Transcript Social networks: the essentials

Social networks,health and
aging
Lisa F Berkman Ph.D.
Measuring Social Activity and Civic
Engagement among Older
Americans
Federal Interagency Forum on Agingrelated Statistics
Gerontological Society of America
May 8 2007
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
Social Network Model
IND. Personal
Cell
Intimate Intimate
Zone A Zone B
Effective
Zone
Nominal
Zone
Extended
Zone
Source: Bolssevain, Jeremy: Friends of Friends, 1974
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
Conceptual Model of How Social Networks Impact
Health
Upstream Factors
Condition: the extent,
shape, and nature of…
Social-Structural
Conditions (Macro)
Culture
• Language
• Norms and values
• Competition/cooperation
Socioeconomic Factors
• Inequality
• Discrimination
• ConflictLabor Market structures
•
•
•
•
Sociogeographic Factors
Urban/rural
Neighborhood characteristics
Social cohesion
Residential and occupational
segregation
Social Change
• Urbanization
• War/civil unrest
• Economic depression
Downstream Factors
Which provides
opportunities for…
Social Networks
(Mezzo)
•
•
•
•
•
•
•
Network Structure
Size
Density
Reciprocity
Reachability
Proximity
Organizational structure
Social ranking
Network Activation
• Frequency of face-to-face
interaction
• Frequency of nonvisual contact
• Frequency of organizational
participation (attendance)
• Duration and intensity of
contacts
Which impacts health
through the following…
Behavioral Mechanisms
(Micro)
•
•
•
•
Social Support
Instrumental and financial
Informational
Appraisal
Emotional
Access to Resources and
Material Goods
• Jobs/economic opportunity
• Access to health care
• Housing
• Human capital
• Referrals/institutional contacts
Social Engagement
• Physical/cognitive exercise
• Reinforcement of meaningful
social role
Social Influence
• Constraining/enabling
influences on health behaviors
• Attitudes and norms toward
help-seeking
• Attitudes and norms toward
treatment adherence
Pathways
Psychobiological Pathways
• Stress-response/allostatic load
• Immune system function
• inflammatory
• Hippocampal atrophy
• Blood pressure
• Cardiovascular reactivity
• Pulmonary function
•
Health Behavioral
Pathways
Smoking/alcohol consumption
Diet
Exercise
Adherence to medical
treatments
Help-seeking behavior
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•
•
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Psychosocial Pathways
Self-efficacy
Coping effectiveness
Relaxation/stress management
Depression/distress
Sense of well-being/QOL
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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
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
Mortality Rate from All Causes by
Social Network Index : Alameda
County 1965-74 (Berkman and Syme AJE, 1979)
18
16
14
12
High SNI
Med-high
Med-low
Low SNI
10
8
6
4
2
0
Men
Women
Relative Risk of Dying (%)
Relative Risk of Dying from Specific
Causes Based on Age-Adjusted Mortality
Rates
4
Men
3.5
Women
3.2
3.2
3.1
3
2.5
2.3
2.1
2
3.0
2.2
1.7
1.5
1
0.5
0
ICD
Cerebro
CA
Specific Cause of Death
Other
Social integration and mortality in a French
occupational cohort: EDF-GDF employees
Berkman et al AJE 2004
3
2.5
2
high
med/high
med/low
low
1.5
1
0.5
0
men
women
Adjusted for age, occupational grade, cigarette smoking, alcohol consumption, BMI,
depressive symptoms, self-rated health, and geographical region.
Pittsburgh Common Cold Study N=276
3 Years
VIRUS
6 Day Quarantine
Social Roles
Clinical Colds
Social Roles and Colds
O
R
=
4
.
2
3
*
6
0
Cohen et al.; JAMA; 1997
5
0
%withColds
O
R
=
1
.
8
7
*
4
0
O
R
=
1
.
0
0
3
0
1
3
4
5
6
+
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How do social networks and
social integration impact health?
Mean Coronary Artery
Atherosclerosis Extent as Measured
by
Intimal
Area
in
Females
0.14
Intimal Area mm2
0.12
0.10
0.08
0.06
0.04
0.02
0.00
Dominant in Social
Groups
Subordinate in Social
Groups (Control)
Housed in Single
Cages
Fibrinogen and Social Isolation in Men
unadjusted
5.75
ln [fibrinogen]
adjusted
5.7
5.65
5.6
5.55
5.5
very low
low
medium
high
Social Network Score
Natural log (ln) of fibrinogen concentrations in men according to social network
score. Error bars represent ln [SEM].
Social Engagement
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.
Social engagement
and cognitive
decline
Social Engagement
– Marital status
– Contact with friends and relatives
–Attendance at religious services
–Voluntary/civic engagement
–Regular social activities
Cognitive decline by social
disengagement among older men and
women ( Bassuk, Glass Berkman, AJE)
60
50
40
0 ties
1-2 ties
3-4 ties
5-6 ties
30
20
10
0
%decline
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.
Epidemiology
• Job stress
• Cost of caring
• Work/family demands
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
CHD RR: Caregivers of Disabled/Ill Spouse
3.5
3.0
2.5
2.0
1.5
1.0
0.5
297
8
16
214
7
10
0.0
Total CHD
Hours of Caregiving Per Week:
Nonfatal CHD
0
1-8
>=9
Multiple work and family demands and all-diagnosis
psychiatric sickness absence: GAZEL cohort men.
16
14
12
Days/p-yr
10
8
6
4,4
4
5,3
0,9
2
1,2
2,5
1,3
0,3
0
0
0,4
3,0
1,2
0,6
0,3
1
2
Level of work and family demands
3
Clerk/Manual w orker
Professional/technician
Executive
Multiple work and family demands and all-diagnosis
psychiatric sickness absence: GAZEL cohort women.
16
15,6
14
12,9
14,4
12
Days/p-yr
10
8
6
4,8
4,8
4
2
2,6
2,5
1,9
1,0
0
0
5,2
1
2,9
Clerk
Professional/technician
0,8
Executive
2
Level of work and family demands
3
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