Does Social Participation Predict Better Health? A Longitudinal Study in Rural Malawi

A bridge too far? Social network structure as a determinant of depression in later life

Existing research has documented various determinants of mental health related to individuals' social connections, but less is known about the role of the structural features of interpersonal networks. This is especially true in the case of bridging, which refers to ties to people who are otherwise disconnected from each other. By intersecting theories of social networks and gerontology, this study employs within- and between-person analysis with data from the National Social Life, Health, and Aging Project (NSHAP) to examine the association between social network bridging and depression in later life. The study finds that bridging, particularly between kin and non-kin members in the network, is associated with increased depressive symptoms in later life. This association is contingent on social support and strain respondents experienced, and it exhibits variations within individuals over time, especially among older adults in the youngest age cohort (57-64 years old included in NSHAP in 2005). In closing, the paper discusses the extent to which heterogeneous network structures may be one mechanism that shapes mental health trajectories in the context of later life-course experiences.

Social associations and cardiovascular mortality in the United States counties, 2016 to 2020

BACKGROUND

The positive aspects of social interaction on health have been described often, with considerably less attention to their negative aspect. This study aimed to assess the impact of social associations on cardiovascular mortality in the United States.

METHODS

The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data sets from 2016 to 2020 were used to identify death records due to cardiovascular disease in the United States population aged 15 years and older. The social association rate defined as membership associations per 10,000 population, accessed from the 2020 County Health Rankings data was used as a surrogate for social participation. All United States counties were grouped into quartiles based on their social association rate; Q1 being the lowest quartile of social association, and Q4 the highest quartile. Age-adjusted mortality rate (AAMR) was calculated for each quartile. County health factor rankings for the state of Texas were used to adjust the AAMR for baseline comorbidities of county population, using Gaussian distribution linear regression.

RESULTS

Overall, the AAMR was highest in the 4th social association rate quartile (306.73 [95% CI, 305.72-307.74]) and lowest in the 1st social association rate quartile (266.80 [95% CI, 266.41-267.20]). The mortality rates increased in a linear pattern from lowest to highest social association rate quartiles. After adjustment for the county health factor ranks of Texas, higher social association rate remained associated with a significantly higher AAMR (coefficient 15.84 [95% CI, 12.78-18.89]).

CONCLUSIONS

Our study reported higher cardiovascular AAMR with higher social associations in the United States, with similar results after adjustment for County Health Rankings in the state of Texas.

Enhancing understanding of healthy aging based on time-varying dependencies among multidimensional health, life satisfaction, and health behaviors of older adults aged 60 years and over

BACKGROUND

Healthy aging is a process of not only achieving good health but also increasing the life satisfaction of older adults aged 60 years and over, in which health behaviors play an important role. There is a lack of research on the time-varying dependencies between health, life satisfaction, and health behaviors, impeding a deeper understanding of healthy aging.

PURPOSE

To develop an integrated framework for modeling the interrelationships among the components of healthy aging between multiple time slices.

METHODS

Based on the Chinese Longitudinal Healthy Living Survey (CLHLS) data in the three waves of 2011/2012, 2014, and 2017/2018, Bayesian network and dynamic Bayesian network are jointly employed to study the relationships among the components of healthy aging within one time slice, as well as to explore the time-varying dependencies among the components between time slices.

RESULTS

The results of structure learning reveal the direction of effects between different dimensions of health, with mental health and social health affecting physical health and self-rated health affecting both physical and mental health. In addition, health behaviors are found to affect mental health and social health, while self-rated health can influence life satisfaction. The parameters learned from the data show the magnitude and direction of concurrent effects, one-period lagged effects and two-period lagged effects between the factors, which find that the time-varying dependencies vary but are generally positive, long-term, and accumulative over time. In addition, the results of autoregressive effects show the positive predictive effects of health and life satisfaction.

CONCLUSIONS

It confirms the influence pathway from health behaviors to multidimensional health to life satisfaction, and the time-varying dependencies among the components of healthy aging, which facilitates a deeper understanding of healthy aging. Combining the results of autoregressive effects and descriptive statistics, it further indicates that healthy aging is a comprehensive result arising from interactions of multiple factors. Policymakers should guide older adults aged 60 years and over to adopt healthier behaviors and ensure the long-term sustainability and continuity of policies.

Uncertainty drives exploration of negative information across younger and older adults

Although individuals generally avoid negative information, recent research documents that they voluntarily explore negative information to resolve uncertainty. However, it remains unclear (a) whether uncertainty facilitates exploration similarly when exploration is expected to lead to negative, neutral, or positive information, and (b) whether older adults seek negative information to reduce uncertainty like younger adults do. This study addresses the two issues across four experimental studies (N = 407). The results indicate that individuals are more likely to expose themselves to negative information when uncertainty is high. In contrast, when information was expected to be neutral or positive, the uncertainty surrounding it did not significantly alter individuals' exploration behavior. Furthermore, we found that uncertainty increased the exploration of negative information in both older and younger adults. In addition, both younger and older adults chose to explore negative information to reduce uncertainty, even when there were positive or neutral alternatives. In contrast to the age-related similarities in these behavioral measures, older adults demonstrated reduced scores in questionnaires on sensation seeking and curiosity, relative to their counterparts who were younger. These results suggest that information uncertainty has a selective facilitation effect on exploration for negative information and that normal aging does not alter this tendency, despite age-related reductions in self-reported measures of personality traits relevant to information seeking.

Differences in the relationship between social capital and hypertension in emerging vs. established economies in Sub-Saharan Africa

Background

The global burden of hypertension is growing, particularly in low- and middle-income countries. This study aimed to investigate differences in the relationship between social capital and hypertension between regions in Sub-Saharan Africa (West vs. South Africa) and within regions (rural vs. urban residence within each country).

Methods

Data for 9,800 adults were analyzed from the Study on Global Ageing and Adult Health (SAGE) 2007-2010 for Ghana (West African emerging economy) and South Africa (South African established economy). Outcomes were self-reported and measured hypertension. The primary independent variable was social capital, dichotomized into low vs. medium/high. Interaction terms were tested between social capital and rural/urban residence status for each outcome by country. Linear and logistic regression models were run separately for both countries and each outcome.

Results

Those with low social capital in the emerging economy of Ghana were more likely to have hypertension based on measurement (OR=1.35, 95% CI=1.18,1.55), but the relationship with self-reported hypertension lost significance after adjustment. There was no significant relationship in the relationship between social capital and hypertension in the established economy of South Africa after adjustment. No significant interactions existed by rural/urban residence status in either country.

Conclusion

Low social capital was associated with worse hypertension outcomes, however, the relationship differed between South Africa and Ghana. Further investigation is needed to understand differences between and within countries to guide development of programs targeted at leveraging and promoting social capital as a positive component of overall health.

Exploring the Effect of Health on Migrants' Social Integration in China

There are 376 million migrants, which account for more than 25% of the population in China according to the newest national demographic census, most of whom are from undeveloped areas to developed urban regions. Migrants’ social integration was one of the most important issues when the country aimed to build an inclusive society. As a form of human capital, the effect of migrants’ health status on social integration has rarely been explored until now, especially empirically. Previous studies have usually ignored health indicators when discussing the determinants of migrants’ social integration, and understanding the role of migrants’ physical health and mental health on their social integration is significant for efforts to ensure inclusive urbanization. For filling this research gap, the China Migrants Dynamic Survey dataset was used to uncover the role of migrants’ health status, including physical health and mental health, in their degree of social integration, and a further comparison of impact was conducted among rural–urban and urban–urban migrants. Through the empirical analysis, our results indicated the following. First, both better physical and mental health lead to higher social integration levels, and a one-point increase in physical and mental health improves the odds of good social integration by 33.27% and 5.98% for belonging and 66.05% and 6.35% for harmony, respectively. Second, health status is equally important for rural–urban and urban–urban migrants’ social integration, and the significant positive effect was consistent across groups, although some other impact factors may exhibit differences. Third, the effect of health status on social integration was moderated by social participation, which was more obvious for mental health than physical health. According to our findings, we discuss the measures to promote migrants’ health status and additional countermeasures to improve their social integration level.

Can social support buffer the association between loneliness and hypertension? a cross-sectional study in rural China

Objectives

Hypertension has reached epidemic levels in rural China, where loneliness has been a major problem among community dwellers as a consequence of rural-to-urban migration among younger generations. The objective of the study is to investigate the association between loneliness and hypertension, and whether social support can buffer the association (i.e., stress buffering theory), using cross-sectional data from 765 adults (mean age: 59.1 years) in rural Fujian, China.

Methods

Social support was measured as the reciprocal instrumental social support from/to neighbors and the reciprocal emotional support (i.e., the number of close friends that the respondent could turn to for help immediately when they are in trouble). A mixed-effect Poisson regression model with a robust variance estimator was used to investigate the association between loneliness, social support, and hypertension.

Results

Analysis revealed that those who were lonely had a higher prevalence ratio for hypertension (prevalence ratio = 1.12, 95% confidence interval 0.99–1.26) compared to those who reported not being lonely. There was an interaction between social support and loneliness in relation to hypertension. Specifically, contrary to the stress buffering theory, the positive association between loneliness and hypertension was more pronounced among those who reported higher social support compared to those who reported lower support (p for interaction <0.001 for instrumental support).

Conclusion

The results suggest that being lonely despite high levels of social support poses the greatest risk for hypertension. This study did not confirm a buffering effect of social support on the association between loneliness and hypertension.

Social Cost and Health: The Downside of Social Relationships and Social Networks

The research tradition on social relationships, social networks, and health dates back to the beginning of sociology. As exemplified in the classic work of Durkheim, Simmel, and Tönnies, social relationships and social networks play a double-edged-protective and detrimental-role for health. However, this double-edged role has been given unbalanced attention. In comparison to the salubrious role, the deleterious role has received less scrutiny and needs a focused review and conceptual integration. This article selectively reviews the post-2000 studies that demonstrate the harmful physical and mental health consequences of social relationships (intimate relationships and parenthood) and social networks. It uses a parsimonious three-category typology-structural forms, structural composition, and contents-to categorize relationship and network properties and proposes the social cost model, in contrast to the social resource model, to synthesize and integrate the adverse aspects of these properties. It concludes with future research directions.

Participation profiles among Chinese stroke survivors: A latent profile analysis

Objectives

To investigate the current status of participation and explore the characteristics of individuals with different levels of participation among stroke survivors in mainland China.

Design

Cross-sectional survey.

Setting

Participants were recruited by convenience sampling from the neurology department of the tertiary hospitals and communities.

Subjects

Stroke survivors (N = 517; mean (±SD) age, 69.97±11.51 y; 36.8% female).

Intervention

Not applicable.

Main outcome measures

Participation was measured using the Chinese version of the Impact on Participation and Autonomy Questionnaire (IPA). Rating of disability was assessed using the Modified Rankin Scale (mRS). The Perceived Social Support Scale (PSSS), the Medical Coping Modes Questionnaire (MCMQ), and the Herth Hope Scale (HHS) were also employed to measure social support, coping strategy, and hope of stroke survivors. The latent profiles analysis (LPA) was conducted using the Mplus version 8.3.

Results

The mean score of participation was 41.21±21.204. Participants were divided into three groups according to the participation using the LPA. The mean score on the sum of IPA for the high, medium, and low participation groups was 18.93±8.529, 42.50±8.302, and 69.44±9.516, respectively.

Conclusions

Stroke survivors have a low level of participation. Stroke survivors with low income, high mRS stage, bad health condition, and being dissatisfied for life tended to have low participation. Healthcare professionals should pay special attention to them and make targeted interventions based on their characteristics.

Validation of the SF12 mental and physical health measure for the population from a low-income country in sub-Saharan Africa

Introduction

The Short Form Survey 12-item (SF12) mental and physical health version has been applied in several studies on populations from Sub-Saharan Africa. However, the SF12 has not been computed and validated for these populations. We address in this paper these gaps in the literature and use a health intervention example in Malawi to show the importance of our analysis for health policy.

Methods

We firstly compute the weights of the SF12 physical and mental health measure for the Malawian population using principal component analysis on a sample of 2838 adults from wave four (2006) of Malawian Longitudinal Study of Aging (MLSFH). We secondly test the construct validity of our computed and the US-population weighted SF12 measures using regression analysis and Fixed Effect estimation on waves four, seven (2012) and eight (2013) of the MLSFH. Finally, we use a Malawian cash transfer programme to exemplify the implications of using US- and Malawi-weighted SF12 mental health measures in policy evaluation.

Results

We find that the Malawian SF12 health measure weighted by our computed Malawian population weights is strongly associated with other mental health measures (Depression:-0.501, p = < 0.001; Anxiety:-1.755; p = < 0.001) and shows better construct validity in comparison to the US-weighted SF12 mental health component (rs = 0.675 versus rs = 0.495). None of the SF12 measures shows strong associations with other measures of physical health. The estimated average effect of the cash transfer is significant when using the Malawi-weighted SF12 mental health measure (treatment effect: 1.124; p = < 0.1), but not when using the US-weighted counterpart (treatment effect: 1.129; p > 0.1). The weightings affect the size of the impacts across mental health quantiles suggesting that the weighting scheme matters for empirical health policy analysis.

Conclusion

Mental health shows more pronounced associations with the physical health dimension in a Low-Income Country like Malawi compared to the US. This is important for the construct validity of the SF12 health measures and has strong implications in health policy analysis. Further analysis is required for the physical health dimension of the SF12.

The Correlation of Self-efficacy and Social Support with Social Participation: A Cross Sectional Study among the Elderly

There is ample evidence that a key contributor to healthy aging is social participation; thus, identifying its determinants can help to improve it. The current study aimed at assessing the relationship between social support and general self-efficacy with social participation. This cross-sectional study was conducted on 456 (male: 237, female: 219) older adults, aged 60-74 years, who were the member of community centers in Tehran, Iran, in 2016. The multi-stage cluster sampling method was employed to select the participants. Primarily, Tehran was divided into five areas (i e, North, South, East, West, and Center). Then, two community centers were randomly selected from each area. Participants with the ability to perform their daily activities independently were enrolled in the study. Participants responded to four self-report questionnaires: socio-demographic, social participation, social support, and general self-efficacy. The majority of the participants were within the age range of 62–68 years with the maximum proportion of social participation (mean ± standard deviation (SD): 37.69 ± 8.34). Findings of the current study indicated that gender, education level, reading books, newspapers, or magazines (p <0.001), living area, living arrangement, and occupational status (p<0.05) were associated with social participation. Multiple linear regression adjusted for living area, sex, and educational level showed that self-efficacy (β= .08; p<.001) and social support (β= .64; p<.001) predicted social participation. Findings showed the importance of social support and self-efficacy in social participation. Also enhancing the literacy of seniors should be given priority.

Religion and Health in Rural Malawi

While research has found important links between religion and health, there is a gap in knowledge in sub-Saharan Africa. The purpose of this paper is to examine the relationship between religion and health in rural Malawi. After controlling for baseline health, results show that: (1) the relationship differs between younger (15-44 years) and older (45 + years) adults; (2) among younger adults, Muslims are relatively less healthy, whereas Muslims are healthier in older age; (3) religious activities have a stronger relationship with health than do other measures, especially for women; and (4) religious activities have a relationship with health only for two or more activities. These findings suggest that religion is tied to health in Malawi, especially for older women. This paper was originally presented at the European Conference on African Studies in June 2017.

Prevalence and correlates of chronic obstructive pulmonary disease and chronic respiratory symptoms in rural southwestern Uganda: a cross-sectional, population-based study

Background

The global burden of chronic obstructive pulmonary disease (COPD) disproportionately affects resource-limited settings such as sub-Saharan Africa (SSA), but population-based prevalence estimates in SSA are rare. We aimed to estimate the population prevalence of COPD and chronic respiratory symptoms in rural southwestern Uganda.

Methods

Adults at least 18 years of age who participated in a population-wide census in rural southwestern Uganda completed respiratory questionnaires and lung function testing with bronchodilator challenge at health screening events in June 2015. We defined COPD as post-bronchodilator forced expiratory volume in one second to forced vital capacity ratio less than the lower limit of normal. We fit multivariable linear and log binomial regression models to estimate correlates of abnormal lung function and respiratory symptoms, respectively. We included inverse probability of sampling weights in models to facilitate population-level estimates.

Results

Forty-six percent of census participants (843/1814) completed respiratory questionnaires and spirometry, of which 565 (67%) met acceptability standards. COPD and respiratory symptom population prevalence were 2% (95% confidence interval (CI)  = 1%-3%) and 30% (95% CI = 25%-36%), respectively. Respiratory symptoms were more prevalent and lung function was lower among women and ever-smokers (P < 0.05). HIV serostatus was associated with neither respiratory symptoms nor lung function.

Conclusions

COPD population prevalence was low despite prevalent respiratory symptoms. This work adds to the growing body of literature depicting lower-than-expected COPD prevalence estimates in SSA and raises questions about whether the high respiratory symptom burden in rural southwestern Uganda represents underlying structural lung disease not identified by screening spirometry.

Social participation and health over the adult life course: Does the association strengthen with age?

RATIONALE

Studies have consistently found positive associations between social participation and health, but it is unclear if they vary across the life course. Younger individuals are likely to initiate and benefit from social participation in different ways from older individuals, which may in turn alter its overall influence on health outcomes. Age-varying associations, if present, may then attenuate or amplify the health consequences stemming from changes in social participation over the adult life course.

OBJECTIVE

To assess the strength of the association between social participation and health across the life course, and whether it increases with age.

METHODS

I use five waves of panel data (N = 11202 person-year observations) from the Americans' Changing Lives Survey, collected over 25 years (1986-2011), to examine the association of formal and informal social participation with (1) the number of chronic health conditions and (2) depressive symptoms, focusing on whether these associations become stronger with age. Growth curve models (stratified by gender) with an accelerated longitudinal design were used to construct age trajectories of the dependent variables. An interaction term was then included to test for age-varying effects for each health outcome.

RESULTS

Results show that the association between formal social participation and depressive symptoms grew stronger with age, but only for men. For women, positive associations between social participation and health were found, but seemed to remain consistent over the life course.

CONCLUSION

Findings suggest that the social participation and health association over the life course is likely to be contingent on gender, the type of social participation, and the specific health outcome being considered.

Epstein-Barr virus antibody titer as a stress biomarker and its association with social capital in rural Fujian communities, China

OBJECTIVES

There has been little research on the association between social capital and psychological stress measured by a biomarker, particularly in developing countries. Our objective was to investigate the association between Epstein-Barr virus (EBV) antibody titer, an indicator of cellular immune function previously shown to be associated with psychological stress, and social capital among rural community dwellers in Fujian Province, China.

METHODS

We conducted a cross-sectional survey in seven rural communities in Fujian in 2015. We used questionnaire data and dried blood spot samples for the measurement of biomarkers collected from 734 local residents for the analysis. We conducted a mixed effects regression analysis to investigate the association between EBV antibody titer and four social capital variables, which included cognitive and structural social capital assessed both at individual and community levels.

RESULTS

Community-level structural social capital was inversely associated with psychological stress (coefficient = -0.96, 95% confidence interval [CI] = -1.91, -0.01) while individual-level structural social capital was positively associated with it (coefficient = 0.21, 95% CI = 0.07, 0.36). Neither individual- nor community-level cognitive social capital was associated with psychological stress status.

CONCLUSIONS

In rural Fujian, China, social capital seemed to be an important determinant of psychological health. While living in a community with active social interaction may benefit the residents psychologically, social interaction in the form of strongly bonded relationships may be a source of psychological stress at the individual level due to the potential demands and obligations that may be associated with such connections.

Social networks, social participation, and health among youth living in extreme poverty in rural Malawi

Extensive research documents that social network characteristics affect health, but knowledge of peer networks of youth in Malawi and sub-Saharan Africa is limited. We examine the networks and social participation of youth living in extreme poverty in rural Malawi, using in-depth interviews with 32 youth and caregivers. We describe youth's peer networks and assess how gender and the context of extreme poverty influence their networks and participation, and how their networks influence health. In-school youth had larger, more interactive, and more supportive networks than out-of-school youth, and girls described less social participation and more isolation than boys. Youth exchanged social support and influence within their networks that helped cope with poverty-induced stress and sadness, and encouraged protective sexual health practices. However, poverty hampered their involvement in school, religious schools, and community organizations, directly by denying them required material means, and indirectly by reducing time and emotional resources and creating shame and stigma. Poverty alleviation policy holds promise for improving youth's social wellbeing and mental and physical health by increasing their opportunities to form networks, receive social support, and experience positive influence.

Social capital and health in Kenya: A multilevel analysis

Despite the acknowledgment that social capital is an important predictor of good health and overall well being in wealthy countries, little empirical research has been conducted in developing countries, particularly in Africa, to examine this relationship. This study examines the association between cognitive (trust) and structural (membership in organization) social capital on health at both the individual and contextual levels. Health was measured using answers to a subjective question on physical health and anxiety/worry suffered by individuals within the last 30 days. This study utilized Afrobarometer data collected in Kenya in 2005 to examine this relationship using multilevel logistic statistical modeling. Upon controlling for socioeconomic and demographic factors, social capital was found to be significantly associated with anxiety/worry and physical health in Kenya. Membership in organizations was associated with increased odds (OR = 1.34, 95%CI: 1.02-1.76) of physical health problems, while individual trust was associated with a 6% (OR = 0.94, 95%CI: 0.90-0.99) reduction in the likelihood of physical health problems. Conversely, generalized trust was associated with a 37% reduction in the odds (OR = 0.63, 95%CI: 0.40-0.99) of anxiety/worry, while individual trust was associated with a 5% reduction (OR = 0.95, 95%CI: 0.90-1.00) of anxiety/worry. With the exception of membership in an organization that exacerbates physical health, both individual level trust and generalized trust were associated with better health outcomes in Kenya. The availability of social organizations at the contextual level was associated with worsening anxiety/worry although the effect size was small. These results show that social capital, particularly trust, is a concept that can apply to different social and cultural contexts and can potentially be harnessed to improve health in settings that suffer from resource poverty.