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 IND. Extended Zone Nominal Zone Effective Zone Intimate Zone B Intimate Zone A Personal Cell 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. Conceptual Model of How Social Networks Impact Health Downstream FactorsUpstream Factors Condition: the extent, shape, and nature of… Which provides opportunities for… Social-Structural Conditions (Macro) Social Networks (Mezzo) Behavioral Mechanisms (Micro) Pathways 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 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 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 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 Psychosocial Pathways Self-efficacy Coping effectiveness Relaxation/stress management Depression/distress Sense of well-being/QOL Which impacts health through the following…

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 employees Berkman et al AJE 2004 Adjusted for age, occupational grade, cigarette smoking, alcohol consumption, BMI, depressive symptoms, self-rated health, and geographical region.

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

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

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

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