Social networks, perceived social support, and HbA1c in individuals with type 2 diabetes mellitus in urban Ghana.

OBJECTIVES: Although links between social relationships and health are well established, few studies have concurrently examined the effects of compositional, structural, and functional dimensions of social networks on glycemic (HbA1c) control in low- and middle-income countries such as Ghana. In these settings where informal social relationships are critical for access to resources, evaluating the links between social network characteristics, social support, and glycemic control may provide clarity about important relationships that facilitate the well-being of individuals with type 2 diabetes mellitus (T2DM). DESIGN: In 2018, we conducted a hospital-based, cross-sectional survey of noninstitutionalized adults with T2DM in Ghana. Using data from 247 study participants, multivariable linear regression models were used to estimate associations between: 1) HbA1c and three social network characteristics (kin composition, household composition, and network density); 2) social support and the three social network characteristics; and 3) HbA1c and social support. We also examined gender differences in these associations and applied mediation techniques to determine if network characteristics operated through social support to affect HbA1c. RESULTS: Findings indicated that higher kin composition and higher household composition were each significantly associated with increased social support. Neither social support nor social network characteristics were significantly related to HbA1c, and there were no gender differences in any of these associations. CONCLUSION: Although family and household members were identified as important sources of social support for diabetes management, the ways in which they influence HbA1c control among Ghanaians require further investigation. Future studies can examine whether changes in social support over time, social support satisfaction, or other dimensions of social relationships improve T2DM outcomes in countries like Ghana.

"They Eat What They Eat, I Eat What I Eat": Examining the Perspectives and Experiences of African Americans Who Adopt Plant-Based Diets.

Adopting a plant-rich or plant-based diet is one of the major recommendations for addressing obesity, overweight, and related health conditions in the United States. Currently, research on African Americans' food choices in the context of plant-based diets is limited. The primary aim of this study was to understand food-related experiences and perceptions of African Americans who were participating in the Nutritious Eating with Soul (NEW Soul) study, a culturally tailored dietary intervention focused on increasing the consumption of plant-based foods. The roles of gender and ethnicity were also examined to identify how eating patterns were chosen or maintained. Twenty-one African American adults in South Carolina, who were randomly assigned to either a vegan diet (n = 11) or a low-fat omnivorous diet (n = 10) in the NEW Soul study, completed one-on-one, qualitative interviews. Emerging themes included awareness, being in control, and identity. The study revealed that access to social support and coping strategies for addressing negative comments about plant-based food choices may be important components to include in future nutrition interventions focused on African Americans.

Causal Relationships between Personal Networks and Health: A Comparison of Three Modeling Strategies.

Prior research documents associations between personal network characteristics and health, but establishing causation has been a long-standing research priority. To evaluate approaches to causal inference in egocentric network data, this article uses three waves from the University of California Berkeley Social Networks Study (N = 1,159) to investigate connections between nine network variables and two global health outcomes. We compare three modeling strategies: cross-sectional ordinary least squares regression, regression with lagged dependent variables (LDVs), and hybrid fixed and random effects models. Results suggest that cross-sectional and LDV models may overestimate the causal effects of networks on health because hybrid models show that network-health associations operate primarily between individuals, as opposed to network changes causing within-individual changes in health. These findings demonstrate uses of panel data that may advance scholarship on networks and health and suggest that causal effects of network support on health may be more limited than previously thought.

The Influence of Religious Participation and Use of Traditional Medicine on Type 2 Diabetes Control in Urban Ghana.

This study examined whether the frequency of participation in religious activities and seeking care from spiritual and other traditional medicine (TM) practitioners were associated with blood glucose (HbA1c) control among urban Ghanaians with type 2 diabetes mellitus (T2DM). Findings revealed that increased frequency of participation in religious activities was significantly associated with decreased HbA1c levels, whereas increased use of TM practitioners was significantly associated with increased HbA1c levels. These findings suggest that strategically integrating religious activities into disease management plans for Ghanaians with T2DM who identify as being religious may be a viable intervention mechanism.

Diabetes-Related Stigma and its Influence on Social Networks, Social Support, and HbA1c in Ghana.

Objective: We applied a social network approach to examine if three types of diabetes-related stigma (self-stigma, perceived stigma and enacted stigma) moderated associations between social network characteristics (network size, kin composition, household composition, and network density), social support, and blood glucose among Ghanaians with type 2 diabetes mellitus (T2DM). Methods: Data were obtained through a cross-sectional survey of 254 adults at a diabetes clinic in Ghana that assessed participants' social networks, social support, and frequency of experiencing three types of diabetes-related stigma. Results: Self-stigma moderated associations between kin composition and social support when controlling for network size ß=-.97, P=.004). Among study participants reporting low self-stigma, kin composition was positively associated with social support (ß=1.29, P<.0001), but this association was not found among those reporting high self-stigma. Network size was positively associated with social support among participants reporting both low and high self-stigma. None of the types of diabetes-related stigma moderated other associations between social networks, social support, and blood glucose. Conclusions: Individuals with T2DM who report high self-stigma may have lower social support, which can reduce their capacity for disease management. Additionally, larger social networks may be beneficial for individuals with T2DM in countries like Ghana, and interventions that expand network resources may facilitate diabetes control.

Older Adults and Social Support in a Disaster Context: Did Relocation Matter for Access to Social Network Resources After the 2015 South Carolina Flood?

OBJECTIVES: The aim of this study was to examine social network characteristics and social support (emotional and instrumental support) and to determine how those factors differed between relocating older adults and nonrelocating older adults who were affected by the 2015 flood in South Carolina. METHODS: Twenty-five community-dwelling elderly (CDE) were interviewed between December 2015 and May 2016 to learn about their experiences in the immediate aftermath of the flood. Ego-centric network data were collected with a focus on social network members and the types of flood-related support that these network members provided. RESULTS: Ten of 25 CDE relocated because of the flood. All CDE were more likely to receive social support from female network members and family members than from other acquaintances. Relocating CDE received significantly less emotional support in comparison to nonrelocating CDE. The odds of receiving instrumental support were higher, but nonsignificant, among relocating CDE in comparison to nonrelocating CDE. CONCLUSIONS: The findings around the support provision are concerning particularly because of the additional psychological burden that relocation can place on flood-affected, older adults. Recommendations for public health preparedness strategies are provided in addition to future research directions for examining the well-being of flood-affected, older adults.

Comparison of Cardiovascular Disease Risk Factors Among African Immigrants and African Americans: An Analysis of the 2010 to 2016 National Health Interview Surveys.

Background Racial/ethnic minorities, especially non-Hispanic blacks, in the United States are at higher risk of developing cardiovascular disease. However, less is known about the prevalence of cardiovascular disease risk factors among ethnic sub-populations of blacks such as African immigrants residing in the United States. This study's objective was to compare the prevalence of cardiovascular disease risk factors among African immigrants and African Americans in the United States. Methods and Results We performed a cross-sectional analysis of the 2010 to 2016 National Health Interview Surveys and included adults who were black and African-born (African immigrants) and black and US-born (African Americans). We compared the age-standardized prevalence of hypertension, diabetes mellitus, overweight/obesity, hypercholesterolemia, physical inactivity, and current smoking by sex between African immigrants and African Americans using the 2010 census data as the standard. We included 29 094 participants (1345 African immigrants and 27 749 African Americans). In comparison with African Americans, African immigrants were more likely to be younger, educated, and employed but were less likely to be insured (P<0.05). African immigrants, regardless of sex, had lower age-standardized hypertension (22% versus 32%), diabetes mellitus (7% versus 10%), overweight/obesity (61% versus 70%), high cholesterol (4% versus 5%), and current smoking (4% versus 19%) prevalence than African Americans. Conclusions The age-standardized prevalence of cardiovascular disease risk factors was generally lower in African immigrants than African Americans, although both populations are highly heterogeneous. Data on blacks in the United States. should be disaggregated by ethnicity and country of origin to inform public health strategies to reduce health disparities.