The National Social Life, Health, and Aging Project: an introduction.

THIS special issue is designed to bring an innovative longitudinal study on one of the least explored areas of aging to the notice of the research community and to encourage its use beyond the original team of investigators. The 2005–2006 National Social Life, Health, and Aging Project (NSHAP) is a national probability survey of 3,005 men and women between the ages of 57 and 85 years that is focused on intimate social relationships, including marriage, family, social ties, and sexuality. The study collected extensive information on physical and cognitive health, health behaviors, medications, and health service utilization. This study, designed to be longitudinal, also collected a wide array of biomarkers and other physiological assessments, including sensory functions. The NSHAP investigators obtained blood spot samples as well as saliva and vaginal swabs. These physiological data will allow researchers to uncover the biological mechanisms that link health and personal relationships. The survey assessed a wide array of psychological attributes, including attitudes, values, and quality of life. The NSHAP collected information on important chronic diseases such as diabetes, hypertension, and arthritis that are highly prevalent among elderly adults and that could affect intimate social relationships. Extensive data were collected on medication use, including prescriptions, over-the-counter medications, and nutritional supplements, in part out of a concern that patients might stop or reduce drugs whose side effects can sometimes affect sexual and other functions. Finally, the study obtained information about social networks and objective and subjective isolation. NSHAP thus was uniquely designed to provide an understanding of the complex unfolding dynamics of what the authors term “intimate dyads embedded in a larger social network” and their interactions with biology, culture, psychology, and health. Given the diversity and broad scope of measures included in the study, from hormones and sensory functions to attitudes and social networks, it is the epitome of a multilevel study. The investigators, representing multiple disciplinary backgrounds, developed a conceptual model of how the different levels or strata of variables might interact, and designed the study based on those hypothesized interactions. Indeed the study is distinctive not only in its focus on sexuality and intimacy but also in the disciplinary expertise that was assembled and, more importantly, integrated by the investigators. This special issue describes the design of the study and reports the results of Wave 1. Under the direction of Robert Wallace, MD, as special guest editor, the articles in this special issue were peer-reviewed in accordance with the usual procedures of this journal. This introduction provides a brief overview of the study and its place within a growing set of longitudinal studies on aging. The introduction also briefly summarizes the contributions that describe the baseline survey and considers some ways in which the study might evolve. NSHAP is the most comprehensive study of sexual attitudes, behaviors, and problems in the U.S. older population. Although the study was designed more broadly to study the effect of close personal relationships and social ties of all kinds on health, NSHAP's special focus on sexuality is rare; sexuality is one important aspect of close personal relationships that has not been rigorously studied in the older population. The central hypothesis that guided the design and its architecture is that those with high-quality intimate social and sexual relationships will age better in terms of health and well-being than those with poor-quality relationships or those who lack social relationships. The study is one of the newest additions to an expanding set of longitudinal studies on aging, and it explores new facets of aging, including areas of aging that, until now, have been mostly terra incognita within population surveys, at least within the domains of national data and, most especially, in panel data. Social relationships, marriage, and social engagement have figured prominently in aging research, and there have been multiple tests of the hypothesis that positive relations and social engagement are associated with good health, longevity, and lower mortality. More recently, these connections have also been associated with to maintenance of cognitive functioning and delayed onset of cognitive impairment and dementia. Prior to this investigation, data on sexuality (whether behaviors, problems, attitudes, or levels of satisfaction) were rarely adequately measured in these longitudinal studies, and certainly never in as much depth as in NSHAP. Perhaps one reason for this was the concern that the topic was too sensitive and considered taboo for inclusion in national surveys. If so, it was by no means the only such topic deemed to be too sensitive to include in surveys. Circa the early 1980s, social and behavioral scientists shied away from collecting biological specimens, especially blood, in social surveys. Conventional wisdom held that doing something like that was terribly intrusive and would have a devastating impact on the study by lowering response rates. By contrast, those in the medical world routinely collected blood samples for their studies but firmly believed that it was impossibly intrusive to collect significant economic data on income, and especially on wealth, a view also shared by many social scientists. Although collecting high-quality data with a low refusal rate is difficult in each of these areas, it is now clear that with an adequate rationale, coupled with intensive interviewer training and a degree of assurance of efforts to protect confidentiality, high-quality data can be collected on these sensitive topics. Interviewer confidence, comfort, and self-assurance that the data are important and can be collected are probably the important ingredients for success.