Social Isolation, Self-Rated Health, and Self-Rated Oral Health Among African Americans

Background and Purpose: Research on social isolation confirms its association with several negative health outcomes, including mortality, emphysema, liver disease, arthritis, depressive symptoms, psychological distress, and cognitive decline. The effects of social isolation on mortality are equivalent to smoking 15 cigarettes per day. Unfortunately, extremely few studies have examined social isolation among African Americans. The purpose of this study is to evaluate the associations between social isolation and self-rated health and self-rated oral health among a nationally representative sample of African Americans.  The additional analysis of oral health is particularly important because of the lack of research in this area. The focus of this paper is consistent with the Grand Challenge of Eradicating Social Isolation.  

Methods: This analysis used the African American sub-sample of the National Survey of American Life (NSAL) (N=3,570).  Social isolation was operationalized to reflect both objective social isolation and subjective social isolation. Objective social isolation was operationalized using frequency of contact with family and friends, and subjective social isolation was operationalized using subjective closeness with family and friends. Further, both objective and subjective isolation were assessed in relation to whether respondents were isolated from family only, from friends only, from both family and friends, or not isolated from either group. Multivariate regression models were used in the current study. The dependent variables in this analysis were self-rated health and self-rated oral health.  All regression models controlled for age, gender, education, family income, and marital status. Survey weights and adjustments for the complex design of the sample were applied in all analyses.

Results: This analysis had several major findings.  Objective isolation from friends only, and objective isolation from family only was associated with worse self-rated health. The addition of subjective isolation in the analysis did not affect these results. With regards to self-rated oral health, objective isolation from friends only was associated with worse self-rated oral health.  This finding, however, was ameliorated when subjective isolation was included in the analysis.  Subjective isolation from both friends and family, and subjective isolation from family only were associated with worse self-rated oral health.

Conclusion and Implications: Overall, these findings indicate that social isolation is negatively associated with the health of African Americans.  Self-rated health and self-rated oral health were related to different dimensions of social isolation from family and friends. This study adds to a growing literature illustrating different dimensions of social isolation are related to different health outcomes. Efforts to address and ameliorate an individual’s social isolation should also address and improve their self-rated health and self-rated oral health. Study findings can be used to help create culturally and ethnically sensitive social isolation risk assessments for African Americans. Longitudinal studies are needed to determine the direction of these effects (whether social isolation predicts worse self-rated health and worse self-rated oral health, or worse self-rated health and particularly worse self-rated oral health predicts social isolation). The findings from this study contribute to the Eradication of Social Isolation Grand Challenge of Social Work.