Social influences, social context, and health behaviors among working-class, multi-ethnic adults

Interventions with Social Integration Components Addressing Psychosocial Outcomes of Young- and Middle-Aged Adult Cancer Individuals: A Systematic Review

BACKGROUND

The majority of adult cancer patients/survivors encounter social challenges (e.g., obtaining social support, maintaining social relationships, feelings of social isolation). This systematic review summarizes intervention studies addressing social integration or social connectedness issues among young- and middle-aged cancer patients/survivors.

METHODS

We searched the PubMed, CINAHL, and Web of Science databases (January 2000-May 2021) to identify intervention studies that addressed social integration, social connectedness, social support, and social isolation for cancer patients/survivors in young- and middle-aged adulthood (18-64.9 years) through a randomized controlled trial (RCT). We categorized the interventions as technology-based, non-technology-based, and mixed-type (technology- and non-technology-based).

RESULTS

A total of 28 studies were identified. These interventions demonstrated improved social outcomes (e.g., increased social support, decreased loneliness), increased awareness of available cancer-related resources, and better patient-reported outcomes among patients/survivors versus controls. Specifically, the use of internet-based discussion sessions was associated with improved social cohesion and social support. Receiving social support from peers through networking sites was associated with improved physical activity. Additionally, implementing mixed-type interventions led to better social support from peer survivors, less fear of social interactions, and improved social connectedness.

CONCLUSIONS

Using existing technology- and/or non-technology-based platforms to facilitate social connectedness among cancer patients/survivors in young- or middle-aged adulthood can help them cope with stressful life circumstances and improve quality-of-life. Further interventions targeting social integration (e.g., social network interventions) are needed to improve the complex social integration challenges experienced by cancer patients and survivors.

Socioeconomic inequalities in employees' health-enhancing physical activity: Evidence from the SHAHWAR cohort study in Iran

BACKGROUND

Increasing level of physical activity (PA) among working population is of particular importance, because of the high return of investment on employees' PA. This study was aimed to investigate socioeconomic inequalities in Health-Enhancing Physical Activity (HEPA) among employees of a Medical Sciences University in Iran.

METHODS

Data were extracted from the SHAHWAR Cohort study in Iran. Concentration index (C) and Wagstaff decomposition techniques were applied to determine socioeconomic inequality in the study outcomes and its contributors, respectively.

RESULTS

Nearly half of the university employees (44.6%) had poor HEPA, and employees with high socioeconomic status (SES) suffered more from it (C = 0.109; 95% CI: 0.075, 0.143). Also, we found while poor work-related PA (C = 0.175; 95% CI: 0.142, 0.209) and poor transport-related PA (C = 0.081, 95% CI: 0.047, 0.115) were more concentrated among high-SES employees, low-SES employees more affected by the poor PA at leisure time (C = -0.180; 95% CI: -0.213, -0.146). Shift working, and having higher SES and subjective social status were the main factors that positively contributed to the measured inequality in employees' poor HEPA by 33%, 31.7%, and 29%, respectively, whereas, having a married life had a negative contribution of -39.1%. The measured inequality in poor leisure-time PA was mainly attributable to SES, having a married life, urban residency, and female gender by 58.1%, 32.5%, 28.5%, and -32.6%, respectively. SES, urban residency, shift working, and female gender, with the contributions of 42%, 33.5%, 21.6%, and -17.3%, respectively, were the main contributors of poor work-related PA inequality. Urban residency, having a married life, SES, and subjective social status mainly contributed to the inequality of poor transport-related PA by 82.9%, -58.7%, 36.3%, and 33.5%, respectively, followed by using a personal car (12.3%) and female gender (11.3%).

CONCLUSIONS

To reduce the measured inequalities in employees' PA, workplace health promotion programs should aim to educate and support male, urban resident, high-SES, high-social-class, and non-shift work employees to increase their PA at workplace, and female, married, rural resident, and low-SES employees to increase their leisure-time PA. Active transportation can be promoted among female, married, urban resident, high-SES, and high-social-class employees and those use a personal car.

Employees' healthy eating and physical activity: the role of colleague encouragement and behaviour

Background:

Exercising and eating healthy are not just an individual choice, but influenced by family members, friends, or neighbours. Little is known, however, about colleagues, who are another important interpersonal influence. Many people spend many hours at work, surrounded by mostly the same colleagues, who could therefore significantly shape employees’ (un)healthy choices. We studied to what extent colleagues may play a part in one another’s eating and exercise behaviours by focusing on two pathways: colleagues can encourage a healthy lifestyle or act as role models whose behaviours can be observed and copied.

Methods:

We used the European Sustainable Workforce Survey, with data on 4345 employees in 402 teams in 113 organisations. We used network autocorrelation models, which resemble regression models, to study to what extent employee encouragement is related to fruit and vegetable consumption, and physical activity. Specific to this type of model is the inclusion of a network correlation parameter which allows for the outcome of an employee to be directly associated with the outcomes of their colleagues. In this way we tested whether colleagues’ behaviours were related to one another.

Results:

We found that employees were more likely to eat fruit and vegetables as well as engage in physical activity when their colleagues encourage a healthy lifestyle. Employees’ healthy eating behaviours were positively related to their colleagues’ fruit and vegetable consumption, while we found a negative correlation concerning physical activity.

Conclusion:

Overall, colleagues’ encouragement and own healthy behaviours have the potential to contribute to creating a culture of health in the workplace and support all employees in making healthy choices.

Determining thresholds for spatial urban design and transport features that support walking to create healthy and sustainable cities: findings from the IPEN Adult study

An essential characteristic of a healthy and sustainable city is a physically active population. Effective policies for healthy and sustainable cities require evidence-informed quantitative targets. We aimed to identify the minimum thresholds for urban design and transport features associated with two physical activity criteria: at least 80% probability of engaging in any walking for transport and WHO's target of at least 15% relative reduction in insufficient physical activity through walking. The International Physical Activity and the Environment Network Adult (known as IPEN) study (N=11 615; 14 cities across ten countries) provided data on local urban design and transport features linked to walking. Associations of these features with the probability of engaging in any walking for transport and sufficient physical activity (≥150 min/week) by walking were estimated, and thresholds associated with the physical activity criteria were determined. Curvilinear associations of population, street intersection, and public transport densities with walking were found. Neighbourhoods exceeding around 5700 people per km², 100 intersections per km², and 25 public transport stops per km² were associated with meeting one or both physical activity criteria. Shorter distances to the nearest park were associated with more physical activity. We use the results to suggest specific target values for each feature as benchmarks for progression towards creating healthy and sustainable cities.

How local partisan context conditions prosocial behaviors: Mask wearing during COVID-19

Does local partisan context influence the adoption of prosocial behavior? Using a nationwide survey of 60,000 adults and geographic data on over 180 million registered voters, we investigate whether neighborhood partisan composition affects a publicly observable and politicized behavior: wearing a mask. We find that Republicans are less likely to wear masks in public as the share of Republicans in their zip codes increases. Democratic mask wearing, however, is unaffected by local partisan context. Consequently, the partisan gap in mask wearing is largest in Republican neighborhoods, and less apparent in Democratic areas. These effects are distinct from other contextual effects such as variations in neighborhood race, income, or education. In contrast, partisan context has significantly reduced influence on unobservable public health recommendations like COVID-19 vaccination and no influence on nonpoliticized behaviors like flu vaccination, suggesting that differences in mask wearing reflect the publicly observable and politicized nature of the behavior instead of underlying differences in dispositions toward medical care.

Race, Racism, and Cardiovascular Health: Applying a Social Determinants of Health Framework to Racial/Ethnic Disparities in Cardiovascular Disease

Health care in the United States has seen many great innovations and successes in the past decades. However, to this day, the color of a person's skin determines-to a considerable degree-his/her prospects of wellness; risk of disease, and death; and the quality of care received. Disparities in cardiovascular disease (CVD)-the leading cause of morbidity and mortality globally-are one of the starkest reminders of social injustices, and racial inequities, which continue to plague our society. People of color-including Black, Hispanic, American Indian, Asian, and others-experience varying degrees of social disadvantage that puts these groups at increased risk of CVD and poor disease outcomes, including mortality. Racial/ethnic disparities in CVD, while documented extensively, have not been examined from a broad, upstream, social determinants of health lens. In this review, we apply a comprehensive social determinants of health framework to better understand how structural racism increases individual and cumulative social determinants of health burden for historically underserved racial and ethnic groups, and increases their risk of CVD. We analyze the link between race, racism, and CVD, including major pathways and structural barriers to cardiovascular health, using 5 distinct social determinants of health domains: economic stability; neighborhood and physical environment; education; community and social context; and healthcare system. We conclude with a set of research and policy recommendations to inform future work in the field, and move a step closer to health equity.

Social connection and physical health outcomes among long-term care home residents: a scoping review

BACKGROUND

Social connection is recognized as an important determinant of health and well-being. The negative health impacts of poor social connection have been reported in research in older adults, however, less is known about the health impacts for those living in long-term care (LTC) homes. This review seeks to identify and summarize existing research to address the question: what is known from the literature about the association between social connection and physical health outcomes for people living in LTC homes?

METHODS

A scoping review guided by the Arksey & O'Malley framework was conducted. Articles were included if they examined the association between social connection and a physical health outcome in a population of LTC residents.

RESULTS

Thirty-four studies were included in this review. The most commonly studied aspects of social connection were social engagement (n = 14; 41%) and social support (n = 10; 29%). A range of physical health outcomes were assessed, including mortality, self-rated health, sleep, fatigue, nutrition, hydration, stress, frailty and others. Findings generally support the positive impact of social connection for physical health among LTC residents. However, most of the studies were cross-sectional (n = 21; 62%) and, of the eleven cohort studies, most (n = 8; 73%) assessed mortality as the outcome. 47% (n = 16) were published from 2015 onwards.

CONCLUSIONS

Research has reported positive associations between social connection and a range of physical health outcomes among LTC residents. These findings suggest an important role for social connection in promoting physical health. However, further research is needed to consider the influence of different aspects of social connection over time and in different populations within LTC homes as well as the mechanisms underlying the relationship with health.

Community social networks, individual social participation and dietary behavior among older Japanese adults: Examining mediation using nonlinear structural equation models for three-wave longitudinal data

Community social networks positively affect older adults' dietary behavior, but the underlying mechanisms remain uncertain. This study investigated if the relationship between community social networks and dietary behavior is mediated by social participation, and whether the influence of community social networks differs across sociodemographic groups. We conducted a cross-lagged panel mediation analysis employing nonlinear structural equation modeling using panel data from the Japan Gerontological Evaluation Study (JAGES), a longitudinal study of Japanese older adults in 2010, 2013, and 2016, which included 11,347 men and 14,105 women aged over 65. Monodirectional relationships in community social networks, individual social participation, and fruit/vegetable intake were examined. Community social networks were associated with social participation regardless of sociodemographic conditions. Individual social participation was in turn, positively associated with fruit/vegetable intake, with this association being stronger among those living alone. Analyses further showed that individuals' social participation positively mediated the relationship between community social networks and fruit/vegetable intake. For both genders, the mediating effects were stronger among people living alone than in those living with someone. However, community networks could also directly and negatively affect fruit/vegetable intake among men who live alone unless they participated in community activities. Community social networks may promote social participation, thereby facilitating healthier dietary behavior regardless of sociodemographic status. Social participation in turn may positively contribute to the dietary health of people living alone. Community-based interventions to encourage people living alone to participate in social activities may help reduce inequality in dietary behavior related to cohabitation status.

Social Processes Associated With Health and Health Behaviors Linked to Early Mortality in People With a Diagnosis of a Serious Mental Illness

Individuals with serious mental illness (SMI) experience a 10- to 25-year reduced life expectancy compared with the general population. Early mortality for people with SMI has mainly been attributed to unhealthy behaviors (e.g., poor diet, sedentary lifestyle), which has led to the development of health promotion and self-management interventions specifically for people with SMI to promote health behavior change. Yet after decades of research, the mortality gap between people with SMI and the general population is increasing. To address this early mortality disparity for individuals with SMI, a new paradigm must be explored. In this article, we present the social processes impacting early mortality in people with SMI paradigm, which highlights the powerful role of social processes in shaping the health and health behaviors of people with SMI. This paradigm explores how loneliness, stigma (social and self), trauma, social exclusion, social isolation, and social norms are related to early mortality in people with SMI. This new paradigm is an important step in understanding and potentially addressing early mortality in people with SMI.

Life-course pathways from childhood socioeconomic status to type 2 diabetes in mid-late Chinese adulthood

The relationship between childhood socioeconomic status (SES) and type 2 diabetes (T2D) remains inconclusive, and the pathways and mechanisms driving this relationship have yet to be clarified. This study aimed to examine the pathways linking childhood SES to T2D prevalence in mid-late adulthood in a low- and middle-income country. The incidence of T2D diagnosed in mid-late Chinese adulthood was assessed using self-reports from the Health and Retirement Longitudinal Study (CHARLS). Childhood SES was assessed by the education, occupation, survivorship of the parents and the financial situation of the family, whereas adulthood SES was assessed by education and wage. This study performed structural equation modeling to clarify the direct and indirect pathways from childhood SES to T2D via childhood health, childhood food shortage, adulthood SES and physical activity. A total of 15,132 participants were included, and the prevalence of T2D was 5.24%. This study found that childhood SES was directly associated with T2D in mid-late adulthood, the probability of developing T2D increased by 9.20% of the standard deviation for each decrease in standard deviation in childhood SES. Childhood SES was indirectly associated with T2D via adulthood SES, physical activity, childhood health and food shortage. Adulthood SES and physical activity mainly mediated the indirect pathway from childhood SES and T2D. This study showed direct and indirect pathways from disadvantaged childhood SES to increased risk of T2D in mid-late Chinese adulthood. Childhood SES, adulthood SES, physical activity, childhood health and food shortage were identified as life-course interventional targets that should be considered in the development of effective strategies to reduce the burden of T2D and SES-related health inequities in childhood.

Association between social network structure and physical activity in middle-aged Korean adults

PURPOSE

Evidence suggests that physical activity participation is shaped through a myriad of structural aspects of social relationships. We examined the relationship between social network structure based on egocentric social network and physical activity.

METHODS

From 6799 middle-aged Korean adults, we assessed the social network density and proportion of closed triads, using the name generator module. Self-reported physical activity for functional and leisure purposes was calculated in metabolic equivalent of task (MET)-min/week. We employed sex-stratified, multivariable linear regression to assess the association between each network structure variable and total physical activity, adjusting for age, network size, socioeconomic status, and comorbidities. We also examined the association with moderate-to-vigorous physical activity (MVPA) and wrist-worn accelerometer assessed physical activity.

RESULTS

The network members of female participants were more likely to be of same sex and family member compared to those of males. There were no sex differences in average network size. Network density based on affiliation was sex-differentially associated with physical activity (male β -346.7, p 0.2221 and female β -528.6, p 0.0002). In parallel, the proportion of closed triads was negatively associated with physical activity only in females (male β -542.6, p 0.0551 and female β -641.51, p < 0.0001). However, network density and closed triads were insignificantly yet positively associated with MVPA in male (density β 229.7, p 0.3193 and closed triad β 109.21, p 0.6333). Network structure by contact frequency or emotional closeness and accelerometer-assessed physical activity showed inconsistent results.

CONCLUSION

Understanding the role of social network structures can help to achieve ideal physical activity level in the context of primary prevention of cardiometabolic disorders.

Gray Matter Volume Covariance Networks, Social Support, and Cognition in Older Adults

OBJECTIVE

We examined the neural substrates of social support in older adults. Social support is associated with better outcomes in many facets of aging-including cognitive and functional health-but the underlying neural substrates remain largely unexplored.

METHODS

Voxel-based morphometry and multivariate statistics were used to identify gray matter volume covariance networks associated with social support in 112 older adults without dementia (M age = 74.6 years, 50% female), using the Medical Outcomes Study Social Support Survey.

RESULTS

A gray matter network associated with overall social support was identified and included prefrontal, hippocampal, amygdala, cingulate, and thalamic regions. A gray matter network specifically associated with tangible social support (e.g., someone to help you if you were confined to bed) was also identified, included prefrontal, hippocampal, cingulate, insular, and thalamic regions, and correlated with memory and executive function.

DISCUSSION

Gray matter networks associated with overall and tangible social support in this study were composed of regions previously associated with memory, executive function, aging, and dementia. Longitudinal research of the interrelationships between social support, brain structure, and cognition is needed, but strengthening social support may represent a new path toward improving cognition in aging that should be explored.

Variations in health behaviors among pregnant women during the COVID-19 pandemic

Purpose

To examine changes in lifestyle behaviors early in the COVID-19 pandemic among pregnant women.

Materials and methods

A cross-sectional internet-based survey was completed by 706 pregnant women (mean age 29.6 years ± 3.2) residing in the United States in May 2020 to assess self-reported changes in diet, physical activity, and sleep during the COVID-19 pandemic. Logistic regression analyses examined whether sociodemographic, clinical, and pandemic-related characteristics were associated with health behavior changes.

Results

Approximately 17% of women reported their diets worsened during the COVID-19 pandemic, 42% reported improvements, and 41% reported no change. For physical activity, 22% reported they stopped being active, 2% reported they became active, and 76% reported no change. Nearly one-third of participants reported getting less sleep. The factors consistently associated with adverse lifestyle changes (worse diet, stopped being active, and reduced sleep) were experiences of pregnancy complications, loss of income due to COVID-19, and changes in social connections due to COVID-19.

Conclusions

A substantial proportion of pregnant women reported adverse lifestyle changes during the COVID-19 pandemic. Interventions during the pandemic to optimize health behaviors in pregnant women, especially among those with pregnancy complications, should address economic disadvantages and social support.

Social network characteristics are correlated with dietary patterns among middle aged and older South Asians living in the United States (U.S.)

Background

Social and cultural norms, operating through social networks, may influence an individual’s dietary choices. We examined correlations between social network characteristics and dietary patterns among South Asians in the United States (U.S.)

Methods

Data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Social Network study were analyzed among 756 participants (mean age = 59 y standard deviation [SD] = 9 y; 44% women). A culturally adapted, validated food frequency questionnaire was used for dietary assessment. A posteriori dietary patterns using principal component analysis were named 1) animal protein, 2) fried snacks, sweets and high-fat dairy, and 3) fruits, vegetables, nuts and legumes. Social network characteristics were assessed using a standard egocentric approach, where participants (egos) self-reported data on perceived dietary habits of their network members. Partial correlations between social network characteristics and egos’ dietary patterns were examined.

Results

The mean social network size of egos was 4.2 (SD = 1.1), with high proportion of network members being family (72%), South Asian ethnicity (89%), and half having daily contact. Animal protein pattern scores were negatively correlated with fruits and cooked vegetables consumption of network. Fried snacks, sweets and high-fat dairy pattern scores were positively correlated with sugar-sweetened beverages, South Asian sweets, fried/fast foods and ghee (clarified butter) consumption of network. Fruits, vegetables, nuts and legumes pattern scores were positively correlated with vegetables, fruits, and brown rice/quinoa consumption of network.

Conclusions

Network member characteristics and their perceived dietary behaviors were correlated with dietary patterns of egos. Dietary intervention studies among South Asians should consider social network characteristics as candidate components for dietary intervention.

"It's about getting the best bang for your buck": Exploring local councils' perceptions about providing exercise infrastructure in public parks

ISSUE ADDRESSED

Growing evidence suggests that public parks enable physically active communities; however, little is known of the impact of council-provided exercise facilities in outdoor green spaces, and the challenges of providing this infrastructure at a local level. This paper sought to describe some of the factors, as perceived by local government area (LGA) council representatives within Queensland, Australia, that influence community use of, as well as council provision for, weight-bearing outdoor fitness station infrastructure in public parks.

METHODS

A nested mixed-methods study was employed, comprised of a survey sent to council representatives for all 78 Queensland LGAs (Stage 1), and follow-up interviews to elicit further insights into the provision of infrastructure in public parks (Stage 2; n = 7). Perceptions around participants' corporate role in the provision of outdoor fitness stations were the focus of analyses.

FINDINGS

A thematic analysis described themes of: Moderating public attitudes and motivation; The flow of information; Supporting an active community; Return on investment; and Safety, complianceand climate. Provision of equipment was influenced by the perception that it represented poor value for money, in terms of the desired outcome of increased physical activity, especially when compared with other types of infrastructure (particularly, walking trails); however, opinions about this lack of use outdoor exercise equipment were most often based on anecdotal evidence.

CONCLUSIONS

Councils are motivated to support active communities. They would benefit from better access to information about park usage, strategies for marketing healthy living initiatives and data about the economic benefits of parks. SO WHAT?: The current study explores the perspectives of LGA professional "gatekeepers," who develop and maintain public physical activity facilities. Their insights are essential to better understand the practicalities of delivering desirable urban green spaces for physically active communities.

Associations between social network properties and metabolic syndrome and the mediating effect of physical activity: findings from the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort

INTRODUCTION

Social isolation and loneliness are positively associated with metabolic syndrome. However, the mechanisms by which social isolation affects metabolic syndrome are not well understood.

RESEARCH DESIGN AND METHODS

This study was designed as a cross-sectional study of baseline results from the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort. We included 10 103 participants (8097 community-based low-risk participants, 2006 hospital-based high-risk participants) from the CMERC Cohort. Participants aged 65 years or older were excluded. Multiple imputation by chained equations was applied to impute missing variables. The quantitative properties of social networks were assessed by measuring the 'size of social networks'; qualitative properties were assessed by measuring the 'social network closeness'. Metabolic syndrome was defined based on the National Cholesterol Education Program Adult Treatment Panel III criteria. Multivariate logistic regression analyses were conducted to assess association between social network properties and metabolic syndrome. The mediating effects of physical inactiveness, alcohol consumption, cigarette smoking and depressive symptoms were estimated. Age-specific effect sizes were estimated for each subgroup.

RESULTS

A smaller social network was positively associated with higher prevalences of metabolic syndrome in all subgroups, except the high-risk male subgroup. There was no clear association between social network closeness and metabolic syndrome. In community-based participants, an indirect effect through physical activity was detected in both sexes; however, in hospital-based participants, no indirect effects were detected. Cigarette smoking, alcohol consumption and depression did not mediate the association. Age-specific estimates showed that the indirect effect through physical activity had a greater impact in older participants.

CONCLUSIONS

A smaller social network is positively associated with metabolic syndrome. This trend could be partially explained by physical inactivity, especially in older individuals.

Correlates of walking among disadvantaged groups: A systematic review

Socioeconomically disadvantaged groups are less likely to be physically active. Walking is important to public health, therefore understanding correlates of walking will inform the development of targeted interventions. The aim of this systematic review was to examine the correlates of walking among socioeconomically disadvantaged adults. PubMed/MEDLINE and Scopus were searched up to February 2020 and titles/abstracts and full-texts were screened against eligibility criteria. Methodological quality was assessed. Correlates were synthesized when two or more comparisons were available. 35 studies were selected for synthesis. 21 examined overall walking, 16 examined leisure-time walking and 9 examined walking for transport (8 examined two or more types of walking). Employment status, home ownership, self-rated health, density or number of social ties, perceived neighborhood aesthetics, perceived walkability and perceived individual safety were positively associated with overall walking. Social support for physical activity from friends and family and perceived individual safety were positively associated with leisure-time walking. Objective walkability, perceived walkability and perceived individual safety were positively associated with walking for transport. Most studies were cross-sectional, did not report response rates and used a validated measure of physical activity. Strategies to improve self-rated health, social ties, neighborhood aesthetics, walkability and perceptions of individual safety should be the focus of interventions that aim to improve walking among socioeconomically disadvantaged groups. Recommendations for future studies include the need to focus on leisure-time walking and walking for transport; the correlates of walking in males; prospective longitudinal designs; psychological, cognitive and emotional variables; and social, behavioral attributes and skills.

Childhood Trauma, Social Networks, and the Mental Health of Adult Survivors

The purpose of this study was to investigate the relationship of childhood trauma to the quality of social networks and health outcomes later in adulthood. Data were obtained from a convenience sample of 254 adults seen in one of 10 primary care clinics in the state of Texas. Standardized measures of adverse childhood experiences (ACEs), stressful and supportive social relationships, medical conditions, anxiety, depression, and health-related quality of life were administered. Using latent class analysis, subjects were assigned to one of four ACE classes: (a) minimal childhood abuse (56%), (b) physical/verbal abuse of both child and mother with household alcohol abuse (13%), (c) verbal and physical abuse of child with household mental illness (12%), and (d) verbal abuse only (19%). Statistically significant differences across the four ACE classes were found for mental health outcomes in adulthood. Although respondents who were physically and verbally abused as children reported compromised mental health, this was particularly true for those who witnessed physical abuse of their mother. A similar relationship between ACE class and physical health was not found. The quality of adult social networks partly accounted for the relationship between ACE classes and mental health outcomes. Respondents exposed to ACEs with more supportive social networks as adults had diminished odds of reporting poor mental health. Conversely, increasing numbers of stressful social relationships contributed to adverse mental health outcomes. Although efforts to prevent childhood trauma remain a critical priority, the treatment of adult survivors needs to expand its focus on both strengthening social networks and decreasing the negative effects of stressful ones.

Male gender and unemployment are associated with lower levels of perceived social support in adults with cystic fibrosis

OBJECTIVE

Adults with cystic fibrosis (CF) face unique challenges with regard to the attainment and maintenance of social support. Although social support has been shown to improve treatment outcomes in other patient-populations, research on social support in adults with CF is limited. In fact, no studies have examined factors associated with less perceived social support in this population. The current study aimed to fill this gap, thus providing CF care teams with empirical evidence about who may be most likely to lack support and inform future intervention.

METHODS

Participants in this cross-sectional study included 233 adults with CF who were part of a larger, longitudinal study. Participants completed the Interpersonal Support Evaluation List, a measure of social support, and attended routine clinical visits where measures of disease severity were obtained.

RESULTS

Being female and employed were associated with greater perceptions of social support in this sample. Age, income, education, marital status, and disease-severity were not related to perceptions of social support.

CONCLUSION

The present study revealed that individuals with CF who are unemployed and those who are male perceived having lower social support, perhaps identifying subgroups for whom targeted interventions may be appropriate.

Social Isolation, Loneliness, and Health Behaviors at Older Ages: Longitudinal Cohort Study

Background

The prospective associations between social isolation, loneliness, and health behaviors are uncertain, despite the potential importance of these relationships over time for outcomes including mortality.

Purpose

To examine the associations between baseline social isolation, baseline loneliness, and engagement in health behaviors over 10 years among older adults.

Methods

Data were from 3,392 men and women aged ≥52 years in the English Longitudinal Study of Ageing from 2004/2005 to 2014/2015. Modified Poisson regression was specified to estimate relative risks (RRs) and 95% confidence intervals for the associations between baseline social isolation, baseline loneliness, and consistent weekly moderate-to-vigorous physical activity, consistent five daily fruit and vegetable servings, daily alcohol drinking at any time point, smoking at any time point, and a consistently overweight/obese body mass index over the follow-up (all yes vs. no). Models were population weighted and adjusted for sociodemographic factors, health indicators, and depressive symptoms, with mutual adjustment for social isolation and loneliness.

Results

Socially isolated participants were less likely than non-isolated participants to consistently report weekly moderate-to-vigorous physical activity (RR = 0.86; 0.77-0.97) or five daily fruit and vegetable servings (RR = 0.81; 0.63-1.04). They were less likely to be consistently overweight or obese (RR = 0.86; 0.77-0.97) and more likely to smoke at any time point (RR = 1.46; 1.17-1.82). Loneliness was not associated with health behaviors or body mass index in adjusted models. Among smokers, loneliness was negatively associated with successful smoking cessation over the follow-up (RR = 0.31; 0.11-0.90).

Conclusions

Social isolation was associated with a range of health-related behaviors, and loneliness was associated with smoking cessation over a 10 year follow-up in older English adults.

An evidence-based toolbox for the design and implementation of selective-prevention primary-care initiatives targeting cardio-metabolic disease

Cardio-metabolic diseases (CMD; cardiovascular disease, type 2 diabetes, chronic kidney disease) represent a global public health problem. Worldwide, nearly half a billion people are currently diagnosed with diabetes, and cardiovascular disease is the leading cause of death. Most of these diseases can be assuaged/prevented through behavior change. However, the best way to implement preventive interventions is unclear. We aim to fill this knowledge gap by creating an evidence-based and adaptable “toolbox” for the design and implementation of selective prevention initiatives (SPI) targeting CMD. We built our toolbox based on evidence from a pan-European research project on primary-care SPIs targeting CMD. The evidence includes (1) two systematic reviews and two surveys of patient and general practitioner barriers and facilitators of engaging with SPIs, (2) a consensus meeting with leading experts to establish optimal SPI design, and (3) a feasibility study of a generic, evidence-based primary-care SPI protocol in five European countries. Our results related primarily to the five different national health-care contexts from which we derived our data. On this basis, we generated 12 general recommendations for how best to design and implement CMD-SPIs in primary care. We supplement our recommendations with practical, evidence-based suggestions for how each recommendation might best be heeded. The toolbox is generic and adaptable to various national and systemic settings by clinicians and policy makers alike. However, our product needs to be kept up-to-date to be effective and we implore future research to add relevant tools as they are developed.

Health Behaviors as a Mediator of the Association Between Interpersonal Relationships and Physical Health in a Workplace Context

The etiology of diseases is multifactorial, involving genetic, environmental, and lifestyle-related behaviors. Considering the pathway that involves behavioral processes, a huge body of empirical evidence has shown that some healthy behaviors such as non-smoking, any or moderate alcohol consumption, a healthy diet, (e.g., fruit and vegetable intake), and physical activity, decrease the risk of disease and mortality. This study aimed to explore the potential mediating effect of combined health behaviors on the association between interpersonal relationships and physical health in a Brazilian adult worker population from the Occupational Health Service within the oil industry in Bahia, Brazil. The sample included 611 workers, of which 567 (92.8%) were males and 44 (7.2%) females, age ranging from 18 to 73 years (M = 41.95; SD = 8.88). The significant predictors of physical health were interpersonal relationships and health behaviors. Health behaviors contributed significantly to a reduction in the effect of interpersonal relationships on physical health outcomes. As far as it is known, there has been no prior work in Brazil that simultaneously examined the best predictors of physical health in oil workers using this conceptual model. Interventions in the workplace environment need to consider health behavior as a mediator between interpersonal relationships and physical health, aligned in a global psychosocial approach to health at work.

The Social Support-Health Link Unraveled: Pathways Linking Social Support to Functional Capacity in Later Life

Objective: Despite evidence that social support is strongly related to health, very little is known about the mechanisms underlying this association. This study investigates whether physical activity, depressive symptoms, and chronic diseases mediate the associations between social support and functional capacity. Method: Data from the Longitudinal Aging Study Amsterdam on 954 participants, aged 75 and older, covering 9 years, are analyzed with latent growth mediation models. Results: Only the indirect path from the initial level of emotional support to the initial level of functional capacity through the initial level of depressive symptoms was significant. All mediators however were significantly associated with the level of and changes in functional capacity. Models with reversed pathways were estimated, but model fit was worse. Discussion: Because only initial levels of social support relate to functional capacity, and changes in social support do not, older adults likely receive the support they need.

Enabling and disabling behaviors in the social environment are associated with physical Activity of older people in the Netherlands

Background

Although research clearly shows that physical activity has significant health benefits and contributes to the prevention of chronic disease onset, the vast majority of the world’s population is insufficiently physically active, and the prevalence of insufficient physical activity is greatest in the population of older adults. The social environment may play an important role in shaping health behaviors, we however, lack knowledge regarding the exact influence of the social environment on older persons’ physical activity levels. This research therefore aims to identify the relationships of physical activity to enabling and disabling behaviors in the social environment among older people in the Netherlands.

Methods

Participants were randomly sampled from the Rotterdam municipality register and stratified by age group (70–74, 75–79, 80–84, and ≥ 85 years) and neighborhood (district). Of 2798 respondents, 1280 (46%) returned filled-in questionnaires. The Perceived Social Influence on Health Behavior (PSI-HB) instrument was used to assess the degree to which individuals’ health behavior is influenced by those around them. Respondents were additionally asked about enabling and disabling behaviors in their social environments and how many days per week they were physically active. Physical activity scores ranged from 0 (not being physically active for 30 min a day at all during the week) to 7 (being physically active every day of the week). Respondents with a score of ≥5 were considered to be physically active and those with a score of < 5 as physically inactive.

Results

Results revealed that increasing age significantly contributed to physical inactivity within this older population. Lower educational level significantly decreased the odds of physical activity. After controlling for background characteristics results show enabling behaviors and utilitarian social influence significantly increased the odds of physical activity while disabling behaviour of the social environment contributed to physical inactivity. No significant associations were found with perceived social influence aspects value-expressive influence and informational influence.

Conclusion

Actual enabling and disabling behaviors of actors in older people’s social environments seem relevant for their physical activity levels, in positive and negative ways. In promoting active aging, consideration of the role of the social environment and ensuring that it is supportive of older people’s physical activity are important.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6670-z) contains supplementary material, which is available to authorized users.

The power of social networks and social support in promotion of physical activity and body mass index among African American adults

Social support and social networks can elucidate important structural and functional aspects of social relationships that are associated with health-promoting behaviors, including Physical Activity (PA) and weight. A growing number of studies have investigated the relationship between social support, social networks, PA and obesity specifically among African Americans; however, the evidence is mixed and many studies focus exclusively on African American women. Most studies have also focused on either functional or structural aspects of social relationships (but not both) and few have objectively measured moderate-to-vigorous physical activity (MVPA) and body mass index (BMI). Cross-sectional surveys of adult African American men and women living in two low-income predominantly African American neighborhoods in Pittsburgh, PA (N = 799) measured numerous structural features as well as functional aspects of social relationships. Specifically, structural features included social isolation, and social network size and diversity. Functional aspects included perceptions of social support for physical activity from the social network in general as well as from family and friends specifically. Height, weight, and PA were objectively measured. From these, we derived Body Mass Index (BMI) and moderate-to-vigorous physical activity (MVPA). All regression models were stratified by gender, and included age, income, education, employment, marital status, physical limitations, and a neighborhood indicator. Greater social isolation was a significant predictor of lower BMI among men only. Among women only, social isolation was significantly associated with increased MVPA whereas, network diversity was significantly associated with reduced MVPA. Future research would benefit from in-depth qualitative investigations to understand how social networks may act to influence different types of physical activity among African Americans, as well as understand how they can be possible levers for health promotion and prevention.

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Contributes to research on the social environment and physical activity among African Americans.

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Social isolation was associated with lower BMI among men.

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Social isolation was associated with more physical activity among women.

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More social network diversity was associated with less physical activity among women.

Weight and weight control behaviors of Latinas and their social ties

OBJECTIVE

Shared behaviors have been implicated in the clustering of obesity among socially connected people. This study determined how weight and weight control behaviors of participants and their social ties are related and how these factors are associated with weight change in participants.

METHOD

Adult Latinas participating in a lifestyle intervention completed an egocentric network measure of weight and weight control behaviors. Participant weight was objectively measured at baseline and 12 months. Multivariable regression models determined the relationship between weight and weight control behaviors of participants and their social ties.

RESULTS

Participants and their social ties shared similarities in weight control behaviors and weight change. Participants who reported social ties that had lost weight were more likely to eat small portions and low-fat foods, but those with social ties that had gained weight were more likely to use herbal supplements. Participants who reported more social ties who exercised, drank liquid meal replacements, took herbal supplements, and self-weighed were more likely to lose weight whereas those with fewer social ties that exercised were more likely to gain weight. Weight loss and weight gain by social ties predicted participant weight loss and weight gain, respectively.

CONCLUSIONS

Given that weight and weight control behaviors of Latinas reflect that of their social ties, targeting existing social networks for lifestyle interventions may more effectively improve and sustain health-promoting behaviors and outcomes. (PsycINFO Database Record

Generational differences in patterns of physical activities over time in the Canadian population: an age-period-cohort analysis

Background

Using longitudinal panel data, the aim of this study was to examine the contribution of age, period, and cohort effects on changes in physical activity over time in a population-based sample of Canadians. We focused on three domains of physical activities: leisure time, commuting (i.e. walking and cycling), and daily activities (i.e. sedentary behavior). We also examined whether changes in sedentary behavior related to changes in participation in leisure time and commuting activities.

Methods

We used data from the Longitudinal National Population Health Survey (1994–2011): 10050 participants born between 1935 and 1984 grouped in five 10-years birth cohorts. We examined three outcomes: moderate-to-vigorous leisure time physical activity, active commuting, and sedentary behavior. We also included education, income, and body mass index as covariates. We used hierarchical age-period-cohort analysis to examine the contribution of age, period, and cohort effects to changes over time for each outcome.

Results

We found that recent cohorts were more likely to report sedentary behavior and greater participation in leisure time physical activities and active commuting. We also found a significant trend of increasing participation in active leisure time physical activity and active commuting among Canadians from 1994/95 to 2010/11 and, at the same time, an increase in sedentary behavior. The greater participation in leisure time physical activities and active commuting in each succeeding recent cohort was partially related to the secular trend of increasing participation in physical activities over time in the population. Furthermore, those with sedentary behavior were less likely to report participation in physical activities. Overall, obese individuals were less likely to be physically active and more likely to be sedentary, while the effect of socio-economic status varied by outcome.

Conclusions

The greater participation in physical activities (leisure time and commuting) in recent cohorts is encouraging and was substantially explained by period effects, which reflect broad social and environmental factors affecting the whole population. The large cohort effect of increasing sedentary behavior and the inverse relationship between sedentary behavior and physical activity is concerning, and identifies a target group for future interventions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5189-z) contains supplementary material, which is available to authorized users.

Childhood socioeconomic status and lifetime health behaviors: The Young Finns Study

BACKGROUND

Differences in health behaviors partly explain the socioeconomic gap in cardiovascular health. We prospectively examined the association between childhood socioeconomic status (SES) and lifestyle factors in adulthood, and the difference of lifestyle factors according to childhood SES in multiple time points from childhood to adulthood.

METHODS AND RESULTS

The sample comprised 3453 participants aged 3-18 years at baseline (1980) from the longitudinal Young Finns Study. The participants were followed up for 31 years (N = 1675-1930). SES in childhood was characterized as reported annual family income and classified on an 8-point scale. Diet, smoking, alcohol intake and physical activity were used as adult and life course lifestyle factors. Higher childhood SES predicted a healthier diet in adulthood in terms of lower consumption of meat (β ± SE -3.6 ± 0.99,p < 0.001), higher consumption of fish (1.1 ± 0.5, p = 0.04) and higher diet score (0.14 ± 0.044, p = 0.01). Childhood SES was also directly associated with physical activity index (0.059 ± 0.023, p = 0.009) and inversely with the risk of being a smoker (RR 0.90 95%CI 0.85-0.95, p < 0.001) and the amount of pack years (-0.47 ± 0.18, p = 0.01). Life course level of smoking was significantly higher and physical activity index lower among those below the median childhood SES when compared with those above the median SES.

CONCLUSIONS

These results show that childhood SES associates with several lifestyle factors 31 years later in adulthood. Therefore, attention could be paid to lifestyle behaviors of children of low SES families to promote cardiovascular health.

Social isolation, health literacy, and mortality risk: Findings from the English Longitudinal Study of Ageing

OBJECTIVE

To investigate the relationships between social isolation, health literacy, and all-cause mortality, and the modifying effect of social isolation on the latter relationship.

METHODS

Data were from 7731 adults aged ≥50 years participating in Wave 2 (2004/2005) of the English Longitudinal Study of Ageing. Social isolation was defined according to marital/cohabiting status and contact with children, relatives, and friends, and participation in social organizations. Scores were split at the median to indicate social isolation (yes vs. no). Health literacy was assessed as comprehension of a medicine label and classified as "high" (≥75% correct) or "low" (<75% correct). The outcome was all-cause mortality up to February 2013. Cox proportional hazards models were adjusted for sociodemographic factors, health status, health behaviors, and cognitive function.

RESULTS

Mortality rates were 30.3% versus 14.3% in the low versus high health literacy groups, and 23.5% versus 13.7% in the socially isolated versus nonisolated groups. Low health literacy (adj. HR = 1.22, 95% CI 1.02-1.45 vs. high) and social isolation (adj. HR = 1.28, 95% CI 1.10-1.50) were independently associated with increased mortality risk. The multiplicative interaction term for health literacy and social isolation was not statistically significant (p = .81).

CONCLUSIONS

Low health literacy and high social isolation are risk factors for mortality. Social isolation does not modify the relationship between health literacy and mortality. Clinicians should be aware of the health risks faced by socially isolated adults and those with low health literacy. (PsycINFO Database Record

The Association Between Social Support, Body Mass Index and Increased Risk of Prediabetes: the Cardiovascular Risk in Young Finns Study

PURPOSE

The psychosocial determinants of prediabetes are poorly understood. The aims of our study were (1) to analyse the association between perceived social support in young adulthood and fasting glucose levels and prediabetes in mid-adulthood in a cohort of healthy Finns, (2) to explore whether body mass index (BMI), inflammation or depression mediate this relationship, (3) and to examine the association between social support trajectory groups and fasting glucose.

METHOD

A prospective design was used with an analytic sample of 1250 participants aged 3-18 years at baseline (1980) and aged 12-39 years when social support was measured. Fasting glucose and prediabetes were assessed 32 years after baseline. Linear and logistic regression was used to examine the association between social support and the outcome measures. A bootstrapping technique was used to examine mediation effects.

RESULTS

Social support was associated with future glucose levels in women after adjusting for childhood socioeconomic status (SES) and youth depression (β = -0.136, p = 0.001) and also predicted prediabetes in women after adjusting for childhood SES (β = 1.31, 95 % CI 1.02 to 1.69, p = 0.031). Both associations were attenuated after adjusting for BMI in mid-adulthood. BMI was found to mediate the relationship between social support and prediabetes in women (β for indirect effect β = 0.09, SE = 0.03, CI = 0.03 to 0.16).

CONCLUSION

Low perceived social support in young adulthood is associated with high fasting glucose and prediabetes in mid-adulthood in women but not men. The association between social support and prediabetes in women can be partly explained by BMI.

The Promise of Qualitative Research to Inform Theory to Address Health Equity

Most public health researchers and practitioners agree that we need to accelerate our efforts to eliminate health disparities and promote health equity. The past two decades of research have provided a wealth of descriptive studies, both qualitative and quantitative, that describe the size, scale, and scope of health disparities, as well as the key determinants that affect disparities. We need, however, to shift more aggressively to action informed by this research and develop deeper understandings of how to shape multilevel interventions, influenced by theories across multiple levels of the social-ecologic framework. In this article, we discuss the promising opportunities for qualitative and health equity scholars to advance research and practice through the refinement, expansion, and application of rigorous, theoretically informed qualitative research. In particular, to advance work in the area of theory to inform health equity, we encourage researchers (a) to move toward thinking about mechanisms and theory-building and refining; (b) to explicitly incorporate theories at the social, organizational, community, and policy levels and consider how factors at these levels interact synergistically with factors at the individual and interpersonal levels;

A Blended Web-Based Gaming Intervention on Changes in Physical Activity for Overweight and Obese Employees: Influence and Usage in an Experimental Pilot Study

Background

Addressing the obesity epidemic requires the development of effective interventions aimed at increasing physical activity (PA). eHealth interventions with the use of accelerometers and gaming elements, such as rewarding or social bonding, seem promising. These eHealth elements, blended with face-to-face contacts, have the potential to help people adopt and maintain a physically active lifestyle.

Objective

The aim of this study was to assess the influence and usage of a blended Web-based gaming intervention on PA, body mass index (BMI), and waist circumference among overweight and obese employees.

Methods

In an uncontrolled before-after study, we observed 52 health care employees with BMI more than 25 kg/m², who were recruited via the company’s intranet and who voluntarily participated in a 23-week Web-based gaming intervention, supplemented (blended) with non-eHealth components. These non-eHealth components were an individual session with an occupational health physician involving motivational interviewing and 5 multidisciplinary group sessions. The game was played by teams in 5 time periods, aiming to gain points by being physically active, as measured by an accelerometer. Data were collected in 2014 and 2015. Primary outcome was PA, defined as length of time at MET (metabolic equivalent task) ≥3, as measured by the accelerometer during the game. Secondary outcomes were reductions in BMI and waist circumference, measured at baseline and 10 and 23 weeks after the start of the program. Gaming elements such as “compliance” with the game (ie, days of accelerometer wear), “engagement” with the game (ie, frequency of reaching a personal monthly target), and “eHealth teams” (ie, social influence of eHealth teams) were measured as potential determinants of the outcomes. Linear mixed models were used to evaluate the effects on all outcome measures.

Results

The mean age of participants was 48.1 years; most participants were female (42/51, 82%). The mean PA was 86 minutes per day, ranging from 6.5 to 223 minutes, which was on average 26.2 minutes per day more than self-reported PA at baseline and remained fairly constant during the game. Mean BMI was reduced by 1.87 kg/m² (5.6%) and waist circumference by 5.6 cm (4.8%). The univariable model showed that compliance, engagement, and eHealth team were significantly associated with more PA, which remained significant for eHealth team in the multivariable model.

Conclusions

This blended Web-based gaming intervention was beneficial for overweight workers in becoming physically active above the recommended activity levels during the entire intervention period, and a favorable influence on BMI and waist circumference was observed. Promising components in the intervention, and thus targets for upscaling, are eHealth teams and engagement with the game. Broader implementation and long-term follow-up can provide insights into the sustainable effects on PA and weight loss and into who benefits the most from this approach.

Health effects of adverse childhood events: Identifying promising protective factors at the intersection of mental and physical well-being

Research documents how exposure to adversity in childhood leads to negative health outcomes across the lifespan. Less is known about protective factors - aspects of the individual, family, and community that promote good health despite exposure to adversity. Guided by the Resilience Portfolio Model, this study examined protective factors associated with physical health in a sample of adolescents and adults exposed to high levels of adversity including child abuse. A rural community sample of 2565 individuals with average age of 30 participated in surveys via computer assisted software. Participants completed self-report measures of physical health, adversity, and a range of protective factors drawn from research on resilience. Participants reporting a greater burden of childhood victimization and current financial strain (but not other adverse life events) had poorer physical health, but those with strengths in emotion regulation, meaning making, community support, social support, and practicing forgiveness reported better health. As hypothesized, strengths across resilience portfolio domains (regulatory, meaning making, and interpersonal) had independent, positive associations with health related quality of life after accounting for participants' exposure to adversity. Prevention and intervention efforts for child maltreatment should focus on bolstering a portfolio of strengths. The foundation of the work needs to begin with families early in the lifespan.

Social Factors Associated With Psychological Distress and Health Problems Among Elderly Members of a Disaster-Affected Population: Subgroup Analysis of a 1-Year Post-disaster Survey in Ishinomaki Area, Japan

OBJECTIVE

We aimed to investigate the influence of social factors, especially social support, on psychological distress and the prevalence of health problems (HPs) among victims living in their homes 14 to 21 months after the Great East Japan Earthquake and tsunami.

METHODS

A subgroup analysis was performed for elderly participants of a cross-sectional household survey in Ishinomaki area, Japan. The prevalence of psychological HPs was assessed by using a psychological distress questionnaire (K6) and by recording the number of subjective HPs. Perceived social support was assessed in 3 dimensions: informational, emotional, and instrumental support. Univariate and multivariate logistic regression models were used to examine the association between social factors and psychological health.

RESULTS

An elderly subgroup with 879 participants was used for analyses. Psychological distress (K6 score≥9) was observed in 6.8% of the participants aged 65 to 74 years and in 8.0% of those aged ≥75 years. Receiving a long-term care service was associated with having HPs, and discontinuation of attendance at a hospital as an outpatient was associated with psychological distress. Receiving emotional support was associated with lower psychological distress and not having HPs.

CONCLUSIONS

Emotional support was found to be an important factor for promoting health among elderly disaster victims. (Disaster Med Public Health Preparedness. 2017;11:64-71).

Association between Social Network Characteristics and Lifestyle Behaviours in Adults at Risk of Diabetes and Cardiovascular Disease

Objectives

In this exploratory study we examined the associations between several social network characteristics and lifestyle behaviours in adults at increased risk of diabetes and cardiovascular diseases. In addition, we explored whether similarities in lifestyle between individuals and their network members, or the level of social support perceived by these individuals, could explain these associations.

Methods

From the control group of the Hoorn Prevention Study, participants with high and low educational attainment were approached for a structured interview between April and August 2010. Inclusion was stopped when fifty adults agreed to participate. Participants and a selection of their network members (e.g. spouses, best friends, neighbours, colleagues) completed a questionnaire on healthy lifestyle that included questions on fruit and vegetable intake, daily physical activity and leisure-time sedentary behaviour. We first examined associations between network characteristics and lifestyle using regression analyses. Second, we assessed associations between network characteristics and social support, social support and lifestyle, and compared the participants’ lifestyles to those of their network members using concordance correlation coefficients.

Results

Fifty adults (50/83 x 100 = 62% response) and 170 of their network members (170/192 x 100 = 89% response) participated in the study. Individuals with more close-knit relationships, more friends who live nearby, and a larger and denser network showed higher levels of vegetable consumption and physical activity, and lower levels of sedentary behaviour. Perceived social norms or perceived support for behavioural change were not related to healthy lifestyle. Except for spousal concordance for vegetable intake, the lifestyle of individuals and their network members were not alike.

Conclusions

Study results suggest that adults with a larger and denser social network have a healthier lifestyle. Underlying mechanisms for these associations should be further explored, as the current results suggest a minimal role for social support and modelling by network members.

Determinants of Engagement in Leisure-time Physical Activity – Dialogue with Senior Athletes

Cet article explore, en examinant leurs croyances saillants, les facteurs qui déterminent si les personnes âgées participent aux Jeux des aînés et de l’activité physique durant les loisirs connexes. Nous avons mené 10 entrevues en profondeur avec des personnes âgées qui ont participé aux Jeux des aînés. Nous avons exploré trois types de croyance sous-tendus par le cadre théorique de comportement prévu: les avantages et les inconvénients (croyances comportementales), le soutien social et la pression (croyances normatives), et les facilitateurs et les obstacles (croyances de contrôle). Les répondants aux entrevues se sont trouvés à s’engager aux Jeux des aînés et à l’activité physique dans la mesure où ils ont associé divers avantages intangibles avec les Jeux et en ont valorisé la satisfaction psychologique. Ils considéraient leurs pairs et les familles comme soutenant et approuvant leur engagement, tout en reconnaissant les capacités physiques et les contraintes structurelles nécessaires pour se livrer aux Jeux et les activités connexes. Les résultats indiquent comment les croyances pertinentes peuvent être combinées avec des interventions pour encourager pour les personnes âgées des activités physiques des loisirs.

Impact of a literacy-sensitive intervention on CRC screening knowledge, attitudes, and intention to screen

Background

Colorectal cancer (CRC) screening rates remain low, especially among low-income populations.

Objective

To determine if a CRC screening intervention (video, brochure) improves knowledge about CRC and CRC screening, attitudes toward screening, and intention to complete CRC screening among average-risk adults with different health literacy skills, seeking medical care at a Federally Qualified Health Center (FQHC).

Methods

Average-risk adults (50 years or older) who were not within CRC screening guidelines completed face-to-face pre-and post-intervention interviews that focused on knowledge about CRC and CRC screening, attitudes toward CRC screening, and intention to complete CRC screening.

Results

Of the 270 participants, 64% were women, 72% were black/African American, 86% were not married, 79% had an annual household income of <$20,000, and 57% did not have health insurance. Reading levels by Rapid Estimate of Adult Literacy in Medicine health literacy test were: 3rd grade or lower, 17 participants (6.3%); 4th-6th grade, 27 (10.0%); 7th-8th grade, 101 (37.4 %); and high school, 125 (46.3%). CRC screening knowledge mean score improved, and perceived CRC susceptibility and self-efficacy to complete screening significantly increased, irrespective of health literacy (all P < .01). There were no significant changes in other attitudes or intention to complete screening.

Limitations

The study was conducted in a single FQHC, so the results may not be generalizable to other health centers or populations of low-income and minority patients.

Conclusion

A CRC screening intervention improved CRC screening knowledge and attitudes across levels of health literacy and may be an important strategy for improving CRC screening in the primary care setting.

Funding

National Cancer Institute K07 CA107079 (Ohio State University) and P30 CA016058 (Behavioral Measurement Shared Resource at The Ohio State University).

High perceived social support protects against the intergenerational transmission of obesity: The Cardiovascular Risk in Young Finns Study

AIMS

Our aims were to assess whether offspring social support moderates the relationship between parental body mass index (BMI) and offspring BMI.

METHODS

A prospective design was used with an analytic sample of 1049 participants from Finland (the offspring) who were 35-50years old in 2012 when adulthood BMI was measured. Parental BMI was self-reported at baseline in 1980. Offspring social support was measured in 2007 when participants were 30-45years old. Linear and logistic regression was used to examine whether there was an interaction between parental BMI and offspring social support when predicting offspring BMI in adulthood. An analysis of simple slopes and multilevel growth curve modeling were used to further examine the interaction.

RESULTS

The interaction between maternal BMI and offspring social support was significantly and negatively related to offspring BMI in adulthood (β=-0.068, R(2) change=0.005, p=0.015) in the fully adjusted model which also adjusted for parental occupational status and offspring depressive symptoms. The logistic regression supported these results, with the interaction between maternal overweight (BMI≥25kg/m(2)) and offspring social support negatively associated with offspring overweight in adulthood (odds ratio=0.74, 95% confidence interval, 0.56 to 0.98). The growth curve analysis further demonstrated that high maternal BMI predicts more rapidly rising offspring BMI in those reporting low social support compared to high social support.

CONCLUSIONS

Our results suggest that social support protects against the intergenerational transmission of obesity and therefore presents an important opportunity for obesity prevention efforts.

Design of a lifestyle intervention to slow menopause-related progression of intra-abdominal adipose tissue in women: The Women in the Southside Health and Fitness (WISHFIT) study

Background

Changes in reproductive hormones during menopause are associated with accumulation of intra-abdominal adipose tissue (IAAT), a subclinical indicator of cardiometabolic disease risk. Independent of reproductive hormones, unhealthy lifestyle contributes to IAAT gain. The Women in the Southside Health and Fitness (WISHFIT) Study aims to develop a lifestyle approach to slowing IAAT accumulation as women begin the menopausal transition.

Methods

The primary aim is to develop and conduct a proof-of-concept test of a multi-component, multi-level behavioral intervention targeting jointly physical activity, diet, and psychological well-being. Participants attend group sessions over 2 years to experiment with healthy living through both experiential and didactic learning, cultivate a health network, and draw on community resources to sustain change. The primary endpoint is 2-year IAAT progression, assessed using computerized tomography. Behavioral targets of treatment and secondary endpoints will be evaluated at 6, 12, 18 and 24 months. Change in social networks and community support will be assessed at 2 years.

Results

WISHFIT recruited 71 pre- and peri-menopausal Caucasian and African American women (mean ± SD age = 47.6 ± 3.4 yrs; BMI = 33.6 ± 7.3 kg/m²; 52% African American). Baseline IAAT was 2104.1 ± 1201.3 cm³. IAAT, physical activity, BMI, and self-reported family income and resilience differed by ethnicity at baseline.

Conclusions

WISHFIT is a multi-component, multi-level intervention aimed at producing a sustained improvement in physical activity, diet, and psychological well-being early in the menopausal transition to slow menopause-related accumulation of IAAT. It provides a model for the process of developing a behavioral treatment to manage a chronic disease.

Incorporating husband influences into a model of physical activity among older women

BACKGROUND

Health behaviour models focus primarily on intrapersonal constructs (e.g., self-efficacy) which are good predictors of intention but less so of actual behaviour. Influences from the social environment, namely from close others, may improve prediction of engagement in ongoing behaviour.

OBJECTIVES

This study sought to broadly assess husband influence on physical activity and to determine whether a multidimensional assessment of husband influence would improve prediction of wives' physical activity.

DESIGN

A two-wave (separated by 4 months) observational study of married women was employed.

METHOD

Women (n = 160, Mage  = 63 years) reported intention, planning, and self-efficacy for physical activity as well as previous month physical activity through Wave 1 mailed surveys. In Wave 2 telephone interviews conducted 4 months later, women reported on their perception of husband influences and their own physical activity in the previous month.

RESULTS

Psychometric analyses supported five components of social support along with social control, injunctive norms, and descriptive norms as a broad assessment of husband social influence on physical activity. Husband influences significantly improved prediction of wives' physical activity, over and above intrapersonal predictors (ΔR(2)  = .09). Social control related negatively to behaviour; moderation analyses revealed a strong negative association when women's intentions were low.

CONCLUSIONS

This work highlights the interpersonal social context and post-intentional influences on daily health behaviour and offers guidance on the expansion of models of health behaviour as well as potential targets for intervention. Statement of contribution What is already known on this subject? Behavioural intentions are the best predictors of behaviour; however, much variability in actual behaviour remains to be explained. Romantic partners are frequent providers of health-related social support and social control. What does this study add? Provides multidimensional assessment of husband influence. Improves prediction of behaviour using husband influences. Demonstrates moderator of social control on behaviour.

Relationship between eating behaviors and physical activity of preschoolers and their peers: a systematic review

OBJECTIVES

Children learn by observing and imitating others, meaning that their eating behaviors and physical activity may be influenced by their peers. This paper systematically reviews how preschoolers' eating behaviors and physical activity relate to their peers' behaviors, and discusses avenues for future research.

METHODS

Six databases were searched for quantitative, peer-reviewed studies published up to July 2015 reporting on the correlates, predictors or effectiveness of peers on eating behaviors and physical activity in preschoolers. Risk of bias was independently assessed by two evaluators using the Quality Assessment Tool for Quantitative Studies.

RESULTS

Thirteen articles were included: six measured physical activity, and seven assessed eating behaviors. Four of the six physical activity studies reported that children were more active when peers were present, while large peer group size was negatively associated with physical activity in two cross-sectional studies. All nutrition interventions reported that children's eating behaviors may be influenced by their peers.

CONCLUSIONS

Although supported by weak evidence, peers appear to influence children's eating behaviors and physical activity. However, this influence may be moderated by the number of peers, gender, age and the perceived status of the role models. Future obesity prevention interventions should consider involving peers as agents for positive eating behaviors and physical activity in preschoolers.

A social network-based intervention stimulating peer influence on children's self-reported water consumption: A randomized control trial

The current pilot study examined the effectiveness of a social network-based intervention using peer influence on self-reported water consumption. A total of 210 children (52% girls; M age = 10.75 ± SD = 0.80) were randomly assigned to either the intervention (n = 106; 52% girls) or control condition (n = 104; 52% girls). In the intervention condition, the most influential children in each classroom were trained to promote water consumption among their peers for eight weeks. The schools in the control condition did not receive any intervention. Water consumption, sugar-sweetened beverage (SSB) consumption, and intentions to drink more water in the near future were assessed by self-report measures before and immediately after the intervention. A repeated measure MANCOVA showed a significant multivariate interaction effect between condition and time (V = 0.07, F(3, 204) = 5.18, p = 0.002, pη(2) = 0.07) on the dependent variables. Further examination revealed significant univariate interaction effects between condition and time on water (p = 0.021) and SSB consumption (p = 0.015) as well as water drinking intentions (p = 0.049). Posthoc analyses showed that children in the intervention condition reported a significant increase in their water consumption (p = 0.018) and a decrease in their SSB consumption (p < 0.001) over time, compared to the control condition (p-values > 0.05). The children who were exposed to the intervention did not report a change in their water drinking intentions over time (p = 0.576) whereas the nonexposed children decreased their intentions (p = 0.026). These findings show promise for a social network-based intervention using peer influence to positively alter consumption behaviors.

TRIAL REGISTRATION

This RCT was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12614001179628). Study procedures were approved by the Ethics Committee of the Faculty of Social Sciences at Radboud University (ECSW2014-1003-203).

The Importance of Exercise in the Well-Rounded Physician: Dialogue for the Inclusion of a Physical Fitness Program in Neurosurgery Resident Training

Exercise, diet, and personal fitness programs are essentially lacking in modern graduate medical education. In the context of long hours and alternating shift and sleep cycles, the lack of exercise and poor dietary choices may have negative consequences on physician physical and mental health. This opinion piece aims to generate important dialogue regarding the scope of the problem, the literature supporting the health benefits of exercise, potential solutions to enhancing diet and exercise among resident trainees, and possible pitfalls to the adoption of exercise programs within graduate medical education.

Depression, Social Isolation, and the Lived Experience of Dancing in Disadvantaged Adults

This qualitative study described the lived experience of dancing as it related to depression and social isolation in 16 disadvantaged adults who completed a 12-week dance intervention. It is the first qualitative study to explore the experience of dance as an adjunct therapy, depression, and social isolation. A descriptive phenomenological framework consisted of two focus groups using semi-structured interviews. A Giorgian approach guided thematic analysis. Four themes emerged: (1) dance for myself and health, (2) social acceptance, (3) connection with others: a group, and (4) not wanting to stop: unexpected benefits from dancing. As the participants continued to dance, they developed a sense of belonging and group identity, which may have maintained group involvement and contributed to reducing depression and social isolation. Thus, dancing is a complementary therapy that should be considered when working with adults with depression and social isolation.

Health implications of social networks for children living in public housing

This study sought to examine whether: (1) the health composition of the social networks of children living in subsidized housing within market rate developments (among higher-income neighbors) differs from the social network composition of children living in public housing developments (among lower-income neighbors); and (2) children's social network composition is associated with children's own health. We found no significant differences in the health characteristics of the social networks of children living in these different types of public housing. However, social network composition was significantly associated with several aspects of children's own health, suggesting the potential importance of social networks for the health of vulnerable populations.

Intergenerational Social Networks and Health Behaviors Among Children Living in Public Housing

OBJECTIVES

In a survey of families living in public housing, we investigated whether caretakers' social networks are linked with children's health status.

METHODS

In 2011, 209 children and their caretakers living in public housing in suburban Montgomery County, Maryland, were surveyed regarding their health and social networks. We used logistic regression models to examine the associations between the perceived health composition of caretaker social networks and corresponding child health characteristics (e.g., exercise, diet).

RESULTS

With each 10% increase in the proportion of the caretaker's social network that exercised regularly, the child's odds of exercising increased by 34% (adjusted odds ratio = 1.34; 95% confidence interval = 1.07, 1.69) after the caretaker's own exercise behavior and the composition of the child's peer network had been taken into account. Although children's overweight or obese status was associated with caretakers' social networks, the results were no longer significant after adjustment for caretakers' own weight status.

CONCLUSIONS

We found that caretaker social networks are independently associated with certain aspects of child health, suggesting the importance of the broader social environment for low-income children's health.

Race, Social and Environmental Conditions, and Health Behaviors in Men

Although understanding race differences in health behaviors among men is an important step in reducing disparities in leading causes of death in the United States, progress has been stifled when using national data because of the confounding of race, socioeconomic status, and residential segregation. The purpose of this study is to examine the nature of disparities in health behaviors among African American and white men in the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore, which was conducted in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. After adjusting for age, marital status, insurance, income, educational attainment, poor or fair health, and obesity status, African American men in National Health Interview Survey had greater odds of being physically inactive (odds ratio [OR] = 1.48; 95% confidence interval [CI], 129-1.69), reduced odds of being a current smoker (OR = 0.77; 95% CI, 0.65-0.90), and reduced odds of being a current drinker (OR = 0.58; 95% CI, 0.50-0.67). In the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore sample, African American and white men had similar odds of being physically inactive (OR = 0.79; 95% CI, 0.50-1.24), being a current smoker (OR = 0.86; 95% CI, 0.60-1.23), or being a current drinker (OR = 1.34; 95% CI, 0.81-2.21). Because race disparities in these health behaviors were ameliorated in the sample where African American and white men were living under similar social, environmental, and socioeconomic status conditions, these findings suggest that social environment may be an important determinant of health behaviors among African American and white men. Public health interventions and health promotion strategies should consider the social environment when seeking to better understand men's health disparities.

Implications for Social Support on Prolonged Sleep Difficulties among a Disaster-Affected Population: Second Report from a Cross-Sectional Survey in Ishinomaki, Japan

Study Objectives

This study aimed to investigate the role of social factors, especially social support for sleep, among victims living at home around 1–2 years after the Great East Japan Earthquake and tsunami.

Design

A cross-sectional household survey was conducted between May and December 2012 (14–21 months after the disaster) in the Ishinomaki area, Japan. Univariate and multivariate logistic regression models were used to examine the association between social factors, including social support, and prolonged sleep difficulties (persisting over 1 month). Social support was divided into three functions: emotional, informational, and instrumental support.

Participants

Data were obtained on 2,593 individuals who were living at home after the disaster.

Results

The prevalence of prolonged sleep difficulties was 6.9% (5.8% male, 7.7% female). This study showed that lack of social support has a stronger association with prolonged sleep difficulties than non-modifiable or hardly modifiable consequences caused directly by the disaster, i.e., severity of home damage, change in family structure and income. Among the three dimensions of social support, lack of emotional support showed the strongest association with prolonged sleep difficulties.

Conclusions

Social support, especially emotional support, may positively affect sleep among victims living at home around 1–2 years after a disaster.

Perceptions and the role of group exercise among New York City adults, 2010-2011: an examination of interpersonal factors and leisure-time physical activity

OBJECTIVE

To examine associations of descriptive norms (i.e., behaviors of social group members) and exercising 'with a partner' or 'as a part of a group' on weekly leisure-time physical activity.

METHODS

T-tests and adjusted multivariable linear models were used to test the associations between descriptive norms and exercising with a partner or as a part of a group with self-reported leisure-time physical activity using the cross-sectional, population-based New York City Physical Activity and Transit (PAT) Survey 2010-2011 (n=3806).

RESULTS

Overall, 70.6% of adult New Yorkers reported having physically active friends. Having active friends was associated with increased leisure-time physical activity; however, the effect varied by sex. Compared to those who did not have active friends, males with active friends reported two times more activity (56 min/week) and women reported two and a half times more activity (35 min/week) (both p-values<0.001). Physically active males and females who usually engaged in leisure-time activities as a part of a group reported 1.4 times more activity than those who exercised alone (both p-values<0.03).

CONCLUSIONS

Descriptive norms and group exercise were associated with leisure-time physical activity among adults. Based on these associations, encouraging group exercise may be an effective strategy for increasing leisure-time physical activity among certain subgroups.