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Learn More. Performed the experiments: WB MC. Wrote the paper: BU WB. These data suggest that the social ties of those we have close relationships with may influence our cardiovascular risk and opens new opportunities to capitalize on untapped social resources or to mitigate hidden sources of social strain. In the most compelling evidence to date, a recent meta-analysis found that positive aspects of relationships i.
Indeed, effect sizes from the meta-analysis appeared as large, if not larger than standard risk factors such as smoking, exercise, and obesity. It is one of the most ificant adult relationships and has been similarly linked to positive health outcomes  — .
Although the evidence linking close relationships to health is relatively strong, specifying the more precise factors that contribute to such links remains an important objective to advance theory and if this work is to be used to guide interventions or health promotion efforts  — . Is it possible that the relationships of those we have close ties with might also be an important determinant of our health?
Several indirect lines of research are consistent with this possibility. Although little is known about the mechanisms responsible for such associations, potential possibilities include social norms and subsequent health behaviors such as eating and exercise patterns .
Of course, this work only examines linkages among social network ties and does not take into the quality of the relationships. This work is consistent with interdependence theory which postulates that close relationships are characterized by a mutual dependence . For instance, Repetti and colleagues  have found strong evidence for spillover in negative social interactions at work to home interactions with a spouse.
In one study, husbands and wives reported more marital anger and withdrawal at home following negative social interactions at work . To date, however, none of this research appears to have been linked to physical health outcomes which would provide a critical bridge to epidemiological studies linking relationships to disease outcomes. A second important issue to consider is that most of the studies on relationships and health focus on the positive aspects of relationship quality such as social support .
This is consistent with a small epidemiological literature that has linked negativity in relationships to poorer physical health . Indeed, positivity and negativity in relationships are separable dimensions  which suggest the need for a more comprehensive approach to studying links between social ties and health. We have proposed a comprehensive framework that incorporates both of these dimensions and thus allows for an integrative approach while also elucidating a unique category of relationships that have both positive and negative aspects i.
Based on this framework, network members can be categorized as supportive high on positivity, no negativityaversive no positivity, high on negativityambivalent, or indifferent no positivity or negativity. We focused on ABP as an outcome because it is an important predictor of future cardiovascular risk even when considering clinic blood pressure levels . In general, indifferent ties were not predicted to be linked to ABP given their limited influence . Written informed consent was obtained from 97 healthy couples who were recruited through advertisements placed in local newspapers, workplace newsletters, and flyers distributed around the community.
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We used the following criteria to select healthy participants based on our prior work: no existing hypertension, no cardiovascular prescription medication use, no history of chronic disease with a cardiovascular component e. Participants were all legally married and living together with a mean age of Three couples who did not follow the study protocol were eliminated from the study, resulting in a total of 94 couples.
Eligible participants first arrived at the laboratory on the morning of a typical work day as part of a larger program project. Height and weight were assessed using a Health-o-Meter scale in order to calculate body mass index to be used as a covariate. Demographic e. The ABP monitor was set to take a random reading once within every 30 minute window. Following each ABP assessment, individuals were instructed to complete questions that assessed basic control variables such as posture and activity level which were programmed into a palm pilot device.
Participants were instructed to complete these questions within 5 minutes of cuff inflation. Participants were fitted with the ABP monitor by a trained research assistant and given detailed instructions on how to use it, including how to remove it at the end of the day. One reading was obtained before the participants left the lab to insure that the monitors were working properly and that participants understood how to use the palm pilots.
Participants were compensated and debriefed at their final return appointment.
The SRI instructs individuals to list the initials of individuals in the following domains: a father, b mother, c other family, d friends, e co-workers, and f social acquaintances. The of other family, friends, co-workers, and social acquaintances are limited to 5 people in order to keep completion of the SRI to a manageable time frame. These positivity and negativity questions load on distinct factors and have relatively high test-retest reliability . Although the SRI can be used to assess marital quality, the primary social network quality analyses reported here do not include this relationship in order to focus on social network influences beyond the marriage.
The Oscar was developed to meet the reliability and validity standards of the British Hypertension Society Protocol . Outliers associated with artifactual readings were identified using standard criteria by Marler, Jacobs, Lehoczky, and Shapiro . Readings were taken once randomly during each 30 minute window. Participants were instructed to complete a series of programmed questions following each ambulatory cardiovascular assessment using the Purdue Momentary Assessment Tool .
The ADR was deed to be easy to complete about 2—3 minutes in order to maximize cooperation. It contained information on basic variables that might influence ABP . Readings were examined to ensure compliance and discarded if not instigated within 5 minutes of a blood pressure reading. A standardized health questionnaire provided information on the following potential health-related variables: weekly exercise habits, use of tobacco products no, yesweekly alcohol consumption, and body mass index calculated from height and weight that was directly measured with a health-o-meter scale.
In the present study, we modeled the covariance structure for the two repeated measures factors of dyad i. The Satterthwaite approximation was used to determine the appropriate degrees of freedom . Consistent with prior work, these factors along with time i. We then tested these actor-partner models by examining each social network category separately i.
These models included both actor and partner social network variables so that each predictor was independent of the other. Finally, we tested actor X partner interactions by including the centered actor and partner main effects followed by the actor-partner cross product term . We first examined the prevalence of different social network in our sample. Importantly, a relatively large proportion of network members were also sources of both positivity and negativity i.
These proportions are consistent with our prior work . The different network types were also only moderately correlated with each other.
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We examined the form of these interactions by plotting predicted values one standard deviation above and below the mean for actor and partner supportive ties . We again plotted predicted values as detailed above and found that ABP was elevated primarily when a participant and their partner both had more aversive ties see Figure 2. Of course, given these were not predicted and was the only ificant link for indifferent ties appropriate caution is necessary in interpreting this isolated result.
We also conducted ancillary analyses aimed at examining if these were relatively independent of each other. We considered these exploratory given the increased complexity of the models i. Thus, for most major findings the same pattern of emerged in these more conservative analyses. Indeed, the predicted values for couples low in support, or high in aversive or ambivalent ties see Figures 1 — 3 meet or exceed the cut-off for normal ABP that corresponds to disease risk for SBP .
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Being married to a spouse who had less supportive ties was associated with higher levels of ABP, whereas being married to a spouse who had more aversive or ambivalent ties was related to higher levels of ABP. Higher ABP was primarily evident if participants and their spouses both had less supportive ties, more aversive ties, and more ambivalent ties. These findings are consistent with work in relationship science suggesting that individuals in close relationships are mutually dependent on each other and such processes can influence marital interactions  — .
The of this study might be viewed as consistent with social contagion influences  — .
Research on social contagion suggests that obesity can spread through related social networks up to three degrees of social network separation and might be influenced by health behaviors. Of course, such studies only consider the linkages among social networks, unlike the present study which take into the quality of the relationship.
Inconsistent with such mechanisms, our models statistically controlled for body mass index and analyses also found that statistically controlling for smoking status, weekly exercise frequency, and weekly alcohol consumption resulted in the same pattern of for this study.
Thus, these links do not appear to be due to differences in health behaviors which in turn influence ABP. Although future research will be needed, one possibility is related to increased affective spillover as negative interactions outside the home can carry over to home interactions and increase feelings of anger towards the spouse .
Regardless of its source, this is relevant because anger in marriage has been linked to greater coronary calcification . Alternatively, the lack of supportive ties may deplete an individual by leading one to expend more personal resources when coping with stress .
There are several limitations of this study that should be noted. First, all individuals were healthy so whether these findings result in clinically-relevant cardiovascular changes over time need further study. ABP, however, is a strong continuous predictor of future cardiovascular risk and the predicted values for individuals low in support, or high in aversive or ambivalent ties meet or exceed the risk cut-off for normal ABP .
The extent of this issue cannot be determined in this study as only minimal identifiable information was obtained from the SRI. Future research using more detailed social network information and complex modeling can address this issue, especially to test if these two facets i. Given the personal and economic burden of cardiovascular disease, it becomes of utmost importance to identify modifiable risk factors that can be targeted for intervention . Uchino, PI.
The funder had no role in study de, data collection and analysis, decision to publish, or preparation of the manuscript. National Center for Biotechnology InformationU. PLoS One.