Social capital and health: implications for public health and epidemiology

Determinants of cognitive function in childhood: a cohort study in a middle income context

BACKGROUND

There is evidence that poverty, health and nutrition affect children's cognitive development. This study aimed to examine the relative contributions of both proximal and distal risk factors on child cognitive development, by breaking down the possible causal pathways through which poverty affects cognition.

METHODS

This cohort study collected data on family socioeconomic status, household and neighbourhood environmental conditions, child health and nutritional status, psychosocial stimulation and nursery school attendance. The effect of these on Wechsler Pre-School and Primary Scale of Intelligence scores at five years of age was investigated using a multivariable hierarchical analysis, guided by the proposed conceptual framework.

RESULTS

Unfavourable socioeconomic conditions, poorly educated mother, absent father, poor sanitary conditions at home and in the neighbourhood and low birth weight were negatively associated with cognitive performance at five years of age, while strong positive associations were found with high levels of domestic stimulation and nursery school attendance.

CONCLUSION

Children's cognitive development in urban contexts in developing countries could be substantially increased by interventions promoting early psychosocial stimulation and preschool experience, together with efforts to prevent low birth weight and promote adequate nutritional status.

More than jobs and houses: mental health, quality of life and the perceptions of locality in an area undergoing urban regeneration

BACKGROUND

Urban regeneration initiatives are considered to be one means of making a contribution to improving people's quality of life and mental health. This paper considers the relationship between lay perceptions of locality adversity, mental health and social capital in an area undergoing urban regeneration.

METHODS

Using qualitative methods as part of a larger multi-method study, perceptions of material, and non-material aspects of the locality and the way in which people vulnerable to mental health problems coped with living in adversity were identified as being more highly valued than intended or actual changes to structural elements such as the provision of housing or employment.

RESULTS

Themes derived from narrative accounts included concerns about the absence of social control in the locality, the reputation of the area, a lack of faith in local agencies to make changes considered important to local residents, a reliance on personal coping strategies to manage adversity and perceived threats to mental health which reinforced a sense of social isolation. We suggest these elements are implicated in restricting opportunities and enhancing feelings of 'entrapment' contributing to low levels of local collective efficacy. The gap between social capital capacity at an individual level and links with collective community resources may in part have accounted for the absence of improvements in mental health during the early life of the urban regeneration initiative.

IMPLICATIONS/CONCLUSIONS

In order to enhance quality of life or mental health, agencies involved in urban initiatives need as a basic minimum to promote security, increase leisure opportunities, and improve the image of the locality.

Linking causal concepts, study design, analysis and inference in support of one epidemiology for population health

In this paper, which is dedicated to Dr. Calvin Schwabe, I review the concepts of causation and how they impact on study design, analysis and interpretation of results. Notwithstanding the fact that no observational study can prove causation, there are a number of issues that if addressed sufficiently, can improve the validity and usefulness of our studies. These are elaborated with specific recommendations for the conduct of future observational research. Approaches that have been useful in my teaching and research experience are also described.

Community life, public health, and children's safety

As the US Advisory Board on Child Abuse and Neglect recognized in the early 1990s, the challenges posed by (a) the ongoing crisis in the child protection system and (b) the generational decline in social capital are intertwined. This issue of Family and Community Health, 31.2, discusses the conceptualization, implementation, and effects of Strong Communities for Children, the first large-scale application of the board's vision for a neighborhood-based child protection system. Having already demonstrated effectiveness in mobilizing large numbers of volunteers and organizations in diverse communities, Strong Communities has potential usefulness not only in promoting child safety but also in meeting other important goals for community health.

HIV and housing assistance in four U.S. cities: variations in local experience

This paper provides an account of how young, HIV-positive women manage their lives on limited budgets in four United States cities: New York City, New Orleans, Miami, and Chicago. The study findings elucidate city-to-city variability in housing assistance, and how this manifests in locality specific differences in the experience of HIV. Our research suggests that the receipt of housing assistance has ramifications for women's engagement in care, and for their health. Women not receiving aid often move frequently in and out of homelessness, or "double up" with others in complex household arrangements to share costs. Women with long-term housing assistance, while still struggling financially, possess a stable base from which to approach daily life and HIV care. This account suggests a need for empirical research assessing the impact of local variations in housing assistance on specific health outcomes for those with HIV. It also highlights the importance of understanding local contexts when designing housing interventions at both the individual and structural levels.

Contextual factors and immigrants' health status: double jeopardy

Poor health among immigrants may be accounted for not only by socio-economic factors affecting individuals but also by the environment in which they live. We investigated the association of contextual factors with disparities in self-rated health between native and immigrant groups. The findings indicated that, compared with native-born Belgians, immigrant groups from Turkey and Morocco were more likely to have poorer self-rated health. When contextual factors and individual socio-economic status were allowed for, all immigrant groups had a health status that was similar to or even better than that of native-born Belgians. Immigrants face a double jeopardy at both the individual and the contextual level.

Mingling, observing, and lingering: everyday public spaces and their implications for well-being and social relations

The rejuvenation of public spaces is a key policy concern in the UK. Drawing on a wide literature and on qualitative research located in a multi-ethnic area of East London, this paper explores their relationship to well-being and social relations. It demonstrates that ordinary spaces are a significant resource for both individuals and communities. The beneficial properties of public spaces are not reducible to natural or aesthetic criteria, however. Social interaction in spaces can provide relief from daily routines, sustenance for people's sense of community, opportunities for sustaining bonding ties or making bridges, and can influence tolerance and raise people's spirits. They also possess subjective meanings that accumulate over time and can contribute to meeting diverse needs. Different users of public spaces attain a sense of well- being for different reasons: the paper calls for policy approaches in which the social and therapeutic properties of a range of everyday spaces are more widely recognised and nurtured.

[Social capital and health promotion in Latin America]

Latin America faces common development and health problems and equity and overcoming poverty are crucial in the search for comprehensive and high impact solutions. The article analyzes the definition of social capital, its relationship with health, its limitations and potentialities from a perspective of community development and health promotion in Latin America. High-priority challenges are also identified as well as possible ways to better measure and to strengthen social capital. Particularly, it is discussed how and why social capital may be critical in a global health promotion strategy, where empowerment and community participation, interdisciplinary and intersectorial work would help to achieve Public Health aims and a sustainable positive change for the global development. Also, some potential limitations of the social capital concept in the context of health promotion in Latin America are identified.

Social capital and rates of gonorrhea and syphilis in the United States: Spatial regression analyses of state-level associations

We conducted spatial regression analysis to account for spatial clustering of sexually transmitted diseases (STDs) and to examine the state-level association between social capital (using Putnam's public use data set) and rates of gonorrhea and syphilis. We conducted the analysis for the 48 contiguous states of the United States for 1990, 1995, and 2000 and controlled for the effects of regional variation in STD rates, and for state variation in poverty, income inequality, racial composition, and percentage aged 15-34 years. We compared the results of the spatial regression analysis with those of ordinary least squares (OLS) regression. Controlling for all population-level variables, the percentage of variation explained by the OLS regression and by the spatial regression were similar (mid-90s for gonorrhea and low-70s for syphilis), the standardized parameter estimates were similar, and the spatial lag parameter was not statistically significant. Social capital was not associated with STD rates when state variation in racial composition was included in the regression analysis. In this analysis, states with a higher proportion of residents who were African-American had higher STD rates. When we did not control for racial composition, regression analysis showed that states with higher social capital had lower STD rates. We conjecture that sexual networks and sexual mixing drive the association between social capital and STD rates and highlight important measurement and research questions that need elucidation to understand fully the relationship between social capital and STDs.

Understanding place and health: A heuristic for using administrative data

The increasing availability, use and limitations of administrative data for place-based population health research, and a lack of theory development, created the context for the current paper. We developed a heuristic to interrogate administrative data sets and to help us develop explanatory pathways for linking place and health. Guided by a worked example, we argue that some items in administrative data sets lend themselves to multiple theories, creating problems of inference owing to the implications of using inductive versus deductive reasoning during the research process, and that certain types of theories are privileged when used administrative data bases.

Social capital and healthy urbanization in a globalized world

This paper critically reviews the extent in which social capital can be a resource to promote health equity in urban contexts. It analyzes the concept of social capital and reviews evidence to link social capital to health outcomes and health equity, drawing on evidence from epidemiological studies and descriptive case studies from both developed and developing countries. The findings show that in certain environments social capital can be a key factor influencing health outcomes of technical interventions. Social capital can generate both the conditions necessary for mutual support and care and the mechanisms required for communities and groups to exert effective pressure to influence policy. The link between social capital and health is shown to operate through different pathways at different societal levels, but initiatives to strengthen social capital for health need to be part of a broader, holistic, social development process that also addresses upstream structural determinants of health. A clearer understanding is also needed of the complexity and dynamics of the social processes involved and their contribution to health equity and better health. The paper concludes with recommendations for policy and programming and identifies ten key elements needed to build social capital.

Chat Room Computer-Mediated Support on Health Issues for Aboriginal Women

Within contemporary health care, increases in chronic disease have necessitated a disease management focus. Given that chronic disease is managed, more so than cured, there are increased demands for greater participation by health care consumers and they are expectated to take on increased responsibility for self-care. The emphasis on consumer responsibility has increased the significance of health-promoting behavior change in contending with contemporary health care concerns. In Canada, the reported inequity in health status between Aboriginal and non-Aboriginal Canadians further emphasizes the need for innovative health strategies. For Aboriginal women isolated by geography, changing societal norms (e.g., women working outside of the home, single parent families), and cultural distinction, online chat participation serves as a novel medium for the provision of health knowledge, support, and motivation within a virtual "neighborhood." Recognizing the significance of social support in the promotion of positive health behavior change, we investigated the theme of social support within health conversations among Aboriginal women participating in an online chat room. Content analysis was the primary methodological focus within a mixed methods approach. Of 101 health-based online conversations, the majority reflected one of three forms of social support: (1) emotional support, (2) informational support, or (3) instrumental support. The value of social support and social cohesion within health has been well documented. The current investigation suggests that "community" need not be physically constructed; virtual communities offer great potential for social cohesion around the issues of health and health care.

Community coalitions as a system: effects of network change on adoption of evidence-based substance abuse prevention

OBJECTIVES

We examined the effect of community coalition network structure on the effectiveness of an intervention designed to accelerate the adoption of evidence-based substance abuse prevention programs.

METHODS

At baseline, 24 cities were matched and randomly assigned to 3 conditions (control, satellite TV training, and training plus technical assistance). We surveyed 415 community leaders at baseline and 406 at 18-month follow-up about their attitudes and practices toward substance abuse prevention programs. Network structure was measured by asking leaders whom in their coalition they turned to for advice about prevention programs. The outcome was a scale with 4 subscales: coalition function, planning, achievement of benchmarks, and progress in prevention activities. We used multiple linear regression and path analysis to test hypotheses.

RESULTS

Intervention had a significant effect on decreasing the density of coalition networks. The change in density subsequently increased adoption of evidence-based practices.

CONCLUSIONS

Optimal community network structures for the adoption of public health programs are unknown, but it should not be assumed that increasing network density or centralization are appropriate goals. Lower-density networks may be more efficient for organizing evidence-based prevention programs in communities.

Social capital and health: civic engagement, community size, and recall of health messages

OBJECTIVES

We explored the effects of community integration and pluralism on recall of cardiovascular disease health information messages.

METHODS

With 1980-1983 data from the Minnesota Heart Health Program, we examined whether ties to community groups were associated with recall of health messages, and whether this relation was modified by size and degree of differentiation of the community.

RESULTS

A higher level of civic engagement through ties to community groups was associated with better recall of health messages. Ties to community groups independently contributed to better message recall even after control for gender, education, and other variables. The moderating role of community size was non-significant but intriguing.

CONCLUSIONS

Community group membership could increase exposure to health messages, providing a critical pathway for social capital to influence health promotion and, thus, public health outcomes.

Healthy naturally occurring retirement communities: a low-cost approach to facilitating healthy aging

Naturally occurring retirement communities (NORCs) are broadly defined as communities where individuals either remain or move when they retire. Using the determinants of health model as a base, we hypothesize that some environmental determinants have a different impact on people at different ages. Health benefits to living within NORCs have been observed and likely vary depending upon where the specific NORC exists on the NORC to healthy-NORC spectrum. Some NORC environments are healthier than others for seniors, because the NORC environment has characteristics associated with better health for seniors. Health benefits within healthy NORCs are higher where physical and social environments facilitate greater activity and promote feelings of well-being. Compared to the provision of additional medical or social services, healthy NORCs are a low-cost community-level approach to facilitating healthy aging. Municipal governments should pursue policies that stimulate and support the development of healthy NORCs.

Is Hong Kong experiencing normalization of adolescent drug use? Some reflections on the normalization thesis

The upsurge of consumption of party drugs among adolescents in recent years in Hong Kong has been part of the global trend of adolescent recreational use of drugs at rave parties, discos and similar party settings. Scholars in Western societies have recently proposed the thesis of "normalization of adolescent drug use" to describe such a trend. The normalization thesis points at three major aspects of the normalization phenomenon, namely, a rapid increase of the prevalence of drug use in young people, the widespread popularity of recreational drug use that is closely linked with the recent arrival of dance club culture, and a receptive attitude towards drug use as a normal part of leisure. This article aims to examine whether the normalization thesis can be applied to analyze the situation of adolescent drug use in Hong Kong. Data are drawn from official statistics and a recent survey conducted in 2002-2004 of drug use of Hong Kong marginal youths (N = 504). The case of Hong Kong only partially supports the thesis. Our findings show that the normalization of drug use among young people has occurred in Hong Kong, but the extent of normalization is smaller than those in Western societies like the United Kingdom. They also suggest that a recognition of possible cultural differences may be complementary to the normalization thesis. Limitations of the study are also noted.

State social capital and individual health status

Recent studies have found that two state-level measures of social capital, average levels of civic participation and trust, are associated with improvements in individual health status. In this study we employ these measures, together with the Putnam index of state social capital, to examine several key aspects of the relationship between state social capital and individual health. We find that for all three measures, the association with health status persists after carefully adjusting for household income and that for two measures, mistrust and the Putnam index, the size of this association warrants further attention. Using the Putnam index, we find particular support for the hypothesis that social capital has a more pronounced salutary effect for the poor. Our findings generate both support for the social capital and health hypothesis and a number of implications for future research.

The social structural production of HIV risk among injecting drug users

There is increasing appreciation of the need to understand how social and structural factors shape HIV risk. Drawing on a review of recently published literature, we seek to describe the social structural production of HIV risk associated with injecting drug use. We adopt an inclusive definition of the HIV 'risk environment' as the space, whether social or physical, in which a variety of factors exogenous to the individual interact to increase vulnerability to HIV. We identify the following factors as critical in the social structural production of HIV risk associated with drug injecting: cross-border trade and transport links; population movement and mixing; urban or neighbourhood deprivation and disadvantage; specific injecting environments (including shooting galleries and prisons); the role of peer groups and social networks; the relevance of 'social capital' at the level of networks, communities and neighbourhoods; the role of macro-social change and political or economic transition; political, social and economic inequities in relation to ethnicity, gender and sexuality; the role of social stigma and discrimination in reproducing inequity and vulnerability; the role of policies, laws and policing; and the role of complex emergencies such as armed conflict and natural disasters. We argue that the HIV risk environment is a product of interplay in which social and structural factors intermingle but where political-economic factors may play a predominant role. We therefore emphasise that much of the most needed 'structural HIV prevention' is unavoidably political in that it calls for community actions and structural changes within a broad framework concerned to alleviate inequity in health, welfare and human rights.

Common mental disorders in a young urban population in Colombia

BACKGROUND

There are few studies of mental ill health among young people in developing countries.

AIMS

To measure the prevalence of common mental disorders among low-income young people in the city of Cali, Colombia and to examine associations with violence and social capital.

METHOD

The Self-Reporting Questionnaire was administered to 1057 young people aged 15-25 years. Social capital, violence, alcoholism and socio-demographic variables were also measured.

RESULTS

We found 255 young people (24%) with common mental disorders. Being a woman, having limited education and experiencing high levels of violence were the main risk factors for common mental disorders. Social capital did not emerge as a risk factor.

CONCLUSIONS

A large burden of mental ill health among young people was found; this requires urgent interventions and more research on the mechanisms which link mental health and violence.

Social capital: an individual or collective resource for health?

Although it is now widely acknowledged that the social environment plays an important role in people's health and well-being, there is considerable disagreement about whether social capital is a collective attribute of communities or societies, or whether its beneficial properties are associated with individuals and their social relationships. Using data from the European Social Survey (22 countries, N = 42,358), this study suggests that, rather than having a contextual influence on health, the beneficial properties of social capital can be found at the individual level. Individual levels of social trust and civic participation were strongly associated with self-rated health. At the same time, the aggregate social trust and civic participation variables at the national level were not related to people's subjective health after controlling for compositional differences in socio-demographics. Despite the absence of a main contextual effect, the current study found a more complex cross-level interaction for social capital. Trusting and socially active individuals more often report good or very good health in countries with high levels of social capital than individuals with lower levels of trust and civic participation, but are less likely to do so in countries with low levels of social capital. This suggests that social capital does not uniformly benefit individuals living in the same community or society.

Defining and measuring gender: a social determinant of health whose time has come

This paper contributes to a nascent scholarly discussion of sex and gender as determinants of health. Health is a composite of biological makeup and socioeconomic circumstances. Differences in health and illness patterns of men and women are attributable both to sex, or biology, and to gender, that is, social factors such as powerlessness, access to resources, and constrained roles. Using examples such as the greater life expectancy of women in most of the world, despite their relative social disadvantage, and the disproportionate risk of myocardial infarction amongst men, but death from MI amongst women, the independent and combined associations of sex and gender on health are explored. A model for incorporating gender into epidemiologic analyses is proposed.

The privileging of communitarian ideas: citation practices and the translation of social capital into public health research

The growing use of social science constructs in public health invites reflection on how public health researchers translate, that is, appropriate and reshape, constructs from the social sciences. To assess how 1 recently popular construct has been translated into public health research, we conducted a citation network and content analysis of public health articles on the topic of social capital. The analyses document empirically how public health researchers have privileged communitarian definitions of social capital and marginalized network definitions in their citation practices. Such practices limit the way public health researchers measure social capital's effects on health. The application of social science constructs requires that public health scholars be sensitive to how their own citation habits shape research and knowledge.

Toward a neighborhood resource-based theory of social capital for health: can Bourdieu and sociology help?

Within the past several years, a considerable body of research on social capital has emerged in public health. Although offering the potential for new insights into how community factors impact health and well being, this research has received criticism for being undertheorized and methodologically flawed. In an effort to address some of these limitations, this paper applies Pierre Bourdieu's (1986) [Bourdieu, P. (1986). Handbook of theory and research for the sociology of education (pp. 241-258). New York: Greenwood] social capital theory to create a conceptual model of neighborhood socioeconomic processes, social capital (resources inhered within social networks), and health. After briefly reviewing the social capital conceptualizations of Bourdieu and Putnam, I attempt to integrate these authors' theories to better understand how social capital might operate within neighborhoods or local areas. Next, I describe a conceptual model that incorporates this theoretical integration of social capital into a framework of neighborhood social processes as health determinants. Discussion focuses on the utility of this Bourdieu-based neighborhood social capital theory and model for examining several under-addressed issues of social capital in the neighborhood effects literature and generating specific, empirically testable hypotheses for future research.

Primary care, social inequalities, and all-cause, heart disease, and cancer mortality in US counties, 1990

OBJECTIVES

We tested the association between the availability of primary care and income inequality on several categories of mortality in US counties.

METHODS

We used cross-sectional analysis of data from counties (n=3081) in 1990, including analysis of variance and multivariate ordinary least squares regression. Independent variables included primary care resources, income inequality, and sociodemographics.

RESULTS

Counties with higher availability of primary care resources experienced between 2% and 3% lower mortality than counties with less primary care. Counties with high income inequality experienced between 11% and 13% higher mortality than counties with less inequality.

CONCLUSIONS

Primary care resources may partially moderate the effects of income inequality on health outcomes at the county level.

Social capital and mental health: an interdisciplinary review of primary evidence

An interdisciplinary interrogation of primary evidence linking social capital and mental health sought to establish: (1) 'quality of evidence' (assessed in terms of study design, methods used to address stated questions, rigor of data analysis, and logic and clarity of interpretation of results), and (2) applicability of the evidence to public health policy and practice with respect to mental health. It is found that social capital, a complex and compound construct, can be both an asset and a liability with respect to mental health of those in receipt of and those providing services and other interventions. The most meaningful assessment of social capital or components thereof may examine individual access to rather than possession of social capital, a property of groups, and therefore an ecological variable. Theoretical advances in research on social capital serve to identify mainly two types of social capital: bonding (between individuals in a group) and bridging (between groups). Each type of social capital has cognitive and/or structural component(s) and may operate at micro and/or macro level(s). Effective mental health policy and service provision may build or strengthen bridging social capital and benefit from both bonding and bridging social capital where either or both exist. Established indicators of social capital are amenable to quantitative and qualitative assessment, preferably in tandem. However studies that employ combined research design are rare or non-existent. Interdisciplinary multi-method investigations and analyses are called for in order to unravel mechanisms whereby social capital and mental health might be meaningfully associated.

Health lifestyle theory and the convergence of agency and structure

This article utilizes the agency-structure debate as a framework for constructing a health lifestyle theory. No such theory currently exists, yet the need for one is underscored by the fact that many daily lifestyle practices involve considerations of health outcomes. An individualist paradigm has influenced concepts of health lifestyles in several disciplines, but this approach neglects the structural dimensions of such lifestyles and has limited applicability to the empirical world. The direction of this article is to present a theory of health lifestyles that includes considerations of both agency and structure, with an emphasis upon restoring structure to its appropriate position. The article begins by defining agency and structure, followed by presentation of a health lifestyle model and the theoretical and empirical studies that support it.

The health of children in foster care

This qualitative study of school nurses describes what the nurses want to do for school children in foster care, what they are actually doing, and how the school organization affects the provision of care. The study looked at the nurses' practice through the lens of the Social Ecological Model of Health, identified interventions using the Minnesota Public Health Intervention Model, and analyzed the school organization using the Bolman-Deal Model (Bolman & Deal, 1997). A purposive sample of nurses was chosen to participate in interviews, and observations of their work and a survey on the frequency of their interventions was implemented. Interviews were analyzed using a phenomenological approach. Four themes derived from the data included structural barriers to client access, nonrecognition of the broad determinants of health, isolationism, and lack of political power. School nurses are aware of foster children's increased health care needs, yet increased services are not provided as a result of a lack of organizational support.

Types of provincial structure and population health

This paper explores the potential of using large administrative units for studies of population health within a country. The objective is to illustrate a new way of defining structural dimensions and to use them in examining variation in life expectancy rates. We use data from the 50 provinces of Spain as a case study. A factor analysis of organizational items such as schools, hotels and medical personnel is employed to define and generate "collective" measures for well-known provincial types, in this case: urban, commercial, industrial and tourist provinces. The scores derived from the factor analysis are then used in a regression model to predict life expectancy. The City-centered and Commercial provinces showed positive correlations with life expectancy while those for the Tourist provinces were negative. The industrial type was nonsignificant. Explanations of these correlations are proposed and the advantages and disadvantages of this exploratory technique are reviewed. The use of this technique for generating an overview of social organization and population health is discussed.

A naturalistic inquiry on the impact of interventions aiming to improve health and the quality of life in the community

The goal of this study is to identify and describe variables contributing to the efficiency of health promotion interventions, and to assess whether these variables can serve as reliable and early indicators of the success of such interventions. The study sample includes 44 interventions selected through a network of key informants from five cities--Liverpool, Sandwell, Vienna, Pula, and Rijeka--by using a chain technique. Data on each intervention are collected through an in-depth interview with a program leader, the collection of project-related documents, and on-site observation. Qualitative analysis of data performed with content analysis and computer-assisted free-text analysis reveals different characteristics of interventions depending on whether they are initiated by the city government sector, health-care system, or citizens sector (independent of the city or country). The assessment of the efficiency of these three groups of interventions also differs because of varying features, scope (activity potentials) and impact they are able to accomplish. We have identified ways in which the efficiency of all three groups of interventions can be improved. The efficiency of the interventions within the city sector can be increased through an improved process of delegation to other sectors, higher involvement of user groups, and higher receptivity and organizational flexibility. The efficiency of the interventions within the citizens sector can be improved through professional, organizational, and financial support. Support from the professional community is important for citizens sector interventions in confirming the importance of the problem they address and legitimizing the actions they propose and undertake.

Developing a profile of consumer intention to seek out additional information beyond a doctor: the role of communicative and motivation variables

Current reports in the medical literature demonstrate increasing acknowledgment of consumer involvement in autonomous health and medical information search beyond the doctor. Although multiple studies have segmented consumers into different groups based on the different levels of patient autonomy, the literature review revealed the lack of systematic attempts at elucidating the antecedents of autonomous consumer health information search. In this article, I examine the role of health consciousness as a mediator of the relation between communicative (interpersonal, community, print, television, and Internet) factors and health information seeking.

Making sense of social capital, health and policy

This paper summarizes current knowledge about social capital and its application to health policy. There is a consensus that social capital is a characteristic of social groups, rather than individuals, and is born of shared experience which fosters mutual trust and reciprocity. It is a collective resource that may accumulate over time and facilitates the accomplishment of objectives that would otherwise be unlikely. The theoretical articulation of social capital remains under-theorized, and its measurement is subject to considerable debate. Health researchers, searching for a pathway to explain the adverse health outcomes associated with income inequality, as well as to understand the results of multi-level analyses that demonstrate an independent etiological role for community of residence, may find social capital an attractive notion. Despite professions of interest, the utility of social capital for health policy formation remains problematic; however, as a theoretical paradigm for policy it may have particular appeal to exponents of the "Third Way".

Associations of smoking prevalence with individual and area level social cohesion

STUDY OBJECTIVE

To discover if area level social cohesion, neighbourhood safety, and home safety are associated with current cigarette smoking among adults after adjustment for concentrations of poverty and low education.

DESIGN

Cross sectional survey of a random sample of adults, stratified by 19 geographical areas.

SETTING

SHAPE, Survey of the Health of Adults, the Population, and the Environment-conducted in 1998 by the Hennepin County Community Health Department and the Minneapolis Department of Health and Family Support in Minnesota.

PARTICIPANTS

5256 men and 4806 women, 18 years and older, randomly selected from 19 geographical areas in an urban county.

MAIN RESULTS

Overall, 21.2% of survey respondents reported current cigarette smoking. Both higher area level social cohesion (OR = 0.85, 95% CI = 0.74 to 0.98) and higher individual social cohesion (OR = 0.96, 95% CI = 0.92 to 0.99) were associated with lower likelihoods of smoking. Similar models were obtained for neighbourhood safety and home safety.

CONCLUSIONS

These findings contribute to the growing literature on the important role of social cohesion and other area level characteristics on smoking behaviour among adults.

Place, discourse and vulnerability—a qualitative study of young adults living in a Swedish urban poverty zone

This paper presents findings from a qualitative study of young adults living in a relatively deprived metropolitan area in Sweden. The analysis of interview data yielded four separate types of neighbourhood discourses, each related to a major hegemonic 'discourse of the problematic area'. The discursive model was used to disclose different patterns of vulnerability, at both the individual and the community level. The discourses are suggested to function as mechanisms through which the spatial context, defined in structural and relational terms, could be linked to health and well-being.

Participation, health and the development of community resources in Southern Brazil

This article seeks to contribute to the debate about participation and health by presenting a framework for psychosocial interventions in primary health care. It highlights the social psychological dimensions of participation and the role it plays in improving conditions of living and thus health. The Freirean concepts of dialogue, recognition and conscientization, combined with understanding of local knowledge are suggested as guiding notions for psychosocial interventions seeking to enhance community participation and develop the local level. The article discusses the challenges as well as the potential gains experienced in the process of participation presented. It concludes by reaffirming the importance of participation and empowerment in health interventions struggling against health inequalities and seeking health for all.

Health, ageing and social differentials: a case study of Soweto, South Africa

This article analyses the relationship between health of people over sixty and a range of social differentials in a specific social context of a relatively deprived community in South Africa. Basic measures of social inequality as well as more sophisticated indicators of social relationships and access to social resources and how they are linked to peoples' perception of their own health are explored. The paper is based on a secondary analysis of data collected in a comprehensive social survey of Soweto conducted in 1997 by a team of researchers based mainly in the Department of Sociology at the University of the Witwatersrand, Johannesburg. The results present an interesting scenario, which, while reaffirming the already established connection between social differentials, social ties and health, also sheds light on a different social context and specific relationships with regard to health.

What is social capital and how does it relate to health?

During the last 25 years, a new term has cropped up in social sciences, social capital. In the last 10 years, this term acquired a new dimension which relates it to health. Following an analysis of theoretical issues surrounding social capital and social support, recent research is used to illustrate how these are affecting health. It is argued that more theoretical development is needed before social capital can be used to form a new community nursing practice. Until then, the ideas of social capital (social contact, companionship, etc.) may guide our mode of operation during nursing interventions.

An alternative approach to social capital: exploring the linkage between health consciousness and community participation

In recent years, social capital has received a great deal of attention in health communication. The fundamental premise behind the increased attention to social capital is the positive health outcome of social capital. Social capital is treated as an antecedent to health. Building on recent research that points out the role of trait-level variables in the production of social capital, this article examines the role of health consciousness in the production of social capital. The central idea here is that health conscious individuals choose to participate in their communities because of the positive health benefits of such participation.

Psychosocial factors and their association with clinical outcomes in patients with heart failure: why clinicians do not seem to care

Poor quality of life, social isolation, depression and anxiety all have been linked to increased risk of rehospitalization and mortality in patients with heart failure. Yet, despite evidence of their importance to outcomes in heart failure patients, psychosocial factors are assessed and treated infrequently in clinical practice. Potential reasons for this include: (1) inadequate dissemination of research about the link between psychosocial factors and outcomes; (2) insufficient training in heart-mind interactions that precludes clinicians from taking advantage of what is known; (3) perceived problems with interventions or with the science of heart-mind interactions that interfere with acceptance of what is known; (4) concerns about how to measure psychosocial factors in clinical practice; and (5) lack of curiosity from clinicians about the role of psychosocial factors in their patients. In this article, each of these possible explanations is explored and recommendations suggested.

Psychosocial pathways to prematurity: changing our thinking toward a lifecourse and community approach

The purpose of this article is to explore the psychosocial antecedents of prematurity. Emphasis is on conceptual areas and supporting literature for (a) the contexts in which prematurity occurs and the diversity of women's experiences; (b) a lifecourse approach to prematurity that highlights allostatic load and the accumulation of trauma and loss in possible prematurity pathways; and (c) diverse psychosocial/biological pathways and mechanisms of prematurity processes. Pathways examining psychosocial and prematurity connections will be explicated, including antecedents and outcomes other than stress proneness and vulnerability. Implications for research are logically derived from a focus on the impact of social context on individual outcomes through multilevel models and methods. Clinical implications are derived from the social contexts, lifecourse, and multiple pathways focus of the article and include increasing social cohesion in communities, population health strategies, particular psychosocial interventions, and attentive listening.