The social environment is hypothesized to broadly influence health by facilitating the distribution of health-promoting resources (e.g., health knowledge; Berkman, Glass, Brissette, & Seeman, 2000). One important health-related resource, knowledge of acute myocardial infarction (MI) symptoms, is theoretically expected to be stratified by social relationships. Like the social environment, socioeconomic status is also associated with multiple health outcomes and is involved in the stratification of health resources (SES; Marmot et al., 1991; Pappas, Queen, Hadden, & Fisher, 1993; Berkman et al., 2000; Oakes & Rossi, 2003), and in turn markers of SES (i.e., income and education) are related to MI symptom knowledge (Dubard, Garrett, & Gizlice, 2006; Lutfiyya, Lipsky, Bales, Cha, & McGrath, 2008). The present study examined the relationship between MI symptom knowledge and functional and structural measures of the social environment in a large U.S. representative sample (N = 33,326). In addition, this study examined the relative contribution of social environment measures in the relationship between SES (income and education) and MI symptom knowledge. A functional measure was defined using a single item assessing perceived emotional support with answers ranging from never to always. Structural measures were obtained by summing responses to 7 items assessing number of frequent social contacts within past two weeks. MI symptom knowledge was defined by the summation of correct answers to 6 questions assessing knowledge of MI symptom categories and the appropriate emergency response. Continuous MI symptom knowledge scores ranged from 0 to 6 with higher values indicating higher knowledge. In the primary multivariate analysis, both dummy-coded social environment measures were associated higher MI symptom knowledge scores after controlling for sociodemographic, health status and SES covariates. Having emotional support usually and always was associated with a .27 and .22 (SE = .05, p < .001; SE = .05, p < .001) increase in MI symptom knowledge scores compared to those reporting never/rarely having emotional support respectively. Also, having 7 social contacts within the past two weeks was associated with a .47 (SE = .08, p < .001) increase in MI symptom knowledge scores compared to having 0/1 social contacts. Emotional support and social contacts explained 5% to 24% (SE = .01, p < .001; SE = .02 p < .001) and 9% to 19% (SE = .02, p < .001; SE = .03, p < .001) of the relationship between MI symptom knowledge and the two SES measures (education and income) respectively. By demonstrating a social environment stratification of a health resource, these findings demonstrate the broad health influence of social ties in a large nationally representative sample (Berkman et al., 2000; House, 2001).
|Commitee:||Huffman, Ann, Sydeman, Sumner|
|School:||Northern Arizona University|
|School Location:||United States -- Arizona|
|Source:||MAI 51/06M(E), Masters Abstracts International|
|Subjects:||Social psychology, Public health|
|Keywords:||Emotional support, Heart attack symptom knowledge, Myocardial infarction symptoms, Social contacts, Social relationships, Socioeconomic status|
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