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Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults?

To investigate associations between social anxiety and smoking behaviour in order to explore whether social anxiety predicts the first onset of cigarette smoking, regular smoking and the development of nicotine dependence. Baseline and four-year follow-up data from the Early Developmental Stages of Psychopathology Study (EDSP), a prospective-longitudinal community study of 3,021 adolescents and young adults, are used. Smoking behaviour and psychopathology were assessed with the M-CIDI and its DSM-IV algorithms. At baseline, 35.7% of the sample were regular smokers, and 18.7% fulfilled criteria for DSM-IV nicotine dependence. Twenty-seven point two percent reported at least one social fear, and 7.2% met criteria for DSM-IV social phobia, most of whom reported first onset of social fear problems clearly prior to smoking initiation. Cross-sectional retrospective baseline analyses based on retrospective reports revealed that social fears and DSM-IV social phobia were both significantly associated with higher rates of nicotine dependence. Prospective-longitudinal analyses that were conducted in an attempt to confirm cross-sectional retrospective results showed that baseline non-users with social fears (OR = 3.85) and baseline non-dependent users with social fears (OR = 1.5) had an increased risk of onset of nicotine dependence during the follow-up period of four years. These findings remained significant even when controlling for co-morbid depressive disorders. Social anxiety was found to be significantly associated with nicotine dependence in both cross-sectional retrospective and prospective-longitudinal analyses. It is suggested that social fears could lead to heavy tobacco use as smoking is a socially acceptable behaviour that relieves anxiety in social situations. Possible differential effects of social anxiety on the early stages of smoking behaviour compared to effects on nicotine dependence are discussed. These findings should stimulate a continued search into potentially causal links between social fear symptoms and the development of tobacco consumption and nicotine dependence in adolescence.

Adolescent↗

Toward socially inspired social neuroscience.

Social neuroscience, often viewed as studying the neural foundations of social cognition, has roots in multiple disciplines. This paper argues that it needs a firmer base in social psychology. First, we outline some major opportunities from social psychology--the power of social context and social motives in shaping human behavior. Second, as the social cognition field moves away from studying only deliberate, explicit processes to studying also automatic, implicit processes, adopting a dual-process perspective, social neuroscience also lends itself to both automatic and controlled processes. Finally, social neuroscience is especially suited to study the efficiency and spontaneity of social judgments. All this brings social behavioral grounding to cognitive neuroscience. Among the implications for social neuroscience: Social cognition intrinsically evokes affect, so social cognitive affective neuroscience glues together a variety of fields in psychological and neurosciences.

Cognition↗

Mental and social health in disasters: relating qualitative social science research and the Sphere standard.

Increasingly, social scientists interested in mental and social health conduct qualitative research to chronicle the experiences of and humanitarian responses to disaster We reviewed the qualitative social science research literature in relation to a significant policy document, the Sphere Handbook, which includes a minimum standard in disaster response addressing "mental and social aspects of health", involving 12 interventions indicators. The reviewed literature in general supports the relevance of the Sphere social health intervention indicators. However, social scientists' chronicles of the diversity and complexity of communities and responses to disaster illustrate that these social interventions cannot be assumed helpful in all settings and times. With respect to Sphere mental health intervention indicators, the research largely ignores the existence and well-being of persons with pre-existing, severe mental disorders in disasters, whose well-being is addressed by the relevant Sphere standard. Instead, many social scientists focus on and question the relevance of posttraumatic stress disorder-focused interventions, which are common after some disasters and which are not specifically covered by the Sphere standard. Overall, social scientists appear to call for a social response that more actively engages the political, social, and economic causes of suffering, and that recognizes the social complexities and flux that accompany disaster. By relating social science research to the Sphere standard for mental and social health, this review informs and illustrates the standard and identifies areas of needed research.

Altruism↗

Social mobility and the interpretation of social class mortality differentials.

The discussion of health inequalities in Britain (e.g. in the Black Report) has been conducted largely on the basis of social class mortality differentials measured by achieved social class and not by social class of origin. It is shown in this paper that social class mortality differentials by achieved social class are not invariant to the rate of social mobility and that the use of them is likely to result in a biased measure of trends in health inequalities when the absolute rate of social mobility varies over time. It is further shown that if, as is likely, health status is a factor systematically affecting the probability for an individual of upward or downward social mobility, then an increase in the rate of social mobility may well result in constant or widening social class mortality differentials by achieved social class even if the differentials are narrowing when measured by social class of origin. It is claimed that this process may well explain why the observed social class mortality differentials, which are measured by achieved social class, have not fallen in Britain during the post-1945 period.

Health Status Indicators↗

Coping, conflictual social interactions, social support, and mood among HIV-infected persons. HCSUS Consortium.

This study considers the interrelationships among coping, conflictual social interactions, and social support, as well as their combined associations with positive and negative mood. Research has shown that each of these variables affects adjustment to stressful circumstances. Few studies, however, examine this full set of variables simultaneously. One hundred forty HIV-infected persons completed a questionnaire containing measures of coping, social support, conflictual social interactions, and positive and negative mood. Factor analyses showed that perceived social support and conflictual social interactions formed separate factors and were not strongly related. Compared to perceived social support, social conflict was more strongly related to coping behaviors, especially to social isolation, anger, and wishful thinking. Conflictual social interactions were more strongly related to negative mood than was perceived social support. Coping by withdrawing socially was significantly related to less positive and greater negative mood. The findings point to the importance of simultaneously considering coping, supportive relationships, and conflictual relationships in studies of adjustment to chronic illness. In particular, a dynamic may occur in which conflictual social interactions and social isolation aggravate each other and result in escalating psychological distress.

Adaptation, Psychological↗

Sociality and social learning in two species of corvids: the pinyon jay (Gymnorhinus cyanocephalus) and the Clark's nutcracker (Nucifraga columbiana).

The hypothesis that social learning is an adaptive specialization for social living predicts that social species should learn better socially than they do individually, but that nonsocial species should not exhibit a similar enhancement of performance under social learning conditions. The authors compared individual and social learning abilities in 2 corvid species: the highly social pinyon jay (Gymnorhinus cyanocephalus) and the less social Clark's nutcracker (Nucifraga columbiana). The birds were tested on 2 different tasks under individual and social learning conditions. Half learned a motor task individually and a discrimination task socially; the other half learned the motor task socially and the discrimination task individually. Pinyon jays learned faster socially than they did individually, but nutcrackers performed equally well under both learning conditions. Results support the hypothesis that social learning is an adaptive specialization for social living in pinyon jays.

Analysis of Variance↗

The Relationship Among Range Adaptation, Social Anhedonia, and Social Functioning: A Combined Magnetic Resonance Spectroscopy and Resting-State fMRI Study.

BACKGROUND AND HYPOTHESIS: Social anhedonia is a core feature of schizotypy and correlates significantly with social functioning and range adaptation. Range adaptation refers to representing a stimulus value based on its relative position in the range of pre-experienced values. This study aimed to examine the resting-state neural correlates of range adaptation and its associations with social anhedonia and social functioning. STUDY DESIGN: In study 1, 60 participants completed resting-state magnetic resonance spectroscopy and fMRI scans. Range adaptation was assessed by a valid effort-based decision-making paradigm. Self-reported questionnaires was used to measure social anhedonia and social functioning. Study 2 utilized 26 pairs of participants with high (HSoA) and low levels of social anhedonia (LSoA) to examine the group difference in range adaptation's neural correlates and its relationship with social anhedonia and social functioning. An independent sample of 40 pairs of HSoA and LSoA was used to verify the findings. STUDY RESULTS: Study 1 showed that range adaptation correlated with excitation-inhibition balance (EIB) and ventral prefrontal cortex (vPFC) functional connectivity, which in turn correlating positively with social functioning. Range adaptation was specifically determined by the EIB via mediation of ventral-medial prefrontal cortex functional connectivities. Study 2 found HSoA and LSoA participants exhibiting comparable EIB and vPFC connectivities. However, EIB and vPFC connectivities were negatively correlated with social anhedonia and social functioning in HSoA participants. CONCLUSIONS: EIB and vPFC functional connectivity is putative neural correlates for range adaptation. Such neural correlates are associated with social anhedonia and social functioning.

Humans↗

Social skills and the stress-protective role of social support.

Cross-sectional analyses of data collected from a large sample of incoming college freshmen were used to determine whether the perceived availability of social support protects persons from stress-induced depressive affect; whether social competence, social anxiety, and self-disclosure are responsible for the stress-protective effect of perceived social support; and whether these social skill measures discriminate among persons for whom support will help, hinder, or be ineffective in the face of stress. Prospective analyses based on the original testing (beginning of school year) and 11- and 22-week follow-ups of a randomly selected subsample were used to determine how the same social skill factors influence the development and maintenance of support perceptions and of friendships. Evidence is provided for a stress-buffering role of the perceived availability of social support. The stress-buffering effect is unaffected by controls for the possible stress-protective influences of social anxiety, social competence, and self-disclosure. Although these social skill factors do not discriminate among persons for whom support will help, hinder, or be ineffective, they are prospectively predictive of the development of both social support and friendship formation. These prospective relations between social skills and the development of perceived availability of social support are only partly mediated by number of friends.

Adolescent↗

[Human social activity under conditions of relative social isolation].

The differences in using a "social isolation" concept in the psychological literature are presented. The term of "relative social isolation" is clarified. A relationship between human adaptation to the relative social isolation environments and the development of his social qualities and social activities is presented. The "social context", dictating motivation attitudes of a man to the isolation situation, emotional experiences, self-appraisal of activity is of crucial importance for evaluating the real environments of relative social isolations. Social activity of a personality is studied as the relations of a man with the conditions of his activity. The results of studying the dynamics of the psychic state of a man during individual and group isolation are compared. It is concluded that social activity of man and his functional state are interrelated. The particular manifestations and direction of the changes in the social activity of the subject depend on the duration of isolation and are determined first of all by social significance and meaningful and balanced work for a person as well as by the amount and frequency of direct and mediated social contacts under specific conditions of relative social isolation.

Humans↗

Social ties and health: the benefits of social integration.

This article explores the relationship between level of social integration and various aspects of health. A search of the literature published since the mid-1970s (under the MEDLINE key words, "social ties," "social network," "social isolation," "social environment") presented strong evidence that social integration leads to reduced mortality risks, and to a better state of mental health. The evidence on physical health outcomes is less conclusive. There is no consistent evidence that social integration affects the incidence of disease (at least for cardiovascular outcomes). However, social integration does appear to have a highly beneficial effect on post-myocardial infarction prognosis (functioning and longevity). A physiologic basis for these effects on health outcomes is also indicated by research demonstrating that both social isolation and nonsupportive social interactions can result in lower immune function and higher neuroendocrine and cardiovascular activity while socially supportive interactions have the opposite effects. In conclusion, available data suggest that, although social integration is generally associated with better health outcomes, the quality of existing ties also appears to influence the extent of such health benefits. Clearly, individuals' networks of social relationships represent dynamic and complex social systems that affect health outcomes.

Health Status↗

Social sensitivity and acne: the role of personality in negative social consequences and quality of life.

BACKGROUND: Acne affects a majority of adolescents and a substantial number of adults. The adverse social impact of acne is well documented. Negative social consequences, however, are likely to be determined by personality features as well as acne severity. PURPOSE: To determine whether a personality trait--dispositional social sensitivity--is associated with the adverse social impact of acne. METHODS: A survey of 479 acne sufferers between the ages of 16 and 62 was conducted in the Piedmont region of North Carolina, United States. Respondents were classified as either high or low social sensitivity and compared on demographic, disease characteristics, and quality of life. Main and interaction effects were evaluated for acne severity and social sensitivity in relation to global and intimate social concerns and social interference. RESULTS: Greater acne severity was significantly associated with poorer social outcomes and quality of life (ps < 0.05). For women, higher social sensitivity was independently associated with poorer outcomes (ps < 0.05), while for men, higher social sensitivity interacted with acne severity and was associated with worse social outcomes and life quality (ps < 0.05). CONCLUSIONS: Acne is a biopsychosocial skin condition. Dispositional social sensitivity is an independent psychological factor associated with poorer social functioning and quality of life. Treatment of the acne patient should consider psychosocial factors as well as biological factors.

Acne Vulgaris↗

Social context, social abstention, and problem recognition correlated with adult female urinary incontinence.

STUDY OBJECTIVE: The aim was to describe types of social contexts and abstention from social activity in women reporting urinary incontinence (UI); to identify social contexts and social abstention specifically associated with clinical UI subtypes; to relate clinical type of UI, social context and social abstention to individual problem perception. DESIGN AND SETTING: A self-administered postal questionnaire was sent to a random population sample comprising 3,114 women aged 30-59 in the Municipality of Aarhus, Denmark. RESPONDERS: A total of 2,631 women (84.5%) responded with a slight decrease in response rate by age. The present study group consists of 511 women (19.4% of the responders) who reported period prevalent UI for at least one of the years 1985-1987. MEASUREMENTS AND MAIN RESULTS: Eighty-six percent of the study group members reported stress UI and 50% urge UI, so that 42% had both (mixed stress and urge UI) and 6% none of them (unspecific UI). Forty-six percent indicated the workplace and 66% the home as principal sites of UI occurrence. Thirty-one percent had experienced UI in specific situations such as during anxiety, sexual intercourse, or sleep. Nineteen percent had abstained from social activities, 17% from non-intimate social activity and 6% from sexual intercourse. Fourteen percent perceived UI as a social problem and 60% as a hygienic problem. Indicators of stress UI were associated with UI occurring at the work-place and during sexual intercourse which, in turn, both were correlates of abstention from non-intimate social activity. Urge UI was associated with episodes of UI occurring at home and in specific situations such as during anxiety and sleep. The experience of UI during sexual intercourse was related to all types of abstention. The perception of UI as a social or hygienic problem depended on the duration since first UI episode as well as social context and abstention. CONCLUSIONS: The everyday life consequences of UI are widespread and may cause serious relational problems for the individual. Stress UI manifests itself as a somatic condition leading to abstention from sport and other non-intimate social activities. Urge UI and the role of the experience of UI during sexual intercourse should be further investigated also from psycho-somatic and psycho-social coping points of view.

Absenteeism↗

[Social inequities of health in Spain. Report of the Scientific Commission for the Study of Social Inequities in Health in Spain].

In 1993 the Ministry of Health of the Spanish Government appointed a Scientific Commission to analyze social inequalities in health in Spain, as well as to make recommendations for improving Spanish health, through the practical implementation of public policies to reduce existing inequalities. The present report is the result of the work carried out by the said Commission. It has the following aims: first, to present a general introduction to the topic of social inequalities in health; second, to offer a global vision of the topic in Spain based upon the editing of available information: finally, to encourage the need for an in-depth analysis of the study and the reduction in social inequalities in health in the scientific and social fields, offering illustrative examples. The first chapter points out the importance of the topic, and Spain is located in the international historical and geographical context. The second chapter presents the most important concepts regarding the definition and measurement of health and inequality. The third and fourth chapters review various international and national studies of particular importance, and the Spanish case includes the current limitations to research. The fifth chapter presents two original investigations on the four perspectives of social inequalities in health in Spain: death rate, noticeable health, conducts related to health and the use and access to health services. Chapter six comments on some examples of policies aimed at reducing inequalities in health. Finally, the seventh chapter summarises the main conclusions of the report and makes some recommendations both for the improvement of current information systems as well as for obtaining the main conclusions for the health policies. Amongst the report's main conclusions the following may be pointed out: 1) an ecological study on the social inequalities in the death rate of small areas between 1990-1992 has revealed the existence of inequalities at a small area level. Autonomous Communities and regions. Inequality is confirmed between North-Northwestern Spain (with a high level) and South-Southwestern Spain (with a low level). Likewise, a positive relationship may be observed between various social indicators and the death rate; 2) the analysis of health surveys for 1987 and 1993 according to social class has revealed the existence of inequalities in health. Thus, in most of the health variables studied regarding the state of health-the conducts related to health or health services-the most disadvantaged social classes present greater health problems; 3) the political social and health experiences carried out in the Basque Country and Barcelona respectively, aimed at improving living standards, social welfare and the health of the most vulnerable sectors of the population have been positive and should be expanded and studied in depth; 4) the study and decrease of social inequalities in health by putting into practice social and health public policies should be a main objective of all political and social forces.

Health Status↗

The relationship of two dimensions of social support to the psychological well-being and social functioning of women with advanced breast cancer.

Of interest to the field is the mechanism through which social support acts as a resistance resource for individuals undergoing stressful life circumstances. Women with advanced breast cancer (N = 86) were interviewed to determine how their outlook on life and social functioning were affected by the social support they received. Emotional support provided by the family was predicted to affect the woman's sense of well-being whereas the opportunities for social exchange provided by one's social activities were expected to effect the woman's social functioning. Consistent with the predictions, the data indicate that social support is multidimensional. Emotional support was strongly related to one's outlook. However, one's opportunities for social exchange affect not only one's social functioning, but also one's outlook on life, suggesting an interactive process whereby family support improves outlook, both outlook and opportunities for social exchange are related to one's sense of social functioning. These data explain the erosion of social support during life-threatening illness such as cancer as a result of the limitations imposed by the illness on one's opportunities for social exchange.

Activities of Daily Living↗

Social network and social support influence mortality in elderly men. The prospective population study of "Men born in 1914," Malmö, Sweden.

The objective of this study was to determine whether there is an association of all-cause mortality with different aspects of social network, social support, and social influence. The study sample (n = 621) was a random half of all male residents of Malmö, Sweden, born in 1914, of whom 500 (80.5%) were interviewed and examined in 1982-1983. On the basis of a model with carefully defined and well-differentiated concepts integrated in a theoretic framework of social resources, an instrument was developed to measure different aspects of social network, social support, and social influence. During the follow-up period from September 1982 to November 1987, 67 (13.4%) of the 500 participants died. In univariate analysis, a higher mortality risk was found among men with low availability of emotional support and low adequacy of social participation and among men living alone (crude relative risk = 2.3, 2.3, and 1.7, respectively). These relative mortality risks changed little after adjustments for social class, health status at baseline, cardiovascular risk factors, alcohol intake, physical activity, and body mass index in the multivariate analysis (adjusted relative mortality risk = 2.5, 2.2, and 2.0 for men with low availability of social support and low adequacy of social participation and for men living alone, respectively). These findings are consistent with the existence of a general effect of social network and social support on mortality among elderly men.

Affective Symptoms↗

Perception of control over anxiety mediates the relation between catastrophic thinking and social anxiety in social phobia.

Cognitive models of social phobia (social anxiety disorder) assume that individuals with social phobia experience anxiety in social situations in part because they overestimate the social cost associated with a potentially negative outcome of a social interaction. Some emotion theorists, on the other hand, point to the perception of control over anxiety-related symptoms as a determinant of social anxiety. In order to examine the relationship between perceived emotional control (PEC), estimated social cost (ESC), and subjective anxiety, we compared three alternative structural equation models: Model 1 assumes that PEC and ESC independently predict social anxiety; Model 2 assumes that ESC partially mediates the relationship between PEC and anxiety, and Model 3 assumes that PEC partially mediates the relationship between ESC and anxiety. We recruited 144 participants with social phobia and administered self-report measures of estimated social cost, perceived anxiety control, and social anxiety. The results support Model 3 and suggest that "costly" social situations are anxiety provoking in part because social phobic individuals perceive their anxiety symptoms as being out of control.

Adolescent↗

Effects of varying levels of anxiety within social situations: relationship to memory perspective and attributions in social phobia.

Cognitive-behavioral theorists (Clark & Wells, 1995: Clark, D. M. & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford Press; Rapee & Heimberg, 1997: Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756.) propose that individuals with social phobia form mental images of themselves as if from an external point of view. Research by Wells and colleagues has shown that, when recalling anxiety-provoking social situations, individuals with social phobia are more likely to take an observer perspective (seeing oneself as if from an external point of view) whereas control subjects are more likely to take a field perspective (as if looking out through one's own eyes). Furthermore, this pattern is specific to social events, as both groups recall non-social events from a field perspective (see Wells, Clark & Ahmad, 1998: Wells, A., Clark, D. M., & Ahmad, S. (1998). How do I look with my minds eye: perspective taking in social phobic imagery. Behaviour Research and Therapy, 36, 631-634; Wells & Papageorigou, 1999: Wells, A. & Papageorgiou, C. (1999). The observer perspective: Biased imagery in social phobia, agoraphobia, and blood/injury phobia. Behaviour Research and Therapy, 37, 653-658). In the current study, individuals with social phobia took more of an observer perspective than non-anxious controls when recalling high anxiety social situations. However, both groups took a predominantly field perspective for memories of medium or low anxiety social situations. As memory perspective has also been shown to be related to causal attributions, we examined this relationship in our sample. Memories of low, medium, and high anxiety social situations were differentially related to attributions for each group. Patients' attributions for their performance became more internal, stable, and global as the anxiety level of the situation increased, while the attributions of control subjects showed the opposite pattern.

Adult↗

The causal role of self-awareness in blushing-anxious, socially-anxious and social phobics individuals.

This study examined the effect of attentional focus on social anxiety in three groups of subjects: high versus low blushing-anxious participants (n=48); high versus low socially anxious participants (n=60); and social phobic patients compared to patients with other anxiety disorders (n=48). Participants were asked to imagine two series of social situations, in which the hero was in the centre of others' attention. In the first series of stories, the type of feedback from the audience (positive, negative and neutral) and the direction of attention of the hero (self- versus task-focused) were manipulated, and in the second series of stories, the presence or absence of blushing and the direction of attention of the hero were manipulated. In line with the expectations, self-focused attention (SFA) led to more social anxiety than task-focused attention (TFA) in all the three experiments, and high blushing-anxious, socially anxious, and social phobic groups reported higher levels of self-awareness than their low-anxious comparison groups. No evidence was found for the idea that self-focusing is specifically detrimental for participants who are already socially anxious, blushing-anxious, or socially phobic. Also, attentional focus did not interact with the valence of social feedback. Finally, results provided some support for the hypothesis that fear of blushing is mediated by self-focusing. The results suggest that irrespective of trait social anxiety, and irrespective of the outcome of a social situation (positive, neutral or negative), SFA increases state social anxiety, or TFA decreases state social anxiety.

Adolescent↗