Social networks,health and aging

1. Social networks,health and aging Lisa F Berkman Ph.D. Measuring Social Activity and Civic Engagement among Older Americans Federal Interagency Forum on Aging-related Statistics Gerontological Society of America May 8 2007

2. Suicide varies inversely with the degree of integration of the social groups of which the individual forms a part. Suicide, Durkheim, 1897, 1951, p. 209

3. Social Network Model PersonalCell Intimate Zone A Intimate Zone B Effective Zone Nominal Zone Extended Zone IND. Source: Bolssevain, Jeremy: Friends of Friends, 1974

4. Social Networks • Networks form the web of social relations or ties that surround us Intimate ties Extended ties • They are usually measured in structural ways • Size: number of contacts • Geographic proximity: how close ties are • Frequency: how often they are seen • Density: how many people know each other • Reciprocity: how people help each other

5. Upstream Factors Downstream Factors Conceptual Model of How Social Networks Impact Health Condition: the extent, shape, and nature of… Which provides opportunities for… Which impacts health through the following… Social-Structural Conditions (Macro) Social Networks (Mezzo) Behavioral Mechanisms (Micro) Pathways • Social Support • Instrumental and financial • Informational • Appraisal • Emotional • Psychobiological Pathways • Stress-response/allostatic load • Immune system function • inflammatory • Hippocampal atrophy • Blood pressure • Cardiovascular reactivity • Pulmonary function • Culture • Language • Norms and values • Competition/cooperation • Network Structure • Size • Density • Reciprocity • Reachability • Proximity • Organizational structure • Social ranking • Socioeconomic Factors • Inequality • Discrimination • ConflictLabor Market structures • Access to Resources and Material Goods • Jobs/economic opportunity • Access to health care • Housing • Human capital • Referrals/institutional contacts • Network Activation • Frequency of face-to-face interaction • Frequency of nonvisual contact • Frequency of organizational participation (attendance) • Duration and intensity of contacts • Health Behavioral Pathways • Smoking/alcohol consumption • Diet • Exercise • Adherence to medical treatments • Help-seeking behavior • Sociogeographic Factors • Urban/rural • Neighborhood characteristics • Social cohesion • Residential and occupational segregation • Social Engagement • Physical/cognitive exercise • Reinforcement of meaningful social role • Social Change • Urbanization • War/civil unrest • Economic depression • Social Influence • Constraining/enabling influences on health behaviors • Attitudes and norms toward help-seeking • Attitudes and norms toward treatment adherence • Psychosocial Pathways • Self-efficacy • Coping effectiveness • Relaxation/stress management • Depression/distress • Sense of well-being/QOL

6. Critical domains of networks or ties • Summary indicator of social networks:size, ties across domains, density, weak ties • Quality of ties: negative and positive • Social engagement or participation • Caregiving roles and demands

7. Social Network Items in Alameda county study • Marital status or living with a partner • Number of contacts (frequency of contact) with friends • Number of contact (frequency of contact) with close relatives • Participation in voluntary and civic organizations • Membership in religious organization

8. Mortality Rate from All Causes by Social Network Index : Alameda County 1965-74 (Berkman and Syme AJE, 1979)

9. Relative Risk of Dying from Specific Causes Based on Age-Adjusted Mortality Rates

10. Social integration and mortality in a French occupational cohort: EDF-GDF employeesBerkman et al AJE 2004 Adjusted for age, occupational grade, cigarette smoking, alcohol consumption, BMI, depressive symptoms, self-rated health, and geographical region.

11. Pittsburgh Common Cold Study N=276 3 Years VIRUS 6 Day Quarantine Social Roles Clinical Colds

12. Social Roles and Colds Cohen et al.; JAMA; 1997

13. How do social networks and social integration impact health?

14. Mean Coronary Artery Atherosclerosis Extent as Measured by Intimal Area in Females

15. Fibrinogen and Social Isolation in Men Natural log (ln) of fibrinogen concentrations in men according to social network score. Error bars represent ln [SEM].

16. Social Engagement

17. Social Engagement and the maintenance of good cognitive function Social engagement is defined as the maintenance of many social connections and a high level of participation in social activities. Bassuk, SS, Glass, TA, Berkman, LF: Social Disengagement and Incident Cognitive Decline. Annals of Internal Medicine 131(3): 165-173, 1999.

18. Social engagement and cognitive decline Social Engagement Marital status Contact with friends and relatives Attendance at religious services Voluntary/civic engagement Regular social activities

19. Cognitive decline by social disengagement among older men and women ( Bassuk, Glass Berkman, AJE)

20. Odd’s ratios of cognitive decline by level of social engagement (multivariate model,1982-1994) 2.37 (CI 1.1-4.9) controlling for age, SPMSQ sex,ethnicity,education,income, physical disability, cardiovascular risk, depression, smoking ,alcohol, physical activity and emotional support.

21. Epidemiology • Job stress • Cost of caring • Work/family demands

22. Caregiving in the Nurses Health Study. Lee,Colditz,Berkman,Kawachi, AM J Prev Med 2003:24(2):113-119 • 54,412 women in the Nurses Health Study, ages 46-71 (no documented CHD) • Information on caregiving in 1992 • CHD follow up 1992-1996 • 321 incident cases

23. CHD RR: Caregivers of Disabled/Ill Spouse

25. Multiple work and family demands and all-diagnosis psychiatric sickness absence: GAZEL cohort men. Days/p-yr Level of work and family demands

26. Multiple work and family demands and all-diagnosis psychiatric sickness absence: GAZEL cohort women. Days/p-yr Level of work and family demands

27. Data needs & resources • Nat8ional data ( NHANES, NHIS, HRS, GSS) should include common core measures and unique measures relevant to each study- some are already available • Assessments across multiple domains is essential ( intimate ties, informal ties, voluntary associations)- no single item • International comparability is valuable