family and friends, or living in a rural environment, or those with impaired mobility. Health status is often considered a determinant for social involvement, and poor health can contribute to isolation, leading to a cause-and-effect scenario. Findings from studies indicate increased mortality with social isolation, loneliness, and living alone. This shows that both types of aloneness affect health outcomes. Increasing healthcare provider awareness of older adults, their living situations, and their ability to access social networks may help identify at-risk individuals, enabling referrals and recommendations for interventions (Singer, 2018). Social factors can be a direct cause of many chronic diseases. For example, smoking is a highly social activity that is associated with cancer, coronary artery disease, chronic obstructive pulmonary disease, diabetes, heart disease, cancer, and stroke (Centers for Disease Control and Prevention [CDC], 2020). The smoking experience is regularly shared with other smokers and is particularly observable with smoking restrictions forcing smokers to leave their building and congregate together outside. Smoking is a learned experience that typically starts in the company of another person teaching the beginner what to do. Growing up in a house with a smoker, having a spouse who smokes, and regularly socializing with smokers are all social situations that contribute to smoking initiation (Cockerham et al., 2017). In addition to smoking initiation, continued use of tobacco products is highly influenced by social circumstances. People from socially disadvantaged communities have more exposure to social situations that promote smoking. These individuals also experience socioeconomic factors that impede smoking cessation, such as stress, financial debt, unemployment, and reduced access to healthcare. This results in a significantly higher concentration of smokers at the bottom of the social ladder, leading to higher rates of the numerous health conditions related to smoking among this group (Cockerham et al., 2017). Healthcare Consideration: For individuals with mental health issues, smoking is perceived as a stress reliever and is found in 23.1% of American adults with any mental illness, compared to 14.5% of adults with no mental health issues (CDC, 2024). albuterol sulfate 0.083% (2.5 mg per/dose) via nebulizer, with directions to inhale one vial using the nebulizer every 4 hours as needed. Albuterol 0.083% is administered via nebulizer. The nurse places a phone call to Adam’s mother regarding asthmatic episodes and discusses keeping an inhaler available for Adam at school and each parent’s home. His mother reports that Adam’s father recently lost his job and health insurance, which has resulted in problems paying for the inhaler and increased stress in the home. His mother continues to work part time cleaning houses, which does not provide health insurance, and now she is not receiving child support payments from Adam’s father because of the job loss. She is worried about paying utilities, purchasing food, and possibly losing their apartment if she cannot pay the rent. The nurse offers to have the guidance counselor and school social worker reach out to Adam’s mother about linking to available community resources. She agrees to this. A plan is developed to utilize an emergency fund to help obtain an inhaler and establish a more consistent transfer of the inhaler between the parents’ homes and school. After the
less hostility, fewer academic problems, and better self- esteem. This effect is not limited to parental influences and is also found in teens with supportive unrelated caregivers, teachers, and community members. Peer connectedness is a factor in positive and negative behaviors. Multiple studies have shown that teens with peers engaged in delinquent behaviors are likely to do the same, and those with peers displaying positive behaviors are less likely to become delinquent. Foster and colleagues found that teens (selected for risk of bullying and social difficulties in low- income urban areas) with high connectedness to parents experience less depression, suicidal ideation, less self-harm behavior, and fewer conduct problems along with higher self-reports of self-esteem and positive use of free time. Students with school connectedness were found to have less sexual activity and fewer depressive and anxiety symptoms (Foster et al., 2017). Strengthening parent–child relationships, supporting parental education in parenting, and providing education and resources to school staff for assisting at-risk youth are some suggestions for increasing social support. To help families strengthen relationships through their child’s adolescence, it is important to have ready information related to available community assistance and support groups as well as online and print resources (Foster et al., 2017). Among the aging adult population, the presence of strong social networks with social support is a strong positive predictor of physical and mental health (Belanger et al., 2016). Studies in multiple countries—including China, Canada, the U.S., and Taiwan—have shown the importance of social connectedness and well-being. Asante and Castillo (2018) found that individuals satisfied with their network of support had higher positive self-rated physical and mental health. The researchers determined that this suggested that quality of support was more important than quantity of support. Social isolation has been correlated with poor health outcomes in older adults. Several factors can be involved with this concept. Social isolation is considered to be present if someone lives alone, has less than monthly contact with family and friends, and does not belong to any type of group. Individuals who choose this lifestyle are less likely to feel lonely than someone living alone because of the death of a significant other, lack of nearby Case study 1 A 12-year-old, sixth grade boy, Adam, enters the school nurse’s office with audible wheezing and difficulty completing a sentence without stopping to catch his breath. “I forgot … to come and … see you before gym … and I left … my other inhaler at home … by accident.” Background information on Adam indicates that he primarily lives with his mother and spends every other weekend with his father. There are two cats and three dogs living at his mother’s house, and his father and stepmother smoke. All of these have been known to trigger Adam’s asthma. There have been past issues with keeping an inhaler at school as he moves between the parents’ homes. He has a positive history for exercise-induced and allergy-related asthma, and no other medical diagnoses. Adam’s respiratory rate is 24 breaths per minute. Lung sounds with inspiratory wheezing are throughout all lobes. Shallow breaths are noted, with no accessory muscle usage. His apical heart rate is 116 beats per minute, pulse oximetry is 88%, and peak flow meter reading is 150. There are orders for an albuterol inhaler, with directions to give two puffs every 4 hours as needed for shortness of breath, and
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