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Social relationships and allostatic

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Social relationships and allostatic load in Taiwanese elderly and near elderlyIntroductionCross-cultural considerationsMethodsResultsDiscussionAcknowledgementsReferencesSocial Science & Medicine 59 (2004) 2245–2257Social relationships and allostatic load in Taiwanese elderlyand near elderlyTeresa Seemana,*, Dana Gleib, Noreen Goldmanc, Maxine Weinsteinb,Burt Singerc, Yu-Hsuan LindaDepartment of Medicine, Division of Geriatrics, University of California, Los Angeles, CA 90095-1687, USAbCenter for Population and Health, Graduate School of Arts and Sciences, Georgetown University, Washington, DC 20057, USAcOffice of Population Research, Princeton University, 243 Wallace Hall, Princeton, NJ 08540, USAdDepartment of Health, Bureau of Health Promotion, Population and Health Research Center, TaiwanAvailable online 24 May 2004AbstractDespite the increasing evidence linking aspects of the social environment to a range of health outcomes, importantquestions remain concerning the precise mechanisms or pathways through which social circumstances exert theirinfluence. Biological pathways are one important area of current research interest. Using data from the SocialEnvironment and Biomarkers of Aging Study (SEBAS) in Taiwan, we examined relationships between socialenvironment characteristics and an index of cumulative biological dysregulation (‘‘allostatic load,’’ AL) in near elderly(NE) (aged 54–70) and elderly Taiwanese (aged 71+). Longitudinal data on levels of social integration and extent ofsocial support were used to predict cumulative AL at the final survey year. Linear regression analyses revealed thatamong the NE, presence of a spouse between 1996 and 2000 was associated with lower AL in 2000 among men, but notwomen. Among the elderly, ties with close friends and/or neighbors were found to be significantly related to lower ALfor both men and women. Perceived qualities of these social relationships did not show consistent associations with AL.This relatively modest set of significant relationships stands in contrast to somewhat stronger patterns of findings fromstudies in Western societies. Cross-cultural differences between Western societies and an East Asian society such asTaiwan raise the intriguing possibility that contextual, normative influences on social experience affect the patterns ofassociation between features of these social worlds and the physiological substrates of health.r 2004 Elsevier Ltd. All rights reserved.Keywords: Allostatic load; Social relationships; Social support; TaiwanIntroductionThe question of whether and how social relationshipsmay influence health has been a topic of considerableresearch interest for some time. Recently, there has beengrowing interest in elucidating the actual pathwaysthrough which social relationships may affect morbidityand mortality. This article seeks to extend efforts tounderstand the biological pathways through which anyhealth effects must ultimately be transmitted.Although a growing body of research has begun todocument links between characteristics of the socialenvironment and biological substrates for health inboth animal and human populations, this research haslargely focused on specific, individual physiologicalparameters or systems (e.g., blood pressure, cortisol,lipids; Uchino, Cacioppo, & Kiecolt-Glaser, 1996;Seeman & McEwen, 1996). Such an approach, whileuseful in providing initial evidence linking social factorsto physiology, does not address the likelihood thatcognitive–emotional processing of social experienceARTICLE IN PRESS*Corresponding author. Tel.: +1-310-825-8253; fax: +1-310-794-2199.E-mail address: [email protected] (T. Seeman).0277-9536/$ - see front matter r 2004 Elsevier Ltd. All rights reserved.doi:10.1016/j.socscimed.2004.03.027likely involves simultaneous impacts on multiple biolo-gical regulatory systems.The concept of allostatic load (AL), first introducedby McEwen and Stellar (1993), proposes that a multi-systems view of physiological risk may be a more usefulheuristic in thinking about the impact of life experiences(including social factors) on health and well-being. Theconcept of AL reflects the idea that there is cumulativephysiological wear and tear exacted on the body’sregulatory systems through our efforts to adapt to life’sdemands. Such wear and tear (or AL) is postulated toresult from adaptive physiological responses that arechronically outside normal operating ranges. The rateand extent of accumulation of AL for an individual ishypothesized to result from both dynamic patterns ofregulatory systems’ responses to challenge as well astheir more general levels of operation outside optimalranges under non-challenge conditions. AL thus repre-sents the cumulative physiological toll of such dysregu-lations across multiple systems over time, reflecting botha multi-system and life-span orientation.Growing evidence provides support for the hypothe-sized role of AL as a pathway between life experiences(including experiences of social integration and support)and health outcomes. An initial operationalization of AL,based on information regarding the hypothalamic–pituitary–adrenal axis, sympathetic nervous system,cardiovascular system, and metabolic processes, wasshown to be positively related to risks for a range ofpathologies, including incident cardiovascular disease,declines in cognitive and physical functioning andmortality (Seeman, Singer, Horwitz, & McEwen, 1997;Seeman, Singer, Rowe, & McEwen, 2001). Differences inAL have also been shown to be related to aspects of socialenvironments. Longitudinal data from the Wisconsinlongitudinal study (WLS) have shown that childhoodexposure to a caring parent and adult exposure to asupportive partner are associated with lower AL in latemiddle-age (Singer & Ryff, 1999). The MacArthur Studyof Successful Aging has also documented a relationshipbetween lower AL and greater social integration andemotional support from others, as well as associationsbetween negative aspects of social experience (e.g.,demands/criticism from others) and greater AL (Seeman,Singer, Ryff, & Levy-Storms, 2002).Cross-cultural considerationsThe Social Environment and Biomarkers of AgingStudy (SEBAS)—a study of health outcomes in nearelderly (NL) (54–70) and elderly (71+) Taiwanese—offers an opportunity to investigate links between socialexperience and biological risk. Available measures ofboth social and biological factors are similar (though


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