PRB

Older Americans with strong social connections are healthier and live longer than their socially isolated peers. Increasingly, researchers are finding that the components of good health are not only the absence of mental disorders and physical disease but also the presence of robust social relationships.

This brief explores recent research probing the dynamics of social connection and health supported by the National Institute on Aging. The findings point to myriad ways in which social ties bolster health—from slowing aging and boosting cancer-fighting hormones to preventing depression and protecting memory. Health policymakers and program planners can use this evidence to inform a variety of interventions—particularly those aimed at reducing social isolation in vulnerable groups—to support longer and healthier lives for older Americans.

Strong Social Ties Slow Aging, Lower Risk of Death

Studies have shown that both the quality and quantity of our social ties shape our mental and physical health, health behaviors, and mortality risk. Researchers are studying multiple aspects of our social lives—from the levels of social support we receive to our activities and the strength of our social networks—to understand how they link to health outcomes.

Healthy, supportive relationships with family and friends may slow aging, concluded a research team from the University of California, Los Angeles (UCLA) and the University of Southern California (USC).¹ According to their DNA, older adults with the most supportive relationships with spouses, adult children, other family members, and friends were aging one to two years slower than those who lacked such ties, they found. The pace of such aging is important—rapid epigenetic aging at younger chronological ages can contribute to the early onset of chronic disease and disability and premature death.

The authors, led by Kelly E. Rentscher, based their analysis on aging-related molecular changes in DNA among older adults participating in the nationally representative Health and Retirement Study (HRS). Even after factoring in smoking, alcohol use, and other lifestyle factors known to accelerate aging, the protective role of strong social relationships persisted, they reported.

Supportive relationships with spouses and children helped slow the pace of aging by more than three weeks per year, they found. Having support from other family members and friends also helped slow the pace of aging, by about three weeks per year and more than two weeks per year, respectively.

Overall, the findings affirm that both the presence of relationships and their quality mattered for longevity. The new study may support interventions with the potential to “prevent, slow, or reverse accelerated aging and extend the healthspan and lifespan,” the authors wrote.

Other ongoing research underscores the important role of social factors in the overall health of older adults. Linda Waite and Yiang Li from the University of Chicago found that the healthiest older adults had strong social connections and just a 4% risk of dying within five years, while those with the poorest health had weaker social connections and a 57% risk of dying within five years.² Key factors linked to longevity included robust social networks and partnered sexual activity, highlighting the importance of social integration in maintaining health in later life. Their preliminary findings are based on nationally representative data from the National Social Life, Health, and Aging Project (NSHAP).

Social Connections May Improve the Well-Being of Patients With Cancer and Other Health Conditions

More new research poses that social connections may also improve the well-being of cancer patients by boosting protective hormones.

A research team from six major universities found that in ovarian cancer patients, social support was associated with higher levels of oxytocin—a hormone linked to some protection against cancer.³ Specifically, having a more positive outlook, a sense of purpose, and a role in caring for others at the time of cancer surgery were associated with higher oxytocin levels. (However, a person’s perceived closeness with others was not related to higher oxytocin levels.)

“Nurturance is consistent with the oxytocin-focused ‘tend and befriend’ hypothesis of female coping and stress response,” wrote the team, led by Michaela G. Cuneo at the University of Iowa. Thus, even though this research is in the early stages, feeling needed by others could have protective health effects for women with ovarian cancer.

Similarly, another team of researchers at the National Cancer Institute and the University of Wisconsin–Madison found that strong, supportive relationships between cancer patients and their caregivers were associated with better self-reported health for both parties.⁴ This was especially the case for those dealing with lung cancer, where social support was linked to better self-reported health 12 months after diagnosis. Dannielle E. Kelley and coauthors speculate that there may be a beneficial “partner effect” for lung cancer that can counter internalized and social stigmas associated with the disease for former smokers.

Social connections might also help a patient adopt more healthful behaviors after diagnosis—but the benefits could depend on their education level. According to Won-tak Joo of the University of Florida, college graduates have more robust health conversations with people in their social networks at the time of diagnosis, which may help explain why they are more successful at improving their health behaviors and show a better prognosis than those with lower education levels.⁵

“The cultivation of health discussion may be more active in earlier stages of illness when patients require external support to adapt to new lives with diseases,” writes Joo. For older adults with lower levels of education, Joo finds that both social networks and health conversations decline with disease diagnosis, suggesting a need for interventions to help this group.

Researchers are also studying how social ties affect the health of older people with disabilities. Karen L. Fingerman of the University of Texas at Austin and colleagues find that those with limiting disabilities were more likely to attend medical appointments when spending time with friends and family.⁶ And Sophie Mitra of Fordham University and coauthors report that older adults with disabilities have as much close, regular contact with partners, family, and friends as those without disabilities.⁷ For those with disabilities and others with serious medical conditions, social connectedness may lead to help with activities that improve their health and well-being.

Connectedness also affects our health in ways that ultimately impact our sleep. A recent study from China’s Xi’an Jiaotong University, the University of Texas at Austin, and the University of Maryland found that socially isolated older adults—those with smaller and less intimate relationships—had more depressive symptoms, were lonelier, and had more chronic diseases and pain, all of which contributed to greater sleep difficulty.⁸ Dan Zhang and coauthors argue that improving older adults’ social connections could enhance their mental, physical, and sleep health.

A Lifetime of Experiences Shape Social Connections at Older Ages

Some groups of people are more likely to be socially isolated than others, report Debra Umberson of the University of Texas at Austin and Rachel Donnelly of Vanderbilt University.⁹ Older married women may become socially isolated when a spouse needs round-the-clock care, while men who either never marry or divorce may begin experiencing social isolation in young adulthood.

In addition, non-Hispanic Black and Hispanic older adults are more likely to experience social isolation than non-Hispanic older white adults, they found (see Figure 1). Black and Hispanic Americans’ social isolation could be related to the impact of lifetime discrimination and financial stress, the researchers suggest. Using HRS data, the study measured isolation among adults ages 50 and older based on whether they are married or cohabiting, participate in volunteer activities, and have contact with parents, children, and neighbors.

Figure 1. Older Non-Hispanic Black Americans Experience Higher Levels of Social Isolation Than Other Groups

Mean Levels of Social Isolation Among U.S. Adults Ages 50 and Older in the Health and Retirement Study, by Race/Ethnicity

Source: Debra Umberson and Rachel Donnelly, “Social Isolation: An Unequally Distributed Health Hazard,” Annual Review of Sociology 49, no. 1 (2023): 379-99. 

Another study out of Johns Hopkins University estimated that nearly one in four (24%) of older Americans living in the community are socially isolated, and one in 25 (4%) are severely isolated.¹⁰ To measure isolation, they examined participants’ living arrangements, religious attendance, social activities, and the number of people they spoke with about important matters. The study used data from the National Health and Aging Trends Study, which includes a nationally representative sample of Medicare beneficiaries ages 65 and older.

Being unmarried, male, and having low education and income levels increased the odds of being socially isolated, according to the analysis, led by Thomas Cudjoe. Specifically, men were four times as likely as women to be severely isolated, while people with annual incomes below $30,000 were twice as likely as people with incomes over $60,000 to be severely isolated. These findings offer “easily identifiable” factors to help program planners target those most at risk, the researchers wrote, noting that living arrangements, discussion networks, and social activities can all be modified to improve social connections.

Calling social isolation “an unequally distributed health hazard,” Umberson and Donnelly urge future researchers to undertake “a systematic assessment of social conditions that foster isolation over the life course” to better understand the root causes and identify ways to reduce isolation among those most at risk.

“We need to understand why people become more isolated over their lives, because social isolation is a public health issue,” Umberson said. “People became more concerned about isolation in the wake of Covid-19 because we were all more isolated for several years, but this is a problem that’s likely to become more serious, not less.”¹¹

The stability of older adults’ lives may also contribute to richer social networks. While younger adults experienced turnover in social networks after a major life transition, such as getting married or having children, older adults maintained relatively stable social networks after such changes, including retirement, changes in marital status, or becoming empty nesters, found Jordan Weiss and team at the University of California, Berkeley.¹² The authors suggest that for older adults, having stable, long-term (often decades-old) relationships make for more reliable networks.

A person’s temperament also may influence their lifelong social ties. Using NSHAP data, James Iveniuk at the University of Toronto finds that among older Americans, personality traits such as extraversion and agreeableness were associated with stronger social ties than openness, conscientiousness, or neuroticism.¹³ Thus, certain personality traits may strengthen the social connections linked to health benefits.

Social Networks May Protect Mental Health and Prevent Cognitive Decline

Older adults’ social networks may protect both their mental health and cognitive abilities. Getting help with daily activities may be an important reason why—since many older adults need assistance bathing, getting in and out of bed, and doing other tasks, some built-in social interaction can accompany aging. But feelings of closeness and companionship may also help stave off memory loss, loneliness, and depression—and may matter as much or more than geographic proximity or number of family or friends, new research shows.

To try to understand the importance of relationship quality, Sarah Patterson of the University of Michigan and Rachel Margolis of the University of Western Ontario looked at four groups of older adults with different types of family connections: those who were geographically and emotionally close with family; those who were kinless and without a partner or children; those who were distanced and lived far from family; and those who were disconnected and had no family members in their social network or did not know where they lived.¹⁴

“We were interested in understanding how much the presence of family ties matters for older adults’ well-being but also in measuring the quality of those relationship ties,” said Patterson.¹⁵

They found that older adults who lived near family members and discussed important concerns with them were less likely to report unmet need for help with daily activities than the other groups (see Figure 2). Meanwhile, those who reported no partner or family or disconnection had the poorest mental health and socialized less often—even less than those who lived far away from their family.

Figure 2. Older Adults Who Are Close to Family Get More Help With Activities

Share of adults ages 70 and older reporting unmet need for help with activities by type of family connections, 2015–2019

Source: Sarah E Patterson and Rachel Margolis, “Family Ties and Older Adult Well-Being: Incorporating Social Networks and Proximity,” The Journals of Gerontology: Series B, Volume 78, no. 12 (December 2023): 2080–89.

The findings suggest that the presence and strength of family ties matter for older adults’ mental health. “As families continue to evolve, researchers should strive to capture the size and shape of family networks, as well as the level of connection that older adults have with those kin,” the authors note.

In fact, social connections can also produce distress. Stephanie T. Child and Leora E. Lawton of UC Berkeley found that social companionship and emergency help mattered most to older adults, whereas having more people from whom they sought advice was related to more psychological distress.¹⁶ The findings suggest that mental well-being may be enhanced by enjoyable and helpful relationships, while those that are more demanding may detract from it. Data are from the UC Berkeley Social Networks Study (UCNets), which includes a locally representative sample from across the San Francisco Bay Area in California.

In a similar study, the Berkeley authors found that those who were more dissatisfied with their social networks also experienced more loneliness and isolation.¹⁷ Interestingly, it wasn’t the number of connections but the closeness of the relationships—especially with family—that buffered loneliness. Further, having a romantic partner helped older adults feel less isolated.

As Child and Lawton write, “evaluations about one’s own social network, including whether someone feels satisfied in the number or quality of connections they have to call on for social engagement or support, may be a more meaningful precursor of loneliness.”

Similarly, social engagement may be connected to cognitive benefits. Using Michigan Cognitive Aging Project data, Abbey M. Hamlin at the University of Michigan and colleagues find important differences by race in both social engagement and its connection to cognition.¹⁸ Older white, non-Hispanic adults engaged in more social activities than their Black peers, and those activities were linked to better episodic memory—or the recall of information from the past—and thus better cognitive health. The findings suggest that social isolation is not only more prevalent among older non-Hispanic Black adults, but also that it may be taking a toll on their cognitive well-being.

Marriage Has Diverse Effects on Older Adults’ Health

Several recent studies build on the well-established link between marriage and better physical and psychological health in old age, particularly for men. They examine some of the ways marriage may benefit health as well as the connections between marriage and other forms of social interaction.

New research finds that marriage can help men be less socially isolated throughout their lives. Umberson of University of Texas at Austin, Zhiyong Lin of University of Texas at San Antonio, and Hyungmin Cha of USC show that men tend to be more isolated in adolescence and young adulthood, while women tend to experience isolation in later life.¹⁹ Their analysis of HRS data shows that levels of social isolation increase with age for both men and women.

But gender patterns differ by marital history (see Figure 3). Among older adults in stable marriages, women are less isolated than men until age 60, but by age 68, men are slightly less isolated than women. This gender gap shrinks at older ages for those who have experienced marital disruptions, possibly because chronic health issues contribute more to social isolation among women, the authors note.

Figure 3. Social Isolation Increases With Age, but Gender Patterns Differ by Marital History

Age Trajectories of Social Isolation Among Adults Ages 50 and Older, by Gender and Relationship History, 1998-2012

Source: Debra Umberson, Zhiyong Lin, and Hyungmin Cha, “Gender and Social Isolation Across the Life Course,” Journal of Health and Social Behavior 63, no. 3 (2022): 319-35. 

There may be an unexpected physiological explanation for some of marriage’s health benefits. Drawing on lessons from primate research and using stool samples from a subset of participants in the long-running Wisconsin Longitudinal Study, researchers affiliated with the University of Wisconsin-Madison find that spouses in self-described close marriages tend to have more diverse and healthful gut microbiota compared with siblings, people without a partner, or married couples in less close relationships.²⁰ Less diverse gut microbiota is related to obesity, cardiac disease, type 2 diabetes, and other inflammatory disorders, Kimberly Dill-McFarland and coauthors note.

Not all marriages are equal when it comes to social support and its potential health effects. Both men and women in same-sex marriages are more likely than those in different-sex marriages to offer concrete support to a spouse in distress, such as taking over chores or giving extra personal time, found Mieke Thomeer of the University of Alabama at Birmingham, Amanda Pollitt of Northern Arizona University, and Umberson.²¹ The team used a survey of 378 midlife couples ages 35 to 65.

Relationships can be a source of stress as well as support, and individuals in a marriage with a difficult or demanding partner experience a similar degree of loneliness as single people and more loneliness than other married people, another study finds.²² Shira Offer’s research at UC  Berkeley draws on UCNets data to identify these differences and finds that the same is true for tough relationships with adult children.

Two other studies offer new insights into the mental health toll of the loss of a spouse due to death, separation, or divorce. People with less than a high school education face a higher risk of losing a spouse than people with more education, research using HRS data shows. But higher education levels do not lessen symptoms of depression when divorce, separation, or death does occur, find Claudia Recksiedler of the German Youth Institute and Robert S. Stawski of Oregon State University.²³

People who lose a spouse often receive helpful support from social networks. Using NSHAP data, James Iveniuk of the Wellesley Institute and coauthors find that friends and family of older adults respond with social support after the death of a spouse, but less so when a close friend or other confidant dies.²⁴

Good Neighbors (and Neighborhoods) Are Good for Well-Being

Multiple studies have shown that a neighborhood’s physical features—from broken sidewalks and high crime to plentiful parks and low air pollution—are related to older residents’ health and quality of life.²⁵ Not surprisingly, the places older people call home also shape their social connections, thereby influencing both their physical and mental health.

Neighborhood social ties may promote sensory health, a study using NSHAP data shows. Older adults who have more social connections in their neighborhoods report better self-rated vision than those who have fewer connections, find Alyssa Goldman of Boston College and Jayant Pinto of the University of Chicago.²⁶ More social ties may lead to more time spent engaging with people and places outside of the home, protecting visual abilities, the researchers suggest. Good vision is key to older adults’ ability to safely navigate their environment, they add.

For caregivers, social support can counteract the negative effects of living in less-connected neighborhoods. Researchers at the University of California, Davis and the University of Michigan show that neighborhoods with low social cohesion—lacking a sense of community and trust among neighbors—can take a toll on mental health in the absence of social support.²⁷ This is particularly true for dementia caregivers, who face a high risk of depression related to the emotional and physical burden of their work. But dementia caregivers living in neighborhoods with low social cohesion had fewer symptoms of depression if they had family and friends to talk to and help with daily tasks, Oanh Meyer and team found.

Community-level interventions focused on increasing neighborhood connections—such as caregiver support groups in disadvantaged neighborhoods—could be important for maintaining caregiver health, the research team suggests.

The proximity of one’s close friends also makes a difference for mental health, reports Keunbok Lee of UCLA.²⁸ Older adults with fewer confidants who live nearby show more severe depression symptoms when faced with traumatic events than those with more close friends in their neighborhood, according to Lee’s study of UCNets data.

Local opportunities for social connection may strengthen social ties and help prevent suicide. A new study finds that suicide rates are much lower among working-age adults, including people ages 51 to 64, in counties with more places for people to connect, such as public libraries, community centers, religious groups, coffee shops, diners, and entertainment and sports venues.²⁹ These findings held true even when the researchers accounted for differences in health care availability, age, education, race/ethnicity, and proximity to metropolitan areas.

Gathering places, part of the social infrastructure, may buffer suicide risk and improve mental health by boosting social connections, reducing social isolation, and facilitating social support, trust, and information and resource sharing, report Xue Zhang and Danielle Rhubart of Penn State University and Shannon Monnat of Syracuse University. Local governments should consider partnering “with market-based services and social service agencies to increase the availability, access, and use of spaces that promote social interaction,” they write. In addition to helping to lower suicide rates, building more robust social infrastructure may also support overall health, they suggest.

Living Alone Linked to Social Isolation and a Variety of Health Risks

Research has established that living alone at older ages raises the risk of poor health, early death, and dementia. New evidence demonstrates that living alone for extended periods increases the risk of dementia more strongly than previously thought.³⁰ Every two years of living alone is linked to about a 10% increase in the risk of dementia, according to study authors Benjamin A. Shaw of the University of Illinois Chicago, Tse-Chuan Yang of the University of Albany, and Seulki Kim of the University of Nebraska.

Social isolation may explain this dynamic. Their analysis, based on HRS data that tracked more than 18,000 older Americans for 18 years (2000 to 2018), suggests that a lack of mental stimulation combined with limited day-to-day companionship may increase stress “that, over time, could accumulate and eventually lead to cognitive impairment.”

Another recent study shows that the impact of social isolation extends to diet and nutrition. Analysis of data from an HRS nutrition survey shows that older adults—particularly men—living alone with no adult children or friends in their neighborhood had the lowest fruit and vegetable intake.³¹ Lack of motivation to cook and eat healthy may explain this pattern, according to Yeon Jin Choi, Jennifer A. Ailshire, and Eileen M. Crimmins of USC.

Because fruits and vegetables provide key nutrients for maintaining health and protecting against age-related diseases, the researchers recommend local agencies consider ways to improve social engagement among older adults who live alone to boost health outcomes. They also suggest providing help with grocery shopping (such as transportation) and meal preparation (including home-delivered meals).

Virtual Interaction Cannot Fully Replace the Health Benefits of Face-to-Face Contact

Phone calls and Zoom or FaceTime gatherings replaced in-person get-togethers for many people during the COVID-19 pandemic shutdowns, but a growing body of research suggests virtual interaction cannot fully replace face-to-face contact. Two recent studies, one led by Namkee Choi at the University of Texas at Austin and the other by Louise Hawkley at NORC at the University of Chicago, show that older adults who had less in-person time with family and friends and more phone calls during the first year of the pandemic were more likely to experience loneliness.³²

Older people with impaired hearing or vision may be an exception—phone and video chats appear to have protected them in 2020 from depressive symptoms, find Amanda Zhang and colleagues at the University of Chicago.³³ One reason may be that phone calls are important for the mental health and mood of people with small social networks, replacing some of the day-to-day interactions that shrink with age and physical impairment, report Yijung K. Kim and Karen L. Fingerman of the University of Texas at Austin, based on another study.³⁴

At the root of these mixed findings on digital versus in-person interaction may be the immune system. A team of researchers from Colorado State University and UCLA show that face-to-face interaction protects health-promoting immune functions in ways that digital contact does not.³⁵ They examined the gene activity that stimulates inflammation and inhibits antiviral responses in the blood of adult study participants during the COVID-19 social distancing period. Participants who had mainly online social contact had higher levels of such unhealthy gene activity than those who had more in-person social contact.

“Digitally mediated social relations do not appear to substantially offset the absence of in-person/offline social connection,” the research team concluded.

Policy Implications

As many as one in four older Americans are socially isolated and face an increased risk of poor health and early death. The research documented in this report underscores the links between strong social ties and longer, healthier lives. U.S. Surgeon General Vivek H. Murthy has called for making social connectedness a national priority, “the same way we have prioritized other critical public health issues such as tobacco, obesity, and substance use disorders.”³⁶ His recent advisory, Our Epidemic of Loneliness and Isolation, identifies multiple actions based on growing research evidence, including:  

• Strengthening social infrastructure: Social ties are not just built by person-to-person interactions, but by the physical elements (parks, libraries, sidewalks, and benches) and the programs and policies in place. Communities can design environments, establish and expand programs, and invest in institutions that bring people together.
• Enacting pro-connection public policies: National, state, local, and tribal governments can play a role in establishing policies for accessible public transportation, paid family leave, and other supports that can enable more connection among communities and families.

Social Isolation and Loneliness Among Older Adults: Opportunities for the Health Care System, a recent report from the National Academies of Sciences, Engineering, and Medicine, details ways health care organizations can address social isolation among older people by better educating their staff to intervene and aligning with other community agencies. Specific recommendations include:

• Partnering directly with ride-sharing programs to help older adults’ get to medical appointments and community events.
• Working with community organizations to integrate social activities and in-person interaction into hospital discharge planning, care coordination, and transitional care planning.

“Our relationships are a source of healing and well-being hiding in plain sight,” Murthy said, “one that can help us live healthier, more fulfilled, and more productive lives.”³⁷

PRB’s World Population Data Sheet is an excellent reference and data analysis tool. Instructors are encouraged to have their students use the Data Sheet for a variety of topics and activities. This lesson plan includes a series of short activities that allow students to access a wealth of data on the world, regions, and individual countries, and develop their data literacy skills and knowledge of geography.

Note: The lesson plan is designed to be used with every edition of the World Population Data Sheet; updates will be made available as needed to reflect changes in indicators. You can find the latest date of revision noted at the end of this page and in each lesson plan file available for download (PDF, PowerPoint).

Grade Level
6–12.

Time Required
One class period for each of activity.

Standards Addressed
Math and geography.

Vocabulary/Concepts
Population size, birth rate, death rate, GNI, infant mortality rate, total fertility rate, life expectancy, age distribution.

LEARNING OBJECTIVES

Activity 1: PRB’s World Population Data Sheet at a Glance

• Identify a country’s population characteristics using the World Population Data Sheet.
• Rank countries highest/lowest in a population indicator.

Activity 2: Profile a Country

• Practice organizing a country’s population information into a country profile.
• Hypothesize about the data in the country profile.

Activity 3: Map the Data

• Illustrate countries’ selected population characteristics on a map.
• Compare the illustrated population characteristics of selected countries.

SUPPORTING MATERIALS

All activities may be used with PRB’s International Data Center (https://www.prb.org/international/), which houses all the data from the most recent World Population Data Sheet except net migration. Data can be accessed and displayed as a map or table and downloaded. PRB’s Population Handbook, 6th edition (2011) is also a valuable resource.

You will also need:

• All activities: The latest World Population Data Sheet (PDF: 2.5MB)
• Activity 2: County Profile Worksheet (PDF: 117KB)
• Activity 3: Country Outline Map (PDF: 225KB) Country outline maps for classroom use, including those for individual world regions, may be found online in a number of places.

The activities in this lesson plan were adapted from exercises submitted by Eugene J. Kinerney of the University of the District of Columbia and Basheer K. Nijim of the University of Northern Iowa. It was last updated in 2024 by Nancy Matuszak, PRB.

New data released today by PRB and the Appalachian Regional Commission shows that rates of labor force participation, educational attainment, income, and poverty continue to improve in Appalachia.

The 14th annual update of The Appalachian Region: A Data Overview from the 2018-2022 American Community Survey draws from the latest American Community Survey and comparable 2022 Census Population Estimates. Known as “The Chartbook,” the report contains more than 300,000 data points comparing Appalachia’s regional, subregional, state, and county economic status with the rest of the nation.

Key improvements in the region’s economic indicators are as follows.

Increased income and lower poverty rates

• Poverty rates declined in every Appalachian subregion, state, and type of county (urban and rural). The region’s overall poverty rate (14.3 percent) decreased two percentage points between 2013-2017 and 2018-2022.
• Median family income increased 9.3 percent between 2013-2017 and 2018-2022, which was on par with national median income growth.
• All income measures increased for every subregion, state, and type of county (urban and rural)—even after adjusting for inflation.

Higher educational attainment and labor force participation

• The share of individuals ages 25 and older who held Bachelor’s degrees increased by three percentage points, with more than one in four Appalachian adults reaching or surpassing this level of educational attainment in 2022.
• Between 2013-2017 and 2018-2022, labor force participation increased in every Appalachian subregion and type of county (urban and rural).

Increased population growth in south

• Southern Appalachia’s population increased 11.8 percent between 2010 and 2022, which surpassed the nation’s population growth average by more than four percentage points.

Increase in broadband access

• The share of Appalachian households with at least one computer device rose 8.6 percentage points between 2013-2017 and 2018-2022, while the share with broadband internet access increased by 12.2 percentage points. Both increases surpassed the national average, with federal and state programs designed to narrow persistent gaps in digital resources likely contributing to improvements.

“We celebrate the progress Appalachia has made, including declined poverty rates and increased broadband access. However, we know that there is still much work to be done for our entire region to reach economic parity with the rest of the country,” said ARC Federal Co-Chair Gayle Manchin. “ARC will continue to prioritize the quality of life of Appalachia’s 26 million residents, and remains committed to continued collaboration across federal, state, and local levels to ensure our people have a bright future.”

Despite positive trends, several data points revealed vulnerabilities that emphasize the inequities in Appalachia compared to the rest of the nation:

Overall population decline

• Nearly 60 percent (252) of the region’s 423 counties saw a population decline between mid-2010 and mid-2022. Rural counties were especially susceptible—77 of the 107 rural Appalachian counties lost residents.

Poverty rates for children and families and specific counties

• Though regional poverty rates have declined overall, rates have stayed the same or increased in 76 Appalachian counties. Poverty rates are highest for Appalachians under 18 (19.2 percent) and ages 18-24 (22.1 percent).
• Though the percentage of Appalachian households receiving payments from the federal Supplemental Nutrition Assistance Program (SNAP) decreased slightly more than the national average, participation was still higher (over 13 percent) compared to all U.S. households (over 11 percent). Participation of Central Appalachian households reached more than 20 percent.
• For households with children under the age of 18, Appalachia’s SNAP participation rate (21 percent) is nearly three percentage points higher than all U.S. households.

Disability and poverty in older adults

• Appalachia’s population trends older than the nation as a whole, with individuals ages 65 and older reaching at least 19.5 percent in 292 Appalachian counties.
• Additionally, the percentage of Appalachians ages 65 and older with a disability is more than three percentage points higher than the national rate. This was also the only age group for which poverty rates increased slightly.

Despite gains in access, digital divides persist

• Even with higher-than-average increases, Appalachian households still lagged nearly four percentage points behind U.S. rates for broadband subscriptions and device ownership. In 73 Appalachian counties, households were at least 13.3 percentage points below the U.S. average for broadband subscriptions. This gap in high-speed internet connectivity impacts residents’ access to remote work, online learning, telehealth, and more.

“The data in this year’s Chartbook highlight strides being made in the Appalachian Region, with noteworthy improvements across economic, educational, and health-related measures,” said Sara Srygley, a senior research analyst at PRB. “Yet, these data also emphasize considerable variation throughout the region—particularly the persistent challenges facing rural communities.”

The data show that Appalachia’s rural areas continue to be more vulnerable than its urban areas. Appalachia’s 107 rural counties are also more uniquely challenged, compared to 841 similarly designated rural counties across the rest of the U.S. Though rural Appalachians did have higher health insurance coverage than the rest of rural America, rural Appalachian counties continue to lag behind on educational attainment, labor force participation, broadband access, household income and population growth.

The Appalachian Region: A Data Overview from the 2018-2022 American Community Survey was written by PRB and the Appalachian Regional Commission.

In addition to the written report, ARC offers companion web pages on Appalachia’s population, employment, education, income and poverty, computer and broadband access, and rural Appalachian counties compared to the rest of rural America’s counties. For more information, visit www.arc.gov/chartbook.

About the Appalachian Regional Commission

The Appalachian Regional Commission is an economic development entity of the federal government and 13 state governments focusing on 423 counties across the Appalachian Region. ARC’s mission is to innovate, partner, and invest to build community capacity and strengthen economic growth in Appalachia to help the region achieve socioeconomic parity with the nation.

In 2020, Uganda began the process of developing a national self-care guideline for sexual and reproductive health and rights. The guideline was based on the World Health Organization (WHO)’s guideline on self-care, released in June 2019 and revised in 2022.

Uganda’s process to develop and test this guideline, led by the Ministry of Health, an expert panel, and a national consultant from Samasha Medical Foundation, was effective in creating a policy tailored to the Ugandan context. The innovative approach also included pilot testing the draft guideline at the subnational level to inform revisions before national launch and scale-up.

Under USAID’s PROPEL Health project, PRB partnered with Samasha Medical Foundation to create a how-to guide based on this work. “Localizing WHO Guidelines on Self-Care: A Practical Guide From Uganda” documents Uganda’s approach and illuminates a five-phase guideline development process that may be helpful for other countries looking to nationalize the WHO guideline. For each phase, the guide shares the purpose and objectives, Uganda’s experience, lessons learned, and suggested activities and tools.

Learn more about PROPEL Health

En 2020, l’Ouganda a entamé le processus d’élaboration de directives nationales pour l’autosoin pour la santé et les droits sexuels et reproductifs. Ces directives sont basées sur les recommandations de l’Organisation mondiale de la santé (OMS) sur l’autosoin, publiées en juin 2019 et révisées en 2022.

Le processus de l’Ouganda pour développer et tester ces directives, conduit par le ministère de la Santé, un panel d’experts et un consultant national de Samasha Medical Foundation, a été efficace pour créer une politique adaptée au contexte ougandais. L’approche innovante a également inclus un test pilote de l’ébauche de la directive au niveau infranational pour révision avant le lancement et le déploiement national.

Dans le cadre du projet PROPEL Health de l’USAID, PRB s’est associé à Samasha Medical Foundation pour créer un guide pratique basé sur ce travail. « Localiser les recommandations de l’OMS sur l’autosoin : un guide pratique de l’Ouganda » documente l’approche de l’Ouganda et illustre un processus de développement de directives en cinq phases qui pourrait être utile pour d’autres pays souhaitant adopter les recommandations de l’OMS. Pour chaque phase, le guide présente l’objectif et les objectifs, l’expérience de l’Ouganda, les leçons apprises et les activités et outils suggérés.

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Children and youth with special health care needs (CYSHCN) who receive family-centered care generally have better health outcomes, research shows. When health care providers engage and prioritize the needs of the family, CYSHCN enjoy better overall health; better access to coordinated, ongoing, comprehensive health care within a medical home; fewer emergency department visits; and fewer unmet health needs.

Yet in the United States, CYSHCN families from disadvantaged groups face barriers to receiving high-quality family-centered care, according to a new analysis of national survey data by Paul Morgan, now at the University at Albany, SUNY, and colleagues at Penn State University and SRI International.¹

The researchers assessed family-centered care by measuring the extent to which doctors or other health providers:

• Spent enough time with the child.
• Listened carefully.
• Showed sensitivity to the family’s values and customs.
• Provided the family with specific information they need concerning the child.
• Helped the family feel like a partner in the child’s care.

Data were from the 2016–2019 National Survey of Children’s Health (NSCH), which uses a five-question screener to identify CYSHCN.

The study focused on the quality of care received by CYSHCN families in visits to health professionals in the previous year and controlled for potentially confounding factors including children’s general health status and the severity of their impairments.

Socioeconomic Background Is Tied to the Quality of Family-Centered Care

Morgan and colleagues found that some CYSHCN families report greater barriers to receiving high-quality family-centered health care, including:

• Families without consistent health insurance coverage.
• Poor and lower-income families.
• Single-parent families.
• Families who usually receive care in a clinic or health center, emergency room, or other setting outside a doctor’s office.
• Families of children with autism spectrum disorders, anxiety, or depression.

By contrast, families of CYSHCN with asthma—the most commonly reported special health care need—were significantly more likely to receive family-centered care than families of CYSHCN without asthma.

The results did not show consistent racial/ethnic disparities across all the measures of family-centered care—a finding that surprised the researchers. However, families of Black and Hispanic CYSHCN reported that providers spent relatively less time with their children compared with families of white CYSHCN. Families of Hispanic CYSHCN also said that providers showed less sensitivity to their family’s culture and customs.

A Targeted Approach Could Help Improve Care

Evidence from the study suggests that socioeconomic factors, rather than race or ethnicity, are central drivers of disparities in family-centered care among CYSHCN in the United States. To address these disparities, policies and systems of care serving these young people and their families can adopt comprehensive, coordinated approaches to increase provider-family engagement, cultural responsiveness, and shared decision-making, the authors noted.

To help particularly vulnerable CYSHCN families, targeted actions should focus on care provided in emergency departments, community clinics/health centers, and other non-office settings, and on providers caring for children with autism spectrum disorders or internalizing disorders, the authors suggested.

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from Penn State University was highlighted.

During the early weeks of the COVID-19 pandemic, it became clear that older Americans faced a higher risk of serious illness and death from infection. As COVID-19 spread rapidly across the country, public health officials focused on containing the virus through unprecedented restrictions on travel and social gatherings. Many older adults were isolated from their families, friends, and caregivers to protect them from the disease.

But protecting older adults’ physical health came at a cost. Researchers have linked prolonged social isolation and loneliness to serious physical and mental health issues, including high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease, and even death.¹

Four years after the pandemic’s onset, new research is starting to uncover the effects of social isolation on the mental health of older Americans. This report summarizes key findings by researchers who, with the support of the National Institute on Aging (NIA), studied the impact of the pandemic on the mental health of older adults and their caregivers. The results can help health officials make informed decisions in the event of another public health emergency—and deliver better care to the millions of older adults dealing with lingering mental health issues from the pandemic.

Isolation Made People Feel Lonelier

The pandemic amplified longstanding problems of social isolation and loneliness among older people, according to Eun Young Choi of New York University and colleagues at the University of Southern California.² Their study, based on self reporting from the 2020 Health and Retirement Study (HRS) COVID-19 module, found that nearly one-third (29%) of adults ages 54 to 74 felt lonelier in 2020 and 2021 than before the pandemic began.

Respondents who said they lacked in-person contact or had poor relationships with family, friends, or neighbors since the pandemic were more likely to report increased loneliness. Older adults tended to feel more “isolated when faced with a sudden social shrink in the availability of social resources and support from everyday interactions,” the researchers observed. They pointed to the social psychology theory of loneliness, which maintains that an “unfulfilled need for social connection leads to loneliness.”

Groups not usually considered at risk—middle-aged adults, women, non-Hispanic whites, and the most educated—were the most likely to report increased loneliness (Figure 1). The researchers suggested that older adults without previous experience of social isolation “may lack coping strategies in the face of the removal of social contacts.”

FIGURE 1. Female, White, and Highly Educated Older Adults Were Most Likely to Feel Lonelier During Pandemic

Percent of U.S. Adults Ages 54 and Older Experiencing an Increase in Loneliness in 2020 and 2021, by Characteristic

Source: Eun Young Choi et al., “Changes in Social Lives and Loneliness During COVID-19 Among Older Adults: A Closer Look at the Sociodemographic Differences,” International Psychogeriatrics 35, no. 6 (2023): 305-17.

In a related study, Choi and colleagues found that older adults who avoided close contact with people in their household or who canceled or postponed social activities during the pandemic were more likely to report feeling lonely.³ Data were from the Understanding America Study, a nationally representative online survey.

Given that older adults will likely practice social distancing in future outbreaks, the researchers argued for rethinking public health practices to identify strategies for older adults to be together safely—in ways that protect them from both infection and social isolation.

Deaths, Loneliness, Finances Taxed Mental Health

Around the world, millions of people lost family members during the pandemic. Using data for 26 European countries and Israel from the Survey of Health, Ageing and Retirement in Europe (SHARE), Haowei Wang of Syracuse University and colleagues found that adults ages 50 and older with spouses who died of COVID-19 were more likely to report feeling depressed or lonely than their peers who lost a spouse before the pandemic.⁴

“Many deaths during the pandemic likely became more traumatic for their loved ones due to fear of seeking medical care and hospitals restricting friends and family from visiting patients, all which likely made it difficult for people to process deaths regardless of its specific cause,” said co-author Ashton Verdery from Pennsylvania State University.

Researchers at the University of Michigan found that older Americans who isolated at home during the first six months of the pandemic faced unique and ongoing mental health risks. Data were from the COVID-19 Coping Study, which tracked the mental health of more than 4,000 Americans ages 55 and older monthly via an online snowball sample, which may overrepresent people with stronger social networks.⁵ University of Michigan researchers Lindsay Kobayashi and Jessica Finlay led the data collection.

Daily isolation at home was tied to elevated symptoms of depression and anxiety, and loneliness that persisted over time, the researchers found. Those who were previously isolated were most likely to experience depressive symptoms in the wake of pandemic isolation.

The Michigan team also found that older adults who were more worried and anxious reported more difficulties with cognitive function and abilities.⁶ They questioned whether such “acute changes in mental health during the pandemic will have long-term implications” for the future burden of dementia, and recommended more research on how a person’s fluctuations in mental health during the pandemic may affect cognitive decline in old age.

Older adults also worried more about their finances, other new research shows. Using data from the Understanding America Study, Fabrice Kämpfen and colleagues at the University of Pennsylvania found that one-third of U.S. adults felt depressed and anxious during the pandemic’s early days—mainly due to economic worries.⁷ This surprised the team, who had predicted that missing family and friends or fear of getting sick would supersede financial concerns.

In preliminary findings, Emily Wiemers of Syracuse University and colleagues reported that adults ages 50 to 64 were more likely to experience economic and mental health difficulties in the first year of the pandemic than those ages 65 and older, based on data from the nationally representative 2020 HRS COVID-19 module.⁸  The researchers hypothesized that adults eligible for Medicare and Social Security may have felt protected from some of the economic uncertainty of the early pandemic. “Perhaps family members buffered the neediest older adults from the most severe impacts of the pandemic,” they suggested.

People With Impairments, Young Adults Faced Extra Stressors

Older adults with visual and/or hearing impairments demonstrated resilience as they faced mental health challenges due to feeling socially isolated during the pandemic, reported Shu Xu of the University of Massachusetts Boston and colleagues.⁹ Using HRS data from 2018 and 2020, Xu and team found that older Americans with impairments reported fewer depressive symptoms than they did in 2018, while their peers without impairments reported an increase in depressive symptoms, suggesting that COVID-19 may have “leveled the field” among older adults. The researchers call for a better understanding of the factors that protect older adults’ mental health during public health crises.

According to research by Kira Birditt of the University of Michigan and colleagues, while COVID-19 affected people of all ages, young adults may have experienced the most stress, life changes, and social isolation related to the pandemic.¹⁰ Birditt and team found that older adults reported less life change due to the pandemic, which may explain their lower levels of stress compared with younger adults, who were more likely to experience disruptions in their employment, finances, and schooling. Data were from the nationally representative Surveys of Consumers.

Older Rural Residents Worried Less About the Pandemic, Despite Greater Challenges

Data from the COVID-19 Coping Study gathered in the early months of the pandemic showed little difference between urban and rural older Americans in reported mental health problems or social well-being, Carrie Henning-Smith of the University of Minnesota and colleagues documented.¹¹ Rural respondents, however, reported more use of social media and lower levels of concern about the pandemic. Both factors, the researchers noted, may have contributed to greater vaccine skepticism and higher mortality rates among rural residents in 2021.

Shannon Monnat of Syracuse University found more distinct rural-urban differences using data from the National Wellbeing Survey, gathered among U.S. adults ages 18 to 64 in early 2021.¹² Working-age Americans in rural areas, especially those closer to urban areas, were more likely to report testing positive for COVID-19 and having a close friend or family member hospitalized with the virus. They were also more likely to seek treatment for mental health symptoms and to experience economic hardship, such as being late on rent, mortgage, or other bills.

Both studies suggest important policy implications, from funding mental health services and expanding access to telehealth to ensuring the availability of accurate health information on social media. Monnat underscored the importance of measures to promote economic recovery for rural residents in the wake of the expiration of state and federal programs and measures such as eviction moratoria and unemployment benefits, which cushioned the impact of COVID-19 shutdowns for many.

Family Caregivers Faced Stressful Decisions and Facility Restrictions

To protect older adults from exposure early in the COVID-19 pandemic, many family members and friends changed the amount of time they spent providing unpaid care, Amanda Leggett and colleagues at the University of Michigan found.¹⁵

Nearly one-third (30.5%) of informal caregivers increased the time spent helping older adults with functional limitations, while 11.5% began providing fewer hours of care, according to their analysis of data from the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare-eligible Americans and their unpaid caregivers.

Some adult children and other relatives provided less care “to reduce the risk of spread, whereas others increased care to keep the care recipient in the home and to help with the increasing care needs during the pandemic,” the researchers explained.

Caregivers who increased their hours reported higher levels of anxiety, depressive symptoms, and signs of being overwhelmed than those whose caregiving hours were unchanged. Programs to support caregivers, such as food delivery or in-home nursing services, may “reduce overload and enhance mental well-being” among those who take on additional care tasks, Leggett said.

Caregivers who cut their hours also reported significantly more emotional difficulties than those whose hours stayed stable. One key reason is that many family caregivers also reported losing access to their loved ones who lived in residential facilities during lockdowns, Leggett and colleagues documented.

In more new research, Norma Coe and Rachel Werner at the University of Pennsylvania found that family and friends spend a significant amount of time providing unpaid help to older adults living in institutional settings.¹⁶

On average, older adults with informal caregivers receive 65 hours of care per month if they live in a residential care facility (such as assisted living) and 37.4 hours per month in a nursing home. Even for nursing home residents, the unpaid care hours family and friends provide are nearly equivalent to an extra full-time work week per month, they point out.

“Family members are an invisible workforce in nursing homes and residential care facilities, providing considerable front-line work for their loved ones,” they argued, based on their analysis of NHATS data.

“Visitor bans, aimed at protecting residents and staff members from the spread of the virus, prevented informal caregivers from entering facilities for substantial periods of time—more than a year for some residents,” Coe and Werner wrote. Several studies tie more depression and behavioral problems among residents to this lack of family interaction, especially among those with dementia, they reported.

Nursing home and residential care administrators also need to acknowledge that care from family and friends sometimes serves as a substitute rather than a supplement to formal care, they emphasized.

Access to Neighborhood Parks, Outdoors Improved Mental Health and Mood

Older urban residents with greater access to parks and green spaces had fewer symptoms of depression and anxiety early in the pandemic, found a team of researchers including Kobayashi and Finlay and Gabriela Bustamante of the University of Minnesota.¹⁷

By contrast, older suburban and rural residents relied less on public parks and expressed “feeling fortunate to live in areas with ample open space available that facilitated being outside without worrying about social distancing or infection risk,” the researchers reported based on the COVID-19 Coping Study.

“Small greenspaces, private gardens, and other natural environments promoted the mental health and well-being of older adults and contributed to their coping mechanisms during the first wave of the COVID-19 pandemic,” the researchers concluded. They suggested that urban planners consider the public health benefits of small-scale outdoor spaces along with larger formal parks.

But during 2020, a sizeable share of older U.S. adults limited the time they spent outdoors. Nearly one in three (32%) ages 70 and older went outside less often and 13% rarely or never left their homes, according to Namkee G. Choi, Diana M. DiNitto, and C. Nathan Marti of the University of Texas at Austin.¹⁸ The share of older adults going outside every day fell from 63% in 2019 to 53% a year later (Figure 2).

Figure 2. One in Eight Older Adults Rarely Went Outside in 2020

Past-Month Frequency of Leaving Home/Building to Go Outside Among U.S. Adults Ages 70 and Older, 2019-2020

Source: Namkee G. Choi, Diana M. DiNitto, and C. Nathan Marti, “Older Adults’ Frequency of Going Outside During the COVID-19 Pandemic: Associations With Physical Distancing, Health Status, and Fall Risk Factors,” Journal of Applied Gerontology 42, no. 2 (2023): 324-35.

Previously active older adults, women, and Black and Hispanic older adults ventured outside less frequently, they showed based on NHATS data. The top reasons given for not going outdoors included avoiding contact with non-household members and needing to use mobility devices such as walkers or canes.

The researchers recommended that aging services providers seek ways to enable older adults to increase outdoor activities safely, including offering diverse physical and social activities, providing appropriate transportation, and increasing the availability of mobility devices. Service providers should “pay particular attention to racial/ethnic minority older adults and those with mobility and cognitive health challenges,” they noted.

For Some, Virtual Interaction Was No Substitute for In-Person Interaction

Phone calls, Zoom or FaceTime gatherings, and other virtual communications became the norm for many people during the pandemic. Recent research shows that for some older adults, this was a mixed blessing.

Less in-person contact with family and friends and more virtual contact increased the likelihood that some older adults experienced loneliness, found another study from Namkee Choi and colleagues at the University of Texas at Austin.¹⁹

While most older adults did not experience increased loneliness during the COVID-19 pandemic, almost one-fifth (19%) did, the researchers reported based on NHATS longitudinal data, which allowed them to examine loneliness before and after the COVID-19 social distancing and containment measures.

All participants reported fewer in-person contacts with friends and families during COVID-19 isolation, while respondents experiencing more loneliness had more phone and virtual contacts with family and friends. This association between virtual contacts and loneliness held both for meetings with family and friends and for participation in “clubs, classes, and other organized activities.”

The researchers identified several reasons why increased virtual contacts may fail to counteract loneliness, including digital stress or burnout (especially for new users), Zoom fatigue, and eye strain. They added that virtual contact lacks the “embodied presence” and experience of human touch, and the opportunity to give or receive instrumental support such as grocery shopping or child care. This led them to a stark conclusion: “Virtual interaction is not an effective substitute for in-person interaction for older adults.”

In a separate study using data from the National Social Life, Health & Aging Project (NSHAP), Louise Hawkley of NORC at the University of Chicago and colleagues confirmed these findings: Older adults reduced their in-person contact with friends and family, and only a small percentage increased the frequency of remote contact.²⁰ During the pandemic lockdowns, people experiencing less in-person contact reported lower levels of happiness and more depressive feelings and loneliness, but these negative effects were not improved by more frequent virtual contact after accounting for the effect of less frequent in-person contact.

On the other hand, research by Amanda Zhang and colleagues at the University of Chicago found that video communications may protect older adults with hearing or visual impairments from depressive symptoms.²¹  These findings were based on NSHAP data collected between September 2020 and January 2021.

People with these impairments used phone and in-person communication but were much less likely to participate in video calling, email, texts, or social media during the pandemic. Video communications appeared to have strong positive effects on mental health, perhaps because they better simulated real-life contact, offering body language, facial expression, and other cues, Zhang and colleagues found. They recommended steps that improve usability of video-mediated communications for older people with impaired hearing or vision.

While Family Could Be Fraught, Keeping Up With Friends Was Beneficial

A study of pairs of parents and adult children by Woosang Hwang of Texas Tech University and colleagues at Syracuse University suggested another approach to understanding the effects of virtual communication on older adults.²² Adult children and their parents surveyed in 2021 and 2022 reported better mental health outcomes when their relationships were rated as strong—with frequent contact, including virtual communication—than when relationships had limited contact or conflict. In a similar 2022 study of South Korean parent-adult child pairs, those who reported strong relationships benefited most from virtual forms of contact.²³ Parents reported better well-being and adult children reported higher levels of life satisfaction, compared to those whose relationships were conflicted.

Virtual contact may be particularly ineffective for older people living alone, suggested Karen Fingerman and colleagues at the University of Texas at Austin, based on a small local survey conducted in May and June 2021.²⁴ For the one-third of respondents ages 69 and older who lived alone, phone and other forms of virtual contact did not improve their mood or emotional well-being. In fact, the researchers linked phone contact with higher levels of self-reported loneliness. They found that contact with friends—as distinct from family—was associated with improved well-being, and this link held for both in-person and phone contact.

Older adults who live alone likely spent more time with friends prior to the pandemic, and this contact felt familiar and comforting during the stressful lockdown period, Fingerman explained. “Friendships also tend to be voluntary and enjoyable, mitigating negative emotions during the lockdown, whereas family members can be a source of worry, tensions, and conflict, adding to the stress.”

Contact with friends and acquaintances may lead to greater levels of physical activity, contributing to health and well-being, reported Fingerman and colleagues in another study.²⁵ Data were from the Daily Experiences in Late Life Study of adults ages 65 and older in the greater Austin, Texas, area. “The results show us that these routine encounters have important benefits for activity levels and psychological well-being,” said co-author Debra Umberson. “This new information suggests the importance of policies and programs that support and promote routine and informal social participation.”

Can Policies Strengthen Social Connection?

Recent NIA-funded research shows that the pandemic affected older adults’ mental health. However, many older adults were experiencing anxiety, depression, and social isolation before the pandemic, and continued to struggle with mental health issues after social restrictions were lifted. The research presented here shows how having strong social networks can provide a buffer against the effects of pandemic protections and improve mental health. “Older adults with smaller or sparser personal networks may face challenges in receiving needed pandemic support,” said Molly Copeland and Hui Liu from Michigan State University. “Policies or interventions targeting individuals most needing pandemic support should consider risks for such relatively isolated older adults.”²⁶

Providers and policymakers could improve the lives of people in residential care facilities and their caregivers by acknowledging, incorporating, and supporting the informal care workforce, Coe and Werner report. Possible interventions include:

• Integrating family caregivers into the care team, including paying them for their care and providing them with formal training.
• Prioritizing safe visits from family members during emergencies.
• Including family caregivers in prioritization formulas for vaccines during future pandemics.

Developing more user-friendly virtual communication tools could help older adults stay connected with family and friends, but research suggests these tools should supplement—not replace—in-person interactions. Helping older adults participate in outdoor activities could improve mental health, particularly for those living in neighborhoods lacking green space, research suggests.

Organizing volunteer activities could help older adults stay active in their communities. NIA-supported research by Steve Cole at the University of California, Los Angeles shows that helping others through caregiving or volunteering also helps people feel less lonely.²⁷ “Working for a social cause or purpose with others who share your values and are trusted partners puts you in contact with others and helps develop a greater sense of community,” he notes. The U.S. Surgeon General calls for a “culture of connection” to address the “devastating impact of the epidemic of loneliness and isolation in the United States.” Social connection is the “medicine hiding in plain sight,” he argues.²⁸

PRB’s analysis of the Survey of Household Economics and Decisionmaking revealed that young adults who lived with their parents during the 2017–2022 period were more economically strained than those who did not. For example, compared with peers in other living arrangements, young adults living at home with their parents were more likely to earn below the median income for their age group, to have difficulty paying bills, and to have a small (or nonexistent) emergency fund.

While many headlines proclaimed a trend of young adults “returning to the nest” during the pandemic, an examination of living arrangements before and during the pandemic reveals a more nuanced story. We found that the characteristics of young adults who lived with their parents during the pandemic were very similar to those of young adults who lived at home before COVID-19 struck the United States in 2020.

And while young adults who lived at home during the pandemic reported feeling that their financial circumstances were worsening, in many ways their personal economic conditions improved during this time. While they remained behind their peers on important measures of financial health, they were more insulated from worsening financial circumstances throughout the pandemic years.

Our dive into the demographic and financial characteristics of young adults and their living arrangements revealed four key findings:

• Overall, the pandemic did not significantly increase the likelihood of young adults living with their parents; in fact, despite a spike at the start of the pandemic, the share of young adults who lived with their parents did not change significantly when comparing the full three-year pandemic period with the years just before.
• The pandemic did not significantly alter the demographics of the young adults who lived with their parents. Both before and during the pandemic, Hispanic young adults, young men, and those earning below the median income were the most likely to live at home in young adulthood.
• Fewer young adults married or cohabited during the pandemic, despite living with a spouse or partner being linked to overall better financial well-being than living with parents.
• Young adults who lived with their parents enjoyed a degree of protection from unforeseen financial blows that their peers living elsewhere did not, despite their overall more strained financial status.

These findings suggest that media reports claiming that the economic downturn during the pandemic prompted new living arrangements for young adults did not reflect the reality of who actually lived with their parents, and that, for many young adults, living with parents during the pandemic did indeed pay off.

PRB’s World Population Data Sheet is an excellent reference and data analysis tool. Teachers are encouraged to have their students use the Data Sheet for a variety of topics and activities. The following series of short activities allows students to access a wealth of data on the world, regions, and individual countries, and develop their data literacy skills and knowledge of geography. Two versions of this lesson plan are available for download: a PDF document and a PowerPoint presentation.

These activities may also be used with PRB’s International Data Center (https://www.prb.org/international/), which houses all the data from the most recent World Population Data Sheet except net migration. Data can be accessed and displayed as a map or table and downloaded. PRB’s Population Handbook, 6th edition (2011) is also a valuable resource.

Grade Level
6–12.

Time Required
One class period for each activity.

Standards Addressed
Math and geography.

Vocabulary/Concepts
Population size, birth rate, death rate, GNI, infant mortality rate, total fertility rate, life expectancy, age distribution.

Materials

• All activities: Using the 2023 World Population Data Sheet (PDF: 2.5MB)
• Activity 2: County Profile Worksheet (PDF: 23KB)
• Activity 3: Country Outline Map (PDF: 94KB) Country outline maps for classroom use, including those for individual world regions, may be found online in a number of places.

ACTIVITY 1: PRB’S WORLD POPULATION DATA SHEET AT A GLANCE

Learning Objectives

• Select a country’s population characteristics using the World Population Data Sheet.
• Identify countries that rank highest/lowest in a population indicator.

Find answers to the following questions using the current World Population Data Sheet.

1. What is the population of the world?
2. Rank the 10 countries with the largest populations, from largest to smallest.
3. Rates are often used instead of absolute numbers to tell how frequently a population or demographic event occurs. Rates show how common an event is (often expressed as per 1,000 people). List the type of information on the World Population Data Sheet reported by a rate.
4. The death rate is the annual number of deaths per 1,000 population. Which country (or countries) has the highest death rate? Which country (or countries) has the lowest death rate?
5. The infant mortality rate measures the number of deaths each year to infants under one year of age per 1,000 live births. Which country (or countries) has the highest infant mortality rate and what is that rate? Which country (or countries) has the lowest and what is that rate?
6. The total fertility rate (TFR) is the average number of children women would have if they maintained the current level of childbearing throughout their reproductive years. Which countries (or countries) share the highest TFR and what is it? Which country (or countries) has the lowest TFR? What is it?
7. Which country (or countries) has the youngest population—that is, the highest share of population under age 15? Which country (or countries) has the oldest population—the highest share of population ages 65 and older?
8. In which country (or countries) are women expected to live the longest at birth? Where are men expected to live the longest at birth? Which country (or countries) has the lowest life expectancy for women at birth? Where do men have the lowest life expectancy at birth?
9. Which country (or countries) has the highest share of people living in urban areas in… Africa? Asia? Europe? Latin America and the Caribbean? Northern America? Oceania?
10. Gross national income in purchasing power parity per capita (GNI PPP) converts income into “international” dollars and indicates the amount of goods and services one could buy in the United States with a given amount of money. Which country (or countries) is the wealthiest in terms of GNI PPP? Which is the second wealthiest?
11. A population projection is a computation of future changes in population numbers based on assumptions about future trends in fertility, mortality, and migration. Which categories on the World Population Data Sheet are shown as projections?
12. Rank the 10 countries with the largest projected populations for both mid-2035 and mid-2050 from largest to the smallest. Which country’s (or countries’) population is projected to drop out of the top 10 by mid-2050? Which will be added to the top 10? Look back to the rankings for the current year. What are the major shifts in this ranking from now to mid-2050?
13. Rank the regions according to population size from largest to the smallest.
14. What share of the world’s people lives in… Africa? Asia? Europe? Northern America? Latin America and the Caribbean? Oceania? What are the projected population shares for these regions? Draw a bar chart showing the regional distributions of the world’s population for this year, mid-2035, and mid-2050.
15. What share of the world’s people live in less-developed countries (LDCs) in the current year? In more-developed countries (MDCs)? What share of the world’s people is projected to live in LDCs in mid-2035? In mid-2050? What share is projected to live in MDCs in mid-2035? In mid-2050?

ACTIVITY 2: PROFILE A COUNTRY

Learning Objectives

• Practice organizing a country’s population information into a country profile.
• Hypothesize about the data in the country profile.

The purpose of this activity is to introduce students to the demographic indicators listed on the Data Sheet by providing them with a tool to organize population information about a country. As students study different countries they can accumulate country profiles in their notebook. Students will need to use the World Population Data Sheet and the Country Profile Worksheet.

Note: The rate of natural increase is the rate at which a population is increasing (or decreasing) in a given year because of a surplus (or deficit) of births over deaths, expressed as a percentage of the base population. To calculate the rate, subtract death rates from birth rates, and then divide by 10. This rate does not include the effects of immigration or emigration.

1. In the Country Profile Worksheet, complete the profile of the United States. Define the indicators as they are mapped out on the worksheet. After completing the country comparison blocks, discuss.

1. Complete a new Country Profile Worksheet for every country you study. Before you begin: Develop a hypothesis about the country’s population characteristics and use the mapping activity (Activity 3) to test your hypothesis. Compare each new country’s profile with the profile of the United States.

As students learn more about the country, they can add other information from the Data Sheet (or other sources) to their profiles.

This lesson was adapted from a lesson developed by Jane Moriarty of the Michigan Geographic Alliance.

ACTIVITY 3: MAP THE DATA

Learning Objectives

• Illustrate countries’ selected population characteristics on a map.
• Compare the illustrated population characteristics of selected countries.

Mapping data is often a good method for analysis. Most of the demographic characteristics on the World Population Data Sheet lend themselves to mapping.

A map that uses color to represent quantitative data is called a choropleth map. Areas are distinguished from one another using different colors or different shades of the same color based on the values they represent. Brighter colors or dark shades of the same color indicate greater values and dimmer colors or lighter shades indicate lesser values.

Resource: PRB’s International Data Center (https://www.prb.org/international/) is particularly useful for this activity. It includes all the data from the most recent World Population Data Sheet except net migration. Data can be displayed as a map or table and downloaded.

Create a Choropleth Map: Country Outline Map

Choose one of the following demographic indicators using the World Population Data Sheet and map the world or regional distribution of that indicator on a world or regional country outline map:

Determine the mapping categories by finding the range of values for that indicator. Identify the number of categories to be used for your map and the interval of each category. For example:

1. After choosing the variable, determine the highest and lowest values for that measure.
2. Subtract these two numbers to calculate the range for the data.
3. Divide the range by the number of mapping categories planned for the map. Four to five categories will be adequate for most measures. The number produced by the division will indicate how many numbers to include in each category interval.
4. Always construct categories so that the numbers in one category do not overlap those in adjacent categories.
5. Arrange a color code or shading pattern for each category. Colors or patterns should increase from light to dark, from lowest to highest category.
6. Determine the proper mapping category for each country and color or shade the country on an outline map. Title the map, place a legend on the page, and indicate the source.

Interpret the Map

After the map has been drawn, interpret it using the following as a guide:

1. Describe the patterns observed on the map.
2. What accounts for the variation?
3. Discuss the factors that could lead to the range of outcomes within this distribution.

Draw Another Map

Draw another map to examine the relationships that may exist between two variables or compare results with another student who has mapped a different variable. Possible pairs of variables to compare:

• Infant Mortality Rate—Life Expectancy (Males or Females)
• Infant Mortality Rate—GNI per Capita, PPP
• Death Rate—Percent of Population Under Age 15
• Birth Rate—Percent of Population Ages 65 and Older

Engage With the Data

1. Does there appear to be a relationship between the two variables mapped? If so, is the relationship positive of negative? For example, are the countries with the highest rates of one variable the same countries with the highest rates of the other variable? If yes, the relationship is positive. If not, the relationship is negative.
2. Discuss whether the factors that contribute to the patterns in one variable affect the patterns in another.

This activity was adapted from exercises submitted by Eugene J. Kinerney of the University of the District of Columbia and Basheer K. Nijim of the University of Northern Iowa. The lesson plan was updated in 2023 by Nancy Matuszak, PRB.

Despite decades of progress between the 1960s and 1990s, each generation of women in the United States does not do better than the generation before—not anymore. In fact, young women of the Millennial Generation have lost ground on key areas of health and safety since our original Index of Young Women’s Well-Being and 2017 report.

PRB’s Population Bulletin, “Losing More Ground: Revisiting Young Women’s Well-Being Across Generations,” presents an updated analysis on the well-being of women ages 25 to 34 to understand how this group has fared across the Silent Generation, the Baby Boom, Generation X, and the Millennial Generation. Where data are available, we include insights on the teenage girls of Gen Z.¹

Our analysis shows improvement for Millennial women in some areas, such as increased education and earnings and decreased rates of women’s incarceration. But important measures of health and safety are headed in the wrong direction, including rates for maternal mortality, suicide, and homicide. This decline in well-being has in many ways intensified amidst rapid changes to the social and economic landscape brought on by factors such as the effects of the COVID-19 pandemic and the Dobbs decision overturning reproductive health protections that had been in place since the Silent Generation.

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Key Findings

• Climbing suicide rates. Among women ages 25 to 34, suicide rates have risen from 4.4 deaths per 100,000 for Generation X to 7 deaths per 100,000 for Millennial women. In recent years, suicide rates have declined among young white women, but they have increased for young women of color; American Indian and Alaska Native young women face a suicide rate 3 times that of their white peers.
• Surging maternal mortality. For Millennial women ages 25 to 34, maternal mortality rates have swelled, from 19.2 deaths per 100,000 live births in 2013-2015 to 30.4 deaths per 100,000 live births in 2019-2021.
• Rising homicide rates. Millennial women ages 25 to 34 have a homicide rate of 4.5 deaths per 100,000 women compared to 4.3 deaths for young women of Generation X, reversing a trend of generational improvement previously seen in 2017. The homicide rate is particularly stark for Millennial Black women, at 14 deaths per 100,000 women in 2019-2021 compared to 9 per 100,000 in 1999-2001—a nearly 60% increase.

These health and safety declines are occurring despite young women’s progress on several indicators of economic well-being and their labor force participation remaining steady or improving across generations.

• Higher education. Nearly 44% of Millennial young women are completing a college education with at least a bachelor’s degree. This share is up from 28% of Generation X young women. Gaps persist by race and ethnicity.
• Lower incarceration rate. Women’s incarceration rate has declined for the first time in more than 50 years, with just under 70 women in prison per 100,000 during the 2019-2021 period compared to 86 per 100,000 when Generation X women were young adults (1999-2001).
• Increased earnings. Millennial young women’s earnings as a percentage of men’s have increased compared to the wages of their Generation X peers, rising just over 7 cents, from 82.4 cents per dollar to 89.7 cents per dollar.