Social Factors and Health Flashcards
Evolutionary basis
Man has evolved as social animal, living in groups for 2 million years
Social bonds facilitate biologically important activities
-Protection and upbringing of children, hunting, making shelter, collaborating in defense against predators and hostile others
Social bonds provide many of the material, informational, and emotional goods needed to function in the world
Aspects of social environment
Personal social relationships
Number of social contacts (Main Effects Model)
-Social integration/social ties
Quality of these contacts (Stress Buffering Model)
-Emotional support
-Instrumental support
Socioeconomic status (SES)
-Degree of resources and prestige in relation to others
Community level social characteristics
-Area level SES
-Social features of your community - Social capital
Social integration/social ties
number of family, friends, social contacts at work, social groups to which we belong
-you could have a number of social groups and you can hate all of them or they could hate you (have to look at the quality of these relationships
Emotional support
is there someone you can go to if you want to talk?
Instrumental support
is there someone you can go to if you want a ride to the hospital?
Degree of resources and prestige in relation to others
Measured in terms of indicators – education, income, occupation
-in society, what is my social ranking?
Area level SES
income, education, and occupation status of your neighborhood
Social capital
cooperative network of social relationships between citizens that facilitates collective action for mutual benefit and problems resolution
- falls into the range of sociology - how many green spaces are there in your neighborhood, how many grocery stores, etc.
Social factors and health
Bottom line: All aspects of social environment are associated with mental and physical health outcomes
But, mechanisms for their effects may differ…..
Main effects model: Mechanisms for health effects
Main effect model
Social relationships have beneficial effects on health regardless of whether one is under stress
-Relationships may influence health behaviors, sense of self, emotion regulation, and other psychological processes, with potential benefits for physiological systems and health
Particularly relevant for number of relationships (social integration)
Main effects model: Social integration and mortality
Consistent association between social ties and mortality risk
-Increasing numbers of social ties associated with decreasing mortality (Ties = marital status, number of close friends/relatives, participation in church and other types of groups)
More social ties = lower mortality (especially for men)
Main effects model: Social relationships and mortality
Meta-analysis of 148 studies with 308,849 participants shows significant association between social relationships and mortality (Holt-Lunstad et al., 2010)
-Overall, 50% reduction in mortality risk for those with strong social relationships
Effect significant across age, sex, and cause of death
Comparing strength of association of social relationships and other conditions associated with decreased mortality. Higher odds ratio = stronger relationship
Highest odds ratio: social relationships then Smoking
-should target smoking and social relationships
Main effects model: Social relationships also influence disease incidence: colds
look at the number of social roles a person had
More social roles associated with lower risk of developing a cold
Social roles = husband/wife, parent, child, close family member, neighbor, friend, workmate, schoolmate, volunteer
Main effects model: Mechanisms linking social relationships and health
Health behaviors
Physiological mechanisms
Main effects model: Health behavior pathway
Marriage and social ties generally associated with greater preventive health behaviors
-Less smoking and drinking, more cancer screening, reducing fat, exercising
BUT, family and friends can also encourage negative health behavior
Social ties also have mixed effects on compliance with medical regimens
Main effects model: Physiological pathways
Social ties are generally associated with better physiological profiles
- Lower heart rate and BP
- Lower cholesterol
- Lower stress hormones
- Lower CRP (marker of inflammation)
Main effects model: Ford et al: Social ties and CRP
Subjects: 14,818 participants in NHANES III (Third National Health and Nutrition Examination Survey)
Completed measure of social integration
Provided blood sample for assessment of CRP
Assessment of social integration:
Married or living as married?
-Yes = 1, No = 0
In a typical week, how many times do you talk on the telephone with family, friends, or neighbors?
How often do you get together with friends or relatives?
-> 156 contacts/year = 1, < 4/year = 0
Do you belong to any clubs or organizations such as church groups, unions, fraternal or athletic groups, or school groups?
-Yes = 1, No = 0
Results:
More social ties associated with lower CRP for older men (age 60+) - only true for men
Effects significant controlling for health behaviors
everyone but the high social network group are in the risk range
Stress buffering model: Mechanisms for health effects
Stress buffering model
Social relationships have beneficial effect on health during times of stress
-Social relationships may influence appraisal and coping processes, provide resources, etc., thereby reducing negative impact of experience
Particularly relevant for quality of relationships (perceived social support)
Stress buffering model: Social support buffers impact of stressful events on mortality (non-lab context)
Perceived social support buffers the negative impact of stressful life events on mortality
- for every life event you have there is an increase in mortality
- if you have emotional support you don’t have the negative impact of stress on mortality
Stress buffering model: Social support and physiological stress responses
Studies have examined effects of social support on cardiovascular reactivity in laboratory models of acute stress
Social support during stressor typically associated with reduced cardiovascular reactivity
Qualifications:
May depend on nature of recipient (e.g., hostile)
May depend on nature of source
Stress buffering model: Glynn et al: Gender, social support and cardiovascular response to stress
Subjects: 109 undergraduates
All gave 5-minute impromptu speech on euthanasia
Varied support:
- Supportive – nod, smile, “good point”
- Non-supportive – neutral, inattentive demeanor
Varied gender of subject and of recipient:
- Female source, female recipient
- Female source, male recipient
- Male source, female recipient
- Male source, male recipient
Results:
With female as source, those in supportive condition show lower reactivity than unsupportive condition
With male as source, no difference between supportive and unsupportive conditions
Women are more effective support providers than men?
-it doesn’t help the women from male source as much as it helps the men getting support from female source
Stress buffering model: Allen et al: Pet ownership and cardiovascular response to stress
Subjects: 240 married couples (1/2 pet owners)
All did mental arithmetic and cold pressor tasks
4 conditions:
Alone
With pet or friend (for non pet owners)
With spouse
With spouse and pet/friend
Highest reactivity? Alone
Lowest reactivity? With pet or friend (for non pet owners)
Pets are more effective support providers than spouses?
They had to do mental arithmetic - there could be worry about social evaluation when spouse or friend is present - your pet doesn’t care if you suck at arithmetic
Stress buffering model: Social support and cortisol response to stress
Fewer studies have examined social support effects on cortisol reactivity
In one study, daily ratings of social support were associated with reduced cortisol response to an acute social stressor
-No experimental manipulation of support
-stress buffering effect - more social support, lower reactivity to TSST
Stress buffering model: Negative effects of social relationships
Social ties are a double-edged sword
- May be a source of demands, conflict, embarrassment, envy, disappointment, and devaluation
- May also serve as models for risky or unhealthful behaviors
Stress buffering model: Social conflict and immunity
Primarily examined in context of marriage by Kiecolt-Glaser and Glaser
Early studies showed that poor marital quality was associated with lower proliferative response in women and other indicators of immune suppression (Kiecolt-Glaser et al., 1987, 1988)
Stress buffering model: Marital conflict and immunity
Newlywed study (Kiecolt-Glaser et al., 1993, 2003, 2013)
Recently married couples came into the lab and engaged in 30 minute discussion of marital problems
Individuals who demonstrated more negative or hostile behaviors during discussion showed decreased natural killer cell cytotoxicity and decreased proliferative response over next 24 hours
Individuals in more distressed marriages showed declines in cellular immune function over 2 years
Couples with higher levels of epinephrine and norepinephrine after conflict task were more likely to be divorced or have troubled marriages 10 years later
-predicting divorce based on the hormones from their stress response system
Wound healing study (Kiecolt-Glaser et al., 2005)
Couples came into lab for two visits: conflict task and support task
Blister wounds were created at each visit and examined for rate of wound healing
Individuals who demonstrated more hostile behavior during task healed more slowly
Hostility = criticism, hostile voice tone, rolling eyes dramatically
People healed more slowly after conflict task than support task
Stress buffering model: Other forms of social conflict
Daily interpersonal stressors
Adolescents (12th graders) reported on interpersonal stressors every day for 14 days
Stressors included:
punished or disciplined by parents
something bad happened to someone in the family
parents had an argument
argued with mother, father, other family member, friend
argued with or punished by teacher
harassed or picked on by a student or other person
Results:
Adolescents who reported higher levels of interpersonal stress had higher levels of CRP (inflammatory marker)
Stress buffering model: What about absence of social support?
Chronic loneliness and absence of supportive social relationships is associated with poor immune function
Elevated inflammation (Cole et al., 2007)
Poor antibody response to vaccination (Pressman et al., 2005)
Also predicts mortality in cancer patients
Social Provisions Scale: Attachment
“I have close relationships that make me feel good”
“I do not have close relationships with other people”
“I feel a strong emotional tie with at least one other person”
“I do not have a feeling of closeness with anyone”
Results:
women with low social attachment died quicker than women with high social attachment
-there’s a profound experience with FEELING connected to people
Stress buffering model: How can we increase feelings of social connection?
Loving kindness meditation (LKM)
Focuses on self-generating feelings of love, compassion, and goodwill towards oneself and others
Kok et al. use this is as a tool to test broaden-and-build model
-looking to influence a physical outcome - this is an intervention study
Does it work to increase social connection and heart rate variability?
does loving kindness lead to increases in vagal tone
Results: What were the effects of Loving Kindness Meditation? -increases in vagal tone -increases in positive affect -increases in social connection
cognitive affect was the mediator
The broader context: Socioeconomic status (SES) and health
Lower SES is associated with higher rates of nearly all major causes of morbidity (disease) and mortality across populations and over time
Linear gradient rather than threshold effect of “poverty”
SES and morbidity/mortality
Slide 56
Subjective SES: the ladder
Where would you place yourself on this ladder, compared with others in your community? (University, neighborhood,etc.)
- this could change based on what “community” you’re talking about (UCLA vs Los Angeles - very different contexts)
- objective would be how much $ do you make and what is your education level
Subjective SES and colds
Subjective lower SES associated with higher likelihood of developing a cold
Independent of objective status
SES and physiology
SES also associated with alterations in sympathetic nervous system, HPA axis, and immune system
Lower SES associated with higher levels of SNS hormones (E, NE) and higher levels of cortisol (e.g., Cohen et al., 2006, 2007)
Lower SES associated with elevated markers of inflammation and prolonged inflammatory response to stress (e.g., Gruenewald et al., 2009; Morozink et al., 2010; Brydon et al., 2004)
Adult SES and inflammation
In community sample of 1028 middle aged and older adults, lower SES associated with higher levels of IL-6
Childhood SES and inflammation
In sample of 112 middle-aged adults, lower parental SES during first two years of life associated with higher IL-6
Effects independent of current education and income!!
-current SES didn’t have an effect
What explains these effects: Medical care? Health behaviors? Exposure to stress? Psychological resources?
Medical care
- Low SES associated with access to less extensive and lower quality medical resources
- BUT, differential access to medical care is not the only, or even the major, contributor to SES effects on health
- See SES effects even in countries with universal health coverage, and even for diseases that are not amenable to medical care
Health behaviors
Low SES associated with higher prevalence of unhealthful lifestyle characteristics
- Less exercise
- More smoking and alcohol consumption
- Poorer diet
BUT, SES effects persist in studies controlling for health behaviors
Exposure to stress
Physical environment
-Crime, crowding, poor physical amenities, exposure to physical hazards
Financial/occupational environment
-Inadequate and/or unpredictable resources, poor job security
Sociocultural environment
-Discrimination, poor social and psychological resources
(Powerlessness, alienation, lack of self-esteem)
Psychological resources
Reduced coping resources -Lower optimism, self-esteem, and self-efficacy -Weaker sense of control Reduced social resources -Fewer social ties -Mistrust of others More psychological distress -Depression, hopelessness, and hostility
Are there protective factors for low SES individuals? (what promotes resilience in the low income children?)
Certain types of coping strategies
-“Shift-and-persist” – using reappraisal and maintaining optimism and hope
Maternal warmth
-Negative effects of low childhood SES on inflammation are buffered if your mother spoke to you in a warm and caring voice
Intervention that increased nurturant-involved parenting lowered inflammation in low SES youth
-10 years later intervention had lower inflammation
