Social network diversity and risks of ischemic heart disease and total mortality: findings from the Copenhagen City Heart Study

Trends, transitions and patterning in social activity over time among aging women and men: A secondary analysis of the Canadian Longitudinal Study on Aging (CLSA)

Social isolation matters for health and longevity, but little research examines transitions into or out of social isolation or whether transitions are gendered or socially patterned. We described gender-specific trends in breadth and lack of social participation over 6 years overall and by age, country of origin, geographic location, education, wealth, and household income. We used three waves of CLSA data to evaluate changes in social isolation (0-1 activities) and broad social participation (5+ activities) in adults aged 45-75 (n = 24,788), by gender and socio-demographics, in linear and multinomial logistic regressions with post-estimated predicted probabilities. The number of social activities decreased over time, with greater declines for women. About half the sample (more men than women) stayed not highly socially active (<5 activities) and almost 1 in 5 became not highly socially active. Most adults (77 %) remained not socially isolated and 14 % became or remained socially isolated. Women were more likely than men to remain not highly socially active and less likely to have multiple social isolation transitions. Broad social participation changed over time for several subgroups of women and men, with gender differences notable for income levels. Social disparities in social isolation transitions differed by gender only for education. Older age and socioeconomically disadvantaged adults had higher probabilities of becoming socially isolated or becoming less socially active. Findings indicated the diversity of social activities declined as Canadians age into later life and transitions in both social isolation and social participation differed between genders, especially for specific vulnerable subpopulations.

Cancer Patients' Social Relationships During 3 Years After Diagnosis-Generic and Cancer-Specific Social Networks

BACKGROUND

Social relationships are important health resources and may be investigated as social networks. We measured cancer patients' social subnetworks divided into generic social networks (people known to the patients) and disease-specific social networks (the persons talked to about the cancer) during 3 years after diagnosis.

METHOD

Newly diagnosed patients with localized breast cancer (n = 222), lymphoma (n = 102), and prostate cancer (n = 141) completed a questionnaire on their social subnetworks at 2-5 months after diagnosis and 9, 18, and 36 months thereafter. Generic and cancer-specific numbers of persons of spouse/partner; other family; close relatives, in detail; and friends were recorded as well as cancer-specific numbers of persons in acquaintances; others with cancer; work community; healthcare professionals; and religious, hobby, and civic participation. The data was analyzed with regression models.

RESULTS

At study entry, most patients had a spouse/partner, all had close relatives (the younger, more often parents; and the older, more often adult children with families) and most also friends. The cancer was typically discussed with them, and often with acquaintances and other patients (74-86%). Only minor usually decreasing time trends were seen. However, the numbers of distant relatives and friends were found to strongly increase by the 9-month evaluation (P < 0.001).

CONCLUSION

Cancer patients have multiple social relationships and usually talk to them about their cancer soon after diagnosis. Most temporal changes are due to the natural course of life cycle. The cancer widened the patients' social networks by including other patients and healthcare professionals and by an increased number of relatives and friends.

Marital Quality and Loneliness Among Aging Vietnam-Era Combat Veterans: The Moderating Role of PTSD Symptom Severity

OBJECTIVES

We examined links between marital quality and loneliness among aging veterans and explored whether veterans' PTSD symptom severity moderated these associations.

METHODS

Data came from 269 Vietnam-Era combat veterans who had a spouse/partner (M age = 60.50). Utilizing two waves of data spanning six years, we estimated multiple regression models that included positive and negative marital quality, PTSD symptom severity, and loneliness in 2010 as predictors of loneliness in 2016.

RESULTS

Facets of positive (but not negative) marital quality were associated with veterans' loneliness. Companionship - spousal affection and understanding - was associated with lower subsequent loneliness among veterans with low/moderate - but not high - PTSD symptom severity. Conversely, sociability - the degree to which one's marriage promotes socializing with others - was associated with lower subsequent loneliness regardless of PTSD symptom severity.

CONCLUSIONS

Companionship and sociability were each associated with veterans' subsequent loneliness. Whereas benefits of companionship were attenuated at higher levels of PTSD symptom severity, benefits of sociability were not.

CLINICAL IMPLICATIONS

For veterans with higher PTSD symptoms, recommending mental health treatment to decrease symptom severity may help them to reap the benefits of close/intimate relationships. However, bolstering veterans' social participation more broadly may provide an additional means of reducing their loneliness.

Social networks, social support, and life expectancy in older adults: the Cardiovascular Health Study

BACKGROUND

Social support and social networks have long been postulated to impact health outcomes but their impact on life expectancy and disability in older adults remains poorly quantified.

METHODS

As part of the Cardiovascular Health Study, we followed 5,749 adults aged 65 years and older from 4 US field centers for 25 years. We assessed the Lubben social network score [range 0-50] and a social support score [range 0-24] derived from the Interpersonal Support Evaluation List (ISEL-12) in two consecutive years starting at study recruitment. We used remaining years of life (YOL) from study enrollment to death to approximate life expectancy. We defined years of active life (YAL) as the number of study years in which participants lived without any difficulties in activities of daily living. We used compression of disability to reflect the proportion of life lived able (YAL/YOL). We used linear regression to adjust for socio-demographics and comorbidity.

RESULTS

The mean (standard deviation [SD]) scores were 32.3 ± 6.8 points for social network score and 8.3 ± 2.4 points for social support score. For every 1-SD increase in social network score, adjusted participant life expectancy was 0.40 years higher (95% CI 0.22-0.58; p<0.0001) and disability-free life expectancy 0.35 years higher (95% CI 0.18-0.53; p<0.0001). The association with life expectancy was modified by participant age (p<0.001), but it remained significant even among participants aged ≥75 years (3 months per SD; 95% CI 0.1-6 months, p = 0.04). Further adjustment for frailty did not attenuate the estimates. The social support scale was not significantly associated with YOL or YAL after adjustment for social network score, and neither measure was associated with compression of disability.

DISCUSSION

In older adults, higher social network scores are significantly associated with longer life expectancy and disability-free life expectancy.

Understanding the life experiences of elderly in social isolation from the social systems perspective: using Hong Kong as an illustrating example

Aim

The elderly in social isolation often referred to as older people who experience social alienation with little social support from their family, peers, and community suffer from a poor quality of life and well-being. Since their life experiences are affected by a range of factors from different levels, this study seeks to investigate their current life situations and experiences from a social systems perspective.

Methods

A qualitative study was conducted to enrich the understanding of their current life situations and experiences and to generate corresponding practice implications. In this study, there were 13 elderly participants in social isolation, which were users of a social service agency in Hong Kong. They took part in a semi-structured individual interview, sharing their life stories about their daily lives, social relationships, and sense of well-being. Qualitative results were analyzed based on these dimensions.

Results

Results showed that the elderly participants in social isolation had a low level of social support and participation in social activities. Their life experiences and situations were affected by multiple levels of factors that were interrelated.

Conclusion

The results support the application of the social systems perspective in investigating the living conditions of the elderly in social isolation. The corresponding practice implications were also discussed.

Stand by Me: Social Ties and Health in Real-Time

Sociological research has documented myriad associations between individuals' overall social connectedness and health, but rarely considers the shorter-term dynamics of social life that may underlie these associations. We examine how being with others ("social accompaniment") is associated with momentary experiences of symptoms, drawing smartphone-based ecological momentary assessments (N=12,720) collected from 342 older adults from the Chicago Health and Activity in Real Time study. We find that patterns of social accompaniment are distinct from global measures of social integration such as network size. Older adults who are in the company of a friend or neighbor are significantly less likely to experience momentary fatigue and stress, even after accounting for overall measures of social integration. These results suggest that social accompaniment has unique implications for short-term health outcomes. New theoretical perspectives and empirical analyses are needed to better understand the dynamic nature of everyday social accompaniment and its longer-term implications for well-being.

Behavioral trajectories of aging prairie voles (Microtus ochrogaster): Adapting behavior to social context wanes with advanced age

Several studies using mice have examined the effects of aging on cognitive tasks, as well as sensory and motor functions. However, few studies have examined the influence of aging on social behavior. Prairie voles (Microtus ochrogaster) are a socially monogamous and biparental rodent that live in small family groups and are now among the most popular rodent models for studies examining social behavior. Although the social behavioral trajectories of early-life development in prairie voles have been well-studied, how social behavior may change throughout adulthood remains unknown. Here we examined behavior in virgin male and female prairie voles in four different age groups: postnatal day (PND) 60–80, 140–160, 220–240, and 300–320. All animals underwent testing in a novel object task, a dominance test, a resident-intruder test, and several iterations of social approach and social interaction tests with varying types of social stimuli (i.e., novel same-sex conspecific, novel opposite-sex conspecific, familiar same-sex sibling/cagemate, small group of novel same-sex conspecifics). We found that age influenced neophobia and dominance, but not social approach behavior. Further, we found that young adult, but not older adult, prairie voles adapt prosocial and aggressive behavior relative to social context, and that selective aggression occurs in relation to age even in the absence of a pair bond. Our results suggest that prairie voles calibrate social phenotype in a context-dependent manner in young adulthood and stop adjusting behavior to social context in advanced age, demonstrating that social behavior is plastic not only throughout early development, but also well into adulthood. Together, this study provides insight into age-related changes in social behavior in prairie voles and shows that prairie voles may be a viable model for studying the cognitive and physiological benefits of social relationships and social engagement in advanced age.

Invited discussant comments during the UCL-Penn Global COVID Study webinar 'Alone Together: Loneliness Research and Social Health Innovation in Lockdown and Beyond'

The coronavirus (Covid-19) pandemic has influenced people's social relationships around the world in surprising ways. It has also underscored the importance of and accelerated innovation in solutions for social isolation and loneliness. This commentary offers takeaways from emerging research findings and a wide lens on the societal movement underway to create more socially connected communities.

Effects of Social Networks in Promoting Young Adults' Physical Activity among Different Sociodemographic Groups

Introduction: Physical inactivity has become a public health issue as it can trigger many chronic diseases. Studies have found that an individual’s social networks (SNs) influence their engagement in physical activity (PA). However, it remains unclear how the influence varies between different sociodemographic groups. This study examined the associations between the SN structures and the PA of young adults across sociodemographic groups. Method: Data on 14,595 young adults aged 24–32 were obtained from Wave IV of the National Longitudinal Study of Adolescent to Adult Health. Latent class analysis was conducted to identify heterogeneous subgroups of respondents with respect to their engagement in PA and SN structures were measured in terms of the relationship quality, contact frequency, network size, and spatial accessibility. Logistic regression and chi-square tests were used to further test the relationships between PA and SNs as well as the sociodemographic factors. Results: SNs were found to have a significant influence on PA. Relationship quality was identified as the most important feature of an individual’s SN, followed by network size, contact frequency, and accessibility. The effects of SNs on PA varied with the individuals’ gender, ethnicity, income, and educational attainment. For example, male participants tended to be physically active if they had frequent connections with their neighbors, while the engagement in PA of the female participants was strongly related to the frequency of their contact with their children. Conclusions: This research has important implications for practitioners as it suggests that PA intervention programs should be designed to target specific population groups.

Social Disconnectedness and Mental Health Problems During the COVID-19 Pandemic in China: A Moderated Mediation Model

Objectives: This study aimed to examine the mediating effect of perceived isolation and the moderating effect of COVID-19 related concerns in the relationship between social disconnectedness and mental health problems during the COVID-19 pandemic in China.

Methods: A cross-sectional online survey of 11,682 Chinese residents were conducted during the COVID-19 outbreak. Conditional process analysis was performed to test the mediating effect of perceived isolation and the moderating effect of COVID-19 related concerns.

Results: Social disconnectedness was positively related to mental health problems, and perceived isolation significantly mediated their relationship. COVID-19 related concerns exacerbated the direct link between social disconnectedness and mental health problems as well as the indirect link via perceived isolation.

Conclusion: Social disconnectedness was a key predictor of mental health problems during the COVID-19 outbreak. The direct and indirect effects of social disconnectedness on mental health problems were stronger for respondents who had more COVID-19 related concerns. Understanding the underlying mechanisms by which social disconnectedness is related to mental health problems has important practical implications for the prevention of mental health problems during the COVID-19 pandemic.

Loneliness and Social Isolation: Determinants of Cardiovascular Outcomes

One in three Americans report experiencing loneliness in everyday life, a number that has grown exponentially over the last few decades. As we respond to the SARS-COV2 pandemic with quarantine and social distancing, social isolation and feelings of loneliness are increasing among people of all ages. This presents as an opportune time to recognize the public health impact of these important psychosocial determinants. Loneliness and social isolation are associated with a higher incidence of CVD, higher healthcare utilization and worse outcomes even after controlling for conventional risk factors of CVD. In this review, we discuss loneliness and social isolation as determinants of cardiovascular outcomes, the pathophysiology of this association, and its implications in clinical practice. We discuss some of the shortcomings in the assessment of loneliness and social isolation while identifying the most commonly used rating scales for the same. Finally, we suggest modifications to interventions for loneliness and social isolation during the COVID-19 pandemic.

Social isolation and risk of heart disease and stroke: analysis of two large UK prospective studies

BACKGROUND

Social isolation has been associated with increased risk of coronary heart disease and stroke. However, it is unclear whether the associations differ between fatal and non-fatal events or by the type of isolation (living alone or having few social contacts). We aimed to examine these associations in two large UK prospective cohorts.

METHODS

Million Women Study and UK Biobank participants without previous coronary heart disease or stroke who provided data in median year 2010 (IQR 2009-2011) on social contacts were included in this prospective analysis. Participants were followed up to median year 2017 (2017-2017) by electronic linkage to national hospital and death records. Risk ratios (RRs) were calculated using Cox regression for first coronary heart disease and stroke event (overall, and separately for hospital admission as the first event and for death without an associated hospital admission as the first event) by three levels of social isolation (based on living alone, contact with family or friends, and group participation) adjusted for age, sex, study, region, deprivation, smoking, alcohol intake, body-mass index, physical activity, and self-rated health.

FINDINGS

938 558 participants were included in our analyses (mean age 63 years [SD 9]): 481 946 participants from the Million Women Study (mean age 68 years [5]) and 456 612 participants (mean age 57 years [8]) from UK Biobank. During a mean follow-up period of 7 years (2), 42 402 first coronary heart disease events (of which 1834 were fatal without an associated hospital admission) and 19 999 first stroke events (of which 529 were fatal without an associated hospital admission) occurred. Little, if any, association was found between social isolation and hospital admission for a first coronary heart disease or stroke event (combined RR for both studies 1·01 [95% CI 0·98-1·04] for coronary heart disease and 1·13 [1·08-1·18] for stroke, when comparing the most isolated group with the least isolated group). However, the risk of death without an associated hospital admission was substantially higher in the most isolated group than the least isolated group for coronary heart disease (1·86 [1·63-2·12]) and stroke (1·91 [1·48-2·46]). For coronary heart disease or stroke death as the first event, RRs were substantially higher (test for heterogeneity, p=0·002) for participants living alone versus those not living alone (1·60 [1·46-1·75]) than for those with fewer versus more contact with family, friends, or groups (1·27 [1·16-1·38]). These findings did not differ greatly between studies, or by self-rated health.

INTERPRETATION

Social isolation seems to have little direct effect on the risk of developing a first coronary heart disease or stroke. By contrast, social isolation substantially increases the risk that the first such event is fatal before reaching hospital, particularly among people who live alone, perhaps because of the absence of immediate help in responding to an acute heart attack or stroke.

FUNDING

UK Medical Research Council, Cancer Research UK.

Communication Hotspots: How Infrastructure Shapes People's Health

Informed by communication infrastructure theory (CIT) and the social capital approach to health, this study focused on the role played by communication hotspots: physical places in a community (e.g., parks, churches, or restaurants) where health information is shared between network actors. By analyzing survey data that included information about communication infrastructure, frequency of health conversations, as well as the size and diversity of respondents' social networks, this study illustrates how communication hotspots may reduce perceived barriers to healthcare among Latinas in the greater Los Angeles area (N = 780). The results suggest that communication hotspots can influence people's health by facilitating information-sharing activities. In addition, communication hotspots may reduce perceived barriers to healthcare by bringing together diverse network actors. We conclude by considering future health interventions and policy planning to leverage and enhance community members' interactions at communication hotspots.

Social Network Characteristics and Their Associations With Stress in Older Adults: Closure and Balance in a Population-Based Sample

OBJECTIVES

Integration into social networks reduces stress during adverse life events and improves coping with disability in late life. The aim was to investigate whether social network closure (frequent contact among ties) and balance (positive contact among ties) are associated with perceived stress. We expect lowest stress for older adults with highly closed and balanced networks.

METHOD

Panel data on self-reported egocentric networks stem from the population-based Chicago Health, Aging, and Social Relations Study. Five waves were collected between 2002 and 2006, with 708 observations from 160 participants aged 50-68 years at baseline. Data include information on the participants' social relationships, that is, interaction frequency and relationship quality, for ego-alter ties and alter-alter ties, and participants' perceived stress. The analytical strategy used fixed- and random-effects models.

RESULTS

Participants reporting the highest number of balanced relationships (positive ties among alters) experience least stress. This effect holds independently of sociodemographic confounders, loneliness, and network size.

DISCUSSION

The absence of a stress-reducing effect from network closure suggests that balance matters more. Future research would benefit from considering balance when examining the characteristics of social networks that impinge on mental health outcomes in older adults.

Realfooders Influencers on Instagram: From Followers to Consumers

(1) Background: Realfooders have positioned themselves in social networks such as Instagram by posting photographs of recipes, advises, habits and nutritional behaviours which are advertised as reliable nutritional patterns and by their self-promotion as highly trained people in the field of nutrition which sometimes jeopardises the health of digital citizenry. (2) Methods: In this article, we develop a quantitative study for analysing the influence of selected Realfooders on 2,866,980 followers on Instagram, taking into account channel variables (gender, location, interests and motivations), followers’ variables (engagement, interaction and consumption) and some variables related to the message of 54 posts about breakfast. (3) Results: Selected Realfooders concentrate their followers in Spain, mostly women between 18 and 24 and between 35 and 44 years old who link their interests on food to the cult of the body and recreational areas. On the other hand, the content generated by Realfooders has been increasing its impact using advertising and marketing techniques for awaking consumer’s interest. (4) Conclusions: Educational and social agents are facing the challenge of low health literacy in young population. Therefore, it is necessary to design and implement strategies for developing critical thinking that allow them to assess the content generated by Realfooders and identify which recommendations can be harmful or beneficial to their health.

Loneliness in Later Life and Reaching Longevity: Findings From the Longitudinal Aging Study Amsterdam

Objectives

There is an increasing research interest in factors that characterize those who reach exceptionally old ages. Although loneliness is often associated with an increased risk for premature mortality, its relationship with reaching longevity is still unclear. We aimed to quantify the association between (social/emotional) loneliness and the likelihood of reaching the age of 90 years in men and women separately.

Methods

For these analyses, data from the Longitudinal Aging Study Amsterdam (LASA) were used. Loneliness, social loneliness, and emotional loneliness were assessed at baseline using the 11-item De Jong-Gierveld scale in 1992–1993 (at age 64–85 years). Follow-up for vital status information until the age of 90 years was 99.5% completed. Multivariable-adjusted Cox regression analyses with a fixed follow-up time were based on 1,032 men and 1,078 women to calculate risk ratios (RR) of reaching 90 years.

Results

No significant associations were observed between loneliness and reaching 90 years in both men (RR, 0.90; 95% confidence interval [CI], 0.70–1.14) and women (RR, 0.98; 95% CI, 0.83–1.14). Social loneliness was significantly associated with a reduced chance of reaching 90 years in women (RR, 0.82; 95% CI, 0.67–0.99).

Discussion

The current analyses did not show support for the existence of a meaningful effect of loneliness on reaching longevity in both sexes. When investigating specific dimensions of loneliness, we observed that reporting social loneliness was associated with reaching 90 years in women. This indicates that, for women, a large and diverse personal network at an older age could increase the probability of reaching longevity. However, replication of our findings in other cohorts is needed.

Effects of Life Events and Social Isolation on Stroke and Coronary Heart Disease

The current coronavirus disease 2019 (COVID-19) pandemic represents a severe, life-changing event for people across the world. Life changes may involve job loss, income reduction due to furlough, death of a beloved one, or social stress due to life habit changes. Many people suffer from social isolation due to lockdown or physical distancing, especially those living alone and without family. This article reviews the association of life events and social isolation with cardiovascular disease, assembling the current state of knowledge for stroke and coronary heart disease. Possible mechanisms underlying the links between life events, social isolation, and cardiovascular disease are outlined. Furthermore, groups with increased vulnerability for cardiovascular disease following life events and social isolation are identified, and clinical implications of results are presented.

Fertility Behavior and Depression Among Women: Evidence From China

Using data from the China Labor-Force Dynamic Survey, this study employed logistic regressions to investigate the association between fertility behavior and depression among Chinese women. The empirical results show that in China, women having children were significantly less likely to have depressive symptoms (OR = 0.651) compared to childless women. We also found a U-shaped relationship between fertility levels and depression in women. The results were robust to using the propensity score matching approach to address the sample selection problem. Further, our heterogeneity analysis demonstrated that the negative relationship between fertility level and depression was more significant among women who were in their 30s, lived in urban areas, and lived in high-income households. Compared to having male children (boys) (OR = 0.874), having female children (girls) (OR = 0.795) was more significantly associated with fewer depressive symptoms among women. In the meantime, we did not find a significant relationship between the childbearing period and depression. The paper discussed possible reasons for our findings and policy implications from the perspectives of the government, society, and family.

Is having an educationally diverse social network good for health?

While network research often focuses on social integration as a predictor of health, a less-explored idea is that connections to dissimilar others may benefit well-being. As such, this study investigates whether network diversity is associated with changes in four health outcomes over a 3-year period of time in the U.S.A. Specifically, we focus on how an underexplored measure of network diversity-educational attainment assortativity-is associated with common self-reported outcomes: propensity to exercise, body-mass index, mental health, and physical health. We extend prior research by conducting multilevel analyses using this measure of diversity while adjusting for a range of socio-demographic and network confounders. Data are drawn from a longitudinal probability sample of U.S. adults (n = 10, 679) in which respondents reported information about themselves and eight possible alters during three yearly surveys (2013-2015). We find, first, that higher educational attainment is associated with more educationally insular networks, while less-educated adults have more educationally diverse networks. Results further suggest that having educationally similar networks is associated with higher body-mass index among the less educated. Further exploration of the relationship between ego network diversity, tie strength, and health is warranted.

Personal networks and mortality in later life: racial and ethnic differences

Background

Social network characteristics are associated with health outcomes in later life, including mortality. Moreover, there are well-established mortality disparities across race and ethnicity. Although previous studies have documented these associations separately, limited research considers the two in tandem. The present study addressed how the associations between social network characteristics and mortality differ across race and ethnicity in later life.

Methods

Data were from the National Social Life, Health, and Aging Project. At baseline, 3005 respondents were interviewed with regards to their health and social networks. Five years later, 430 respondents had died. Logistic regression models were used to estimate the odds of all-cause mortality over the study period.

Results

Network size and kin composition were negatively associated with mortality, whereas density was positively associated with mortality. There was a stronger negative association between the kin composition and mortality for Hispanic respondents compared with white and Black respondents.

Conclusion

The present study contributes to the large literature documenting the link between social networks and health by highlighting the importance of analyzing networks through a sociocultural lens.

A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing: Loneliness, Social Isolation, and Connectedness

Background

This review studies technology-supported interventions to help older adults, living in situations of reduced mobility, overcome loneliness, and social isolation. The focus is on long-distance interactions, investigating the (i) challenges addressed and strategies applied; (ii) technology used in interventions; and (iii) social interactions enabled.

Methods

We conducted a search on Elsevier's Scopus database for related work published until January 2020, focusing on (i) intervention studies supported mainly by technology-mediated communication, (ii) aiming at supported virtual social interactions between people, and (iii) evaluating the impact of loneliness or social isolation.

Results

Of the 1178 papers screened, 25 met the inclusion criteria. Computer and Internet training was the dominant strategy, allowing access to communication technologies, while in recent years, we see more studies aiming to provide simple, easy-to-use technology. The technology used was mostly off-the-shelf, with fewer solutions tailored to older adults. Social interactions targeted mainly friends and family, and most interventions focused on more than one group of people. Discussion. All interventions reported positive results, suggesting feasibility. However, more research is needed on the topic (especially randomized controlled trials), as evidenced by the low number of interventions found. We recommend more rigorous methods, addressing human factors and reporting technology usage in future research.

Degree of influence in class modifies the association between social network diversity and well-being: Results from a large population-based study in Japan

BACKGROUND

Social network diversity can be associated with physical and mental health among adolescents, which might be modified by their perceived degree of influence in class. We aimed to examine the association between social network diversity and physical and mental health, and to elucidate its effect modification by perceived degree of influence in class.

METHODS

Data were obtained from the Kochi Child Health Impact of Living Difficulty (K-CHILD) study in 2016, which targeted 5th, 8th and 11th grade children living in Kochi Prefecture in Japan (N = 9998). Social network diversity accounted for the number of social roles in which adolescents had regular contact. Degree of influence in class, depression (using Depression Self-Rating Scale for children (DSRS)) and self-rated health were assessed by children, and behavior problem and prosocial behavior (using Strengths and Difficulties Questionnaire (SDQ)) was assessed by caregivers.

RESULTS

Significant association of social network diversity with depression (Coefficient (B) = -0.59, 95% confidence interval (CI) = -0.68 to -0.50), self-rated health (B = 0.09, 95% CI = 0.07 to 0.11), behavior problem (B = -0.71, 95% CI = -0.82 to -0.61) and prosocial behavior (B = 0.06, 95% CI = 0.02 to 0.11) were found. The association with depression and self-rated health was stronger among children with perceived low degree of influence (both p for interaction < 0.001). A similar trend was observed for behavior problem (p for interaction = 0.053), but effect modification was not found for the association between social network diversity and prosocial behavior.

CONCLUSIONS

Social network diversity was beneficial for adolescent physical and mental health, especially for children with perceived lower degree of influence in class.

Review of the Association Between Number of Social Roles and Cardiovascular Disease: Graded or Threshold Effect?

OBJECTIVE

There is increasing evidence for an inverse association between the number of social roles (e.g., spouse, friend, and neighbor) we engage in and our risk of disease, especially cardiovascular disease (CVD). Two mechanistic models have been proposed to explain this association. The social integration model refers to a graded association where every additional social role is associated with an increase in resistance to disease. The social isolation model refers to a threshold effect where the lack of a minimal criterion number of roles increases risk of disease.

METHODS

We conducted a systematic review of prospective studies examining the association between number of social roles and CVD risk.

RESULTS

When we include all studies assessing number of social roles, irrespective of whether associations are attributable to graded effects (social integration) and threshold effects (social isolation) or cannot be determined by the data presented, those holding fewer social roles were found to be at greater risk of CVD incidence, CVD mortality (evidence stronger for men than women), and greater progression of disease (only for short [≤5 years] follow-ups). However, closer analyses indicate that the association between a greater number of social roles and decreased CVD incidence was attributable to graded effects among men but to both effects among women. In contrast, the association of number of social roles and disease progression was driven by threshold effects (social isolation) for both sexes, whereas mortality studies included evidence for both effects.

CONCLUSIONS

These results suggest underlying mechanisms linking social roles to different CVD outcomes.

Egocentric social networks, lifestyle behaviors, and body size in the Asian Community Health Initiative (CHI) cohort

BACKGROUND

Social networks have been shown to influence lifestyle behaviors in non-Latinx white (NLW) populations. We examined their influence in Asian American, Native Hawaiian and Pacific Islander (AANHPI) women.

METHODS

We included 477 AANHPI women from the Asian Community Health Initiative Study who provided egocentric (degree, density, composition) and epidemiologic (size, types of ties) social network data and data on alcohol intake, physical activity, smoking, diet, and body size. We used logistic regression to evaluate associations of social network measures and dichotomous outcomes, and linear regression for continuous outcomes.

RESULTS

In multivariable-adjusted analyses, higher degree and/or proportion of friends were significantly related to higher Western diet, higher odds of any alcohol consumption, and lower odds of physical inactivity and body mass index (BMI)≥23 kg/m2. Additionally, a higher proportion of NLW in women's networks was related to lower Asian diet but also lower waist size. Community participation was related to higher Western diet and lower Asian diet. By contrast, degree and/or proportion of relatives were positively related to BMI, waist size and to a higher odds of BMI≥23 kg/m2 and of ever smoking 100 cigarettes. Being married was related to fewer alcoholic drinks per week and higher Asian diet. A higher density of relationships with frequent contact was also associated with higher Asian diet.

CONCLUSIONS

AANHPI women with larger proportions of friends and NLWs in their networks had more Western health behaviors and smaller body size. Norms for health behaviors and body size may be influenced by the size, composition, and structure of social networks, relevant to chronic disease prevention.

Social relations in late adolescence and incident coronary heart disease: a 38-year follow-up of the Swedish 1969-1970 Conscription Cohort

OBJECTIVES

Increasing evidence suggests that low social support is associated with an elevated risk of coronary heart disease (CHD). Earlier studies in this field were conducted in predominantly middle-aged or older samples; thus, the associations reported previously may have been confounded by subclinical manifestations of the disease. We investigated whether social relationships in late adolescence, that is, well before symptoms of subclinical disease manifest, are associated with CHD during a 38-year follow-up.

SETTING

Sweden.

PARTICIPANTS

Men born 1949-1951 and conscripted for military service in Sweden during 1969-1970 (n=49 321). At conscription, participants completed questionnaires about social relationships, lifestyle and health-related factors and underwent a medical examination.

PRIMARY AND SECONDARY OUTCOME MEASURES

CHD, acute myocardial infarction (AMI).

RESULTS

We found no relationship between having no confidant and frequency of confidential discussions with friends and the risk of CHD or AMI in the first 30 years of follow-up. However, after 30 years, men with no confidant at baseline had increased CHD and AMI risks relative to those having a confidant; the childhood socioeconomic status-adjusted HR and 95% CIs (CI) were 1.25 (1.10 to 1.41) and 1.27 (1.08 to 1.49), respectively. The frequency of confidential discussions with friends had an inverse U-shaped relationship with the outcomes after 30 years; the HR (95% CI) for 'sometimes' versus 'quite often' was 1.16 (1.04 to 1.29) for CHD and 1.16 (1.01 to 1.33) for AMI. These associations persisted after adjusting for mental ill-health, lifestyle factors and systolic blood pressure. A low number of friends in late adolescence was not related to an increased CHD or AMI risk.

CONCLUSIONS

Not having a confidant in late adolescence was associated positively, while the frequency of confidential discussions with friends had an inverse U-shaped relationship with CHD and AMI after 30 years of follow-up, suggesting that these associations are not due to subclinical disease manifestations.

The Association Between Family Social Network Size and Healthy Lifestyle Factors: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

We examined associations of central family (i.e., children, parents, in-laws) social network size with healthy lifestyle factors (i.e., favorable body mass index, physical activity, diet, alcohol use, smoking). Using data on 15,511 Hispanics/Latinos 18-74 years old from the Hispanic Community Health Study/Study of Latinos, multivariable adjusted survey logistic regression was used to compute associations of social network size with healthy lifestyle factors. A one-unit higher total of central family size was associated with lower odds of healthy body mass index (OR 0.90; 95% CI 0.86-0.93) and having all five healthy lifestyle factors (OR 0.90; 95% CI 0.85-0.96). Findings suggest familial structural social support may contribute to healthy lifestyle factors and differ based on the type of relationship among Hispanics/Latinos.

Prospective Predictors of Multiple Sexual Partners Among African American Men Who Have Sex with Men

Studies show that having sex with multiple partners increases the risk of acquiring and transmitting sexually transmitted diseases, including HIV. The present article reports prospective predictors of having multiple sexual partners among 505 African American men in Philadelphia who have sex with men (MSM) who participated in an intervention trial and attended a 6-month follow-up. Participants completed audio computer-assisted surveys of demographics, sexual behavior, and Reasoned Action Approach and Social Cognitive Theory mediators concerning multiple partners. We analyzed the incidence of self-reported multiple partners at the 6-month follow-up, controlling for treatment condition and baseline levels of the theoretical variables. The odds of having multiple partners decreased with increasing age (p < .03). Participants who said they were HIV positive had lower odds of having multiple partners (p < .009). The more pride participants reported in their identities as black or African American men, the lower the odds that they reported having multiple partners (p < .02). Adverse outcome expectancies accruing to multiple partners fully mediated the effect of black pride and partially mediated the effects of age on the odds of having multiple partners. Modifiable factors such as perceived negative outcome expectancies regarding having multiple sex partners should be addressed in designing interventions and prevention programs with the goal of decreasing the number of sexual partners among African American MSM.

A conceptual model of social networks and mechanisms of cancer mortality, and potential strategies to improve survival

Women with larger personal social networks have better breast cancer survival and a lower risk of mortality. However, little work has examined the mechanisms through which social networks influence breast cancer outcomes and cancer outcomes more generally, potentially limiting the development of feasible, clinically effective interventions. In fact, much of the emphasis in cancer research regarding the influence of social relationships on cancer outcomes has focused on the benefits of the provision of social support to patients, especially through peer support groups, and only more recently through patient navigation. Though critically important, there are other ways through which social relationships might influence outcomes, around which interventions might be developed. In addition to social support, these include social resources, social norms, social contagion, social roles, and social burdens and obligations. This narrative review addresses how social networks may influence cancer outcomes and discusses potential strategies for improving outcomes given these relationships. The paper (a) describes background and limitations of previous research, (b) outlines terms and provides a conceptual model that describes interrelationships between social networks and relevant variables and their hypothesized influence on cancer outcomes, (c) clarifies social and psychosocial mechanisms through which social networks affect downstream factors, (d) describes downstream behavioral, treatment, and physiological factors through which these subsequently influence recurrence and mortality, and (e) describes needed research and potential opportunities to enhance translation. Though most literature in this area pertains to breast cancer, this review has substantial relevance for cancer outcomes generally. Further clarification and research regarding potential mechanisms are needed to translate epidemiological findings on social networks into clinical and community strategies to improve cancer outcomes.

Modelling of the ICF core sets for chronic ischemic heart disease using the LASSO model in Chinese patients

Background

This study aimed to examine the associations among the International Classification of Functioning, Disability, and Health (ICF) core sets relevant to chronic ischemic heart disease (CIHD) using the least absolute shrinkage and selection operator (LASSO) model based on the ICF core sets scale in Chinese patients.

Methods

This was a prospective study of 120 patients with CIHD selected from January 2013 to June 2014 at the Fada Institute of Forensic Medicine & Science (Beijing, China). Functioning was qualified using the ICF core sets checklist for CIHD (Chinese version). The variables of core set categories of the ICF assessment scale for CIHD were entered into the LASSO model for mining dependencies among those variables. Graphical modeling was applied using LASSO generalized linear models.

Results

“Muscle endurance functions”, “sensations associated with cardiovascular and respiratory functions”, “blood vessel functions”, and “heart functions” were the most injured in CIHD status. “Recreation and leisure” and “intimate relationships” were the most affected in CIHD status. “General social support services, systems, and policies” and “acquaintances, peers, colleagues, neighbors, and community members” were important for the outcome of functional status of the CIHD patient. “Economic self-sufficiency” and “family relationships” of the CIHD patient were not undermined in most cases.

Conclusions

Graphical modeling can be used to describe associations between different areas of functioning in CIHD patients. The results suggest that these associations could be used as basis to improve rehabilitation and provide a deeper understanding of functioning in Chinese CIHD patients.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0957-0) contains supplementary material, which is available to authorized users.

Effects of social network diversity on mortality, cognition and physical function in the elderly: a longitudinal analysis of the Chicago Health and Aging Project (CHAP)

Background

Having a larger social network has been shown to have beneficial effects on health and survival in adults, but few studies have evaluated the role of network diversity, in addition to network size. We explore whether social network diversity is associated with mortality, cognition and physical function among older black and white adults.

Methods

Data are obtained from the Chicago Health and Aging Project, a longitudinal, population-based study of adults aged 65 years and older at baseline. Using Cox proportional hazards regression, we estimate the hazard of mortality by network diversity (n=6497). The association between network diversity and cognition (n=6560) and physical function (n=6561) is determined using generalised estimating equations. Models were adjusted for age, gender, race, socioeconomic status, marital status and health-related variables.

Results

In fully adjusted models, elderly with more diverse social networks had a lower risk of mortality (HR=0.93, p<0.01) compared with elderly with less diverse networks. Increased diversity in social networks was also associated with higher global cognitive function (coefficient=0.11, p<0.001) and higher physical function (coefficient=0.53, p<0.001).

Conclusions

Social networks are particularly important for older adults as they face the greatest threats to health and depend on network relationships, more than younger individuals, to meet their needs. Increasing diversity, and not just increasing size, of social networks may be essential for improving health and survival among older adults.

Age moderates the association between social integration and diurnal cortisol measures

Social integration is defined as the degree to which an individual participates in a broad range of social relationships. Although measures of social integration vary across studies, it is often assessed as the number of social roles (e.g., parent, friend, student, volunteer) that an individual reports actively participating in. More socially integrated individuals tend to be healthier than those less socially integrated, but the biological mechanisms through which this occurs remain unclear. One possibility is that social integration might alter the function of the hypothalamic-pituitary-adrenal axis, of which cortisol is a key product, and in turn influence a broad range of health outcomes. This study examined the association between social integration and two indices of cortisol in a community sample of 680 healthy men and women aged 18-55. Because the social roles held by younger individuals may be more numerous yet superficial than those held by older individuals, this study also tested the hypothesis that these associations could be moderated by age such that lower levels of integration would be associated with cortisol dysregulation for older but not younger individuals in our sample. Participants provided salivary cortisol samples during waking hours on three days that were used to calculate diurnal cortisol levels and slopes. Increased social integration was associated with lower cortisol AUC among older (ages 35-55) but not younger (ages 18-34) individuals in our sample. Moreover, while increased social integration was associated with steeper diurnal cortisol slopes regardless of age, this association was strongest among older individuals. Differences in health behaviors, affect, and psychological stress did not mediate these associations. The results of this study support cortisol as a candidate biological mechanism through which increased social integration is associated with better physical health among older individuals.

Characteristics of Social Networks and Mortality Risk: Evidence From 2 Prospective Cohort Studies

The size of a person's social network is linked to health and longevity, but it is unclear whether the number of strong social ties or the number of weak social ties is most influential for health. We examined social network characteristics as predictors of mortality in the Finnish Public Sector Study (n = 7,617) and the Health and Social Support Study (n = 20,816). Social network characteristics were surveyed at baseline in 1998. Information about mortality was obtained from the Finnish National Death Registry. During a mean follow-up period of 16 years, participants with a small social network (≤10 members) were more likely to die than those with a large social network (≥21 members) (adjusted hazard ratio (HR) = 1.23, 95% confidence interval (CI): 1.04, 1.46). Mortality risk was increased among participants with both a small number of strong ties (≤2 members) and a small number of weak ties (≤5 members) (HR = 1.55, 95% CI: 1.26, 1.79) and among participants with both a large number of strong ties and a small number of weak ties (HR = 1.28, 95% CI: 1.08, 1.52), but not among those with a small number of strong ties and a large number of weak ties (HR = 1.04, 95% CI: 0.87, 1.25). These findings suggest that in terms of mortality risk, the number of weak ties may be an important component of social networks.

Social isolation and all-cause mortality: a population-based cohort study in Denmark

Social isolation is associated with increased mortality. Meta-analytic results, however, indicate heterogeneity in effect sizes. We aimed to provide new evidence to the association between social isolation and mortality by conducting a population-based cohort study. We reconstructed the Berkman and Syme's social network index (SNI), which combines four components of social networks (partnership, interaction with family/friends, religious activities, and membership in organizations/clubs) into an index, ranging from 0/1 (most socially isolated) to 4 (least socially isolated). We estimated cumulative mortality and adjusted mortality rate ratios (MRR) associated with SNI. We adjusted for potential important confounders, including psychiatric and somatic status, lifestyle, and socioeconomic status. Cumulative 7-year mortality in men was 11% for SNI 0/1 and 5.4% for SNI 4 and in women 9.6% for SNI 0/1 and 3.9% for SNI 4. Adjusted MRRs comparing SNI 0/1 with SNI 4 were 1.7 (95% CI: 1.1-2.6) among men and 1.6 (95% CI: 0.83-2.9) among women. Having no partner was associated with an adjusted MRR of 1.5 (95% CI: 1.2-2.1) for men and 1.7 (95% CI: 1.2-2.4) for women. In conclusion, social isolation was associated with 60-70% increased mortality. Having no partner was associated with highest MRR.

Determinants of occurrence and survival after sudden cardiac arrest-A European perspective: The ESCAPE-NET project

AIMS

The ESCAPE-NET project ("European Sudden Cardiac Arrest network- towards Prevention, Education and New Effective Treatments") aims to study: (1) risk factors and mechanisms for the occurrence of sudden cardiac arrest (SCA) in the population, and (2) risk factors and treatment strategies for survival after SCA on a European scale.

METHODS

This is an Horizon2020 funded program of the European Union, performed by a European public-private consortium of 16 partners across 10 EU countries. There are 11 deep-phenotyped SCA cohorts for the study of risk factors and treatment strategies for survival after SCA, and 5 deep-phenotyped observational prospective population cohorts for the study of risk factors for occurrence of SCA. Personalized risk scores for predicting SCA onset and for predicting survival after SCA will be derived and validated.

RESULTS

The 11 clinical studies with SCA cases comprise 85,790 SCA cases; the 5 observational prospective population cohorts include 53,060 subjects. A total of 15,000 SCA samples will be genotyped for common and rare variants at the Helmholtz Zentrum München (Germany) using the Illumina Global Screening Array which contains > 770,000 SNPs, and after imputation, a database of an estimated > 9 million variants will be available for genome wide association studies. Standardization of risk factors definition and outcomes is ongoing. An Executive Committee has been created along with a Collaboration Policy document.

CONCLUSION

ESCAPE-NET will complement ongoing efforts on SCA outside Europe and within Europe including the EuReCa project.

Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association

Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.

Social networks and patterns of health risk behaviours over two decades: A multi-cohort study

OBJECTIVE

To determine the associations between social network size and subsequent long-term health behaviour patterns, as indicated by alcohol use, smoking, and physical activity.

METHODS

Repeat data from up to six surveys over a 15- or 20-year follow-up were drawn from the Finnish Public Sector study (Raisio-Turku cohort, n=986; Hospital cohort, n=7307), and the Health and Social Support study (n=20,115). Social network size was determined at baseline, and health risk behaviours were assessed using repeated data from baseline and follow-up. We pooled cohort-specific results from repeated-measures log-binomial regression with the generalized estimating equations (GEE) method using fixed-effects meta-analysis.

RESULTS

Participants with up to 10 members in their social network at baseline had an unhealthy risk factor profile throughout the follow-up. The pooled relative risks adjusted for age, gender, survey year, chronic conditions and education were 1.15 for heavy alcohol use (95% CI: 1.06-1.24), 1.19 for smoking (95% CI: 1.12-1.27), and 1.25 for low physical activity (95% CI: 1.21-1.29), as compared with those with >20 members in their social network. These associations appeared to be similar in subgroups stratified according to gender, age and education.

CONCLUSIONS

Social network size predicted persistent behaviour-related health risk patterns up to at least two decades.

Types of Non-kin Networks and Their Association With Survival in Late Adulthood: A Latent Class Approach

Objectives

Integration into social networks is an important determinant of health and survival in late adulthood. We first identify different types of non-kin networks among older adults and second, investigate the association of these types with survival rates.

Method

Official register information on mortality is combined with data from the Longitudinal Aging Study Amsterdam (LASA). The sample includes 2,440 Dutch respondents aged 54-85 at baseline in 1992 and six follow-ups covering a time span of 20 years. Using latent class analysis, respondents are classified into distinct types of non-kin networks, based on differences in number and variation of non-kin relations, social support received from non-kin, and contact frequency with non-kin. Next, membership in network types is related to mortality in a Cox proportional hazard regression model.

Results

There are four latent types of non-kin networks that vary in network size and support. These types differ in their associations with mortality, independent of sociodemographic and health confounders. Older adults integrated into networks high in both number and variation of supportive non-kin contacts have higher chances of survival than older adults embedded in networks low in either amount or variation of support or both.

Discussion

A combination of structural and functional network characteristics should be taken into account when developing intervention programs aiming at increasing social integration outside the family network.

Social Integration and Reduced Risk of Coronary Heart Disease in Women: The Role of Lifestyle Behaviors

RATIONALE

Higher social integration is associated with lower cardiovascular mortality; however, whether it is associated with incident coronary heart disease (CHD), especially in women, and whether associations differ by case fatality are unclear.

OBJECTIVES

This study sought to examine the associations between social integration and risk of incident CHD in a large female prospective cohort.

METHODS AND RESULTS

Seventy-six thousand three hundred and sixty-two women in the Nurses' Health Study, free of CHD and stroke at baseline (1992), were followed until 2014. Social integration was assessed by a simplified Berkman-Syme Social Network Index every 4 years. End points included nonfatal myocardial infarction and fatal CHD. Two thousand three hundred and seventy-two incident CHD events occurred throughout follow-up. Adjusting for demographic, health/medical risk factors, and depressive symptoms, being socially integrated was significantly associated with lower CHD risk, particularly fatal CHD. The most socially integrated women had a hazard ratio of 0.55 (95% confidence interval, 0.41-0.73) of developing fatal CHD compared with those least socially integrated (P for trend <0.0001). When additionally adjusting for lifestyle behaviors, findings for fatal CHD were maintained but attenuated (P for trend =0.02), whereas the significant associations no longer remained for nonfatal myocardial infarction. The inverse associations between social integration and nonfatal myocardial infarction risk were largely explained by health-promoting behaviors, particularly through differences in cigarette smoking; however, the association with fatal CHD risk remained after accounting for these behaviors and, thus, may involve more direct biological mechanisms.

CONCLUSIONS

Social integration is inversely associated with CHD incidence in women, but is largely explained by lifestyle/behavioral pathways.

Payback time? Influence of having children on mortality in old age

BACKGROUND

It is known that parents have lower mortality than childless individuals. Support from adult children to ageing parents may be of importance for parental health and longevity. The aim of this study was to estimate the association between having a child and the risk of death, and to examine whether the association increased at older ages when health starts to deteriorate and the need of support from a family member increases.

METHODS

In this nationwide study, all men and women (born between 1911 and 1925 and residing in Sweden), as well as their children, were identified in population registers and followed over time. Age-specific death risks were calculated for each calendar year for individuals having at least one child and for individuals without children. Adjusted risk differences and risk ratios were estimated.

RESULTS

Men and women having at least one child experienced lower death risks than childless men and women. At 60 years of age, the difference in life expectancy was 2 years for men and 1.5 years for women. The absolute differences in death risks increased with parents' age and were somewhat larger for men than for women. The association persisted when the potential confounding effect of having a partner was taken into account. The gender of the child did not matter for the association between parenthood and mortality.

CONCLUSIONS

Having children is associated with increased longevity, particularly in an absolute sense in old age. That the association increased with parents' age and was somewhat stronger for the non-married may suggest that social support is a possible explanation.

Social gradient in the metabolic syndrome not explained by psychosocial and behavioural factors: evidence from the Copenhagen City Heart Study∗

BACKGROUND

Psychosocial stressors may mediate the effect of social status on the metabolic syndrome (MS). The paper explores this hypothesis in a random sample of the general population.

DESIGN

A total of 3462 women and 2576 men aged 20-97 years from the Copenhagen City Heart Study.

METHODS

An MS index was defined from the seven components: waist-hip ratio, high-density lipoprotein (HDL)-cholesterol, triglycerides, systolic blood pressure (SBP), blood glucose, C-reactive protein (CRP) and fibrinogen. Social status was measured by educational level. Psychosocial factors included fatigue and depression, perceived stress, social network and cohabitation. Behavioural factors were smoking, alcohol and physical activity.

RESULTS

There was an inverse social gradient in the prevalence of the seven components of the MS. The age-adjusted odds ratio (OR) (95% confidence interval) for occupying the most disadvantaged quintile, comparing highest with lowest educational level, were for men and women, respectively: waist-hip ratio 0.48 (0.34-0.69) and 0.48 (0.33-0.69); HDL-cholesterol 0.61 (0.45-0.84) and 0.46 (0.33-0.64); triglycerides 0.71 (0.51-0.98) and 0.37 (0.25-0.53); SBP 0.64 (0.44-0.92) and 0.76 (0.50-1.15); blood glucose 0.57 (0.41-0.80) and 0.55 (0.38-0.78); CRP 0.53 (0.37-0.74) and 0.44 (0.31-0.63), and fibrinogen 0.50 (0.35-0.70) and 0.56 (0.38-0.82). The pooled OR for having an MS index score of 3 or more was 0.32 (0.24-0.42) for highest versus lowest educational level. A higher fatigue and depression score in both sexes and a lack of social support in men were associated with the MS, as were smoking, low alcohol consumption and a lack of physical activity. However, OR for educational level were not affected by adjustment for the psychosocial or behavioural factors.

CONCLUSIONS

There is a strong inverse social gradient in the prevalence of the MS, which is not explained by psychosocial or major behavioural factors.

Do age, psychosocial, and health characteristics alter the weak and strong tie composition of network diversity and core network size in urban adults?

Social capital and social support are two key constructs in the study of social networks and health. Despite their importance, little research has sought to examine the characteristics of those social ties by which individuals access social capital and support resources. Network diversity – a key structural feature in accessing social capital – refers to a person's broad but generally weak and heterogeneous social ties; core network size – a key structural feature in accessing social support – refers to the close, strong ties in personal networks. Our study examines whether the tie strength composing network diversity and core network size varies according to age-, psychosocial-, or health-related characteristics. Data came from the Montreal Neighbourhood Networks and Healthy Aging (MoNNET-HA) study, a representative sample of 2707 Montreal, Canada adults. Position and name generators were used to collect data on network diversity and core networks, and whether access to social resources was through kin, friends, or acquaintances. Multilevel negative binomial regression was used to account for the counts of different tie strengths nested within individuals and tracts. Network diversity and core network size both declined with older age groups, with those declines being more noticeable in not having ties at all or fewer ties with friends. Psychosocial and health factors altered the relative contribution of kin, friends and acquaintances to network diversity and core network size in similar patterns. Understanding the tie composition of network diversity and core network size can contribute to our knowledge of the social mechanisms linking social capital and support to health outcomes.

•

Acquaintance ties contribute the greatest proportion of ties to network diversity.

•

Friend ties contribute the greatest proportion to core network size.

•

Having no network diversity rises significantly in age groups older than 65 years.

•

Friends compared to kin contribute more to networks of adults who participate.

•

Acquaintances contribute more to the networks of adults with depressive status.

Number of children and later-life mortality among Finns born 1938-50

We investigated the association between number of offspring and later-life mortality of Finnish men and women born 1938-50, and whether the association was explained by living conditions in own childhood and adulthood, chronic conditions, fertility timing, and unobserved characteristics common to siblings. We used a longitudinal 1950 census sample to estimate mortality at ages 50-72. Relative to parents of two children, all-cause mortality is highest among childless men and women, and elevated among those with one child, independently of observed confounders. Fixed-effect models, which control for unobserved characteristics shared by siblings, clearly support these findings among men. Cardiovascular mortality is higher among men with no, one, or at least four children than among those with two. Living conditions in adulthood contribute to the association between the number of children and mortality to a greater extent than childhood background, and chronic conditions contribute to the excess mortality of the childless.

Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies

BACKGROUND

The influence of social relationships on morbidity is widely accepted, but the size of the risk to cardiovascular health is unclear.

OBJECTIVE

We undertook a systematic review and meta-analysis to investigate the association between loneliness or social isolation and incident coronary heart disease (CHD) and stroke.

METHODS

Sixteen electronic databases were systematically searched for longitudinal studies set in high-income countries and published up until May 2015. Two independent reviewers screened studies for inclusion and extracted data. We assessed quality using a component approach and pooled data for analysis using random effects models.

RESULTS

Of the 35 925 records retrieved, 23 papers met inclusion criteria for the narrative review. They reported data from 16 longitudinal datasets, for a total of 4628 CHD and 3002 stroke events recorded over follow-up periods ranging from 3 to 21 years. Reports of 11 CHD studies and 8 stroke studies provided data suitable for meta-analysis. Poor social relationships were associated with a 29% increase in risk of incident CHD (pooled relative risk: 1.29, 95% CI 1.04 to 1.59) and a 32% increase in risk of stroke (pooled relative risk: 1.32, 95% CI 1.04 to 1.68). Subgroup analyses did not identify any differences by gender.

CONCLUSIONS

Our findings suggest that deficiencies in social relationships are associated with an increased risk of developing CHD and stroke. Future studies are needed to investigate whether interventions targeting loneliness and social isolation can help to prevent two of the leading causes of death and disability in high-income countries.

STUDY REGISTRATION NUMBER

CRD42014010225.

Early Life Family Conflict, Social Interactions, and Carotid Artery Intima-Media Thickness in Adulthood

OBJECTIVE

Conflict in early life family environments is known to affect psychosocial functioning and coping styles into adulthood and is reported to negatively affect access to psychosocial resources that are critical to the management of stress. However, it remains unknown whether early life family conflict similarly affects subclinical cardiovascular disease (CVD) in adulthood. We predicted that family conflict in early life would be associated with greater mean intima-media thickness (IMT), a subclinical marker of CVD risk, in adulthood.

METHODS

Data were collected in a community sample of 503 adults (47.4 % male, mean [standard deviation] age = 42.8 [7.3] years). Associations between family conflict in early life with IMT (assessed using B-mode ultrasound) in adulthood were examined using regression analysis. We also tested for indirect effects of early life family conflict on mean IMT through ecological momentary assessment reports of social interactions, diversity of social roles, and perceived social support.

RESULTS

Linear regression analyses adjusted for demographics and physiological risk factors showed conflict in early life associated with greater mean IMT (β = 0.08, t(447) = 2.13, p = .034, R = 0.46). Early life conflict was significantly related to diversity of social roles, perceived social support, and ecological momentary assessment reports of pleasant and social conflict interactions. Significant indirect effects of early life conflict on mean IMT were observed through fewer pleasant social interactions and more frequent social conflict interactions in adulthood (β = 0.001 [95% confidence interval = 0.0001-0.0014] and β = 0.001 [95% confidence interval = 0.0002-0.0015], respectively).

CONCLUSIONS

These findings provide initial evidence that family conflict in early life heightens CVD risk in adulthood, in part by shaping the quality of adulthood social interactions.

Post-diagnosis social networks, and lifestyle and treatment factors in the After Breast Cancer Pooling Project

OBJECTIVE

Larger social networks have been associated with better breast cancer survival. To investigate potential mediators, we evaluated associations of social network size and diversity with lifestyle and treatment factors associated with prognosis.

METHODS

We included 9331 women from the After Breast Cancer Pooling Project who provided data on social networks within approximately two years following diagnosis. A social network index was derived from information about the presence of a spouse or intimate partner, religious ties, community participation, friendship ties, and numbers of living relatives. Diversity was assessed as variety of ties, independent of size. We used logistic regression to evaluate associations with outcomes and evaluated whether effect estimates differed using meta-analytic techniques.

RESULTS

Associations were similar across cohorts though analyses of smoking and alcohol included US cohorts only because of low prevalence of these behaviors in the Shanghai cohort. Socially isolated women were more likely to be obese (OR = 1.21, 95% CI:1.03-1.42), have low physical activity (<10 MET-hours/week, OR = 1.55, 95% CI:1.36-1.78), be current smokers (OR = 2.77, 95% CI:2.09-3.68), and have high alcohol intake (≥15 g/d, OR = 1.23, 95% CI:1.00-1.51), compared with socially integrated women. Among node positive cases from three cohorts, socially isolated women were more likely not to receive chemotherapy (OR = 2.10, 95% CI:1.30-3.39); associations differed in a fourth cohort. Other associations (nonsignificant) were consistent with less intensive treatment in socially isolated women. Low social network diversity was independently associated with more adverse lifestyle, but not clinical, factors.

CONCLUSIONS

Small, less diverse social networks measured post-diagnosis were associated with more adverse lifestyle factors and less intensive cancer treatment. Copyright © 2016 John Wiley & Sons, Ltd.