Social network and activities in relation to mortality from cardiovascular diseases, cancer and other causes: a 12 year follow up of the study of men born in 1913 and 1923

Men's Social Connectedness in Later Life: A Qualitative Study with Older Men

This qualitative study aimed to understand men's social connectedness in later life in Portugal focusing on their perceptions, obstacles, strategies, and impact on well-being. The sample included 104 older Portuguese men over 65 years of age (Mage = 70.76 years). The qualitative data were the direct transcriptions of the answers given by participants to the electronic interview using thematic analysis. Findings revealed six overarching themes encompassing 18 subcategories: definitions of social connectedness (social support, community identity, mental health promotion, use of community structures), difficulties/obstacles in maintaining social connectedness (ageism, lack of initiative, physical limitations, psychological traits, resources), strategies/actions or resources to establish social connections (use of technology, use of community groups, leisure and sport activities, church/religion), negative impact of difficulties in establishing relevant social connections (mental health, physical health, relationships), positive actions from being socially connected (positive prescriptions to promote social connectedness), and concerns from being socially disconnected (health risks). These findings indicate that the lack of social connectedness creates social vulnerability in later life, and social support is needed to ensure safer aging among older men.

The Role of Social Engagement in Older Adults' Health

The purpose of the current study was to explore the association between social engagement and the health status, cognition, and perceived well-being of older adults using data from the National Health and Aging Trends Study. Descriptive statistics, clustering, and regression modeling were performed to analyze the data. We used the regression model to identify statistically significant relationships between the representative variables and the extent to which participants participated in social activities. The most representative variable for each of the three clusters was selected and fitted to the regression model, which consists of (1) acute health problems and events, (2) cognitive and communication barriers, and (3) chronic conditions contributing to long-term health status. A regression model found that two factors-cognitive and communication barriers and chronic conditions contributing to long-term health status-were statistically significant in determining social engagement in older adults. Health care providers should consider various factors in planning and implementing social programs that can positively engage older adults. [Research in Gerontological Nursing, xx(x), xx-xx.].

Associations between social network properties and metabolic syndrome and the mediating effect of physical activity: findings from the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort

INTRODUCTION

Social isolation and loneliness are positively associated with metabolic syndrome. However, the mechanisms by which social isolation affects metabolic syndrome are not well understood.

RESEARCH DESIGN AND METHODS

This study was designed as a cross-sectional study of baseline results from the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort. We included 10 103 participants (8097 community-based low-risk participants, 2006 hospital-based high-risk participants) from the CMERC Cohort. Participants aged 65 years or older were excluded. Multiple imputation by chained equations was applied to impute missing variables. The quantitative properties of social networks were assessed by measuring the 'size of social networks'; qualitative properties were assessed by measuring the 'social network closeness'. Metabolic syndrome was defined based on the National Cholesterol Education Program Adult Treatment Panel III criteria. Multivariate logistic regression analyses were conducted to assess association between social network properties and metabolic syndrome. The mediating effects of physical inactiveness, alcohol consumption, cigarette smoking and depressive symptoms were estimated. Age-specific effect sizes were estimated for each subgroup.

RESULTS

A smaller social network was positively associated with higher prevalences of metabolic syndrome in all subgroups, except the high-risk male subgroup. There was no clear association between social network closeness and metabolic syndrome. In community-based participants, an indirect effect through physical activity was detected in both sexes; however, in hospital-based participants, no indirect effects were detected. Cigarette smoking, alcohol consumption and depression did not mediate the association. Age-specific estimates showed that the indirect effect through physical activity had a greater impact in older participants.

CONCLUSIONS

A smaller social network is positively associated with metabolic syndrome. This trend could be partially explained by physical inactivity, especially in older individuals.

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 Health Networks and Cardiovascular Risk Factors in the ECHORN Cohort Study

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Caribbean region.

OBJECTIVE

This study explored the concept of a health network, relationships focused on health-related matters, and examined associations with CVD risk factors in the Eastern Caribbean.

DESIGN

The Eastern Caribbean Health Outcomes Research Network Cohort Study is an ongoing longitudinal cohort being conducted in the US Virgin Islands, Puerto Rico, Trinidad and Tobago, and Barbados.

PARTICIPANTS

Participants (n = 1989) were English or Spanish-speaking adults 40 years and older, who were residents of the island for at least 10 years, and who intended to live on-island for the next 5 years.

MAIN MEASURES

Logistic regression was used to examine associations between health network characteristics and CVD risk factors: physical activity, hypertension, and smoking. A baseline survey asked questions about health networks using name generator questions that assessed who participants spoke to about health matters, whose opinions on healthcare mattered, and who they would trust to make healthcare decisions on their behalf.

KEY RESULTS

Health networks were mainly comprised of family members and friends. Healthcare professionals comprised 7% of networks, mean network size was four, and 74% of health network contacts were perceived to be in "good" to "excellent" health. Persons with larger health networks had greater odds of being physically active compared with those with smaller networks (OR = 1.07, CI = 1.01-1.14).

CONCLUSIONS

Health networks may be useful to intervention efforts for CVD risk factor reduction. More studies are needed to examine health networks in Caribbean contexts and explore associations with other CVD risk factors.

If electric cars are the answer, what was the question?

INTRODUCTION

Roads facilitate trade, development and communication, as well as spread illness and disease, but since mass car use began, the disbenefits, including injuries, pollution and physical inactivity have been significantly magnified. Electric cars are now being seen by many as the solution to the problems associated with internal combustion engine cars.

SOURCES OF DATA

This article reviews existing literature to determine the extent to which a switch to electrification can solve many of the problems that cars have wrought.

AREAS OF AGREEMENT

It concludes that there may be some benefits in rural areas, where public transport is poor.

AREAS OF CONTROVERSY

However, it also argues that even in rural areas it may be better to invest in public transport for many, rather than electric car infrastructure for some. It is clear that even for air quality, where electric cars are suggested to offer benefits these are unlikely to be as great as has been suggested. Overall, the negative health consequences of electric cars seem likely to be at least those of internal combustion engine cars.

GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN MARITAL STATUS AND HYPERTENSION IN GHANA

Hypertension is a significant contributor to the global burden of cardiovascular and related target organ diseases such as heart failure, coronary heart disease, stroke and kidney failure, and their associated premature morbidity, mortality and disability. Marital status is an important social characteristic known to predict a range of health outcomes including cardiovascular disease. However, little is known about its impact on hypertension in sub-Saharan Africa. This study explored the relationship between marital status and hypertension among women and men in Ghana. Drawing on data from the 2014 Ghana Demographic and Health Survey (GDHS), descriptive statistics and binary logistic regression models were used to analyse the link between marital status and hypertension. About 13% of women aged 15-49 and 15% of men aged 15-59 were found to be hypertensive. After controlling for lifestyle and socio-demographic covariates, the logistic regression models showed significantly higher odds of hypertension for married (OR=2.14, 95% CI=1.30-3.53), cohabiting (OR=1.94, 95% CI=1.16-3.23) and previously married (OR=2.23, 95% CI=1.29-3.84) women. In contrast, no significant association was found between any of the marital status cohorts and hypertension for men. Other significant predictors of hypertension were age, body mass index and wealth status. The results demonstrate that marital status is an independent risk factor for hypertension in Ghana for women, rather than men. This could have immediate and far-reaching consequences for cardiovascular health policy in Ghana. In particular, the findings could lead to better targeted public health interventions, including more effective risk factor assessment and patient education in clinical settings, which could lead to more effective patient management and improved cardiovascular outcomes.

Daily social interactions, close relationships, and systemic inflammation in two samples: Healthy middle-aged and older adults

OBJECTIVE

Systemic inflammation is thought to be a biological mediator between social relationship quality and premature mortality. Empirical work has yielded mixed support for an association of social relationship variables with systemic inflammation, perhaps due to methodological limitations. To date, research in this literature has focused on global perceptions of social relationships, with limited attention to the covariance of characteristics of daily social interactions with inflammation. Here, we examine whether daily interactions, as assessed by ecological momentary assessment (EMA), associate with peripheral markers of inflammation among midlife and older adults.

METHODS

Global social support and integration were measured using the Interpersonal Support Evaluation List (ISEL) and the Social Network Index (SNI), respectively, in older adults from the Pittsburgh Healthy Heart Project (PHHP), and in middle-aged adults from the Adult Health and Behavior Project-II (AHAB-II). Using time-sampled EMA, we assessed the proportion of the day spent in positive and negative social interactions. Systemic markers of inflammation were interleukin (IL)-6 and C-reactive protein (CRP).

RESULTS

Global measures of support and integration did not associate with inflammation in either sample. In older adults, relative frequency of total positive interactions, those with close others (i.e. spouse, friends, family), and those with coworkers predicted lower concentrations of IL-6 in fully adjusted models, accounting for age, sex, race, education, BMI, smoking and alcohol. In middle-aged adults, relative frequency of positive interactions with close others was also inversely associated with IL-6 level and relative frequency of negative marital interactions was unexpectedly inversely associated with CRP level.

CONCLUSIONS

Characteristics of daily social interactions among midlife and older adults associate with markers of systemic inflammation that are known to predict risk for cardiovascular disease. Ambulatory measures may better capture health-relevant social processes in daily life than retrospective, global self-report measures.

Health-Related Quality of Life in Pacemaker Patients: A Single and Multidimensional Self-Rated Health Comparison Study

Since implantation of the first permanent pacemaker in 1958, significant advances have been made in pacemaker technology. To date, however, health-related quality of life (HRQoL) in a large pacemaker population has not been investigated. With dwindling clinical resources, it is important to study HRQoL in a pacemaker population in a reliable and straightforward manner. This study aimed to determine and compare single and multidimensional self-rated health (SRH) in a pacemaker population in terms of sociodemographic characteristics, pacemaker mode and symptoms. The findings showed that irrespective of whether the perspective was single or multidimensional, this Swedish pacemaker population (n=697) with a mean age of 76 years had an acceptable HRQoL. Men, aged 65-84 years, persons who were cohabiting, who had their own dwelling, who had a DDD or who had a pacemaker for <or=3 and 4-7 years experienced better HRQoL. Efforts need to be made for women, single persons, the elderly and retired persons. In conclusion, the SRH of a pacemaker population can be trustworthy established by means of a single-dimensional SRH question.

Social support and management of hypertension in South-west Nigeria

INTRODUCTION

Social support can facilitate compliance or adherence to recommended treatment regimens, especially for chronic disease management. There is little data from Africa on the role of social support in the management of chronic disease.

OBJECTIVE

The current study investigated the relationship between social support for treatment compliance among hypertensive subjects in a poor urban community in southwest Nigeria. A second objective was identifying the correlates of social support in the study sample.

METHODS

The study was a community-based, cross-sectional and descriptive study of 440 community residents (mean age 60 years, 65.2% women) from Idikan community, Ibadan, Nigeria who had hypertension.

RESULTS

Most subjects (˜ 93%) reported receiving some social support from family members and approximately 55% reported receiving social support from friends. Social support from friends (p < 0.0001) but not from family (p = 0.162) was significantly associated with good compliance with treatment for hypertension. Factors associated with receiving significant support from both family and friends included marital status and religion, while age and educational level were associated with receiving significant support from family members only. Gender was not significantly associated with receiving social support.

CONCLUSION

We concluded that social support is strongly associated with hypertension treatment compliance in this community in south-west Nigeria. These findings suggest a need for exploring the promotion of social support as a useful tool in chronic disease treatment programmes.

The Connection Prescription: Using the Power of Social Interactions and the Deep Desire for Connectedness to Empower Health and Wellness

Social connection is a pillar of lifestyle medicine. Humans are wired to connect, and this connection affects our health. From psychological theories to recent research, there is significant evidence that social support and feeling connected can help people maintain a healthy body mass index, control blood sugars, improve cancer survival, decrease cardiovascular mortality, decrease depressive symptoms, mitigate posttraumatic stress disorder symptoms, and improve overall mental health. The opposite of connection, social isolation, has a negative effect on health and can increase depressive symptoms as well as mortality. Counseling patients on increasing social connections, prescribing connection, and inquiring about quantity and quality of social interactions at routine visits are ways that lifestyle medicine specialists can use connection to help patients to add not only years to their life but also health and well-being to those years.

Understanding the Links Between Social Support and Physical Health: A Life-Span Perspective With Emphasis on the Separability of Perceived and Received Support

Social support has been reliably related to physical health outcomes. However, the conceptual basis of such links needs greater development. In this article, I argue for a life-span perspective on social support and health that takes into account distinct antecedent processes and mechanisms that are related to measures of support over time. Such a view highlights the need to distinguish measures of perceived and received support and its links to more specific diseases (e.g., chronic, acute) and stages of disease development (e.g., incidence). I discuss both the novel implications of these theoretical arguments for research on social support and physical health, as well as the potential intervention approaches that are apparent from this perspective.

Social network and development of prediabetes and type 2 diabetes in middle-aged Swedish women and men

AIM

Explore if social network affects development of prediabetes and type 2 diabetes.

METHODS

Individuals with normal glucose tolerance at baseline, 2924 women and 2039 men, aged 35-56 years, were followed-up 8-10 years later by an oral glucose tolerance test. Prediabetes and type 2 diabetes was then evident in 168 and 50 women and in 236 and 93 men, respectively. Measures of social network (AVSI-index (availability of social integration), civil status and participation in social activities), recorded by questionnaire at baseline, were evaluated by logistic regression.

RESULTS

Having AVSI scores in the highest tertile was associated with a decreased risk to develop type 2 diabetes in women (age-adjusted odds ratio 0.41 [95% CI: 0.19-0.88]) less significant after full adjustment (0.50 [0.22-1.16]). Contrary, in men AVSI was associated with an increased risk to develop type 2 diabetes (1.93 [1.03-3.60]) after full adjustment. Participation in social activities decreased the risk to develop prediabetes and type 2 diabetes in women, (age-adjusted 0.65 [0.46-0.91] and 0.43 [0.24-0.77], respectively), less significant when adjusted for confounders (0.78 [0.54-1.12] and 0.59 [0.31-1.13]). In men a decreased risk was observed for prediabetes (0.59 [0.43-0.82] multi-adjusted model). Being married or living with a partner decreased type 2 diabetes risk only in men (0.57 [0.33-0.97] and 0.61 [0.34-1.08] age- and multi-adjusted models, respectively).

CONCLUSIONS

Individuals having a social network seemed less likely to develop abnormal glucose regulation. Contradictory to an overall protective pattern of having a social network, high AVSI-index in men increased the risk to develop type 2 diabetes.

Prediagnostic self-assessed health and extent of social networks predict survival in older individuals with cancer: a population based cohort study

OBJECTIVES

To assess the association between social networks on survival after cancer diagnosis in a population-based sample of elderly Israelis (>60 yo) living in the community in 1985 and followed for up to 20 years.

MATERIALS AND METHODS

We conducted a historical prospective study, using baseline measurements from a 1985 survey of a representative sample of community-dwelling population. Five distinct social networks were defined using information regarding number and intensity of social contacts: traditional-family (reference category), friends and neighbors, narrow-family, diverse, and attenuated. Cancer was ascertained through the Israel Cancer Registry, and mortality through the Population Registry after 20 years of follow-up.

RESULTS

The final study population included 676 participants diagnosed with cancer after 1985. Persons in the diverse network showed a lower risk of death (HR=0.74, 95% CI: 0.56-0.98) after adjusting for age, sex, smoking and self-assessed health. On the other hand, poor self-rated health at baseline (HR=1.39, 95% CI: 1.10-1.74 poor vs. all other categories of self-assessed health) was associated with increased risk of death. After excluding cancers amenable to early detection (breast, prostate, and colon) a borderline significant decreased risk of death following a diagnosis of cancer (HR=0.72, 95% CI: 0.52-1.01) was found.

CONCLUSION

There is evidence of a significant protective association between diverse social networks present before a cancer diagnosis and survival after the onset of disease. Social support from a variety of sources may be an important element in improving cancer survival in older individuals.

Predictors of 30-year mortality in depressed and comparison samples

BACKGROUND

Although higher rates of depression and lower rates of social behaviors (i.e., social support and activities) and physical activities are associated with mortality, the independent contribution of each of these factors needs examination.

METHODS

A prospective sample of 848 individuals (55% female) was used; half were clinically depressed at baseline; the other half comprised a comparison sample matched on census tract, gender, and marital status. Depressive symptoms, social behaviors, and physical activities were examined as time-varying predictors of mortality over a 30-year period using multiple imputation for missing data and Cox proportional hazards regression, controlling for demographic factors and health risk factors.

RESULTS

By the end of the study, 137 individuals from the depressed sample and 99 individuals from the comparison sample had died. Although the mortality rate is higher in the depressed sample, after controlling for demographic, health risk factors, social behaviors, and physical activity, there was no significant difference in mortality between the depressed and control samples. Among participants in the depressed sample, reduced participation in social activities was significantly associated with a higher risk of mortality.

LIMITATIONS

Frequency and intensity of activities were not assessed and all data except for mortality were self-report.

CONCLUSIONS

Promoting social engagement through activities may hold promise for delaying mortality among individuals who are depressed. Potential methods to promote social engagement and factors such as positive emotions that should be considered in future studies are discussed.

Can social support alleviate inflammation associated with childhood adversities?

OBJECTIVE

Childhood adversities have been linked to elevated high-sensitivity C-reactive protein (hsCRP), which has been associated with increased morbidity. Low social support has been reported to worsen the prognosis in heart disease and cancer, and high social support has been linked to lower hsCRP. We hypothesized that social support could be a mediating factor between childhood adversities and hsCRP.

METHODS

The sample was drawn from the data of the nationwide Health and Social Support Study (HeSSup Study) to which 25,898 Finns had responded in 1998. The cohort was stratified into groups of high and low social support, and the study group consisted of 100 women in both groups. Additionally, we invited a randomly drawn group of 50 subjects and a group of 62 women who had reported depressive symptoms. Of the 312 women, 116 participated in the study.

RESULTS

Social support score (Social Support Questionnaire, SSQ) was lower when the number of adverse experiences in childhood was high (r = - 0.251, P = 0.007). hsCRP and SSQ were inversely associated (r = - 0.188, P = 0.046). In the adjusted general linear model, the level of social support was significantly associated with hsCRP and there was a statistically significant interactive effect of small effect size of childhood adversities and the level of social support on hsCRP (ES = 0.123, P = 0.004).

CONCLUSION

This finding suggests that childhood adversity may affect social relationships and that high social support may attenuate the health risks caused by childhood adverse experience.

Atrial natriuretic peptide as a predictor of atrial fibrillation in a male population study. The Study of Men Born in 1913 and 1923

BACKGROUND

Atrial fibrillation is one of the most common arrhythmias in clinical practice and it is often diagnosed after a complication occurs. The study aimed to evaluate the predictive value of atrial natriuretic peptide (ANP) for atrial fibrillation in a male population-based study.

METHODS AND RESULTS

This study is a part of the "Study of Men Born in 1913 and 1923", a longitudinal prospective cohort study of men, living in the city of Gothenburg in Sweden. A population-based sample of 528 men was investigated in 1988 when they were aged 65 years (n=134) and 75 years (n=394), and they were followed up for 16 years. Blood samples were collected from all 528 men at baseline and plasma ANP levels were analyzed by radioimmunoassay. Hazard ratios were estimated by competing-risk regression analysis. One hundred five participants were excluded because of a prior diagnosis of atrial fibrillation, congestive heart failure, severe hypertension, or severe chronic renal insufficiency. Of the remaining 423 participants, 90 men were diagnosed with atrial fibrillation over the 16-year follow-up. In multivariable analysis, men in the two highest quartiles of ANP levels had a significantly higher risk for atrial fibrillation compared with men in the lowest ANP quartile. The adjusted ratio was 3.14 (95% CI 1.59-6.20) for the third ANP quartile and 3.36 (95% CI 1.72-6.54) for the highest quartile of ANP level.

CONCLUSIONS

In this population-based longitudinal study, we found that elevated ANP levels at baseline predicted atrial fibrillation during a follow-up time of 16 years.

How positive emotions build physical health: perceived positive social connections account for the upward spiral between positive emotions and vagal tone

The mechanisms underlying the association between positive emotions and physical health remain a mystery. We hypothesize that an upward-spiral dynamic continually reinforces the tie between positive emotions and physical health and that this spiral is mediated by people's perceptions of their positive social connections. We tested this overarching hypothesis in a longitudinal field experiment in which participants were randomly assigned to an intervention group that self-generated positive emotions via loving-kindness meditation or to a waiting-list control group. Participants in the intervention group increased in positive emotions relative to those in the control group, an effect moderated by baseline vagal tone, a proxy index of physical health. Increased positive emotions, in turn, produced increases in vagal tone, an effect mediated by increased perceptions of social connections. This experimental evidence identifies one mechanism-perceptions of social connections-through which positive emotions build physical health, indexed as vagal tone. Results suggest that positive emotions, positive social connections, and physical health influence one another in a self-sustaining upward-spiral dynamic.

Socioeconomic status, structural and functional measures of social support, and mortality: The British Whitehall II Cohort Study, 1985-2009

The authors examined the associations of social support with socioeconomic status (SES) and with mortality, as well as how SES differences in social support might account for SES differences in mortality. Analyses were based on 9,333 participants from the British Whitehall II Study cohort, a longitudinal cohort established in 1985 among London-based civil servants who were 35–55 years of age at baseline. SES was assessed using participant's employment grades at baseline. Social support was assessed 3 times in the 24.4-year period during which participants were monitored for death. In men, marital status, and to a lesser extent network score (but not low perceived support or high negative aspects of close relationships), predicted both all-cause and cardiovascular mortality. Measures of social support were not associated with cancer mortality. Men in the lowest SES category had an increased risk of death compared with those in the highest category (for all-cause mortality, hazard ratio = 1.59, 95% confidence interval: 1.21, 2.08; for cardiovascular mortality, hazard ratio = 2.48, 95% confidence interval: 1.55, 3.92). Network score and marital status combined explained 27% (95% confidence interval: 14, 43) and 29% (95% confidence interval: 17, 52) of the associations between SES and all-cause and cardiovascular mortality, respectively. In women, there was no consistent association between social support indicators and mortality. The present study suggests that in men, social isolation is not only an important risk factor for mortality but is also likely to contribute to differences in mortality by SES.

Community severance and health: what do we actually know?

Community severance occurs where road traffic (speed or volume) inhibits access to goods, services, or people. Appleyard and Lintell's seminal study of residents of three urban streets in San Francisco found an inverse relationship between traffic and social contacts. The extent of social networks predicts unhealthy behaviors, poor health, and mortality; high rather than low social integration is associated with reduced mortality, with an effect size of similar magnitude to stopping smoking. Although community severance diminishes social contacts, the implications of community severance for morbidity and mortality have not been empirically established. Based on a systematic literature search, we discuss what is actually known about community severance. There is empirical evidence that traffic speed and volume reduces physical activity, social contacts, children's play, and access to goods and services. However, no studies have investigated mental or physical health outcomes in relation to community severance. While not designed specifically to do so, recent developments in road design may also ameliorate community severance.

The association between active participation in a sports club, physical activity and social network on the development of lung cancer in smokers: a case-control study

BACKGROUND

This study analyses the effect of active participation in a sports club, physical activity and social networks on the development of lung cancer in patients who smoke. Our hypothesis is that study participants who lack social networks and do not actively participate in a sports club are at a greater risk for lung cancer than those who do.

METHODS

Data for the study were taken from the Cologne Smoking Study (CoSmoS), a retrospective case-control study examining potential psychosocial risk factors for the development of lung cancer. Our sample consisted of n = 158 participants who had suffered lung cancer (diagnosis in the patient document) and n = 144 control group participants. Both groups had a history of smoking.Data on social networks were collected by asking participants whether they participated in a sports club and about the number of friends and relatives in their social environment. In addition, sociodemographic data (gender, age, education, marital status, residence and religion), physical activity and data on pack years (the cumulative number of cigarettes smoked by an individual, calculated by multiplying the number of cigarettes smoked per day by the number of years the person has smoked divided by 20) were collected to control for potential confounders. Logistic regression was used for the statistical analysis.

RESULTS

The results reveal that participants who are physically active are at a lower risk of lung cancer than those who are not (adjusted OR = 0.53*; CI = 0.29-0.97). Older age and lower education seem also to be risk factors for the development of lung cancer. The extent of smoking, furthermore, measured by pack years is statistically significant. Active participation in a sports club, number of friends and relatives had no statistically significant influence on the development of the cancer.

CONCLUSIONS

The results of the study suggest that there is a lower risk for physically active participants to develop lung cancer. In the study sample, physical activity seemed to have a greater protective effect than participation in a sports club or social network of friends and relatives. Further studies have to investigate in more detail physical activity and other club participations.

Social relationships and mortality risk: a meta-analytic review

BACKGROUND

The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.

OBJECTIVES

This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.

DATA EXTRACTION

Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.

RESULTS

Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).

CONCLUSIONS

The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary.

Social relationships and mortality risk: a meta-analytic review

BACKGROUND

The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.

OBJECTIVES

This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.

DATA EXTRACTION

Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.

RESULTS

Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).

CONCLUSIONS

The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary.

Positive and negative experiences of social support and long-term mortality among middle-aged Dutch people

This study investigated the relation between positive and negative experiences of social support and mortality in a population-based sample. Data were derived from Dutch men and women aged 20-59 years who participated in the Doetinchem Cohort Study in 1987-1991. Social support was measured at baseline and after 5 years of follow-up by using the Social Experiences Checklist indicating positive (n = 11,163) and negative (n = 11,161) experiences of support. Mortality data were obtained from 1987 until 2008. Cox proportional hazards regression models, adjusted for age and sex, showed that low positive experiences of support at baseline were associated with an increased mortality risk after, on average, 19 years of follow-up (hazard ratio = 1.26, 95% confidence interval: 1.04, 1.52). Even after additional adjustment for socioeconomic factors, lifestyle factors, and indicators of health status, the increased mortality risk remained statistically significant (hazard ratio = 1.23, 95% confidence interval: 1.01, 1.49). For participants with repeated measurements of social support at 5-year intervals, a stable low level of positive experiences of social support was associated with a stronger increase in age- and sex-adjusted mortality risk (hazard ratio = 1.57, 95% confidence interval: 1.03, 2.39). Negative experiences of social support were not related to mortality.

Feasibility and effects of preventive home visits for at-risk older people: design of a randomized controlled trial

BACKGROUND

The search for preventive methods to mitigate functional decline and unwanted relocation by older adults living in the community is important. Preventive home visit (PHV) models use infrequent but regular visits to older adults by trained practitioners with the goal of maintaining function and quality of life. Evidence about PHV efficacy is mixed but generally supportive. Yet interventions have rarely combined a comprehensive (biopsychosocial) occupational therapy intervention protocol with a home visit to older adults. There is a particular need in the USA to create and examine such a protocol.

METHODS/DESIGN

The study is a single-blind randomized controlled pilot trial designed to assess the feasibility, and to obtain preliminary efficacy estimates, of an intervention consisting of preventive home visits to community-dwelling older adults. An occupational therapy-based preventive home visit (PHV) intervention was developed and is being implemented and evaluated using a repeated measures design. We recruited a sample of 110 from a population of older adults (75+) who were screened and found to be at-risk for functional decline. Participants are currently living in the community (not in assisted living or a skilled nursing facility) in one of three central North Carolina counties. After consent, participants were randomly assigned into experimental and comparison groups. The experimental group receives the intervention 4 times over a 12 month follow-up period while the comparison group receives a minimal intervention of mailed printed materials. Pre- and post-intervention measures are being gathered by questionnaires administered face-to-face by a treatment-blinded research associate. Key outcome measures include functional ability, participation, life satisfaction, self-rated health, and depression. Additional information is collected from participants in the experimental group during the intervention to assess the feasibility of the intervention and potential modifiers. Fidelity is being addressed and measured across several domains.

DISCUSSION

Feasibility indications to date are positive. Although the protocol has some limitations, we expect to learn enough about the intervention, delivery and effects to support a larger trial with a more stringent design and enhanced statistical power.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT00985283.

Social support and cancer progression: a systematic review

OBJECTIVE

The variability in the conceptualization and categorization of social support has resulted in mixed findings regarding its role in cancer progression. This systematic review identifies and summarizes the evidence for the significance of two important indices of social support in progression of different cancers.

METHOD

We used systematic and replicable methods to search, select, and evaluate findings.

RESULTS

Thirty-one longitudinal prospective findings (in 26 papers) which were selected for inclusion categorized social support into structural and functional support. The types of cancer included in these studies fell into three major categories: breast cancer (16), other cancer (10), and mixed cancers (5). Results suggest that the evidence for the relationship between social support and cancer progression is sufficiently strong for breast cancer as shown by five out of seven methodologically sound studies but consistently unconvincing for other types of cancer or in studies which combined different types of cancer. Structural support indices were found to be more frequently associated with disease progression than the indices of functional support in breast cancer. Disease-related variables such as severity, treatment, nodal status, and site of metastasis were found to be significant predictors of cancer progression, and it is suggested that these variables must be considered when conducting studies on the role of psychosocial factors in cancer-related outcomes including progression.

CONCLUSION

Methodological limitations of the studies and counterintuitive findings are discussed, and further conclusive research, particularly randomized controlled trials of social support interventions, is warranted to support the findings of this systematic review.

Engagement in cultural activities and cause-specific mortality: prospective cohort study

OBJECTIVE

To determine the relation between engagement in cultural activities and main causes of mortality among full-time employees.

METHODS

Finnish industrial employees (N=7922) completed a questionnaire about engagement in cultural activities (arts and culture, activities in associations, societal action, reading literature, and studying) in 1986 and were followed-up for mortality rates until 1986-2004.

RESULTS

High engagement in cultural activities was independently associated with decreased all-cause mortality (hazard ratio 0.71, 95% CI 0.57-0.88) and external causes of death (hazard ratio 0.46, 95% CI 0.24-0.90) after adjustment for socio-demographic factors, socio-economic status, work stress, social characteristics, diabetes, and hypertension. High engagement was also associated with a reduced risk of cardiovascular mortality after controlling for socio-demographic factors and stress (hazard ratio 0.68, 95% CI 0.49-0.95). The associations with all-cause mortality and deaths from external causes remained after further adjustment for behavioral risk factors. Of the forms of engagement, solitary cultural activities were related to all-cause mortality while socially shared cultural activities were more closely linked to external mortality.

CONCLUSION

Better overall survival of culturally engaged employees is largely attributable to their lower risk of death from external causes.

Associations of social networks with cancer mortality: a meta-analysis

This meta-analysis integrates results of 87 studies on the associations of perceived social support, network size, and marital status with cancer survival. In controlled studies, having high levels of perceived social support, larger social network, and being married were associated with decreases in relative risk for mortality of 25%, 20%, and 12%, respectively. Moderator analyses revealed that never married patients had higher mortality rates than widowed and divorced/separated patients. Associations of social network with mortality were stronger in younger patients, and associations of marital status with mortality were stronger in studies with shorter time intervals, and in early-stage cancer. Relationships varied by cancer site, with stronger associations of social support observed in studies of patients with leukemia and lymphomas and stronger associations of network size observed in studies of breast cancer. Further randomized intervention studies are needed to test causal hypotheses about the role of social support and social network for cancer mortality.

Mental-stress-induced platelet activation among patients with coronary artery disease

OBJECTIVE

To study patients with coronary artery disease (CAD) scheduled for coronary angioplasty and to examine platelet activation in response to mental stress as a potential mechanism involved in the association between psychosocial factors and cardiac outcomes. Psychosocial factors have been identified as risk factors for CAD and adverse cardiac outcomes, although the underlying mechanisms are poorly understood.

METHODS

Markers of platelet activation and platelet reactivity in response to experimentally induced mental stress (mental arithmetic and anger recall) were examined, using flow cytometry analysis and beta-thromboglobulin (BTG) assays among 249 CAD patients (age = 60.3 +/- 9.0 years, 15% women) who were scheduled to undergo elective percutaneous coronary intervention.

RESULTS

Mental stress-induced increases in platelet activation (CD41 (GP IIb/IIIa), p = .002; percent of mononuclear cells positive for CD41, p = .01; CD62P (P-selectin) expression, p = .005; and percent platelets positive for CD62P, p < .001). The degree of platelet reactivity was not related to demographic, clinical, or psychological variables, or cardiovascular hemodynamic changes.

CONCLUSIONS

Experimentally induced mental stress induced platelet activation in patients with CAD. This mechanism may partially explain the link between psychosocial variables and the development of adverse cardiac outcomes in patients with CAD.

Prevalence of cardiovascular risk factors and the metabolic syndrome in middle-aged men and women in Gothenburg, Sweden

Background

Random samples of 50-year-old men living in Gothenburg have been examined every 10^th year since 1963 with a focus on cardiovascular risk factors. The aims of the study were to acquire up-to-date information about risk factors in the fifth cohort of 50-year-old men and women, to re-examine those who were 50 years of age in 1993, and to analyse the prevalence of the metabolic syndrome (MetSyn) using different definitions.

Methods

A random sample of men and women born in 1953 were examined in 2003–2004 for cardiovascular risk factors. Men born in 1943 and that participated in the examination in 1993 were also invited. Descriptive statistics were calculated.

Results

The participation rate among men and women born in 1953 was 60 and 67% respectively. Among men born in 1943, the participation rate was 87%. The prevalence of obesity was from 15 to 17% (body mass index, BMI ≥ 30) in the three samples. The prevalence of known diabetes was 4% among the 50-year-old men and 6% among the 60-year-old men, and 2% among the women. Increased fasting plasma glucose varied substantially from 4 to 33% depending on cut-off level and gender. Mean cholesterol was 5.4 to 5.5 mmol/l. Smoking was more common among women aged 50 (26%) than among men aged 50 (22%) and 60 years (15%). The prevalence of the MetSyn varied with the definition used: from 10 to 15.8% among the women, from 16.1 to 26% among 50-year-old men, and from 19.9 to 35% among the 60-year-old men. Only 5% of the men and women had no risk factors.

Conclusion

This study provides up-to-date information about the prevalence of cardiovascular risk factors and the MetSyn in middle-aged Swedish men and women. Different definitions of the MetSyn create confusion regarding which definition to use.

Amount of social contact and hip fracture mortality

OBJECTIVES

To study the association between amount of social contact and mortality after hip fracture in elderly participants.

DESIGN

Prospective cohort.

SETTING

Community residents of Baltimore, Maryland.

PARTICIPANTS

Six hundred seventy-four elderly participants.

MEASUREMENTS

Amount of telephone and direct personal contact between participants and their relatives and friends and mortality up to 2 years after fracture.

RESULTS

No social contact with friends during the 2 weeks before the fracture was associated with a five times greater risk of death over 2 years than daily contact with friends during the 2 weeks before the fracture (hazard ratio (HR)=5.04, 95% confidence interval (CI)=2.75-9.23). Participants with less than daily contact were also at greater risk of dying, although the CI spanned 1 (HR=1.76, 95% CI=0.99-3.13). Participants who had no contact with family members prefracture were more than twice as likely to die as those who communicated daily during the 2 weeks before fracture (HR=2.26, 95% CI=1.36-3.77). Participants who had less than daily contact were also more than twice as likely to die (HR=2.55, 95% CI=1.65-3.94).

CONCLUSION

This study suggests that lower social contact before hip fracture is associated with poorer survival after 2 years.

Do different factors explain self-rated health in men and women?

BACKGROUND

Self-rated health has elicited special interest, in the wake of a number of studies demonstrating that it is a powerful predictor of future mortality, mare so for men than for women. The association between self-rated health and biological correlates also appears to differ between men and women, for reasons unknown.

OBJECTIVE

The purpose of this study was to examine gender differences in the interpretation and/or valuation of health-related information by comparing men and women's association of abroad array of perceived health determinants with their statements about health.

METHODS

We conducted a cross-sectional study in a randomly selected population of 8200 men and women aged >17 years in Stockholm, Sweden. Subjects received a 120-item questionnaire that included measures of health care utilization, lifestyle, demographics, psychosocial factors, and mental, functional, and physical health.

RESULTS

Among the 5470 people who responded to the questionnaire, most of the 42 potential correlates (41 for men, 40 for women) were significantly correlated to self-rated health. The overall association pattern was surprisingly similar for men and women. However, some small differences appeared: educational level, physical activity, and cultural activities played a more crucial role when men judged their health, whereas satisfaction with sleep and doctor visits played a more crucial role when women judged their health. These results were also for the most part confirmed in regression analyses that included all variables. The correlates explained 50% of the variance in self-rated health for both men and women.

CONCLUSIONS

Our results highlight the necessity of taking a broad perspective on potential correlates when analyzing mechanisms of self-rated health. When judging their own health, men and women appear to consider approximately the same broad array of factors. The similarities in association patterns indicate that men and women interpret and/or value health-related factors similarly when making statements about health. These results may influence the medical profession's acceptance or consideration of self-rated health. Understanding the gender-specific mechanisms involved in the assessment of self-rated health may contribute to the promotion of health-protective behavior and health intervention practices.

A randomized trial of a physical conditioning program to enhance the driving performance of older persons

BACKGROUND

As the number of older drivers increases, concern has been raised about the potential safety implications. Flexibility, coordination, and speed of movement have been associated with older drivers' on road performance.

OBJECTIVE

To determine whether a multicomponent physical conditioning program targeted to axial and extremity flexibility, coordination, and speed of movement could improve driving performance among older drivers.

DESIGN

Randomized controlled trial with blinded assignment and end point assessment. Participants randomized to intervention underwent graduated exercises; controls received home, environment safety modules.

PARTICIPANTS

Drivers, 178, age > or = 70 years with physical, but without substantial visual (acuity 20/40 or better) or cognitive (Mini Mental State Examination score > or =24) impairments were recruited from clinics and community sources.

MEASUREMENTS

On-road driving performance assessed by experienced evaluators in dual-brake equipped vehicle in urban, residential, and highway traffic. Performance rated three ways: (1) 36-item scale evaluating driving maneuvers and traffic situations; (2) evaluator's overall rating; and (3) critical errors committed. Driving performance reassessed at 3 months by evaluator blinded to treatment group.

RESULTS

Least squares mean change in road test scores at 3 months compared to baseline was 2.43 points higher in intervention than control participants (P = .03). Intervention drivers committed 37% fewer critical errors (P = .08); there were no significant differences in evaluator's overall ratings (P = .29). No injuries were reported, and complaints of pain were rare.

CONCLUSIONS

This safe, well-tolerated intervention maintained driving performance, while controls declined during the study period. Having interventions that can maintain or enhance driving performance may allow clinician-patient discussions about driving to adopt a more positive tone, rather than focusing on driving limitation or cessation.

Marital status and longevity in the United States population

PURPOSE

To investigate the relation between marital status and survival.

DATA SOURCES

The US 1989 national health interview survey (NHIS) merged with the 1997 US national death index.

RESULTS

Among 1989 NHIS respondents, 5876 (8.77%) died before 1997 and 61 123 (91.23%) were known to be alive. Controlling for demographic and socioeconomic characteristics, the death rate for people who were unmarried was significantly higher than it was for those who were married and living with their spouses. Although the effect was significant for all categories of unmarried, it was strongest for those who had never married. The never married effect was seen for both sexes, and was significantly stronger for men than for women. For the youngest age group (19-44), the predominant causes of early death among adults who had never married were infectious disease (presumably HIV) and external causes. In the middle aged and older men and women, the predominant causes were cardiovascular and other chronic diseases.

CONCLUSION

Current marriage is associated with longer survival. Among the not married categories, having never been married was the strongest predictor of premature mortality. It is difficult to assess the causal effect of marital status from these observational data.

Social Support and Health: A Review of Physiological Processes Potentially Underlying Links to Disease Outcomes

Social support has been reliably related to lower rates of morbidity and mortality. An important issue concerns the physiological mechanisms by which support influences such health endpoints. In this review, I examine evidence linking social support to changes in cardiovascular, neuroendocrine, and immune function. Consistent with epidemiological evidence, social support appears to be related to more positive "biological profiles" across these disease-relevant systems. Recent research on immune-mediated inflammatory processes is also starting to provide data on more integrative physiological mechanisms potentially linking social support to health. The implications of these links, along with future research directions are discussed.

Mortality of the oldest old in China

OBJECTIVE

This study investigates the role of customary activities, both social and solitary, in mortality among the oldest old in China.

METHODS

The data come from the Chinese Longitudinal Healthy Longevity Survey. Weibull hazard models analyze the mortality risk of those 80 years of age and older within a 2-year period between 1998 and 2000.

RESULTS

Results show that solitary activities, either active or sedentary, are significantly associated with lower mortality risk. The effect of social activities on mortality gradually diminishes with age and is reversed at very old ages when physical exercise, health status, and sociodemographic characteristics are controlled.

DISCUSSION

Customary activities, which are less physically demanding, show independent effects on the elderly's survival. Withdrawal from social contacts may be an adaptive response to challenges faced at very advanced ages. It is important to recognize the unique characteristics of this rapidly growing population.