Influence of Occupation on Health and Well-Being in Adults (Part I)
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For the last several weeks, my colleague and I have been spending all our working hours, plus some, on preparing the 30,00 plus records in OT SEARCH for conversion to a more powerful and sophisticated software. There has been no time for me to ponder a subject for a Resource Note during this interval; however, I do still need to respond to requests for literature searches. One that I enjoyed doing concerned the influence of occupational roles, social or physical activities, and role engagement on the health, well-being, and quality of life in older adults. I am going to share the results with you in two parts. This first is a group of references from MEDLINE/PubMed that I retrieved on July 21, 2003. The next Resource Note will be the list on this topic from OT SEARCH.

Adelmann P.K. (1994). Multiple roles and psychological well-being in a national sample of older adults. Journal of Gerontology, 49, S277-785.

Activity theory and the role enhancement hypothesis predict that multiple role involvement in late life is linked to greater psychological well-being, but the disengagement hypothesis and the role change hypothesis anticipate a negative association between these variables. In this study, the association between multiple roles and psychological well-being is tested among adults age 60 and over from a national sample. Three measures of well-being are regressed on background variables, number of roles (from among employee, spouse, parent, volunteer, homemaker, grandparent, caregiver, and student), and interaction terms. Multiple roles are associated with higher life satisfaction and self-efficacy and lower depressive symptoms. A significant interaction shows larger regression coefficients for roles among men than women on life satisfaction, and a three-way interaction indicates a stronger association of roles with self-efficacy for Black men than the other three gender-ethnicity combinations. Findings support the role enhancement hypothesis and the activity perspective among older adults.

Bassuk S.S., Glass T.A., & Berkman L.F. (1999). Social disengagement and incident cognitive decline in community-dwelling elderly persons. Annals of Internal Medicine, 131, 220-221

BACKGROUND: Social engagement, which is defined as the maintenance of many social connections and a high level of participation in social activities, has been thought to prevent cognitive decline in elderly persons. However, few longitudinal studies of this relation have been done. OBJECTIVE: To determine the relation between social disengagement and incident cognitive decline in community-dwelling elderly persons. DESIGN: Cohort study. SETTING: New Haven, Connecticut. PARTICIPANTS: 2812 noninstitutionalized elderly persons (65 years of age or older) who were interviewed in their homes in 1982, 1985, 1988, and 1994. MEASUREMENTS: A global social disengagement scale was constructed from the following indicators: presence of a spouse, monthly visual contact with three or more relatives or friends, yearly nonvisual contact with 10 or more relatives or friends, attendance at religious services, group membership, and regular social activities. Cognitive function was assessed with the Short Portable Mental Status Questionnaire. Response to the questionnaire was scored as high, medium, or low. Cognitive decline was defined as a transition to a lower category. RESULTS: Compared with persons who had five or six social ties, those who had no social ties were at increased risk for incident cognitive decline after adjustment for age, initial cognitive performance, sex, ethnicity, education, income, housing type, physical disability, cardiovascular profile, sensory impairment, symptoms of depression, smoking, alcohol use, and level of physical activity. The 3-year odds ratio was 2.24 (95% CI, 1.40 to 3.58; P < 0.001), the 6-year odds ratio was 1.91 (CI, 1.14 to 3.18; P = 0.01), and the 12-year odds ratio was 2.37 (CI, 1.07 to 4.88; P = 0.03). CONCLUSION: Social disengagement is a risk factor for cognitive impairment among elderly persons.

Cochran D.L, Brown D.R, & McGregor KC. (1999). Racial differences in the multiple social roles of older women: implications for depressive symptoms. Gerontologist, 39, 465-72.

The relationship between multiple role participation and depressive symptoms experienced by African American (n = 547) and White (n = 2,152) women aged 55-61 was explored. Data were obtained from the Health and Retirement Study (HRS). Racial differences in the social roles of marriage, employment, grandmother, care provider, and volunteer and their influence on level of depressive symptoms were examined. African Americans reported higher levels of depressive symptoms than Whites. Additionally, marriage, employment, and total number of social roles were the most powerful predictors of depressive symptoms for both African American and White women. However, employment was more important in diminishing depressive symptoms among African American than White women occupying multiple social roles.

Dighe M.S., Aparasu R.R., & Rappaport H.M. (1997). Factors predicting survival, changes in activity limitations, and disability in a geriatric post-stroke population. Gerontologist, 37, 483-9.

This study is based on data for individuals with a history of stroke taken from the NIA-sponsored Longitudinal Study of Aging (LSOA), 1984-1990. It provides information on the factors predicting survival and changes in disability and activity limitations in this cohort with stroke or cerebrovascular accident over the period of two years, 1984 to 1986. The results indicate that individuals who were less than 80 years old had higher chances of survival and were likely to show reduced activity limitations and disabilities. It was also observed that the individuals who were in excellent health were more likely to survive despite a history of stroke. Individuals with severe activity limitations had a very low incidence of survival over the two-year period. Further, the results of this study support the contention that the increased use of health cares resources in the form of visits to physicians, hospitals, and nursing homes results in improved survival and lower disability and activity limitations among the elderly.

Eklund M., Hansson L., & Bejerholm U. (2001). Relationships between satisfaction with occupational factors and health-related variables in schizophrenia outpatients. Social Psychiatry and Psychiatric Epidemiology, 36, 79-83.

BACKGROUND: The purpose of this study was to explore relationships between satisfaction with occupational factors, operationalized as occupational status and the total daily occupational situation, and health-related variables among people with schizophrenia. The health-related variables included quality of life, perceived control, sense of coherence, and psychopathology. Gender differences in these relationships were explored as well. METHODS: A sample of 74 individuals, aged 20-55 years, from outpatient psychiatric services were recruited to the study. A variety of interviews and self-rating scales were used in the data collection. RESULTS: When controlling for depressive symptoms, the results showed that satisfaction with employment status was of significance for health among patients with schizophrenia, but satisfaction with the total daily occupational situation seemed to be even more important to quality of life and other health-related aspects. In particular, satisfaction with daily occupations constituted an important dimension for self-rated quality of life. Some minor sex differences could be discerned in the pattern of associations. CONCLUSIONS: The strong association between satisfaction with daily occupations and self-rated quality of life adds a new dimension to the understanding of quality of life for this group of subjects, and suggests that helping to organise an individual's daily occupations ought to be a significant task in planning for psychiatric services.

Glass T.A., de Leon C.M., Marottoli R.A., & Berkman LF. (1999). Population based study of social and productive activities as predictors of survival among elderly Americans. British Medical Journal, 319, 478-83.
Comment in: BMJ. 2000 Jan 15; 320(7228, 184-5.

OBJECTIVES: To examine any association between social, productive, and physical activity and 13 year survival in older people. DESIGN: Prospective cohort study with annual mortality follow up. Activity and other measures were assessed by structured interviews at baseline in the participants' homes. Proportional hazards models were used to model survival from time of initial interview. SETTING: City of New Haven, Connecticut, United States. PARTICIPANTS: 2761 men and women from a random population sample of 2812 people aged 65 and older. MAIN OUTCOME MEASURE: Mortality from all causes during 13 years of follow up. RESULTS: All three types of activity were independently associated with survival after age, sex, race/ethnicity, marital status, income, body mass index, smoking, functional disability, and history of cancer, diabetes, stroke, and myocardial infarction were controlled for. CONCLUSIONS: Social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do. This suggests that in addition to increased cardiopulmonary fitness, activity may confer survival benefits through psychosocial pathways. Social and productive activities that require less physical exertion may complement exercise programmes and may constitute alternative interventions for frail elderly people.

Hong J. & Seltzer M.M. (1995). The psychological consequences of multiple roles: the nonnormative case. Journal of Health and Social Behavior, 36, 386-98.

Occupying multiple roles has been shown to be a major predictor of psychological well-being. We investigated the effects of multiple roles in the nonnormative case: a sample of aging mothers of adult children with mental retardation. These women have been in the role of caregiver for up to five decades, in addition to occupying the range of roles normatively held in adulthood and old age. We found, using longitudinal analyses, that holding multiple roles in significantly and negatively related to depression in this sample, as in the general population. The effect of multiple roles remains significant even after the previous level of depression is controlled. These results support the role accumulation hypothesis predicting positive consequences of multiple roles on psychological well-being, even in this sample of older women who have had lifelong caregiving responsibilities.

Horgas A.L., Wilms H.U., & Baltes M.M. (1998). Daily life in very old age: everyday activities as expression of successful living. Gerontologist, 38, 556-68.

The goals of this article are (a) to describe the daily life of the very old in terms of frequency, duration, variety, and social and physical contexts of activities, and (b) to examine the effects of background variables (e.g., age, sex, residential and marital status, income, and education) on late life activity engagement. A representative sample of 516 adults aged 70-105 was interviewed about their activities using the Yesterday Interview. In contrast to most research on activity engagement, this measurement approach allows for assessment of both the type and context of activities engaged in during the day preceding the interview. The results indicated high frequencies of obligatory activities but also showed substantial time spent in discretionary activities, with television viewing occupying most of the participants' leisure time. Most activities were done alone and at home. In bivariate and multiple regression analyses, age and residential status had the strongest association with activity frequency, duration, and variety; the oldest-old and those residing in long-term care facilities had lower levels of activity engagement. Results are discussed in terms of their relevance for successful aging.

House J.S., Robbins C., & Metzner H.L. (1982). The association of social relationships and activities with mortality: prospective evidence from the Tecumseh Community Health Study. American journal of Epidemiology, 116, 123-40.

The prospective association of social relationships and activities reported during a round of interviews and medical examinations in 1967-1969 with mortality over the succeeding nine to 12 years was examined for a cohort of 2754 adult (aged 35-69 years as of 1967-1969) men and women in the Tecumseh Community Health Study. After adjustments for age and a variety of risk factors for mortality, men reporting a higher levels of social relationships and activities in 1967-1969 were significantly less likely to die during the follow-up period. Trends for women were similar, but generally nonsignificant once age and other risk factors were controlled. These results were invariant across age, occupational, and health status groups. No association was observed between mortality and satisfaction with social relationships or activities. How and why social relationships and activities predict mortality are discussed and identified as important foci for future research.

Hoyt D.R., Kaiser M.A., Peters G.R., & Babchuk N. (1980). Life satisfaction and activity theory: a multidimensional approach. Journal of Gerontology, 35, 935-41.

Life satisfaction is examined utilizing a multidimensional approach. Hypotheses were proposed and tested for each of the dimensions of LSIA (Life Satisfaction Index A) within an activity theory perspective. The results provide qualified support for the theory. Some dimensions; however, show a better fit than others. Lack of a more general confirmation proved to be due to problems with activity theory and its attendant measures rather than with the multidimensional approach. The patterns of relationships found across the dimensions provide further support for using a multidimensional analysis when dealing with LSIA.

Lee C. & Powers J.R. (2002). Number of social roles, health, and well-being in three generations of Australian women. International Journal of Behavioral Medicine, 9, 195-215

The relation between multiple social roles and health is a particular issue for women, who continue to take major responsibility for childcare and domestic labor despite increasing levels of involvement in the paid workforce. This article analyzes Survey 1 data from the Australian Longitudinal Survey on Women's Health to explore relations between role occupancy and health, well-being, and health service use in three generations of Australian women. A total of 41,818 women in three age groups (young, 18-23; mid-age, 40-45; older, 70-75) responded to mailed surveys. Young and mid-age women were classified according to their occupancy of five roles--paid worker, partner, mother, student, and family caregiver--whereas older women were classified according to occupancy of partner and caregiver roles only. Common symptoms (headaches, tiredness, back pain, difficulty sleeping), diagnosis of chronic illness, and use of health services were compared across groups characterized by number of roles. Comparisons were also conducted on the physical and mental component scores of the SF-36 and perceived stress, with and without adjustment for confounders. Among young women, the best health was associated with occupancy of one role; among mid-age women, those with three or more roles were in the best health; and for older women, those with one role were in the best health. Young women with none or with four or more roles, and mid-age and older women with none of the defined social roles tended to be in the poorest health. Different patterns of results may be explained by differences in the extent to which women at different life stages feel committed to various social roles, and to the extent to which they are able to draw on social, material, and economic supports.

Lee D.J. & Markides K.S. (1990). Activity and mortality among aged persons over an eight-year period. Journal of Gerontology, 45, S39-42.

The influence of level of activity examined with data from an eight-year (1976 to 1984) longitudinal study of 508 older Mexican Americans and Anglos. Over the study interval, 119 subjects were confirmed to have died. Activity was a significant predictor of mortality at the univariate level. However, when age, gender, education, marital status, ethnicity, and self-rated health were controlled for in the analysis, activity was not a significant predictor of mortality. The popular notion that an active life among elderly persons might lead to extended longevity was not supported by these data.

Lennartsson C. & Silverstein M. (2001). Does engagement with life enhance survival of elderly people in Sweden? The role of social and leisure activities. The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences, 56, S335-342.

OBJECTIVES: This research examined whether engagement with life, defined as involvement in social, leisure, and productive activities, produced a survival advantage among oldest old persons in Sweden. Survival was investigated with respect to activities that involved (a) social integration, (b) physical mobility, and (c) neither social nor physical aspects. The authors also investigated the degree to which any observed survival benefits were related to prior health differences that select older adults into active roles. METHODS: Baseline data derived from the Swedish Panel Study of Living Conditions of the Oldest Old, a nationally representative sample of persons aged 77 years and older living in Sweden in 1992. The authors used factor analysis to apply a simplifying measurement structure to frequency of participation in 10 leisure activities. They used Cox proportional hazard regression to estimate the relative effects of activity factors and other independent variables on the logged hazard rate of mortality up to 1996. RESULTS: Analyses revealed 4 domains of activities that lie along 2 basic dimensions: solitary-social and sedentary-active. Among men, only participation in activities that were both solitary and active was significantly associated with reduced mortality risk when health variables were controlled. Among women, none of the activity domains was significant when health variables were controlled. For the entire sample, greater participation in solitary-active activities significantly reduced risk of mortality when all other activity domains and health factors were controlled. DISCUSSION: Although most of the observed associations between activity involvement and survival are a byproduct of the confound between poor initial health and low activity levels, solitary activities have a positive influence on the survival of very old individuals, especially men, suggesting that nonsocial aspects of activities may promote health and longevity in late old age.

Lomranz J., Bergman S., Eyal N., & Shmotkin D. (1988). Indoor and outdoor activities of aged women and men as related to depression and well-being. International Journal Aging & Human Development, 26(4), 303-14.

This article examines the relations between reported level of activity and measures of affect in old people exploring possible sex differences. It was hypothesized that these relations are mediated by the satisfaction from the specific activity. The sample consisted of fifty-four women and forty-five men, ranging in age from sixty to eighty, functioning normally in the community. A questionnaire assessed participants' levels of indoor/outdoor activities. Participants rated their satisfaction for each of these activities. Negative affect was measured by Zung's Self-Rating Depression Scale, and positive affect was measured by Bradburn's Well-Being (Affect-Balance) Scale. For male respondents, results showed significant negative correlations between depression and both activities, and significant positive correlations with respect to well-being. Significant positive correlation was obtained only between well-being and outdoor activity for female respondents. When satisfaction from the specific activity was controlled for, only two correlations remained significant in the male participants, lending partial support to the hypothesis. A multiple regression analysis revealed reported levels of activity could predict both depression and well-being for men much better than for women, whereas satisfaction from activity could do that much better for women than for men. Discussion deals with the sex differences regarding the meaning of activity in old age and its implications for affect. The differentiation between kinds of activity as well as measures of affect is also referenced.

McIntosh B.R. & Danigelis NL. (1995). Race, gender, and the relevance of productive activity for elders' affect. The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences, 50, S229-239.

The influences of both paid and unpaid productive activity outside the home on positive and negative affect among White and Black males and females were examined in this study. Data are from a weighted subsample of those 60 and over from Wave 1 (1986) of the Americans' Changing Lives Panel Study. Multivariate analyses confirm the basic thesis that race and gender are critical social contexts when considering the relationship between productive activity and positive and negative affect. Major findings are: (a) paid work has no direct influence on either positive or negative affect for any of the four race/gender subgroups; (b) formal religious participation decreases the negative affect of older Black women; (c) formal nonreligious participation increases the positive affect of White men and decreases the negative affect of Black men; (d) informal volunteering increases positive affect and decreases negative affect among older Black men and White women. Discussion focuses on the importance of role distinctions by race in explaining the various productive activity/affect associations.

Mendes de Leon C.F., Glass T.A., Beckett L.A., Seeman T.E., Evans D.A., & Berkman L.F. (1999). Social networks and disability transitions across eight intervals of yearly data in the New Haven EPESE. The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences, 54, S162-172.

OBJECTIVES: There is considerable evidence that social networks are strongly related to survival and other health outcomes. However, findings regarding the effect of social networks on disability outcomes have been inconsistent. This study examines this relationship with respect to the risk of developing disability and recovering from disability. METHODS: Data come from a community-based sample of the New Haven population aged 65 years and older, with nine annual interviews conducted between 1982 and 1991. Disability was measured by a 6-item index of activities of daily living (ADL), and a 3-item Rosow-Breslau index, with disability defined as impairment in one or more tasks on each measure. Social network variables were constructed for each of four domains of ties: children, relatives, friends, and a confidant, and a summary measure of total social networks. A Markov model was used to estimate one-year disability transitions averaged across all 8 intervals, after controlling for sociodemographic and health-related variables. RESULTS: Total social networks was associated with a significantly reduced risk of developing ADL disability (beta = -0.009, p < .01), and a significantly increased likelihood of ADL recovery (beta = 0.017, p < .01). Emotional and instrumental support did not affect the protective effect of social networks against disability, but partially accounted for their effect on enhanced recovery. Network variables related to relatives and friends were significantly associated with disability and recovery risks, but those related to children or a confidant were not. The associations with disability transitions as measured by the Rosow-Breslau index were generally smaller and nonsignificant. DISCUSSION: The findings lend further support for the role of social relationships in important health outcomes in old age. They suggest that being "embedded" in a social network of relatives and friends reduces risk for ADL disability, and enhances recovery from ADL disability.

Mendes de Leon C.F., Glass T.A., & Berkman L.F. (2003). Social engagement and disability in a community population of older adults: the New Haven EPESE. American Journal of Epidemiology, 157, 633-642.

This paper examines the effect of social engagement on disability among community-dwelling older adults in 1982-1991. Data were collected from the New Haven, Connecticut, site of the Established Populations for Epidemiologic Studies of the Elderly. Baseline social engagement was measured by using 11 items related to social and productive activity. Disability data consisted of a six-item measure of activities of daily living, a three-item measure of gross mobility, and a four-item measure of basic physical functions. Nine waves of yearly disability data were analyzed by using generalized estimating equations models. After adjustment for age, gender, race, and physical activity, significant cross-sectional associations (p's < 0.001) were found between social engagement and all three measures of disability, with more socially engaged older adults reporting less disability. Social engagement also showed small, but negative interaction effects with follow-up-time outcomes (p's < 0.01), indicating that the protective effect of social engagement decreased slightly during follow-up. Results suggest a strong, but not necessarily causal association of social engagement with disability. Promotion of social engagement may still be important for the prevention of disability.

Pushkar D., Arbuckle T., Conway M., Chaikelson J., & Maag U. (1997). Everyday activity parameters and competence in older adults. Psycholology and Aging, 12, 600-9.

Parameters of everyday activities in relation to cognitive, social, and emotional competence were examined in 2 studies. The parameters included frequency, difficulty, importance, intentions for future activities, changes in past activities, and ability of performance. The challenge hypothesis, in which performance of optional activities experienced as moderately difficult is associated with greatest well-being, was also tested. Two samples of older adults completed a life history interview and measures of psychological functioning. Parameters of activities necessary for maintaining an independent engaged lifestyle were measured by the Everyday Activities Questionnaire. In both studies, competence variables helped explain activity parameters independently of age and demographic variables. There was no support for the challenge hypothesis in either study.

Reid J. & Hardy M. (1999). Multiple roles and well-being among midlife women: testing role strain and role enhancement theories. The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences, 54, S329-38.

OBJECTIVE: Research on women's multiple roles frequently adopts one of two perspectives: role strain, which argues that assuming multiple roles is detrimental to mental well-being, or role enhancement, which argues that engaging in multiple roles enhances mental well-being. We argue that the relationship between role occupancy and well-being is manifested through multiple dimensions of role experiences. We investigate the association between depressive symptomatology and various dimensions of the roles of wife, mother, paid worker, and informal caregiver to aging parents. METHODS: Data are from the 1992 wave of the Health and Retirement Study. Depressive symptomatology, measured by a subset of the CES-D scale, is the dependent variable. To assess the robustness of findings relative to different functional forms of the dependent variable, we estimate multiple regression, log-linear regression, and multinomial logit models. Independent variables include demographic characteristics, measures of role occupancy, role demands, and role satisfaction. RESULTS: Although the number of roles women assume affects their reports of depressive symptoms, once the demand and satisfaction associated with these roles is controlled, number has no effect; that is, the effect of the number of roles is indirect. DISCUSSION: Our results highlight the importance of women's perceptions of the quality of their roles in relation to their overall well-being. Future investigations of women's multiple roles should examine how roles may provide rewards, impose constraints, or generate conflict, as well as the extent to which the willingness to assume multiple roles and the reported levels of role satisfaction and mental well-being may be jointly endogenous.

Rushing B., Ritter C., & Burton R.P. (1992). Race differences in the effects of multiple roles on health: longitudinal evidence from a national sample of older men. Journal of Health and Social Behavior, 33, 126-139.

This paper examines race differences in the effects of social roles on physical health. Using data from the older men cohort of the National Longitudinal Surveys of Labor Market Experience, we examine the impact of employment, marriage, and being a supporter on health limitations and mortality. Employment has the most consistent health-protective effect, and the benefits of employment are more pronounced for Blacks than for Whites. Marriage affects health in conjunction with employment. These findings lend further support to the growing literature on the effects of roles on health. The results further illustrate the importance of ascribed statuses as structural determinants of the relationship between roles and health, highlighting the very real differences in the meanings and expectations of social roles for Blacks and Whites.

Seeman T.E., Berkman L.F., Kohout F., Lacroix A., Glynn R., & Blazer D. (1993). Intercommunity variations in the association between social ties and mortality in the elderly. A comparative analysis of three communities. Annals of Epidemiolology, 3, 325-335.
Comment in: Annals of Epidemiology, 1993 Jul;3(4):448-50.

Identical measures of social ties obtained from three community-based cohorts aged 65 and over from East Boston, MA; New Haven, CT; and two rural counties in Iowa permit the first direct cross-community comparison of the hypothesis that social isolation increases 5-year mortality risks (1982 to 1987) for older men and women. In sex-specific proportional hazards analyses, social ties were significantly and inversely related to mortality independently of age in all three cohorts (e.g., relative hazard (RH) = 1.97 to 3.06 for men and women, comparing those with no ties to those with four types of ties). After controlling for age, pack-years of smoking, body mass, chronic conditions, angina, and physical and cognitive disability, social ties remain significant predictors of mortality risk for the men and women in New Haven (RH = 2.4 and 1.8) and for women in Iowa (RH = 1.9). For the men in Iowa (RH = 1.4) and the men and women in East Boston (RH = 1.0 and 1.3), the associations are weaker and nonsignificant.

Welin L., Larsson B., Svardsudd K., Tibblin B., & Tibblin G. (1992). Social network and activities in relation to mortality from cardiovascular diseases, cancer and other causes: a 12 year follow up of the study of men born in 1913 and 1923. Journal of Epidemiology and Community Health, 46, 127-132.

OBJECTIVE--The aim was to examine the relationship between social network and activities and causes of death. DESIGN--The study was a prospective cohort study of middle aged men examined in 1973 and followed for 12 years. SETTING--Gothenburg, Sweden. SUBJECTS--The subjects were 769 60 year old and 220 50 year old men who had participated in a health examination. MEASUREMENTS AND MAIN RESULTS--Main outcome measures were mortality from cardiovascular diseases, cancer and other causes. In multivariate analyses cardiovascular mortality was related to baseline blood pressure (p less than 0.001), smoking habits (p = 0.002), myocardial infarction or stroke (p less than 0.001), and a low level of social activities (p = 0.04). Cancer mortality was related to age (p = 0.003) and smoking habits (p = 0.001). Other causes of death were related to poor perceived health (p = 0.02) and a low level of home activities (p = 0.004). In univariate analyses the above risk factors were strongly related to all three causes of death. In addition cardiovascular mortality was related to age, a low level of home and outside home activities, few persons in the household, and poor perceived health. Cancer mortality was related to poor perceived health, few persons in the household, and a low level of social activities. Other causes of death were related to living alone, poor perceived health, and a low level of social and outside home activities. CONCLUSIONS--Well known risk factors for premature mortality like smoking, hypertension, and major cardiovascular disease are verified. Middle aged men with a good "social network" (here measured as a high level of social, home, and outside home activities) may be partly protected against non-cancer mortality.

Compiled by Mary Binderman, MSLS, American Occupational Therapy Foundation, Bethesda, MD.