Social Factors and Health

Question 1

Evolutionary basis

Answer 1

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

Question 2

Aspects of social environment

Answer 2

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

Question 3

Social integration/social ties

Answer 3

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

Question 4

Emotional support

Answer 4

is there someone you can go to if you want to talk?

Question 5

Instrumental support

Answer 5

is there someone you can go to if you want a ride to the hospital?

Question 6

Degree of resources and prestige in relation to others

Answer 6

Measured in terms of indicators – education, income, occupation
-in society, what is my social ranking?

Question 7

Area level SES

Answer 7

income, education, and occupation status of your neighborhood

Question 8

Social capital

Answer 8

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.

Question 9

Social factors and health

Answer 9

Bottom line: All aspects of social environment are associated with mental and physical health outcomes
But, mechanisms for their effects may differ…..

Question 10

Main effects model: Mechanisms for health effects

Answer 10

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)

Question 11

Main effects model: Social integration and mortality

Answer 11

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)

Question 12

Main effects model: Social relationships and mortality

Answer 12

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

Question 13

Main effects model: Social relationships also influence disease incidence: colds

Answer 13

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

Question 14

Main effects model: Mechanisms linking social relationships and health

Answer 14

Health behaviors

Physiological mechanisms

Question 15

Main effects model: Health behavior pathway

Answer 15

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

Question 16

Main effects model: Physiological pathways

Answer 16

Social ties are generally associated with better physiological profiles

• Lower heart rate and BP
• Lower cholesterol
• Lower stress hormones
• Lower CRP (marker of inflammation)

Question 17

Main effects model: Ford et al: Social ties and CRP

Answer 17

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

Question 18

Stress buffering model: Mechanisms for health effects

Answer 18

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)

Question 19

Stress buffering model: Social support buffers impact of stressful events on mortality (non-lab context)

Answer 19

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

Question 20

Stress buffering model: Social support and physiological stress responses

Answer 20

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

Question 21

Stress buffering model: Glynn et al: Gender, social support and cardiovascular response to stress

Answer 21

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

Question 22

Stress buffering model: Allen et al: Pet ownership and cardiovascular response to stress

Answer 22

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

Question 23

Stress buffering model: Social support and cortisol response to stress

Answer 23

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

Question 24

Stress buffering model: Negative effects of social relationships

Answer 24

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

Question 25

Stress buffering model: Social conflict and immunity

Answer 25

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)

Question 26

Stress buffering model: Marital conflict and immunity

Answer 26

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

Question 27

Stress buffering model: Other forms of social conflict

Answer 27

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)

Question 28

Stress buffering model: What about absence of social support?

Answer 28

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

Question 29

Stress buffering model: How can we increase feelings of social connection?

Answer 29

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

Question 30

The broader context: Socioeconomic status (SES) and health

Answer 30

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”

Question 31

SES and morbidity/mortality

Answer 31

Slide 56

Question 32

Subjective SES: the ladder

Answer 32

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

Question 33

Subjective SES and colds

Answer 33

Subjective lower SES associated with higher likelihood of developing a cold Independent of objective status

Question 34

SES and physiology

Answer 34

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)

Question 35

Adult SES and inflammation

Answer 35

In community sample of 1028 middle aged and older adults, lower SES associated with higher levels of IL-6

Question 36

Childhood SES and inflammation

Answer 36

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? ```

Question 37

Medical care

Answer 37

- 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

Question 38

Health behaviors

Answer 38

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

Question 39

Exposure to stress

Answer 39

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)

Question 40

Psychological resources

Answer 40

``` 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 ```

Question 41

Are there protective factors for low SES individuals? (what promotes resilience in the low income children?)

Answer 41

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