Module 1

1. Social Connections Build Healthier Lives

During the last 30 years, researchers have shown great interest in the phenomena of social support, particularly in the context of health. Prior work has found that those with high quality or quantity of social networks have a decreased risk of mortality in comparison to those who have low quantity or quality of social relationships, even after statistically controlling for baseline health status. In fact, social isolation itself was identified as an independent major risk factor for all-cause mortality.

Being Socially Active May Foster Better Physical and Mental Health. Keeping a busy social calendar may help you stay not only busy -- but happy and healthy as well. A new study shows that social connections are as important to mental and physical health as other healthy behaviors, such as quitting smoking or exercising regularly.

Researchers found people who volunteer, go to church, or belong to a club are more likely to report better overall health than people who don't engage in regular social activities.

"Complete health may be achieved through ways other than, or in addition to, those focusing on individuals' patterns of exercise, eating, and smoking," says Joseph G. Grzywacz, PhD, of Wake Forest University School of Medicine, in a news release. "Social behaviors have been largely overlooked in health promotion practice, yet they may hold significant promise for enhancing individual and population health."

2. Social Activities Foster Good Health

In the study, published in the March/April issue of the American Journal of Health Behavior, researchers analyzed responses from more than 3,000 adults who participated in the National Survey of Midlife Development in 1995. The survey asked about their physical health, activities, and their emotional and mental health.

In their analysis, researchers defined "complete health" not as merely the absence of physical or mental disease but as enjoying a high level of physical and mental well-being.

About 19% of the participants were completely healthy and a similar number reported complete ill health.

The study showed, as expected, that behaviors such as quitting smoking and exercising regularly were frequently associated with complete health.

But they say the more interesting finding was that adopting healthy behaviors often wasn't enough to produce overall physical and mental health. Some people in the intermediate range exercised regularly but were also mentally unhealthy.

In addition, the prevalence of ill health was highest among those who rarely or never attended church and lowest among those that attended church regularly. Members of civic groups or those who volunteered regularly were also more likely to be completely healthy and less likely to report complete ill health than others.

Researchers say the results show that health promotion efforts should also target social behavior modifications as well as personal health choices in fostering better overall mental and physical health.

In one longitudinal study, social participation was shown to predict incidence of first-time acute myocardial infarction (MI same as having a Heart Attack, even after adjusting for demographic and health variables. In this study, those who had lower social involvement were 1.5 times more likely to have a first MI.

Other studies also found support for social integration’s protective effect on MI morbidity. These researchers found that those with moderate or low social integration were almost twice as likely to be readmitted to the hospital post-MI then those with high social integration. In fact, social integration showed a positive dose-response association that was equivalent to other known predictors of re-hospitalization.

Beyond cardiovascular disease, other studies have taken a less structural approach and focused on perceived and received support, particularly emotional support. One such population survey showed that for elderly women, low perceived emotional support predicted higher mortality.

One study found that feelings of social usefulness in the elderly predicted lower disability and mortality. Similarly, a study on church-based support showed that providing support, not receiving it, reduced the effects of one’s financial strain on mortality. These findings are consistent with a recent ambulatory study that showed giving support was related to lower systolic and diastolic blood pressure.

Interestingly, those who reported giving more support also reported getting more support. The authors postulate that giving and receiving support have unique pathways to stress: giving is mediated by increased efficacy, leading to lower stress, while receiving support has a direct effect on stress.

Taken together, studies such as these suggest that there is something potentially unique about giving support. It may be that people experience positive affect while helping others, which may improve their health, or it may suggest that it is in the context of a high-quality relationship in which one feels valued and can reciprocate by providing support that benefits occur. Future research will be needed to examine these intriguing findings in the recent literature.

Social support is also related to broader types of health behavior, including fruit and vegetable consumption, exercising, and smoking cessation.

One study contrasted partner support (aiding and reinforcing a partner’s own efforts) with partner control behaviors (inducing change in one’s partner). Results showed that supportive behaviors predicted better mental health, while control behaviors predicted worse mental health and health behavior in their partners. Consistent with social control models, these data suggest that effective support may need to act as a more gentle guiding force that will motivate behavioral change for the better.

As we learn more about the effectiveness of social support in affecting health outcomes, it becomes appealing to use this information to directly help clinical populations. This may explain why the largest proportion of recent research in social support and health involved interventions, with many focused on chronic disease populations such as cancer patients.

Support groups may be particularly useful because of the gaps they may fill in the support needs of patients. For instance, one qualitative study in cancer support groups identified the unique role of such groups to be sources of available community, information, and acceptance; in contrast to waning support from overburdened family and friends. Additionally, these are situations in which patients can offer support to others and patients report that belonging to these groups provided an element of support that augmented other-network support.

This type of intervention has also been shown to work in child patient populations. For instance, children with cystic fibrosis were involved in a randomized intervention trial that educated the children about their disease and taught them relevant social skills. Those in the treatment group improved their quality of life and peer relationships, and decreased their loneliness and the perceived impact of the disease. These findings are especially important due to the potential isolation faced by children in some chronic disease contexts. 

In another intervention. recent research is examining these issues by focusing on telephone and internet-based support interventions. Although no physical health outcomes were measured, one study found that an education and coping intervention over the phone for patients awaiting lung-transplant increased quality of life and lowered depression.

Additionally, using a randomized control design, other researchers studied a telephone support group and found it to reduce depression in older caregivers compared to no-intervention control group caregivers.

3. 8 Tips for Social Success

If your routine feels stale, you may feel the urge to shake up your social life with new activities or friends. There’s a good reason for this goal: Social activity and relationships are just as important for good health as not smoking or staying at a healthy weight.

Here several ways to step out of your comfort zone and onto the social scene:

• Reap the healthy rewards of belonging to a group or community. Studies have shown that people with strong social ties tend to have fewer stress-related health problems and a lower risk of mental illness, and they often recover faster from sickness or injury. Find a group that meets regularly to talk about things you’re interested in, like a book club, a walking group, or a service organization.

• Before you go to your first gathering, do your research. Find out about the event, location, neighborhood, or audience so you are ready to engage. Show up on time so you can meet people one-on-one rather than try to break into huddles that form later on.

• It’s tempting to drag your best friend along to a new group so you can avoid awkward small talk with others. But the best way to boost your confidence and expand your social circle is to talk to lots of new people a little at a time. It shows you are comfortable with different people, which, in turn, draws others.

• Contrary to popular belief, you don’t need to be brilliant, hilarious, worldly, or beautiful to succeed socially. Hold yourself to such standards and you’re sure to stay put. It’s enough to be nice, kind, and open. Most of us like to meet someone who is genuinely interested in us.

• Volunteering is a great way to be social. Find a cause that’s close to your heart and puts a smile on your face. You’ll meet people who share your passions and interests. Plus, your volunteer schedule may bring you together on a regular basis, so you’ll have a chance to get to know each other and grow your circle of friends.

• All those Facebook friends you have? Make a point to invite one per month to meet up with you or, if they are far away, have a phone call or video chat. Make your online friends less virtual and more real.

• If you plan to meet with new or old friends, make a firm date. Get it on the calendar so that it really happens (rather than, “Hey, we should get together sometime ...” which rarely happens). Name a place and time. Take all the detail guesswork out for everyone, so that it’s just about getting there, not arranging logistics.

• Ditch the drinks as you sharpen your social skills. Alcohol slows your brain down so you don’t think as fast or as clearly. Also, when you drink to be social, you may begin to think that’s the only way you can be fun and interesting.

4. The Loneliness Epidemic Has Very Real Consequences

You're busy: You work, you go to the gym, you manage your household. So you may feel you just don't have time to get together with your friends. But the truth is, you may not have time not to. People who are lonely are up to 32% more likely to die early than their more connected peers, research shows.

"Lack of social connection has a significant effect comparable to other leading indicators of risk for early death," says Julianne Holt-Lunstad, PhD, a professor of psychology at Brigham Young University. Feeling alone, she says, ranks up there with smoking, obesity, and physical inactivity in terms of its effects on your health.

Social isolation isn't just a problem for the elderly or homebound. In a survey of 20,000 Americans, nearly half reported always or sometimes feeling lonely or left out. Young adults ages 18 to 22 are the loneliest generation of all, the survey found.

"All of us fall somewhere on the loneliness continuum," says Holt-Lunstad, "so these risks apply to all of us."

As for why the socially connected may live longer, researchers have several theories. It could be as simple as having people around who encourage you to make healthy choices, such as keeping doctor's appointments, eating right, and taking medications. Or, chronic loneliness could be a recipe for chronic stress, which in turn wreaks havoc on your health. "Having close connections makes you feel safe," says Holt-Lunstad. "When you're alone, you are more reactive to the stresses in your environment, which can lead to problems such as high blood pressure or [heart] disease."

Some studies show that continual loneliness can lead to inflammation, which makes the body susceptible to numerous illnesses. It may also affect sleep quality, which is linked to a higher risk of a range of diseases as well.

No matter why loneliness is bad for your health, "You have to take it seriously," says Holt-Lunstad. "Just as you make time in your busy schedule to be physically active, you need to make time to be socially active."