Assessing how Age, Sex, Race, and Education Affect the Relationships Between Cognitive Domains and Odor Identification.

BACKGROUND: The associations between cognitive domains and odor identification are well established, but how sociodemographic variables affect these relationships is less clear. PURPOSE: Using the survey-adapted Montreal Cognitive Assessment instrument (MoCA-SA), we assess how age, sex, race, and education shape these relationships. METHODS: We first used cluster analysis and multidimensional scaling to empirically derive distinct cognitive domains from the MoCA-SA as it is unclear whether the MoCA-SA can be disaggregated into cognitive domains. We then used ordinal logistic regression to test whether these empirically derived cognitive domains were associated with odor identification and how sociodemographic variables modified these relationships. STUDY POPULATION: Nationally representative sample of community-dwelling US older adults. RESULTS: We identified 5 out of the 6 theoretical cognitive domains, with the language domain unable to be identified. Odor identification was associated with episodic memory, visuospatial ability, and executive function. Stratified analyses by sociodemographic variables reveal that the associations between some of the cognitive domains and odor identification varied by age, sex, or race, but not by education. CONCLUSIONS: These results suggest that (1) the MoCA-SA can be used to identify cognitive domains in survey research and (2) the performance of smell tests as a screener for cognitive decline may potentially be weaker in certain subpopulations.

Tracking Egocentric Social Network Change Across Three Rounds of National Survey Data.

BACKGROUND: The National Social Life, Health, and Aging Project (NSHAP) has collected 3 rounds of data on older adults' egocentric social networks. We describe the structure of network data collection for different components of the sample and the data that are available for those groups. We also describe survey techniques that were used to track specific personnel changes that occurred within respondents' networks during the 10-year study period. METHOD: Descriptive statistics are presented for measures of network size, composition, and internal structure at all 3 rounds, respondent-level summary measures of change in these characteristics between and across rounds, and measures of change associated with the loss and addition of network members across Rounds 1, 2, and 3. Procedures that were used to clean the network change data are also explained. RESULTS: The NSHAP network change module provides reliable information about specific changes that occurred within respondents' confidant networks. For returning baseline respondents, there is considerable overlap with respect to which confidants are named in successive rosters, but the norm is for Round 3 networks to be composed primarily of new confidants. DISCUSSION: These data provide new insights into the dynamic nature of networks in later life. Data limitations, and directions for future research, are discussed.

Homeostasis Revisited: Patterns of Stability and Rebalancing in Older Adults' Social Lives.

OBJECTIVES: To examine patterns of change in later-life social connectedness: (a) the extent and direction of changes in different aspects of social connectedness, including size, density, and composition of social networks, network turnover, and three types of community involvement and (b) the sequential nature of these changes over time. METHOD: We use three waves of nationally representative data from the National Social Life, Health, and Aging Project, collected from 2005/2006 to 2015/2016. Respondents were between the ages of 67 and 95 at follow-up. Types of changes in their social connectedness between the two successive 5-year periods are compared to discern over-time change patterns. RESULTS: Analyses reveal stability or growth in the sizes of most older adults' social networks, their access to non-kin ties, network expansiveness, as well as several forms of community involvement. Most older adults experienced turnover within their networks, but losses and additions usually offset each other, resulting in generally stable network size and structural features. Moreover, when older adults reported decreases (increases) in a given form of social connectedness during the first half of the study period, these changes were typically followed by countervailing increases (decreases) over the subsequent 5-year period. This general pattern holds for both network and community connectedness. DISCUSSION: There is an overwhelming tendency toward either maintaining or rebalancing previous structures and levels of both personal network connectedness and community involvement. This results in overall homeostasis. We close by discussing the need for a unifying theoretical framework that can explain these patterns.

Sexuality in Older Couples: Individual and Dyadic Characteristics.

Sexuality is a key component of health and functioning that changes with age. Although most sexual activity takes place with a partner, the majority of research on sexuality has focused on individuals. In this paper, we focused on the sexual dyad. We proposed and tested a conceptual model of the predictors of partnered sexual activity in older adulthood. This model began with the personality of each of the partners, which affects individuals' views of sex and characteristics of the partnership, which in turn affected sexual expression in the couple. We measured a key feature of personality, Positivity, which reflected the individual's tendency to present his or herself positively in social situations. This trait, we posited, increased frequency of sex through increased desire for sex, and the subjective importance of sex to each member of the couple. In this model, Positivity also impacted characteristics of the relationship that promoted dyadic sexual behavior. These processes differed for men and women in the model. We tested this model with data from the National Social Life, Health and Aging Project, which conducted personal interviews with both partners in 940 American dyads (average male age 72; average female age 69). We found that couples in which the husbands' (but not wives') were high in Positivity show higher levels of sexual activity, and that this association was partially mediated by dimensions of relationship quality, but more so by individual factors such as thinking about sex and believing sex is important.

Multiplex Competition, Collaboration, and Funding Networks Among Health and Social Organizations: Toward Organization-based HIV Interventions for Young Men Who Have Sex With Men.

BACKGROUND: Young men who have sex with men (YMSM) have the highest rates of human immunodeficiency virus (HIV) infection in the United States. Decades into the HIV epidemic, the relationships that YMSM-serving health and social organizations have with one another has not been studied in depth. OBJECTIVES: The aim of this study was to examine the competition, collaboration, and funding source structures of multiplex organization networks and the mechanisms that promote fruitful relationships among these organizations. RESEARCH DESIGN: The study data collection method was a survey of health and social organizations from 2013-2014 in 2 cities, Chicago, IL and Houston, TX. SUBJECTS: Study participants were representatives from 138 health and social organizations. MEASURES: Responses to survey questions were used to reconstruct competition, collaboration, and combined competition-collaboration networks. RESULTS: While taking into consideration the collaborative relationships among organizations, we provide statistical evidence that organizations of similar type, similar social media use patterns, comparable patterns of funding, and similar network contexts tended to compete with one another. This competition was less likely to be accompanied by any sort of collaboration if the organizations shared common funding sources. CONCLUSIONS: Competition that excludes potential collaboration may be detrimental to mobilizing the collective efforts that serve local YMSM communities. System-level interventions may provide promising approaches to scaling-up HIV prevention and treatment efforts so as to encourage organizations to form partnerships with otherwise competing providers.

Empirical redefinition of comprehensive health and well-being in the older adults of the United States.

The World Health Organization (WHO) defines health as a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Despite general acceptance of this comprehensive definition, there has been little rigorous scientific attempt to use it to measure and assess population health. Instead, the dominant model of health is a disease-centered Medical Model (MM), which actively ignores many relevant domains. In contrast to the MM, we approach this issue through a Comprehensive Model (CM) of health consistent with the WHO definition, giving statistically equal consideration to multiple health domains, including medical, physical, psychological, functional, and sensory measures. We apply a data-driven latent class analysis (LCA) to model 54 specific health variables from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of US community-dwelling older adults. We first apply the LCA to the MM, identifying five health classes differentiated primarily by having diabetes and hypertension. The CM identifies a broader range of six health classes, including two "emergent" classes completely obscured by the MM. We find that specific medical diagnoses (cancer and hypertension) and health behaviors (smoking) are far less important than mental health (loneliness), sensory function (hearing), mobility, and bone fractures in defining vulnerable health classes. Although the MM places two-thirds of the US population into "robust health" classes, the CM reveals that one-half belong to less healthy classes, independently associated with higher mortality. This reconceptualization has important implications for medical care delivery, preventive health practices, and resource allocation.

The health benefits of network growth: new evidence from a national survey of older adults.

Scholars who study how social networks affect older adults' health are often concerned with the prospect of declining social connectedness in late life. This paper shifts the focus to older adults' tendencies to cultivate new social ties. This process of network growth can improve access to social resources, boost self-esteem, reduce loneliness, and increase physical activity. We therefore examine the link between tie cultivation and health using new longitudinal data from the National Social Life, Health, and Aging Project (NSHAP), which recorded changes in older adults' confidant network rosters over a period of about five years. Most respondents (81.8%) added at least one new network member during the study period, and most (59.4%) cultivated multiple new confidant relationships. Longitudinal analyses suggest that the addition of new confidants is associated with improvements in functional, self-rated, and psychological health, net of baseline connectedness as well as any network losses that occurred during the same period. Network losses were associated with physical but not psychological well-being. These findings underscore the importance of distinguishing between concurrent processes that underlie social network change in later life, and highlight the need for additional research on the mechanisms by which network change may improve health.

A new HIV prevention network approach: sociometric peer change agent selection.

Internationally, the Peer Change Agent (PCA) model is the most frequently used conceptual framework for HIV prevention. Change agents themselves can be more important than the messages they convey. PCA selection is operationalized via heterogeneous methods based upon individual-level attributes. A sociometric position selection strategy, however, could increase peer influence potency and halt transmission at key network locations. In this study, we selected candidate PCAs based upon relative sociometric bridging and centrality scores and assessed their attributes in comparison to one another and to existing peer educators. We focused upon an emerging HIV epidemic among men who have sex with men in Southern India in 2011. PCAs selected based on their bridging score were more likely to be innovators when compared to other centrally-located PCAs, to PCAs located on the periphery, and to existing peer educators. We also found that sociodemographic attributes and risk behaviors were similar across all candidate PCAs, but risk behaviors of existing peer educators differed. Existing peer educators were more likely to engage in higher risk behavior such as receiving money for sex when compared to sociometrically selected peer changes agents. These existing peer educators were also more likely to exhibit leadership qualities within the overall network; they were, however, just as likely as other non-trained candidate peer change agents to report important HIV intravention behavior (encouraging condoms within their network). The importance of identifying bridges who may be able to diffuse innovation more effectively within high risk HIV networks is especially critical given recent efficacy data from novel HIV prevention interventions such as pre-exposure prophylaxis. Moreover, while existing peer educators were more likely to be leaders in our analysis, using peer educators with high risk behavior may have limited utility in enacting behavior change among sex worker peers or male clients in the network.

Personality measures in the National Social Life, Health, and Aging Project.

OBJECTIVES: Provide recommendations for researchers on the use of the Big Five personality battery in the National Social Life, Health, and Aging Project (NSHAP), and ensure that the battery does proxy the Big Five. Also, describe the levels of Big Five traits across gender and age. METHOD: We used an Exploratory Structural Equation Model (ESEM) to analyze NHSAP's personality battery, comparing NSHAP with the National Longitudinal Study of Midlife in the United States (MIDUS) and the Health and Retirement Study (HRS). RESULTS: ESEM revealed a 5-factor structure in the NSHAP battery, but with considerable cross-loadings. When these cross-loadings were not included in the model, model fit notably worsened. Reliabilities of Big Five scales were comparable to the HRS and MIDUS, even though NSHAP's battery is shorter. Women were considerably more Agreeable than men, although this gender gap closed among the oldest in the sample (80 years or older). DISCUSSION: Researchers will be able to make use of NSHAP's personality battery to examine a range of social, biological, and psychological factors at older ages, in light of individuals' general traits. We recommend models which allow for cross-loadings.

Assessment of social network change in a national longitudinal survey.

OBJECTIVES: This article describes new longitudinal data on older adults' egocentric social networks collected by the National Social Life, Health, and Aging Project (NSHAP). We describe a novel survey technique that was used to record specific personnel changes that occurred within respondents' networks during the 5-year study period, and we make recommendations regarding usage of the resulting data. METHOD: Descriptive statistics are presented for measures of network size, composition, and structure at both waves, respondent-level summary measures of change in these characteristics between waves, as well as measures that distinguish between changes associated with losses of Wave 1 network members, additions of new ones, and changes in relationships with network members who were present at both waves. RESULTS: The NSHAP network change module was successful in providing reliable information about specific changes that occurred within respondents' confidant networks. Most respondents lost at least one confidant from W1 and added at least one new confidant between waves as well. Network growth was more common than network shrinkage. Both lost and new ties were weaker than ties that persisted throughout the study period. DISCUSSION: These data provide new insight into the dynamic nature of networks in later life, revealing norms of network turnover, expansion, and weakening. Data limitations are discussed.

Social network properties and self-rated health in later life: comparisons from the Korean social life, health, and aging project and the national social life, health and aging project.

BACKGROUND: This paper has two objectives. Firstly, it provides an overview of the social network module, data collection procedures, and measurement of ego-centric and complete-network properties in the Korean Social Life, Health, and Aging Project (KSHAP). Secondly, it directly compares the KSHAP structure and results to the ego-centric network structure and results of the National Social Life, Health, and Aging Project (NSHAP), which conducted in-home interviews with 3,005 persons 57 to 85 years of age in the United States. METHODS: The structure of the complete social network of 814 KSHAP respondents living in Township K was measured and examined at two levels of networks. Ego-centric network properties include network size, composition, volume of contact with network members, density, and bridging potential. Complete-network properties are degree centrality, closeness centrality, betweenness centrality, and brokerage role. RESULTS: We found that KSHAP respondents with a smaller number of social network members were more likely to be older and tended to have poorer self-rated health. Compared to the NSHAP, the KSHAP respondents maintained a smaller network size with a greater network density among their members and lower bridging potential. Further analysis of the complete network properties of KSHAP respondents revealed that more brokerage roles inside the same neighborhood (Ri) were significantly associated with better self-rated health. Socially isolated respondents identified by network components had the worst self-rated health. CONCLUSIONS: The findings demonstrate the importance of social network analysis for the study of older adults' health status in Korea. The study also highlights the importance of complete-network data and its ability to reveal mechanisms beyond ego-centric network data.

A digital network approach to infer sex behavior in emerging HIV epidemics.

PURPOSE: Improve the ability to infer sex behaviors more accurately using network data. METHODS: A hybrid network analytic approach was utilized to integrate: (1) the plurality of reports from others tied to individual(s) of interest; and (2) structural features of the network generated from those ties. Network data was generated from digitally extracted cell-phone contact lists of a purposeful sample of 241 high-risk men in India. These data were integrated with interview responses to describe the corresponding individuals in the contact lists and the ties between them. HIV serostatus was collected for each respondent and served as an internal validation of the model's predictions of sex behavior. RESULTS: We found that network-based model predictions of sex behavior and self-reported sex behavior had limited correlation (54% agreement). Additionally, when respondent sex behaviors were re-classified to network model predictions from self-reported data, there was a 30.7% decrease in HIV seroprevalence among groups of men with lower risk behavior, which is consistent with HIV transmission biology. CONCLUSION: Combining the relative completeness and objectivity of digital network data with the substantive details of classical interview and HIV biomarker data permitted new analyses and insights into the accuracy of self-reported sex behavior.

Structural bridging network position is associated with HIV status in a younger Black men who have sex with men epidemic.

Younger Black men who have sex with men (BMSM) ages 16-29 have the highest rates of HIV in the United States. Despite increased attention to social and sexual networks as a framework for biomedical intervention, the role of measured network positions, such as bridging and their relationship to HIV risk has received limited attention. A network sample (N = 620) of BMSM respondents (N = 154) and their MSM and transgendered person network members (N = 466) was generated through respondent driven sampling of BMSM and elicitation of their personal networks. Bridging status of each network member was determined by a constraint measure and was used to assess the relationship between this bridging and unprotected anal intercourse (UAI), sex-drug use (SDU), group sex (GS) and HIV status within the network in South Chicago. Low, moderate and high bridging was observed in 411 (66.8 %), 81 (13.2 %) and 123 (20.0 %) of the network. In addition to age and having sex with men only, moderate and high levels of bridging were associated with HIV status (aOR 3.19; 95 % CI 1.58-6.45 and aOR 3.83; 95 % CI 1.23-11.95, respectively). Risk behaviors observed including UAS, GS, and SDU were not associated with HIV status, however, they clustered together in their associations with one another. Bridging network position but not risk behavior was associated with HIV status in this network sample of younger BMSM. Socio-structural features such as position within the network may be important when implementing effective HIV prevention interventions in younger BMSM populations.

Network mixing and network influences most linked to HIV infection and risk behavior in the HIV epidemic among black men who have sex with men.

OBJECTIVES: We evaluated network mixing and influences by network members upon Black men who have sex with men. METHODS: We conducted separate social and sexual network mixing analyses to determine the degree of mixing on risk behaviors (e.g., unprotected anal intercourse [UAI]). We used logistic regression to assess the association between a network "enabler" (would not disapprove of the respondent's behavior) and respondent behavior. RESULTS: Across the sample (n = 1187) network mixing on risk behaviors was more assortative (like with like) in the sexual network (r(sex), 0.37-0.54) than in the social network (r(social), 0.21-0.24). Minimal assortativity (heterogeneous mixing) among HIV-infected men on UAI was evident. Black men who have sex with men reporting a social network enabler were more likely to practice UAI (adjusted odds ratio = 4.06; 95% confidence interval = 1.64, 10.05) a finding not observed in the sexual network (adjusted odds ratio = 1.31; 95% confidence interval = 0.44, 3.91). CONCLUSIONS: Different mixing on risk behavior was evident with more disassortativity among social than sexual networks. Enabling effects of social network members may affect risky behavior. Attention to of high-risk populations' social networks is needed for effective and sustained HIV prevention.

Candidate change agent identification among men at risk for HIV infection.

Despite limited HIV prevention potency, peer-based programs have become one of the most often used HIV prevention approaches internationally. These programs demonstrate a need for greater specificity in peer change agent (PCA) recruitment and social network evaluation. In the present three-phase study based in India (2009-2010), we first explored the nature of friendship among truck-drivers, a group of men at high risk for HIV infection, in order to develop a thorough understanding of the social forces that contribute to and maintain their personal networks. This was accomplished in the first two study phases through a combination of focus group discussions (n = 5 groups), in-depth qualitative interviews (n = 20), and personal network analyses (n = 25) of truck-drivers to define friendship and deepen our understanding of friendship across geographic spaces. Measures collected in phases I and II included friend typologies, discussion topics, social network influences, advice-giving, and risk reduction. Outcomes were assessed through an iterative process of qualitative textual analysis and social network analysis. The networks of truck-drivers were found to comprise three typologies: close friends, parking lot friends, and other friends. From these data, we developed an algorithmic approach to the identification of a candidate PCA within a high-risk man's personal network. In phase III we piloted field-use of this approach to identify and recruit PCAs, and further evaluated their potential for intervention through preliminary analysis of the PCA's own personal networks. An instrument was developed to translate what social network theory and analysis has taught us about egocentric network dynamics into a real-world methodology for identifying intervention-appropriate peers within an individual's personal network. Our approach can be tailored to the specifications of any high-risk population, and may serve to enhance current peer-based HIV interventions.

HIV health center affiliation networks of black men who have sex with men: disentangling fragmented patterns of HIV prevention service utilization.

BACKGROUND: In the United States, black men who have sex with men (BMSM) are at highest risk for HIV infection and are at high risk for limited health service utilization. We describe HIV health center (HHC) affiliation network patterns and their potential determinants among urban BMSM. METHODS: The Men's Assessment of Social and Risk Network instrument was used to elicit HHC utilization, as reported by study respondents recruited through respondent-driven sampling. In 2010, 204 BMSM were systematically recruited from diverse venues in Chicago, IL. A 2-mode data set was constructed that included study participants and 9 diverse HHCs. Associations between individual-level characteristics and HHC utilization were analyzed using Multiple Regression Quadratic Assignment Procedure. Visualization analyses included computation of HHC centrality and faction membership. RESULTS: High utilization of HHCs (45.9%-70.3%) was evident among BMSM, 44.4% who were HIV infected. Multiple Regression Quadratic Assignment Procedure revealed that age, social network size, and HIV status were associated with HHC affiliation patterns (coeff., 0.13-0.27; all P < 0.05). With the exception of one HHC, HHCs offering HIV prevention services to HIV-infected participants occupied peripheral positions within the network of health centers. High-risk HIV-uninfected participants affiliated most with an HHC that offers only treatment services. CONCLUSIONS: Subcategories of BMSM in this sample affiliated with HHCs that may not provide appropriate HIV prevention services. Using 2-mode data, public health authorities may be better able to match prevention services to BMSM need; in particular, HIV prevention services for high-risk HIV-uninfected men and HIV "prevention for positives" services for HIV-infected men.

Classification of older adults who have diabetes by comorbid conditions, United States, 2005-2006.

INTRODUCTION: Older adults who have diabetes vary widely in terms of comorbid conditions; these conditions help determine the risks and benefits of intensive glycemic control. Not all people benefit from intensive glycemic control. The objective of this study was to classify by comorbid conditions older American adults who have diabetes to identify those who are less likely to benefit from intensive glycemic control. METHODS: We used latent class analysis to identify subgroups of a nationally representative sample of community-dwelling older adults (aged 57-85 y) who have diabetes (n = 750). The subgroups were classified according to 14 comorbid conditions prevalent in the older population. Using the Akaike Information Criterion, the Bayesian Information Criterion (BIC), the sample-size adjusted BIC, and the χ(2) goodness-of-fit statistic, we assessed model fit. RESULTS: We found 3 distinct subgroups. Class 1 (63% of the sample) had the lowest probabilities for most conditions. Class 2 (29% of the sample) had the highest probabilities of cancer, incontinence, and kidney disease. Class 3 (9% of the sample) had the highest probabilities (>90%) of congestive heart failure and myocardial infarction. Class 1 had only 0, 1, or 2 comorbid conditions, and both class 2 and class 3 had 6 or more comorbid conditions. The 5-year death rates for class 2 (17%) and class 3 (33%) were higher than the rate for class 1 (9%). CONCLUSION: Older adults who have diabetes, cardiovascular disease, and 6 or more comorbid conditions may represent a subgroup of older adults who are less likely to benefit from intensive glycemic control.

Network position and sexual dysfunction: implications of partner betweenness for men.

This article combines relational perspectives on gender identity with social network structural perspectives on health to understand men's sexual functioning. The authors argue that network positions that afford independence and control over social resources are consistent with traditional masculine roles and may therefore affect men's sexual performance. For example, when a heterosexual man's female partner has more frequent contact with his confidants than he does--which the authors refer to as partner betweenness--his relational autonomy, privacy, and control are constrained. Analyses of data from the National Social Life, Health, and Aging Project (NSHAP) show that about a quarter of men experience partner betweennessa and that these men are 92% more likely to report erectile dysfunction. Partner betweenness is strongest among the youngest men in the sample, which may reflect changing conceptions of masculinity in later life. The authors consider several explanations for these findings and urge additional research on the links between health, gender, and network structure.