e.g., culture, functional limitations, social network changes) on the expression and fulfillment of older adults' universal and age-specific relationship expectations. The proposed Social Relationship Expectations Framework may fruitfully inform future loneliness research and interventions for a heterogeneous aging population.
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Affiliation(s)
- Samia C. Akhter-Khan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London
| | - Gloria Hoi-Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong
| | - Rosie Mayston
- Department of Global Health and Social Medicine, Institute of Global Health, King’s College London
| | - Leon Li
- Department of Psychology and Neuroscience, Duke University
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Li Y, Ding X, Aierken A, Pan Y, Chen Y, Hu D. The role of community cohesion in elderly people during the COVID-19 epidemic: a cross-sectional study. JMIR Public Health Surveill 2023; 9:e45110. [PMID: 36921236 PMCID: PMC10148212 DOI: 10.2196/45110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/25/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Elderly people were regarded as the most impacted and most vulnerable social group during the COVID-19 epidemic. The community environment is vital for their health. The elderly people had to stay home during the implementation of the management and control of the COVID-19 epidemic. They lack resources and suffer from anxiety. Thus, determining environmental factors beneficial for their physical and mental health is very important. OBJECTIVE This study aims to assess the association between community cohesion and physical and mental health among elderly people and to identify the related community service and environmental factors that may promote community cohesion. METHODS This community-based cross-sectional study was designed during the COVID-19 epidemic. A multistage sampling method is applied to this study. A total of 2,036 participants aged ≥ 60 years were sampled from 27 locations in China. Data were collected through face-to-face interviews. The neighborhood cohesion instrument consisting of three-dimensional scales was used to assess community cohesion. Self-efficacy and life satisfaction, cognitive function and depression, and community service and environmental factors were also measured using standard instruments. Statistical analyses were restricted to 2,017 participants. Separate logistic regression analysis was conducted to assess the association between community cohesion and physical and mental health factors, as well as related community service and environmental factors, among elderly people. RESULTS The results showed that high levels of community cohesion were associated with good self-perceived health status and life satisfaction and high levels of self-efficacy and psychological resilience, and their odds ratios (ORs) were 1.27 (95% CI, 1.01-1.59) and 1.20 (95% CI, 1.15-1.27) and 1.09 (95% CI, 1.05-1.13) and 1.05 (95% CI, 1.03-1.06), respectively. The length of stay in the community and the level of physical activity were positively associated with community cohesion scores, whereas the educational level was negatively associated with the community cohesion scores (P < .05). Community cohesion was also associated with low level of depression and high level of cognitive function. The community cohesion was significantly associated with community services and environmental factors from four dimensions. High levels of community cohesion were associated with transportation service, rental of rehabilitation equipment, high levels of satisfaction for community doctors' technical level and community waste disposal, and their ORs were 3.14 (95% CI, 1.87-5.28), 3.62 (95% CI, 2.38-5.52), 1.37 (95% CI, 1.08-1.73), and 1.23 (95% CI, 1.01-1.50), respectively. CONCLUSIONS Community cohesion was associated with the physical and mental health of elderly people. Our research suggests that enhancing community services and environmental management may be an effective strategy to increase community cohesion during the epidemic period of major infectious diseases. CLINICALTRIAL
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Affiliation(s)
- Ying Li
- Zhejiang University, 866 Yu-hang-tang Road, HangZhou, CN
| | - XiWen Ding
- Zhejiang University, 866 Yu-hang-tang Road, HangZhou, CN
| | | | - YiYang Pan
- Zhejiang University, 866 Yu-hang-tang Road, HangZhou, CN
| | - Yuan Chen
- Zhejiang Provincial People's Hospital, HangZhou, CN
| | - DongBin Hu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, CN
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Kemppainen L, Kemppainen T, Fokkema T, Wrede S, Kouvonen A. Neighbourhood Ethnic Density, Local Language Skills, and Loneliness among Older Migrants-A Population-Based Study on Russian Speakers in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1117. [PMID: 36673878 PMCID: PMC9859331 DOI: 10.3390/ijerph20021117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
So far, little attention has been paid to contextual factors shaping loneliness and their interaction with individual characteristics. Moreover, the few existing studies have not included older migrants, identified as a group who are vulnerable to loneliness. This study examined the association between neighbourhood ethnic density (the proportion of own-group residents and the proportion of other ethnic residents in an area) and loneliness among older migrants. Furthermore, we investigated whether local language skills moderated this association. A population-based representative survey (The CHARM study, n = 1082, 57% men, mean age 63.2 years) and postal code area statistics were used to study Russian-speaking migrants aged 50 or older in Finland. The study design and data are hierarchical, with individuals nested in postcode areas. We accounted for this by estimating corresponding mixed models. We used a linear outcome specification and conducted logistic and ordinal robustness checks. After controlling for covariates, we found that ethnic density variables (measured as the proportion of Russian speakers and the proportion of other foreign speakers) were not associated with loneliness. Our interaction results showed that increased own-group ethnic density was associated with a higher level of loneliness among those with good local language skills but not among those with weaker skills. Good local language skills may indicate a stronger orientation towards the mainstream destination society and living in a neighbourhood with a higher concentration of own-language speakers may feel alienating for those who wish to be more included in mainstream society.
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Affiliation(s)
- Laura Kemppainen
- Faculty of Social Sciences, University of Helsinki, P.O. Box 4 (Yliopistonkatu 3), 00014 Helsinki, Finland
| | - Teemu Kemppainen
- Department of Geosciences and Geography, University of Helsinki, P.O. Box 4 (Yliopistonkatu 3), 00014 Helsinki, Finland
| | - Tineke Fokkema
- Netherlands Interdisciplinary Demographic Institute (NIDI)-KNAW/University of Groningen, Lange Houtstraat 19, 2511 CV The Hague, The Netherlands
- Department of Public Administration and Sociology, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
| | - Sirpa Wrede
- Faculty of Social Sciences, University of Helsinki, P.O. Box 4 (Yliopistonkatu 3), 00014 Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, P.O. Box 4 (Yliopistonkatu 3), 00014 Helsinki, Finland
- Centre for Public Health, Institute of Clinical Science, Queen’s University Belfast, Block A, Royal Victoria Hospital, BT12 6BA Belfast, Ireland
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Gallagher S, Howard S, Muldoon OT, Whittaker AC. Social cohesion and loneliness are associated with the antibody response to COVID-19 vaccination. Brain Behav Immun 2022; 103:179-185. [PMID: 35470012 PMCID: PMC9027289 DOI: 10.1016/j.bbi.2022.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/29/2022] [Accepted: 04/20/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Recent research has suggested that psychosocial factors influence the antibody response to vaccine, including SARS-CoV-2 (COVID-19) vaccines. Here we investigated whether social cohesion and loneliness were predictive of antibody response to a single dose of a COVID-19 vaccine. We also tested if the association between social cohesion and antibody response was mediated by feelings of loneliness. METHODS Participants (N = 676) COVID-19 antibody data were extracted from March 2021 wave of the Understanding Society COVID-19 study from the UK. Relevant socio-demographics, health and lifestyle, loneliness, social cohesion indices were also used in a series of hierarchical linear regression to test our main hypotheses. RESULTS After controlling for covariates (e.g., age and chronic health conditions), lower social cohesion was associated with a lower antibody response. Further, the association between social cohesion and poorer antibody responses was mediated by loneliness; those reporting lower social cohesion also reported higher loneliness, which in turn was associated with lower antibody response. CONCLUSION This study confirms that feelings of 'being in it together' relate to the strength of the antibody response to COVID-19 vaccination, emphasising the importance of the social cohesion agenda during the pandemic.
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Affiliation(s)
- Stephen Gallagher
- Centre for Social Issues, Department of Psychology, University of Limerick, Castletroy, Limerick, Ireland; Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland.
| | - Siobhán Howard
- Centre for Social Issues, Department of Psychology, University of Limerick, Castletroy, Limerick, Ireland; Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
| | - Orla T Muldoon
- Centre for Social Issues, Department of Psychology, University of Limerick, Castletroy, Limerick, Ireland
| | - Anna C Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Chum A, Teo C, Azra KK. Does the longitudinal association between neighbourhood cohesion and mental health differ by ethnicity? Results from the UK Household Longitudinal Survey. Soc Psychiatry Psychiatr Epidemiol 2022; 57:859-872. [PMID: 34241637 DOI: 10.1007/s00127-021-02125-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 06/22/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE While the association between neighbourhood cohesion and mental health has been widely studied in the general population, the effects of neighbourhood cohesion across ethnic groups are not well understood. Ethnicity is often left out of study design, many studies do not consider effect modification by ethnicity, or they rely on overly simplistic ethnic categories. METHODS Data from the UK household longitudinal study were used to investigate whether changes in neighbourhood cohesion are independently associated with changes in mental health (measured using the GHQ) over 9 years (2009-2018), and whether the association differed across 17 ethnic groups. The study used a fixed-effect modeling approach that includes within-person estimators that allow each participant to act as their own control. RESULTS Compared to British White, the following ethnic groups all saw a similar improvement in GHQ (- 0.76, 95% CI - 0.83 to - 0.70) for each point increase in neighbourhood cohesion: Irish, any other White, White and Asian mixed, Chinese, Caribbean, African, any other Black, Arab, and others. Some ethnic groups saw stronger improvements in mental for each point increase in neighbourhood cohesion, including White and Black Caribbean mixed, any other mixed, Indian, Pakistani, any other Asian, with the strongest effect seen in Bangladeshi participants (- 2.52. 95% CI - 3.48 to - 1.56). CONCLUSION Our study highlights the importance of ethnocultural data in research examining neighbourhood effects on mental health. Future research should evaluate policies to improve neighbourhood cohesion for ethnic minorities to address ethnic mental health disparities.
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Affiliation(s)
- Antony Chum
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 4A, Canada. .,MAP Center for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, M5V 1W8, Canada.
| | - Celine Teo
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 4A, Canada
| | - Karanpreet Kaur Azra
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 4A, Canada
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Galvez-Hernandez P, González-de Paz L, Muntaner C. Primary care-based interventions addressing social isolation and loneliness in older people: a scoping review. BMJ Open 2022; 12:e057729. [PMID: 35121608 PMCID: PMC8819903 DOI: 10.1136/bmjopen-2021-057729] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Primary care is well positioned to identify and address loneliness and social isolation in older adults, given its gatekeeper function in many healthcare systems. We aimed to identify and characterise loneliness and social isolation interventions and detect factors influencing implementation in primary care. DESIGN Scoping review using the five-step Arksey and O'Malley Framework. DATA SOURCES MEDLINE, CINAHL, EMBASE, COCHRANE databases and grey literature were searched from inception to June 2021. ELIGIBILITY CRITERIA Empirical studies in English and Spanish focusing on interventions addressing social isolation and loneliness in older adults involving primary care services or professionals. DATA EXTRACTION AND SYNTHESIS We extracted data on loneliness and social isolation identification strategies and the professionals involved, networks and characteristics of the interventions and barriers to and facilitators of implementation. We conducted a thematic content analysis to integrate the information extracted. RESULTS 32 documents were included in the review. Only seven articles (22%) reported primary care professionals screening of older adults' loneliness or social isolation, mainly through questionnaires. Several interventions showed networks between primary care, health and non-healthcare sectors, with a dominance of referral pathways (n=17). Two-thirds of reports did not provide clear theoretical frameworks, and one-third described lengths under 6 months. Workload, lack of interest and ageing-related barriers affected implementation outcomes. In contrast, well-defined pathways, collaborative designs, long-lasting and accessible interventions acted as facilitators. CONCLUSIONS There is an apparent lack of consistency in strategies to identify lonely and socially isolated older adults. This might lead to conflicts between intervention content and participant needs. We also identified a predominance of schemes linking primary care and non-healthcare sectors. However, although professionals and participants reported the need for long-lasting interventions to create meaningful social networks, durable interventions were scarce. Sustainability should be a core outcome when implementing loneliness and social isolation interventions in primary care.
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Affiliation(s)
- Pablo Galvez-Hernandez
- Lawrence S. Bloomberg Faculty of Nursing & Health Services and Policy Research Collaborative Specialization, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Luis González-de Paz
- Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), IDIBAPS, Barcelona, Spain
- Escola Superior d'Infermeria del Mar (ESIMar), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Parmar M, Ma R, Attygalle S, Mueller C, Stubbs B, Stewart R, Perera G. Associations between loneliness and acute hospitalisation outcomes among patients receiving mental healthcare in South London: a retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:397-410. [PMID: 33877370 PMCID: PMC8784491 DOI: 10.1007/s00127-021-02079-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE It is well known that loneliness can worsen physical and mental health outcomes, but there is a dearth of research on the impact of loneliness in populations receiving mental healthcare. This study aimed to investigate cross-sectional correlates of loneliness among such patients and longitudinal risk for acute general hospitalisations. METHOD A retrospective observational study was conducted on the data from patients aged 18 + receiving assessment/care at a large mental healthcare provider in South London. Recorded loneliness status was ascertained among active patients on the index date, 30th Jun 2012. Acute general hospitalisation (emergency/elective) outcomes were obtained until 31st Mar 2018. Length of stay was modelled using Poisson regression models and time-to hospitalisation and time-to mortality were modelled using Cox proportional hazards regression models. RESULTS The data from 26,745 patients were analysed. The prevalence of patients with recorded loneliness was 16.4% at the index date. In the fully adjusted model, patients with recorded loneliness had higher hazards of emergency (HR 1.15, 95% CI 1.09-1.22) and elective (1.05, 1.01-1.12) hospitalisation than patients who were not recorded as lonely, and a longer duration of both emergency (IRR 1.06, 95% CI 1.05-1.07) and elective (1.02, 1.01-1.03) general hospitalisations. There was no association between loneliness and mortality. Correlates of loneliness included having an eating disorder (OR 1.67, 95% CI 1.29-2.25) and serious mental illnesses (OR 1.44, 1.29-1.62). CONCLUSION Loneliness in patients receiving mental healthcare is associated with higher use of general hospital services. Increased attention to the physical healthcare of this patient group is therefore warranted.
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Affiliation(s)
- Mayur Parmar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
| | - Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
| | | | - Christoph Mueller
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gayan Perera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK.
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The Effect of Social Cohesion on Interest, Usefulness, and Ease of Use of a Driving Assistance System in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111412. [PMID: 34769929 PMCID: PMC8583404 DOI: 10.3390/ijerph182111412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022]
Abstract
This study examined the relationship between social cohesion and the perceived interest in, the usefulness of, and the ease of use of an instructor-based driver assistance system in a sample of older adults. With the aging of the population, the use of technologies to support the driving skills of the elderly is expected, and it is necessary to clarify the conditions under which the elderly will be interested in these advanced technologies. Traditionally, social cohesion has been focused on as a function of instrumental and practical support in the lives of the elderly. Since social cohesion reflects the intention to help each other, it could be an opportunity to provide information on advanced driving skill techniques to older people who are becoming more difficult to drive. As an initial exploration, this study examined whether social cohesion was associated with the interest in, the usefulness of, and the ease of use of an instructor-based driver assistance system in 150 elderly people. The results showed that a greater social cohesion was significantly associated with these evaluations, and that a comprehension of the system also contributed. The possession of a license was significantly associated with interest in the program. These findings are an essential step toward the understanding of the roles of social cohesion and positive perception of advanced technology in older adults.
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Subiza-Pérez M, García-Baquero G, Babarro I, Anabitarte A, Delclòs-Alió X, Vich G, Roig-Costa O, Miralles-Guasch C, Lertxundi N, Ibarluzea J. Does the perceived neighborhood environment promote mental health during pregnancy? Confirmation of a pathway through social cohesion in two Spanish samples. ENVIRONMENTAL RESEARCH 2021; 197:111192. [PMID: 33872648 DOI: 10.1016/j.envres.2021.111192] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 05/16/2023]
Abstract
Physical neighborhood attributes such as greenness, walkability and environmental pollution may have an influence on people's behavior and health. It has been claimed that part of such effects may come from the promotion of physical activity and the strengthening of social cohesion. In this study, we recruited samples of pregnant women in two Spanish cities (Donostia-San Sebastián, 440 participants and Barcelona, 360 participants) who filled in a questionnaire and wore an accelerometer for 1 week during the first trimester of pregnancy. The influence of perceived residential greenness, walkability and environmental pollution on mental health (GHQ-12) was tested in two structural equation models that included light physical activity, moderate-to-vigorous physical activity and social cohesion as mediators. Two solutions showing excellent and good fits (Donostia-San Sebastián: X2(3) = 2.56, p = .465, CFI = 1, RMSEA < 0.001; Barcelona: X2(6) = 4.86, p = .566, CFI = 1, RMSEA = 0.048) consistently showed that neighborhood attributes promote mental health through social cohesion in the two cities. Stratified analyses revealed that the social cohesion-mental health effect was only statistically significant for low and medium socioeconomic status groups in the Donostia-San Sebastián sample. Pathways through physical activity were not confirmed.
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Affiliation(s)
- Mikel Subiza-Pérez
- Department of Clinical and Health Psychology and Research Methods, University of the Basque Country UPV/EHU, Avenida Tolosa 70, 20018, Donostia-San Sebastián, Spain; Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain S/n, 20014, Donostia-San Sebastián, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Madrid, 28029, Spain.
| | - Gonzalo García-Baquero
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain S/n, 20014, Donostia-San Sebastián, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Madrid, 28029, Spain.
| | - Izaro Babarro
- Department of Clinical and Health Psychology and Research Methods, University of the Basque Country UPV/EHU, Avenida Tolosa 70, 20018, Donostia-San Sebastián, Spain; Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain S/n, 20014, Donostia-San Sebastián, Spain.
| | - Asier Anabitarte
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain S/n, 20014, Donostia-San Sebastián, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), Barrio Sarriena S/n, Leioa, 48940, Spain.
| | - Xavier Delclòs-Alió
- Institute of Urban and Regional Development (IURD), University of California, Berkeley, United States.
| | - Guillem Vich
- Geography Department, Universitat Rovira I Virgili, 43480, Vila-seca, Tarragona, Spain; ISGlobal (Barcelona Institute for Global Health), Barcelona, 08036, Spain; Grup D'Estudis en Mobilitat, Transport I Territori (GEMOTT), Departament de Geografia, Universitat Autònoma de Barcelona, Edifici B, Campus de Bellaterra, 08193, Cerdanyola Del Vallès (Barcelona), Spain.
| | - Oriol Roig-Costa
- Grup D'Estudis en Mobilitat, Transport I Territori (GEMOTT), Departament de Geografia, Universitat Autònoma de Barcelona, Edifici B, Campus de Bellaterra, 08193, Cerdanyola Del Vallès (Barcelona), Spain.
| | - Carme Miralles-Guasch
- Grup D'Estudis en Mobilitat, Transport I Territori (GEMOTT), Departament de Geografia, Universitat Autònoma de Barcelona, Edifici B, Campus de Bellaterra, 08193, Cerdanyola Del Vallès (Barcelona), Spain.
| | - Nerea Lertxundi
- Department of Clinical and Health Psychology and Research Methods, University of the Basque Country UPV/EHU, Avenida Tolosa 70, 20018, Donostia-San Sebastián, Spain; Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain S/n, 20014, Donostia-San Sebastián, Spain.
| | - Jesús Ibarluzea
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain S/n, 20014, Donostia-San Sebastián, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Madrid, 28029, Spain; Ministry of Health of the Basque Government, SubDirectorate for Public Health and Addictions of Gipuzkoa, 20013, San Sebastian, Spain; Faculty of Psychology, University of the Basque Country UPV/EHU, Avenida Tolosa 70, 20018, Donostia - San Sebastian, Spain.
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