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Which gender is more social?

In general, women tend to have more close relationships than men, although men usually have larger social networks [46]. Therefore, the different types of social support and networks may operate in different ways and with different impacts on health between genders.

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Sample design and data collection

A cross-sectional study, the 1st Survey of Health Status and Life Conditions of the Elderly (1ª Pesquisa sobre Condições de Saúde e Vida de Idosos), was conducted in Rio de Janeiro during the Brazilian Health Care influenza vaccination campaign for older adults in 2006 [34]. This national program offers free immunisation for people aged 60 and above via public health clinics. In 2006, the campaign served approximately 77% of the Rio de Janeiro population in this age group. Data were collected at the vaccination locations during 5 days of the campaign between April and May 2006. A total of 4,003 participants aged 60 and above were recruited. Data obtained consisted of socioeconomic characteristics, level of functioning, health-related behaviours, use of health services, presence of somatic health problems, and SRH status. Inclusion was restricted to adult residents of Rio de Janeiro aged 60 and above who had participated in the 2006 influenza vaccination campaign and who were competent to answer the interview questions. The sample was recruited in two stages to ensure representativeness with respect to the 10 Administrative Areas of Health Planning of Rio de Janeiro; these were considered the primary units of selection (PUS). In the first stage, a systematic sample of 60 vaccination posts from 49 health care units was drawn without replacement, considering the population of the corresponding PUS. In the second stage, a systematic sample of older adults was selected from the people visiting each vaccination post and approached for interview. The number of individuals recruited across each post was proportional to the frequency of vaccination given in the previous year. Further details are available elsewhere [34]. Sixty-seven older adults were selected from each vaccination post; thus, 4,003 people were recruited. Interviews were conducted by 137 trained examiners and 37 supervisors. Examiners were college students attending health-related programmes who had received previous training for this study. Supervisors were staff members from the Department of Health of the Rio de Janeiro Council with previous experience in conducting health surveys.

Ethical approval

This study was approved by the Research Ethics Committee of the Department of Health of the Rio de Janeiro Council, no. 19-A and by the Research Ethics Committee of the National School of Public Health, Fiocruz (protocol no. 145/10 CAAE: 0152.0.031.000-10, 08/11/2010). All participants who agreed to participate signed an informed consent form.

Variables and covariates

A 70-item structured interview schedule questionnaire assessed participants’ perceived social support, social network, SRH, and other covariates. SRH was assessed using the question: ‘Compared to other people of your age, how do you consider your health?’ Responses were made on a 5-point scale. The available range of responses was very good; good, regular, poor, and very poor. Perceived social support focused on the structure of interpersonal relationships and the functional components of social support [11]. Structure of perceived social support refers to the existence of social relationships (e.g. marital status) and is most frequently measured in terms of the existence of or contact with potentially supportive persons [11]. This was assessed through the following question: ‘With whom do you live? (categories: a) alone/b) with partner or family)’. Functional social support refers to the degree to which interpersonal relationships serve particular functions. This is the perceived availability of instrumental social support from any formal or informal relationships [11]. The question assessing functional social support was ‘Are there any people you can count on or whom you can ask for help? (categories: a) Yes/b) No)’. Social networks are the ‘web’ of social relationships surrounding the individual, consisting of the groups of people the individual is in contact with along with their characteristics and the different forms of social participation he or she engages in [35]. The following two questions were used to assess the extent of social network: ‘How often did you receive visits or visit someone else? (categories: a) None in the last 30 days/b) Once a month/c) Once every 15 days/d) One to three times a week/e) Almost every day)’ and ‘Did you attend any group activities such as religious groups, community associations, clubs, or games with friends, relatives, or acquaintances in the last 30 days? (categories: a) Yes/b) No)’. The items evaluating perceived social support and social network were adapted from previous studies in Brazil [36, 37].

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The demographic and socioeconomic variables were age, gender, employment status (working/not working), and years of schooling (classified into four groups: no formal education/1–4 years/5–8 years/9 years or more). Income from pension or paid work was classified into four groups, where 1 represents the minimum wage (response options: 0.0–1.0/1.1–3.0/3.1–5.0/5.1 and above) [38]. Information about kinship between participants was not collected. However, since they were systematically drawn from different vaccination posts, they were assumed to be unrelated and not residents of the same household. Health-related behaviours referred to engaging in physical activity 5 or more times per week for at least 30 min (response options: Yes/No) [39] and smoking status (response options: current smoker/former smoker/non-smoker). Whilst universality, comprehensive care and equity are the core principles of the national health care system in Brazil (SUS), profound inequalities in access persist and elderly people with health insurance are more likely to receive care [40]. Use of health services was assessed whether the participant had health insurance (Yes/No) and type of health services used when receiving treatment (Public/Private). Participants’ functional status was assessed by their capacity to perform tasks in scales assessing basic and instrumental activities of daily living (ADL and IADL). ADL refers to ability to bathe, dress, use the toilet, transferring, continence, and eating. IADL gauges performance in unassisted meal preparation, housekeeping, laundering, medication management, and use of the telephone. Non-domestic activities considered in IADL are unassisted shopping for food, clothing, and medicine, and attending medical appointments and social and religious events without help. All the ADL and IADL items were scored for each activity the participant could perform independently [41]. Participants were categorized as independent (ADL and IADL = 0), partially dependent (ADL = 0 and IADL ≥ 1), and dependent (ADL ≥ 1). Somatic health problems (joint disease, such as arthritis, arthrosis, or rheumatism; depression; hypertension; and diabetes) were measured by the following question: ‘Have you ever been diagnosed with […] by a physician or health care professional?’ (Yes/No). Participants were categorised by the number of health problems reported (0, 1, 2–4, and ≥5).

Statistical analysis

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The outcome variable was dichotomised into ‘good SRH’ (very good and good) and ‘poor SRH’ (regular, poor, and very poor) [7]. SRH status, perceived social support, social network, and other covariates were compared against gender by using Pearson’s chi-square test. Proportions and 95% confidence intervals (95% CIs) of perceived social support, social network, and covariates were estimated for ‘good SRH’ and ‘poor SRH’ groups and stratified by gender. Comparisons of the independent variables between SRH groups were also conducted through Pearson’s chi-square test. All independent variables that had a p value below 0.20 in the bivariate analysis were selected for multivariate analysis. The variable ‘With whom do you live?’, used to measure perceived social support, was excluded in the multivariate analysis because of this criterion. Multivariate logistic regression using nested models tested the association of perceived social support and social networks with SRH while adjusting for covariates. The analysis was conducted separately for each gender. Odds ratios (ORs) and 95% CIs were estimated. Stepwise forward selection of variables in different blocks was performed according to the theoretical framework (Figure 1). This approach is recommended when testing the effect of a postulated risk factor on an outcome derived from a conceptual framework while describing the hierarchical relationships between risk factors [42]. Independent variables were organised into six blocks: (1) perceived social support and social network, (2) age group, (3) socioeconomic characteristics, (4) health-related behaviours, (5) use of health care services, (6) functional status measures and somatic health problems. The significance of additional variables was tested at each stage and non-significant variables (p > 0.05) were excluded to reduce discrepancy between the data and the model and to obtain an model with relatively few parameters [43]. Age group and education (years of schooling) were maintained in all models as important predictors of SRH. Variance inflation factor analysis did not indicate multicollinearity between perceived social support, size of social network, and covariates. Sample weights were used to adjust for sampling complexity. Weighted data were obtained by using a complex sample plan and were submitted to the complex samples analysis in SPSS version 17 for Windows (SPSS Inc., Chicago, IL).

bmcgeriatr.biomedcentral.com - Gender differences in the association of perceived social support and ...

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