This article was downloaded by: [Nanyang Technological University]On: 04 March 2015, At: 00:59Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

Journal of Nutrition For theElderlyPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/wjne20

Influence of Social SupportSystems on Dietary Intake ofthe ElderlyWilliam A McIntosh PhD a & Peggy A Shifflett PhD ba Associate Professor, Dept of Sociology, Texas A & MUniversity, College Station, TX 77843b Assistant Professor, Dept of Sociology, VirginiaPolytech Institute and State University, Blacksburg,VA 24061Published online: 18 Oct 2008.

To cite this article: William A McIntosh PhD & Peggy A Shifflett PhD (1984) Influenceof Social Support Systems on Dietary Intake of the Elderly, Journal of Nutrition For theElderly, 4:1, 5-18, DOI: 10.1300/J052v04n01_03

To link to this article: http://dx.doi.org/10.1300/J052v04n01_03

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified with

primary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

Influence of Social Support Systems on Dietary Intake of the Elderly

Wil l iam A. McIntosh, PhD Peggy A. Shifflett, PhD

ABSTRACT. Various forms of social support have been found to have positive associations with good health and preventative health behavior while other forms have negative consequences. Consider- ing dietary intake as a form of preventative health behavior, this ex- ploratory research examines the association of various types of social support systems with nutrient intake. The findings suggest that social supports which include close physical proximity (marriage, neighbors, religious salience) as opposed to simple emotional attach- ments to relatives, friends, and community, are significantly as- sociated with higher intakes of specific nutrients. It is also suggested that support systems in which the elderly individual may feel depen- dent (relatives, friends, community) could possibly have negative consequences for dietary intake.

INTRODUCTION

An increasing amount of research continues to demonstrate that the physical and emotional well-being of the individual is dependent on informal social support (Langlie, 1977; Kaplan et al., 1977; Turner, 1981). That is, health is relative to the supportive rela-

Dr. McIntosh is Associate Profcssor. Dept. of Sociology, Tcxas A & M University. Col- lege Station, Texas. 77843. Dr. Shifflett is Assistan! Professor, Dept. of Sociology. Virginia Polytechnic Institute and State University. Blacksburg, Virginia 24061. The marerial in this report is based upon work supported by thc Science and Education Administration of the U.S. Department of Agriculture under Competitive Grant No. 5901-0410-0126-0. Any opin- ions, findings, and conclusions or rccornmendations expressed in this paper are those of the authors and do not necessarily reflect the views of the U.S. Depanment of Agriculture.

Journal of Nutrition for the Elderly. Vol. 4(1), Fall 1984 O 1984 by Thc Hawonh Press, Inc. All rights reserved. 5

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

6 JOURNAL OF NUTRITION FOR THE ELDERLY

tionships that are found in groups of which the person is a mem- ber.

The social support approach is becoming important in studies of the elderly. The salience of this approach to elderly populations is clearly indicated by studies that show "the buffering effect of social support to moderate the relationship between acute stress. . . and criteria for well-being" (Kahn, 1979:85).

One aspect of social support research argues that good health is fostered directly through supportive social relationships; however, there are indirect effects. For example, research has demonstrated that social support leads to preventative health behavior and pro- vides aid during times of stress (MacKinlay, 1973; Langlie, 1977; Gottlieb, 1981).

A major form of health preventative behavior is the choice of foods individuals select as their everyday diet. While people may not always be fully cognizant of the health costs and benefits of all items of food, health is generally a consideration in the selection of food by most (Lowenberg et at., 1979) including the elderly (Shiff- lett and Johnson, 1984). After reviewing the literature, questions about various types of social support and their association with nu- trient intake levels will be explored in this paper. The sample of elderly used is not representative of all elderly; therefore, we do not attempt to generalize our findings.

SOCIAL SUPPORT: A REVIEW

Social support can be provided by friends, relatives, neighbors, work mates, voluntary organizations, religion and religious orga- nizations, or the immediate community. Supportive ties to others can provide significant emotional and informational services (e.g., concern during grief and illness, babysitting, recipes, food prep- aration) and material resources (e.g., money, meals). Indirect social support, however, can also be obtained by identifying with a group through participation in its interests and accepting its norms, values, and beliefs (Kaplan et a]., 1977). Thus, for some people, religion can provide social support similar to that which relatives and friends provide (Caplan, 1974).

The research pertaining to social support generally indicates that supportive relationships are associated with lower illness rates, faster recovery rates, and higher levels of health-care behavior. The

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

William A. Mclntosh and Peggy A. ShSqlert 7

relationship of social support to diseases in old age is of two sorts. First, there are associations of lack of social support with onset of diseases (e.g., tuberculosis (Chen and Cobb, 1960); arthritis (Cobb, 1976); and coronary heart disease (Caplan, 1971; Parkes, 1969; Berkrnan and Syme, 1979). Second, other studies indicate that it is social support which increases the probability of recovery from heart and other ailments (Robertson and Suim, 1968; Croog et al., 1972; Finlayson and McEwen, 1977; Smith, 1981).

Phillips and Feldman (1973) provided data to illustrate that social support is important in sparing life in old age. They found that social support is significant in the reduction of deaths in the six months following birthdays. A second significant study was reported by Berkrnan (1977). She provided data from the California Human Population Laboratory study of 7,000 residents of Alameda County which show that over a ten-year period, age adjusted mortality is reduced among those who have good social network support.

It should also be considered, however, that not all human rela- tionships may be supportive. At least one study found that unhappy and broken marriages are related to heart problems, cancer, and mental illness (Hugher and Cove, 1981). Furthermore, not all friendships result in positive consequences for the individuals in- volved. Research on drug abuse, for example, indicates that in- dividuals are generally introduced to drugs by friends; and it is through the supportive relationships with the group that the in- dividual learns the techniques of drug abuse (Becker, 1953; Akers et al., 1979) and learns to overcome formal laws and informal social controls (Burkett and Jensen, 1975; Conger, 1976).

Other relationships which might be expected to provide some form of social support may, in fact, not do so. Localism, or strong attachment to the local community and local figures within that com- munity tends to provide a narrow, restricted view of the world. Cos- mopolitanism, by contrast, entails a wider, more open, view of the world permitting access to less restricted sources of information (Merton, 1968). Medical research suggests that localities rely on traditional health beliefs while cosmopolites enact preventive health care behaviors to a significantly greater extent than localites (Such- man, 1972; Langlie, 1977).

In summary, social support has positive consequences for physical and emotional health both in terms of avoidance and heal- ing of various disorders once they have occurred. Also, some types of relationships with other people may have negative health conse-

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

8 JOURNAL OF NUTRITION FOR THE ELDERLY

quences including the maintenance of outdated health beliefs and practices.

RESEARCH QUESTIONS

Research questions based on the literature reviewed have been formulated. First, it has been noted that social support is associated with better health and with preventative health behavior. Since choice of foods is a type of preventative health behavior, we will ex- plore the possibility that various types of social support are as- sociated with higher intake of specific nutrients.

Second, the literature has suggested that not all human relation- ships may be supportive. Therefore, we will explore the question of whether some types of relationships are associated with lower nutri- ent intake.

Third, some related literature has suggested that a strong attach- ment to the local community may be associated with a limited world view in terms of preventative health behaviors. Thus, the final ques- tion to be explored is whether strong attachment to the local commu- nity is associated with lower nutrient intake.

METHODOLOGY

Research Setting

The research was conducted in the Central Shenandoah Planning District VI, a 5-county region under the jurisdiction of Virginia's Office on Aging. This area encompasses relatively isolated moun- tain enclaves (rural non-farm), valley communities (rural farm), and small urban centers ranging from 6 to 26 thousand in population.

The study site includes counties (Rockingham and Augusta) with growing populations and substantial in-migration of retirees from northeastern urban centers. Other counties (Bath, Highland, and Rockbridge) have declining populations due to out-migration of younger people. This has resulted in the majority of the population now falling into older age categories. The small urban centers are experiencing increasing populations of in-migrants from northeast- ern areas as well as from the local rural farming communities.

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

William A. Mclnrosh and Peggy A. Shimen 9

Study Population and Data Collection

The source of data for this study was elderly persons (N=805) who participated at 13 nutrition sites in Planning District VI. A 25% random sample (n=201) was selected as respondents. The sample size was based on the fact that further longitudinal research was to be conducted and the researchers were considering the potential at- trition rate for the elderly sample over several years. In order to per- mit adequate subgroup comparisons, the sample was stratified by age and sex. The method of data collection was a questionnaire ad- ministered in a face-to-face interview conducted summer and fall of 1980.

Dependent Variables

Indicators of nutrient intake were derived from a 24-hour dietary recall which included asking each respondent to recall all of the kinds and amounts of food eaten over the 24-hour period preceding the interview (Guthrie, 1979; Evers and McIntosh, 1977). A stan- dardized technique was used by the interviewers to collect accurate data and to minimize individual variability. This technique consisted of probing questions to stimulate the memories of the subjects about their dietary intake. The menus from the nutrition sites, direct ob- servation, and food inventories were used to validate the dietary recalls. Also, Madden et al. (1972) found that a highly significant relationship existed between actual and recalled nutrient values for participants in a congregate feeding program for the elderly.

Data from these records were transformed to nutrient values using composition data as published in the Home and Garden Bul- letin No. 72 (Adams and Richardson, 1978). These data were analyzed through the Department of Human Nutrition and Foods Nutrient Intake Program at Virginia Polytechnic Institute and State University, Blacksburg, Virginia. This program transformed the items of food into nutrients (calories, protein, niacin, thiamin, Vita- mins C and A and others).

Because approximately 50 food items consumed by members of our sample were not included in the Home and Garden Bulletin No. 72, it was necessary to substitute equivalent foods. This was ac- complished with the aid of a nutrition consultant and several pub- lications listing the nutritive values of food items. These included

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

10 JOURNAL OF NUTRITION FOR THE ELDERLY

Adarns (1975), Church and Church (1966) and Watt and Merrill (1963). In some instances it was necessary to derive the nutritive value of an uncommon item from a standardized recipe. One exarn- ple was the food "panhaus" which required a breakdown into in- gredients after obtaining the recipe orally from several local people.

Independent Variables

The questionnaire contained items to collect social data. Proxy measures of social support were derived from the following: (1)fre- quency of contact with relatives, friends, neighbors; (2) religious salience: the degree to which religious beliefs were perceived to af- fect the everyday life of the respondent; (3) localism: a composite scale (Roof, 1978), measuring attachment to the local versus the outside world; (4) marital status: currently married as opposed to widowed, divorced, separated, or single; and (5) living arrange- ments: living alone or with other persons.

Statistical Analysis

In the bivariate analysis, Pearson product-moment correlations were computed between social support variables and nutrient intake variables. This was accomplished by using the Statistical Package for the Social Sciences (Nie et al., 1975). The Pearson correlation coefficient r is used to measure the strength of relationship between two variables.

Further verification of strength of relationships was provided by the multivariate analysis using multiple regression. The objective was to examine the impact of social support variables on nutrient in- take while including sex, age, race, and income in the model.

RESULTS

Nutrient Intake

Analysis of the 24-hour dietary recall data indicated that average intakes of all the nutrients examined achieved levels of greater than two-thirds the Recommended Dietary Allowances (RDA) (1978 standards). However, the dispersions around the means suggest that 34% of the respondents had intakes of such nutrients as Vitamin A,

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

William A. Mc~ntosh and Peggy A. Shtflert I I

riboflavin, Vitamin C, and calcium as low as 40% of RDA. These data suggest that, regarding vitamin and mineral intake, the respondents are similar to the poor whites identified in the Ten-State Nutrition Survey (1972) and in recent studies of disadvantaged aged (Abraham et al., 1981). In spite of the fact that 24-hour recall data tends to exaggerate intake at the extremities of the distribution (Guthrie, 1979) and that the recommended dietary allowances con- tain safety margins, the data suggest that a significant number of the aged in the sample have less than adequate diets.

Bivariate Relationships

Table 1 shows that respondents who are married have higher in- takes of calories, phosphorus, calcium, thiamine, Vitamin A, fat, and food quantity. Respondents with social support from neighbors have significantly higher amounts of phosphorus, iron, protein, niacin, riboflavin, thiamine, and magnesium in their diets. The respondents for whom religion is highly salient have higher intakes of calories, calcium, riboflavin, and thiamine. Those respondents living alone consume diets with significantly less magnesium and fat. Finally, as we noted in the literature review, not all social sup- ports are positive. The data in Table 1 illustrate that those with stronger attachments to relatives have lower intakes of calories; and those with strong attachments to friends have lower intakes of iron and thiamine. Also, strong attachment to the local community is associated with lower intakes of calcium, Vitamin A, Vitamin C, potassium, and overall food quantity.

Multivariate Relationships

We next examined the combined effects of social support vari- ables and sex, race, income and age. Sex, race, income and age were included due to their commonly known relationship with nutri- ent intake (Slesinger et al., 1980). Males, both for social and biolog- ical reasons, tend to exhibit higher intakes than females, while in- take generally declines with age (Watkin, 1980; Weg, 1980). Whites and more financially secure persons also tend to have higher intakes of nutrients (Ten State Nutrition Survey, 1972).

Table 2 shows that while sex and income are often very important predictors, measures of social support such as marital status, re- ligious salience, and a close relationship to neighbors remain

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

Pearson Product Moment C o r r e l a t i o n Coe f f i c i en t s Between Soc ia l Support and N u t r i e n t in take Var iab les .

Attachments Attachments Attachments Rel ig ious M a r i t a l L i v i n g t o Rela t ives t o Fr iends t o Neighbors Sa l ience Local ism Status Arrangement

Ca lo r i es

Phosphorous

Calcium

I r o n

P r o t e i n

N i a c i n

R i b o f l a v i n

Thiamine

V i tamin A

V i tam in C

Fa t

Potassium

Magnesium

Food Q u a n t i t y

S i g n i f i c a n t a t t h e .05 l e v e l ; ** S i g n i f i c a n t a t t h e .01 l eve l ; *** S i g n i f i c a n t a t the ,001 l e v e l

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

LO 0 Y U

YI 5 PI U L I m c o m u

E a

22 2 : E - 3 2 U -a .cca . 3 .d .A m u m m e U." O?- d Y n i c ld

2 : E U Y)

m u . d m m . A U . A L I U t d m u k " , > m x u ffl : 2 .: " 0 " < ~~~~~~ .-: DL 2 :: -

U m U C

3 4

2 5 .d

.?

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

William A. Mclntosh and Peggy A. Shiflett 15

significantly associated with nutritional health. Generally, those respondents reporting these types of supportive relationships have higher intakes of important vitamins (A and thiamine) and minerals (calcium, phosphorus, and magnesium).

DISCUSSION

The objective of this study was to explore several questions con- cerning the possible association of various types of social support with the intake of nutrients. The first question dealt with all types of social support measured in this project and their association with in- take of specific nutrients. The bivariate analysis suggests that mar- riage, close attachment to neighbors, and religious salience, for our sample, are associated with significantly higher intake of specific nutrients.

As to whether some types of relationships are associated with lower nutrient intake, we found that strong attachment to relatives and friends are similar to living alone in terms of level of nutrient in- take. These two types of relationships and living alone are signifi- cantly associated with lower intakes of calories, iron, thiamine, fat, and magnesium.

The findings for the first two research questions suggest that, for our sample, being married and having close ties to neighbors are forms of social support with physical proximity greater than attach- ment to relatives and friends. Even religion, as measured by salience, is "close-by.'' Perhaps the more readily available sup- ports lead to better dietary intake, whereas the less available have little impact. Another possible explanation of our findings is related to dependence. Having to depend on relatives and friends may have negative consequences for dietary habits.

The third question dealt with the association of a strong attach- ment to the local community (localism) and the levels of nutrient in- take. Significantly lower levels of calcium, Vitamin A, Vitamin C, potassium, and overall food quantity were found for those with a strong attachment to the local community. This, again, suggests that attachment to the local community may lead to dependence on a limited world view in terms of making the necessary dietary changes (Weg, 1980) as one ages.

In the multivariate analysis, the objective was to examine the im- pact of social support variables on intake of selected nutrients while including sex, age, race, and income in the model. All variables were regressed on level of intake for selected nutrients. While sex

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

I6 JOURNAL OF NUTRITION FOR THE ELDERLY

and income remained in the general model as important predictors of nutrient levels, social support systems such as marriage, close at- tachment to neighbors, and religious salience also remained in the model as significant predictors of nutrient levels. Thus, the multi- variate analysis further verified the strength of associations found in the bivariate analysis.

These findings must be considered in the context of our limited sample; however, even these exploratory findings have important implications for nutritionists and social service providers working with the elderly. Several specific possibilities include the encour- agement of neighborhood cooking clubs, consumer clubs, or food co-op situations among those in close proximity. This would provide additional social contacts while avoiding transportation problems. The potential for learning for the elderly involved is unlimited- knowledge of special dietary needs of elders, a more positive at- titude toward eating, and better shopping habits are some possible outcomes.

Another consideration stemming from the finding that strong at- tachment to friends and relatives and the local community was as- sociated with lower intake of some nutrients is that those elderly who must rely on friends or family may have an uncomfortable sense of dependence. This suggests the need for nutrition program planners to concentrate efforts toward more outreach particularly in rural and small town areas. Those elderly who must depend on family and friends should be encouraged to meet their peers and develop cooperative associations such as those suggested above. When basic needs are met within the peer group, a feeling of in- dependence and contribution to group effort may be reestablished.

It is hoped that this study has generated some interest in the possi- ble influence of social support systems on dietary habits of the elder- ly. With further research on the questions raised here, some policy and practical issues may be identified which could lead to future im- provements in nutrition programs for the elderly.

submitted: April 1983 revised: October 1983

REFERENCES

Abraham, S . , Carroll, M. D., Dresser, C. M., and Johnson, C. L. Community Nulririon: People, Policies, and Programs. Monterey , CA: Wadsworth, 1981.

Adams. C. F. Nutririve Value ofAmerican Foods. Common Foods Agricultural Handbook

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

William A . Mclntosh and Peggy A. Shiflett

No. 456. Washington. D.C.: U. S. Department of Agriculture Research Service, 1975. Adams, C. F. and Richardson, M. Nurririve Value of Foods. Revised edition. U . S. De-

partment of Agriculture, Home and Garden Bulletin No. 72. Washington, D.C.: U . S. Government Printing Office. 1978.

Akers, R. L., Krohn, M. D., Lanza-Kaduce, L., and Radosevich, M. Social learning and deviant behavior: a specific test of a general theory. American Sociological Review, 1979. 44:636-655.

Becker, H. S. Becoming a marijuana user. American Journal of Sociology, 1953, 59:235- 242.

Berkman, L. F. Psychosocial resources, health behavior and mortality: a nine-year follow- up study. Presented at American Public Health Association, 1977.

Berkman. L. F. and Syme, S. L. Social nctworks, host resistance, and mortality: a nine- year follow-up of Alamcda County residents. American Journal of Epidemiology, 1979, 109: 186-204.

Burkett, S. R. and Jensen, E: L. Conventional ties, peer influence, and the fear of apprehen- sion: a study of adolescent marijuana use. 7he Sociological Quanerly, 1975, 16:522- 533.

Caplan, G. Suppon systems. In: Caplan. G., ed. Suppon Sysrems and Cammuniry Mental Healrh. New York: Behavioral Publications, 1974, pp. 10-16.

Caplan. R. D. Organizational Slress and Individual Strain. Doctoral Dissertation. University of Michigan. 1971.

Chen, E. and Cobb. S. Family structure in relation to health and disease. Journal of Chronic Diseases. 1960, 12:544-567.

Church. C. F. and Church, H. N. Food Values in Ponions Commonly Used. Tenth edition. Philadelphia: I. B. Lippincott Co., 1966.

Cobb. S. Social support as a moderation of life stress. Psychosomatic Medicine. 1976, 38:300-363.

Conger. R. Social control and social learning models of delinquent behavior: a synthesis. Criminology, 1976, 14: 1 7 4 .

Croog, S., Lipson. A,. and Levine, S. Help patterns in severe illness: the roles of kin net- work, nonfamily resources, and institutions. Journal of Marriage and rhe Family, 1972, 34:32-41.

Evers, S. and Mclntosh, W. A. Social indicators of human nutrition: measures of nutri- tional status. Social lndicarors Research, 1977, 4: 185-205.

Finlayson, A. and McEwen, J. Coronary Hean Disease and Parrerns of l iv ing. New York: Pordist, 1977.

Gottlieb. B. H. Social networks and social support in community mental health. In: Gott- lieb, B. H., ed. Social Newarks and Social Suppon. Beverly Hills, CA: Sage Publica- tions. 1981. pp. 11-42.

Guthrie, H. A. Inrroducrory Nurririon. Fourth edition. St. Louis: C. V. Mosby, 1979. Hughes, M. and Cove. W. R. Living alone, social integration and mental health. American

Journal of Sociology. 1981, 87:48-53. Knhn, R. L. Aging and social support. In: Riley, M. W., ed. Agingfram Binh ro Death.

Boulder: Westview Press, 1979, pp. 77-91. Kaplan, B. H., Cassel. J . C.. and Gore, S. Social support and health. Medical Care, 1977,

15:47-58. Langlic. J. K. Social networks, health beliefs, and preventative health behavior. Journal of

Health a i d Social Behavior. 1977. l8:244-260. Lowenberg, M. E., Todhunter. E. N.. Wilson. E. D.. Savage, I. and Lubawslu, I. L.

Foodand People. Third edition. New York: John Wiley and Sons, 1979. MacKinlay. J . B. Social networks, lay consultation, and help-seeking behavior. Social

Forces. 1973, 5 1 :275-292. Madden. 1. P. and Yoder. M. D. Program evaluation, commodity distribution programs in

rural areas of Central Pennsylvania. Agricultural Experimental Research Bulletin No. 780. University Park, PA: Pennsylvania State University. 1972.

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5

18 JOURNAL OF NU1"RITION FOR THE ELDERLY

Menon, R. K. Types of influentials: the local and the cosmopolitan. In: Merton, R. K. Social Theory and Social Structure. New York: Free Press, 1968, pp. 447474.

National Research Council, Food and Nutrition Board, 10th revision.. Recommended Di- etary Allowances, National Academy of Sciences, Washington, D.C., 1980.

Nie, N. H., Hull, C. H., Jenkins, J. G., Steinbrenner, K., and Bent, D. H. Srntistical Pack- age for the Social Sciences Second edition. New York: McGraw-Hill, 1975.

Parkes, C. M., Benjamin, B., and Filzgerald, R. G. Broken heart: a study of increased mor- tality among widows. British Medical Journal, 1969, 1:740-743.

Phillips, D. P. and Feldman, K. A. A dip in deaths before ceremonial occasions; some new relationships between social integration and mortality. American Sociological Review, 1973, 38:678-696.

Robertson, E. K. and Suim, R. M. The determination of rate of processing stroke patients through empathy measures of patient and family. Journal of Psychosomaric Research, 1968. 12:189-191.

Shifflen, P. A. and Johnson G. D. Future time perspective and food habits of the aged: an empirical exploration of George Herbert Mead's theory of time as process. In review, 1984.

Slesinger, D. P., McDewitt, M., and O'Donnell, F. M. Food patterns in an urban popula- tion: age and sociodemograpbic correlates. Journal of Gerontology, 1980, 35 :43241 .

Smith, R. T. Disability and the recovery process: role of social networks. In: Jaco, E. G., ed. Patients. Physicians, and Illness: Sourcebook in Behavioral Science and Health. Third edition. New York: Free Press, 1979, pp. 218-226.

Suchman, E. Social patterns of illness and medical care. In: Jaco, E. G., ed. Patients. Physi- cians, ond Illness: Sourcebook in Behavioral Science and Healrh. Second edition. New York: Free Press, 1972, pp. 260-280.

Ten-State Nutrition Survey, 1968-1970. Highlights. Department of Health, Education. and Welfare Publication No. (HSM) 72-8134. Atlanta, GA: U. S. Depanment of Health, Education. and Welfare, Center for Disease Control, 1972.

Turner, R. J. Social support as a contingency in psychological well-being. Journal oJHealth and Social Behavior, 1981, 22:357-367.

Watkin, D. M. Nutrition for the aging and the aged. In: Goodhart, R. S. and Shils, M. F., eds. Modem Nutririon in Health andDisease. Sixth edition. Philadelphia: Lea & Fekjger, pp. 781-813.

Wan, B. K. and Merrill, A. L. Composition of Foods-Raw, Processed, Prepared. Re- vised edition. USDA Aericulture Handbook No. 8. Washineton, D.C.: Consumer and Food Economics ~esearch Division, Agricultural Research Service, 1963.

Weg, R. B. Prolonged mild nutritional deficiencies: significance for health maintenance. Journal of Nutrition for the Elderly, 1980, 1:3-22.

for your convenience. . . for readers o f reprints or photocopies of this article: would you like a complimentary sample copy of this journal? Just fill ou t the form below and mail t o us. A complimentary copy will be mailed t o you. Please just show it t o your institutional library! Thank you. I I Yes, please send me a complimentary sample o f

I will show it to our institutional or agency library for a possible subscription.

CITY: STATE: ZIP:

Send ;his form to: THE HAWORTH PRESS. Inc., 2 8 East 22nd Street. New York, NY 10010

Dow

nloa

ded

by [

Nan

yang

Tec

hnol

ogic

al U

nive

rsity

] at

00:

59 0

4 M

arch

201

5