1. THE EFFECTS OF SOCIAL INTEGRATION ON SELF-RATED HEALTH AMONG OLDER ADULTS IN URBAN CHINA Iris Chi, D.S.W. Weiyu Mao, M.Phil., Ph.D. Candidate 2012 Joint World Conference on Social Work and Social Development July 11, 2012

2. 2 BACKGROUND Social integration has shown profound impact on physical health (Berkman, Glass, Brissette, & Seeman, 2000) Berkman et al. (2000) theorized the causal process from social integration to health and the model has been tested predominantly in western contexts (e.g., Stephens, Alpass, Towers, & Stevenson, 2011; Zunzunegui et al., 2004) Social- Structural Conditions Social- Structural Conditions Social Networks Social Networks Psychosocial Mechanisms Psychosocial Mechanisms Pathway Pathway Health Outcome Health Outcome

3. 2 LITERATURE GAPS Research on the relationship between social integration and health within the Chinese context is limited in terms of factors considered, sample representativeness, and examination of interrelationships among correlates (e.g., Cheng, Lee, Chan, Leung, & Lee, 2009; Gu, Feng, & Sautter, 2008; Wang, Chan, Ho, & Xiong, 2008) The findings from studies conducted in the Chinese context were inconsistent

4. SECTION TITLE | 2 AGING POPULATION IN CHINA 5 Figure 1 Population Aged 60 and Over: 1953 to 2050

5. 4 OBJECTIVES Guided by the social integration and health conceptual framework, we aim to: -Examine how social integration (social networks and community involvement ) influences self-rated health among older adults in urban China accounting for the social context -Understand the mediating role of depressive symptoms in the relationship between social integration and self- rated health

6. 6 CONCEPTUAL FRAMEWORK Social- Structural Conditions Social- Structural Conditions Social Networks Social Networks Psychosocial Mechanisms Psychosocial Mechanisms Pathway Pathway Gender Age Education Marital Status Economic Security Chronic Conditions ADLs IADLs Gender Age Education Marital Status Economic Security Chronic Conditions ADLs IADLs Family Network Friend Network Family Network Friend Network Community Involvement Community Involvement Depression Self- Rated Health Self- Rated Health Health Outcome Health Outcome

7. 6 METHODS Data: Nationally representative study “Sample Survey on Aged Population in Urban and Rural China in 2006”, collected by the China Research Center on Aging Sampling method: Probability proportional to size Sample: A subsample of adults aged 60 and older in urban China (N=8,018) Analysis: Structural equation modeling with latent variables using Mplus 5.1

8. 9 KEY MEASUREMENTS Self-rated health (DV) was assessed by a single question: “Now, how do you assess your current health status?” With a 5-point response set: 1= very bad, 2= bad, 3= so-so, 4= good, and 5= very good Depressive symptoms (IV) were measured with the Chinese version of Geriatric Depression Scale (GDS) A summated score with a range from 0 to 15 was used in the analysis

9. 10 SOCIAL INTEGRATION MEASUREMENTS Social networks were measured by 6-item Chinese version of Lubben Social Network Scale (Lubben et al., 2006) 3-item on family networks; 3-item on friend networks Scores for the family and friend subscales are an equally weighted sum of all three items, respectively, ranging from 0 to 15, Robust cut-off point is 6 Community involvement was a summated score for the engagement in multiple (20) community activities, ranging from 0-19

10. SAMPLE CHARACTERISTICS PercentageMean (SD)Range Male 49.84 Age 71.31 (6.87)60-103 Years in School 5.92 (4.84)0-25 Depressive Symptoms 4.81 (3.21)0-15 Self-rated Health 3.04 (0.84)1-5 Robust Family Network 68.20 Robust Friend Network 50.90 Community Involvement 4.42(3.11)0-19

11. 14 ESTIMATED MODEL WITH STANDARDIZED COEFFICIENTS FAMILY NETWORKS FRIEND NETWORKS COMMUNITY INVOLVEMENT DEPRESSIVE SYMPTOMS SELF- RATED HEALTH ITEM 1 ITEM 2 ITEM 3 ITEM 4 ITEM 5 ITEM 6 0.822 0.826 0.778 0.855 0.920 0.815 0.040 0.212 -0.097 -0.069 -0.063 -0.283 0.034 The model fit was acceptable (χ2 = 2352.09; df = 53; p =.000; CFI =.934; RMSEA =.074)

12. 15 RESULTS Both social networks and community involvement influence self-rated health among older adults in urban China accounting for the social structural conditions (direct effect) The effects of family network and friend network on self- rated health were fully mediated by depressive symptoms The effects of community involvement on self-rated health was partially mediated by depressive symptoms

13. 15 OTHER SIGNIFICANT FINDINGS Gender, years of education, marital status, functional capacities, chronic disease status, and depressive symptoms were also significantly associated with self- rated health among older adults in urban China

14. 17 CONCLUSIONS The model by Berkman et al. (2000) seemed to be beneficial in understanding the process from social integration to health status among older adults in urban China This study contributes to our knowledge base by examining the direct and indirect effects of social integration on self-rated health within the Chinese context

15. 17 IMPLICATIONS Protective effects of social integration on self-rated health among older adults in urban China were found Interventions should also focus on preventing and reducing depressive symptoms besides strengthening and expanding social connections among older adults in order to improve health outcomes

16. 16 LIMITATIONS Cross-sectional design, unable to establish causal relationships between variables or rule out reverse causations Self-rated health was measured by a single item on a 5- point scale and treating it as a continuous variable may be limited

17. 18