Week 4 Lectures; o Contextual Moderators of the Stress Process; Social Support, Racism, SES

Question 1

Social and environmental factors;

Answer 1

= psychological factors located ‘outside the individual’ that moderate the stress process
o Social support – aka relationships with others
o Racism – relationship to others and society
o Socioeconomic status (SES) – relationship within society

Question 2

Humans as Social Animals

Answer 2

• Social relationships are critical to our survival; both as children and as adults
  o Many of our psychological processes are attuned to processing social stimuli and facilitating social interaction
   Face perception
   Theory of mind (ToM)
   Rejection and Social Threat Sensitivity
   Self-esteem
   Desire for friendship, love
   Social emotions (embarrassment, shame)
  o Feelings or physical health and even cellular health is influenced by our social wellbeing

Question 3

History of Research on Social Relationships and Health

Answer 3

o More socially isolated or less socially integrated individuals are less healthy, and they are more likely to die.
o Up until the 1970’s, research was not strong enough to determines the causal direction
o Changed in the 1970s with large scale prospective (cohort/longitudinal studies) – eg. Berkman and syme, 1979
o And further validated in an important meta-analysis published in 2010 of professional julianne holt-lunstad

Question 4

 Holt-Lunstad et al., 2010

Answer 4

• Social relationships and mortality risk; a meta-analytic review of 148 studies
  o More social relationships produced greater longevity and fewer relationships increased mortality
• Across 148 studies the random effects weighted average effect size indicating a 50% increased likelihood of survival for participants with stronger social relationships. These findings were 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; the association was strongest for complex measures of social integration and lowest for binary indicators of residential status (living alone versus with others) So you could live alone but have an enriched social enviro
• The strongest link between connectivity and longevity was with complex structural connections (eg. group membership) – so the more groups you’re a part of the longer you’re predicted to live
• The effect of loneliness or low social integration on mortality is as great as the effects of smoking on mortality

Question 5

o Functional Social Connectedness =

Answer 5

The quality of your relationships aka. What you get out of them. Describes the functions provided or perceived to be available by social relationships
 Refers to
* Received support
* Perceptions of social support
* Perception of loneliness

Question 6

o Structural Connectedness =

Answer 6

How many networks you’re embedded within. The exeistence and interconnections among differeing social ties and roles
 Refers to
* Marital status
* Social networks (breadth and depth of networks)
* Social integration (club membership)
* Living alone
* Social isolation etc

Question 7

o Combined connectedness =

Answer 7

Assessment of both structural and functional measures
 Multifaceted measure that considers structural and functional

Question 8

Summary of Holt-Lundstad et al., 2010

Answer 8

• An important meta-anlysis which showed that few or poor social relationships predicted decreased mortality moreso than other factors including physical activity or BMI
• More complex measures of structural social integration (eg. having larger networks, being married etc) was the strongest protective factor, on par with the risk of smoking
• Loneliness was the strongest functional support predictor of death. More loneliness increased risk of death by 45%. But loneliness wasn’t the strongest predictor of mortality overall

Question 9

How do we measure social relationships

Answer 9

 We can measure social relationships or social connection in terms of structure, function and quality on a continuum. Low levels of these components are associated with risk and high levels are associated with protection against poor health outcomes
o Structure = the connection to others via the existence of relationships and their roles
o Functions = a sense of connection that results from actual or perceived support or inclusion
o Quality – the sense of connection to others that is based on positive and negative qualities

Question 10

List two popular functional support measures

Answer 10

1. Interpersonal support evaluation list
2. UCLA loneliness scale

Question 11

1. Interpersonal support evaluation list

Answer 11

• Is a list of 12 items
• Asks whether you have people to fill 4 roles in 3 categories
• Appraisal support
  a. Share worries and fears
  b. Get advice about family problems
  c. Get suggestions for personal problems
  d. Get good advice during a crisis
• Belonging Supports
  a. Someone to go on a daytrip
  b. Someone to go to a movie
  c. Get invited to do things with others
  d. Someone to get lunch with
• Tangible support
  a. Get help with daily chores when unwell
  b. Water plants, feed pets, etc
  c. Pickup if stranded 10 miles from home
  d. Help move into a house or apartment
• This model suggests that not having people for each of these functions can worsen health and increase the risk of stress related illness
• This assessment is a list to see if you have a person to do z,y and z

Question 12

2. UCLA loneliness scale

Answer 12

• Is a 20 question survey
• Participants give likert scale responses which get coded
• 20-40 score = you are operating comfortably and experience an average level of loneliness
• 41-60 score = you struggle a little with social interactions experiencing frequent loneliness
• 61-80 = you are likely experiencing severe loneliness

Question 13

Connection to ideas from the reading (Holt-Lunstad 2021)

Answer 13

• The term social connection (or conversely social disconnection) is an umberella term that encompasses the structure, functions and quality of social relationships
• Reviewed the evidence that social disconnection is a significant risk factor in prospectively predicting earlier death (mortality) and physical health outcomes (morbidity)
• Reveiwed the mechanisms linking social connection to health (considering 3 factors, the psychological, behavioural and biological)
• Presented evidence for causality using Bradford Hill guidelines (which supports the prospective evidence that social interaction causes good health)
• Raised gaps and challenges (measurement, underrepresented samples, roles of social technologies etc)
• Discussed implications for public policy

Question 14

The Loneliness Epidemic

Answer 14

• The term pop health is giving to the effect of loneliness on health

Question 15

Social and Environmental Factors

Answer 15

• Factors located ‘outside the individual’ that moderate the stress process.
• Eg.
  o Social support – relationships with others
  o Racism – relationships to others and society
  o Socioeconomic status (SES) – relationship with society

Question 16

• Talamaivao et al., (2020)

Answer 16

• Main idea; reviews quantitative research examining how self-reported experiences of racial discrimination are associated with seven types of indicators of health
  a. Mental health, wellbeing/overall health
  b. Physical health, health behaviours, healthcare/maternal health, other health indicators
• This review included 24 studies (mostly cross-sectional although some longitudinal) from NZ that measured racism and health variables in the same study
• Findings; More consistent links between experiences of racism and mental health than physical health
  a. There were still links between experiences of racism and some physical indicators. Eg more consistent links to cardiovascular disease, healthcare experiences and sleep disturbance
  b. Links between racism and health not just observed among one ethnicity – could be seen for all non-pakeha (maori, pacific, Asian peoples of Aotearoa NZ)
  c. Only focussed on ethnic/racial discrimination not other marginalised groups

Question 17

• Ministry of health uses the following working definition of racism

Answer 17

• = comprices racial prejudice and societal power and manifests in different ways. It results in unequal distribution of power, privilege, resources and opportunity to produce outcomes that chronically favour, privilege and benefit one group over another. All forms of racism are harmful and its effects are distinct and not felt equally

Question 18

• NZ data on who faces discrimination

Answer 18

• Maori women score the highest on experiences of racial discrimination, followed by Asian Women, and Pacific women
• Asian communities over time are experiencing more racism (highest levels of ethnically motivated racial attacks that are increasing across years )

Question 19

• SES for an individual is measured by

Answer 19

o Income
o Employment
o Educational attainment
 A composite measure of these factors is what forms an individual SES score

Question 20

• SES for a community is measured by

Answer 20

o Deprivation index
 A neighbourhood by neighbourhood measure
* A deprivation index, considers many factors including communication (eg. how many people have no internet access), income (how many people are receving means tested benefits or below income threshold, how many people are unemployed, unqualified, don’t own their home etc etc

Question 21

• Deprivation SES and Health

Answer 21

o Areas that have the most deprived NZDep scores have residents with the highest rates of smoking, showing how deprivation is linked to poor health behaviours

Question 22

• SES gradient

Answer 22

o Describes the relationship between SES and health
o Every step up in SES correlates with better health and vice-versa
o This is a mostly linear relationship
 This has been reflected throughout history – eg. anesi 2006 looks at SES of titantic passengers and those with a high SES score (Eg. first class kids) had higher survival rates
 Adult males and females show this trend too with higher SES scores or the top 20% of income earners having the lowest smoking rates
 This is seen in hospitalisations etc

Question 23

Whitehall Studies (in Sapolsky chapter)

Answer 23

Main points; comparing the lowest to highest rank jobs, those lower on the ladder had higher rates of mortality from heart disease than those higher on the ladder. Importantly, employees had universal healthcare, ‘living wage’ and job security. This held when controlling for other health behaviour risk factors (smoking, exercise etc)
The SES gradient for indivudal diseases is strongest in diseases with sensitivity to stress (eg. heart disease, diabetes)

Question 24

 Mechanisms for These SES Gradient outcomes

Answer 24

• Behavioural routes – a low SES is associated with poorer health behaviours
• Psychological pathways; low SES associated with greater depression, anxiety, etc which all effects health
• Physiological pathways; low SES equals greater wear and tear on body
  o Eg chronic stress activating SAM and HPA axis systems
  o Eg. greater inflammation and immune impairment

Question 25

Cohen, Doyle and Baum, 2006

Answer 25

193 healthy American adults, age 21 – 55, low median income (17,5K, range 2.5-162.5k). Half were smokers with a BMI approaching obesity
- They took urine samples every 24 hours to measure SNS/SAM activation aswell as epinephrine and norepinephrine levels every 2 days
- Saliva samples were taken every 7 days to measure HPA and cortisol
- SES (income and education), health behaviours, psychosocial factors
The aim of this research was to assess whether SES was associated with stress hormones and to see if the SES, stress hormone relationship was mediated or explained by health behaviours and psychosocial factors
Results;
They founds lower SES (higher deprivation) people had a higher cortisol. - In this study, the link between SES and cortisol was explained (MEDIATED) by health factors (predominantly smoking) and psychosocial factors (predominantly social network index). Higher cortisol activation is just one of the possible mechanisms through which contextual factors like SES affect health.

Question 26

A mediator

Answer 26

= a third variable (or set of variables) that explains the relationship between two variables

Asks what factors explain or account for the relationship between SES and cortisol
Eg. health practises and psychosocial factors

Question 27

• Mediation in the Cohen, Doyle and Baum 2006 study

Answer 27

o Lower SES was associated with greater activation of the HPA-Axis via cortisol levels
o In this study, the link between SES and cortisol was explained (aka mediated) by health factors (predominantly smoking) and psychosocial factors (predominantly social network index)
o Higher cortisol activation is just one of the possible mechanisms through which contextual factors like SES affects health

Question 28

Moderators

Answer 28

A moderator = a third variable that changes the relationship between two variables
Eg. gender is a moderator on the effect of stress on bloodpressure as men experience greater effects

Question 29

Moderators … whilst Mediators …

Answer 29

change, explain

Question 30

Social Determinants of Health

Answer 30

o Social determinants of health = social support, racism, education/SES
o Defined as = the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems

Question 31

o The WHO provies a list of the social determinants of health, which can influence halthy equity in positive and negative ways eg.

Answer 31

o Eg. income and oscial protection
o Unemployment and job insecurity
o Education
o Working life conditions
o Food insecurity
o Etc etc
o