Social capital and health: a review of prospective multilevel studies

Caring for the Unseen: Using Linking Social Capital to Improve Healthcare Access to Irregular Migrants in Spain

PURPOSE

To describe a novel strategy using linking social capital to provide healthcare access to irregular migrants with low literacy, low numeracy, and limited cultural assimilation in a European metropolitan area.

ORGANIZING CONSTRUCT

Public data show numerous shortcomings in meeting the healthcare needs of refugees and irregular migrants surging into Europe. Many irregular migrants living in European communities are unable to access information, care, or services due to lack of social capital. An overview of the problem and traditional charity strategies, including their barriers, are briefly described. A novel strategy using linking social capital to improve healthcare access of irregular migrants is explored and described. Information regarding the impact of this approach on the target population is provided. The discussion of nursing's role in employing linking social capital to care for the vulnerable is presented.

CONCLUSIONS

Immigration and refugee data show that issues related to migration will continue. The novel strategy presented can be implemented by nurses with limited financial and physical resources in small community settings frequented by irregular migrants to improve health care.

CLINICAL RELEVANCE

The health and well-being of irregular migrants has an impact on community health. Nurses must be aware of and consider implementing novel strategies to ensure that all community members' healthcare needs, which are a basic human right, are addressed.

Neighborhood features and physiological risk: An examination of allostatic load

Poor neighborhoods may represent a situation of chronic stress, and may therefore be associated with health-related correlates of stress. We examined whether lower neighborhood income would relate to higher allostatic load, or physiological well-being, through psychological, affective, and behavioral pathways. Using data from the Biomarker Project of the Midlife in the United States (MIDUS) study and the 2000 Census, we demonstrated that people living in lower income neighborhoods have higher allostatic load net of individual income. Moreover, findings indicate that this relation is partially accounted for by anxious arousal symptoms, fast food consumption, smoking, and exercise habits.

Relationships of Community and Individual Level Social Capital with Activities of Daily Living and Death by Gender

This study determined whether there is an association between social capital and a composite outcome of decline in Activities of Daily Living (ADL) and death by gender. A prospective 3.5 year cohort study was conducted in a rural town in Japan. The study participants were 984 individuals aged 65 years and older with not impaired on ADL at 2010 baseline survey. Social participation and generalized trust were measured as social capital. The individual level responses were dichotomized and aggregated into the community level (eight areas). Multilevel logistic regression adjusting for covariates revealed that social participation at the individual level was significantly associated with higher odds of composite outcome (OR of “not participate” = 1.97, 95% CI = 1.38–2.81). Regarding generalized trust, only in men, there was an inverse association at the community level (OR of “low” = 0.55, 95% CI = 0.32–0.96), and a positive association at the individual level (OR of “tend to be careful” = 2.22, 95% CI = 1.27–3.90). These results suggest that social capital were associated with a decline in ADL and death and that the association may differ by gender.

Social capital and health in Kenya: A multilevel analysis

Despite the acknowledgment that social capital is an important predictor of good health and overall well being in wealthy countries, little empirical research has been conducted in developing countries, particularly in Africa, to examine this relationship. This study examines the association between cognitive (trust) and structural (membership in organization) social capital on health at both the individual and contextual levels. Health was measured using answers to a subjective question on physical health and anxiety/worry suffered by individuals within the last 30 days. This study utilized Afrobarometer data collected in Kenya in 2005 to examine this relationship using multilevel logistic statistical modeling. Upon controlling for socioeconomic and demographic factors, social capital was found to be significantly associated with anxiety/worry and physical health in Kenya. Membership in organizations was associated with increased odds (OR = 1.34, 95%CI: 1.02-1.76) of physical health problems, while individual trust was associated with a 6% (OR = 0.94, 95%CI: 0.90-0.99) reduction in the likelihood of physical health problems. Conversely, generalized trust was associated with a 37% reduction in the odds (OR = 0.63, 95%CI: 0.40-0.99) of anxiety/worry, while individual trust was associated with a 5% reduction (OR = 0.95, 95%CI: 0.90-1.00) of anxiety/worry. With the exception of membership in an organization that exacerbates physical health, both individual level trust and generalized trust were associated with better health outcomes in Kenya. The availability of social organizations at the contextual level was associated with worsening anxiety/worry although the effect size was small. These results show that social capital, particularly trust, is a concept that can apply to different social and cultural contexts and can potentially be harnessed to improve health in settings that suffer from resource poverty.

[Social capital is associated with students’ subjective well-being in 1st year university life]

The purpose of this study was to examine how university social capital and subjective social capital could predict undergraduate students’ subjective well-being including depression, school satisfaction, and life satisfaction. In this cross-sectional study, we conducted multilevel structural equation modeling on the data of 2,021 students at 38 universities in Japan. At the university level, we found the associations between social capital (fellows) and depression, social capital (classmates) and life satisfaction, and social capital (faculty) and school satisfaction. At the student level, all subjective social capital (fellows, classmates, and faculty) were associated with all the factors of subjective well-being. These results suggest the influence of university social capital and that of subjective social capital are associated with students’ subjective well-being.

Households, the omitted level in contextual analysis: disentangling the relative influence of households and districts on the variation of BMI about two decades in Indonesia

Background

Most of the research investigating the effect of social context on individual health outcomes has interpreted context in terms of the residential environment. In these studies, individuals are nested within their neighbourhoods or communities, disregarding the intermediate household level that lies between individuals and their residential environment. Households are an important determinant of health yet they are rarely included at the contextual level in research examining association between body mass index (BMI) and the social determinants of health. In this study, our main aim was to provide a methodological demonstration of multilevel analysis, which disentangles the simultaneous effects of households and districts as well as their associated predictors on BMI over time.

Methods

Using both two- and three-level multilevel analysis, we utilized data from all four cross-sections of the Indonesian Family life Survey (IFLS) 1993 to 2007-8.

Results

We found that: (i) the variation in BMI attributable to districts decreased from 4.3 % in 1993 to 1.5 % in 1997-98, and remained constant until 2007–08, while there was an alarming increase in the variation of BMI attributable to households, from 10 % in 2000 to 15 % in 2007–08; (ii) ignoring the household level did not change the relative variance contribution of districts on BMI, but ignoring the district level resulted in overestimation of household effects, and (iii) households’ characteristics (socioeconomic status, size, and place of residence) did not attenuate the variation of BMI at the household-level.

Conclusions

Estimating the relative importance of multiple social settings allows us to better understand and unpack the variation in clustered or hieratical data in order to make valid and robust inferences. Our findings will help direct investment of limited public health resources to the appropriate context in order to reduce health risk (variation in BMI) and promote population health.

Disentangling the directions of associations between structural social capital and mental health: Longitudinal analyses of gender, civic engagement and depressive symptoms

The present paper analysed the directions of associations between individual-level structural social capital, in the form of civic engagement, and depressive symptoms across time from age 16-42 years in Swedish men and women. More specifically, we asked whether civic engagement was related to changes in depressive symptoms, if it was the other way around, or whether the association was bi-directional. This longitudinal study used data from a 26-year prospective cohort material of 1001 individuals in Northern Sweden (482 women and 519 men). Civic engagement was measured by a single-item question reflecting the level of engagement in clubs/organisations. Depressive symptoms were assessed by a composite index. Directions of associations were analysed by means of gender-separate cross-lagged structural equation models. Models were adjusted for parental social class, parental unemployment, parental health, and family type at baseline (age 16). Levels of both civic engagement and depressive symptoms were relatively stable across time. The model with the best fit to data showed that, in men, youth civic engagement was negatively associated with depressive symptoms in adulthood, thus supporting the hypothesis that involvement in social networks promotes health, most likely through provision of social and psychological support, perceived influence, and sense of belonging. Accordingly, interventions to promote civic engagement in young men could be a way to prevent poor mental health for men later on in life. No cross-lagged effects were found among women. We discuss this gender difference in terms of gendered experiences of civic engagement which in turn generate different meanings and consequences for men and women, such as civic engagement not being as positive for women's mental health as for that of men. We conclude that theories on structural social capital and interventions to facilitate civic engagement for health promoting purposes need to acknowledge gendered life circumstances.

Theoretical basis and explanation for the relationship between area-level social inequalities and population oral health outcomes - A scoping review

This study was conducted to review the evidence on the association between area-level social inequalities and population oral health according to type and extent of social theories. A scoping review was conducted of studies, which assessed the association between area-level social inequality measures, and population oral health outcomes including self-rated oral health, number of teeth, dental caries, periodontal disease, tooth loss, oral health-related quality of life (OHRQoL) and dental pain. A search strategy was applied to identify evidence on PubMed, MEDLINE (Ovid), EMBASE, Web of Science, ERIC, Sociological Abstracts, Social Services Abstracts, references of selected studies, and further grey literature. A qualitative content analysis of the selected studies was conducted to identify theories and categorize studies according to their theoretical basis. A total of 2892 studies were identified with 16 included in the review. Seven types of social theories were used on 48 occasions within the selected studies including: psychosocial (n=13), behavioural (n=10), neo-material (n=10), social capital (n=6), social cohesion (n=4), material (n=3) and social support (n=2). Of the selected studies, four explicitly tested social theories as pathways from inequalities to population oral health outcomes, three used a theoretical construct, seven used theories for post-hoc explanation and two did not have any use of theory. In conclusion, psychosocial theories were used most frequently. Although theories were often mentioned, majority of these studies did not test a social theory.

Facilitators and barriers of adopting healthy lifestyle in rural China: a qualitative analysis through social capital perspectives

Non-communicable diseases (NCDs) are the major public health concerns in China. However, little has been known yet about the background social factors that influence lifestyles as possible NCD risk factors. This qualitative study aimed to explore facilitators and barriers of adopting healthy lifestyles among residents in a rural community of China. Three age-stratified focus group discussions (FGDs) were conducted in Fangshan district of Beijing in 2013. A FGD guide was designed to elicit the participants' perception and experience regarding their lifestyles. The audio-records were transcribed, and data were qualitatively analyzed through thematic approach. Through social capital framework with bonding, bridging, and linking classifications, we identified the following facilitators and barriers to adopt healthy lifestyles. (1) Facilitators: mutual support from family/friends and motivation to participate in regular exercises (bonding); cooperative relationships with community health workers (bridging); and nationwide high level of healthy lifestyle awareness (linking). (2) Barriers: negative influence from family/friends, insufficient support from family/friends, peer pressure and tolerance towards unhealthy lifestyles (bonding); insufficient support from health professionals (bridging); and inequity in allocation of public resources (linking). This study revealed that bonding, bridging and linking social capital would work as facilitators and barriers to adopt healthy lifestyles among rural residents in China.

Community social capital and tooth loss in Japanese older people: a longitudinal cohort study

OBJECTIVE

To date, no study has prospectively examined the association between social capital (SC) in the community and oral health. The aim of this longitudinal cohort study was to examine the association between both community-level and individual-level SC and tooth loss in older Japanese people.

DESIGN

Prospective cohort study

SETTING

We utilised data from the Japan Gerontological Evaluation Study (JAGES) performed in 2010 and 2013 and conducted in 525 districts.

PARTICIPANTS

The target population was restricted to non-institutionalised people aged 65 years or older. Participants included 51 280 people who responded to two surveys and who had teeth at baseline.

PRIMARY OUTCOME MEASURE

The primary outcome measure was loss of remaining teeth, measured by the downward change of any category of remaining teeth, between baseline and follow-up.

RESULTS

The mean age of the participants was 72.5 years (SD=5.4). During the study period, 8.2% (n=4180) lost one or more of their remaining teeth. Among three community-level SC variables obtained from factor analysis, an indicator of civic participation significantly reduced the risk of tooth loss (OR 0.93; 95% CI 0.88 to 0.99). The individual-level SC variables 'hobby activity participation' and 'sports group participation' were also associated with a reduced risk of tooth loss (OR 0.88; 95% CI 0.81 to 0.95 and OR 0.90; 95% CI 0.82 to 0.99, respectively).

CONCLUSIONS

Living in a community with rich SC and individuals with good SC is associated with lower incidence of tooth loss among older Japanese people.

Promoting Healthy Behaviors among Egyptian Mothers: A Quasi-Experimental Study of a Health Communication Package Delivered by Community Organizations

Decisions made at the household level, for example, to seek antenatal care or breastfeed, can have a direct impact on the health of mothers and newborns. The SMART Community-based Initiatives program in Egypt worked with community development associations to encourage better household decision-making by training community health workers to disseminate information and encourage healthy practices during home visits, group sessions, and community activities with pregnant women, mothers of young children, and their families. A quasi-experimental design was used to evaluate the program, with household surveys conducted before and after the intervention in intervention and comparison areas. Survey questions asked about women's knowledge and behaviors related to maternal and newborn care and child nutrition and, at the endline, exposure to SMART activities. Exposure to program activities was high in intervention areas of Upper Egypt: 91% of respondents reported receiving home visits and 84% attended group sessions. In Lower Egypt, these figures were 58% and 48%, respectively. Knowledge of danger signs related to pregnancy, delivery, and newborn illness increased significantly more in intervention than comparison areas in both regions (with one exception in Lower Egypt), after controlling for child's age and woman's education; this pattern also occurred for two of five behaviors (antenatal care visits and consumption of iron-folate tablets). Findings suggest that there may have been a significant dose-response relationship between exposure to SMART activities and certain knowledge and behavioral indicators, especially in Upper Egypt. The findings demonstrate the ability of civil society organizations with minimal health programming experience to increase knowledge and promote healthy behaviors among pregnant women and new mothers. The SMART approach offers a promising strategy to fill gaps in health education and counseling and strengthen community support for behavior change.

Population aging in local areas and subjective well-being of older adults: Findings from two studies in Japan

Subjective well-being (SWB) of older adults could be affected by both individual and community characteristics. However, the effect of community characteristics, such as population aging in local areas, remains unclear. This study examined the cross-sectional and longitudinal associations between the area-level population aging and SWB of older individuals from two distinct surveys. Those analyzed were 572 respondents aged 75 years and older for a cross-sectional survey in a metropolitan area in Tokyo, Japan (Study 1) and 1,257 and 859 respondents for a cross-sectional and longitudinal analysis, respectively, for a 2-year longitudinal survey project in urban and rural areas of Fukui Prefecture (Study 2). Area-level population aging was assessed by the number of people aged 65 years or older per 100 residents. SWB was assessed with the Life Satisfaction Index-A (LSIA). Multilevel analysis was performed to examine unconditional and conditional associations between the area-level number of older adults per 100 residents and the individual-level LSIA scores. The area-level number of older adults per 100 residents was significantly and positively associated with the LSIA scores in Study 1 (p = 0.042), even after controlling for the area- and individual-level covariates. In Study 2, we also found a significant effect of the area-level number of older adults per 100 residents on LSIA scores in the longitudinal multivariate analysis (p = 0.049). Findings from two survey projects suggested cross-validity in the positive effect of area-level population aging on older adults' SWB. Policymakers should consider older citizens' SWB in the recent urban-to-rural migration governmental policy as well as in urban renovation planning.

Social capital and health and job related outcomes: the case of a large municipality

Purpose

– The purpose of this paper is to investigate the relationship between workplace social capital and health and job related outcomes in a large Danish municipality.

Design/methodology/approach

– Data used in this cross-sectional study are based on an electronic employee survey conducted in 2012 in a large municipality. Of the total population of 5,672 individuals, the number of participants amounted to 4,162, leading to a response rate of 73.4 percent. Binary logistic regression analysis is used as a statistical method, and odds ratios and their corresponding 95 percent confidence intervals have been estimated.

Findings

– The level of social capital is fairly high in the municipality (3.75 on a five-point scale). Social capital is related to health (OR=0.420) and psychological distress (OR=0.282) but has an even stronger relationship to job satisfaction and commitment (OR is 9.889 and 7.800, respectively). The study contributes with the conclusion that different sub-dimensions of social capital are related to health and job related outcomes. Therefore, managers need to be specific about what exactly they want to achieve with the implementation of social capital in municipalities.

Originality/value

– Research of the relationship between social capital and health and job related outcomes based on a case study approach of a municipality are limited. This paper makes an original contribution in providing evidence of the importance of social capital for Danish municipal sector employees’ health, job satisfaction, and commitment in a work context.

A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development

BACKGROUND

Patient complexity is often operationalized by counting multiple chronic conditions (MCC) without considering contextual factors that can affect patient risk for adverse outcomes.

OBJECTIVE

Our objective was to develop a conceptual model of complexity addressing gaps identified in a review of published conceptual models.

DATA SOURCES

We searched for English-language MEDLINE papers published between 1 January 2004 and 16 January 2014. Two reviewers independently evaluated abstracts and all authors contributed to the development of the conceptual model in an iterative process.

RESULTS

From 1606 identified abstracts, six conceptual models were selected. One additional model was identified through reference review. Each model had strengths, but several constructs were not fully considered: 1) contextual factors; 2) dynamics of complexity; 3) patients' preferences; 4) acute health shocks; and 5) resilience. Our Cycle of Complexity model illustrates relationships between acute shocks and medical events, healthcare access and utilization, workload and capacity, and patient preferences in the context of interpersonal, organizational, and community factors.

CONCLUSIONS/IMPLICATIONS

This model may inform studies on the etiology of and changes in complexity, the relationship between complexity and patient outcomes, and intervention development to improve modifiable elements of complex patients.

The 2008 financial crisis: Changes in social capital and its association with psychological wellbeing in the United Kingdom - A panel study

The global financial crisis of 2008 was described by the IMF as the worst recession since the Great Depression. This historic event provided the backdrop to this United Kingdom (UK) longitudinal study of changes in associations between social capital and psychological wellbeing. Past longitudinal studies have reported that the presence of social capital may buffer against adverse mental health outcomes. This study adds to existing literature by employing data from the British Household Panel Survey and tracking the same individuals (N = 11,743) pre- and immediately post-crisis (years 2007-09). With longitudinal, multilevel logistic regression modelling, we aimed to compare the buffering effects of individual-level social capital (generalised trust and social participation) against worse psychological wellbeing (GHQ-12) during and immediately after the 2008 financial crisis. After comparing the same individuals over time, results showed that stocks of social capital (generalised trust) were significantly depleted across the UK during the crisis, from 40% trusting others in 2007 to 32% in 2008. Despite this drop, the buffering effect of trust against worse psychological wellbeing was pronounced in 2008; those not trusting had an increased risk of worse psychological wellbeing in 2008 compared with the previous year in fully adjusted models (OR = 1.49, 95% CI (1.34-1.65). Levels of active participation increased across the timeframe of this study but were not associated with psychological health. From our empirical evidence, decision makers should be made aware of how events such as the crisis (and the measures taken to counter its effects) could negatively impact on a Nation's trust levels. Furthermore, past research implies that the positive effects of trust on psychological wellbeing evident in this study may only be short-term; therefore, decision makers should also prioritise policies that restore trust levels to improve the psychological wellbeing of the population.

Individual and neighbourhood social capital and all-cause mortality in Brazilian adults: a prospective multilevel study

OBJECTIVE

The relationship between social capital and mortality is not clear-cut. There have been few longitudinal studies investigating this association so far. The objective was to assess the effect of different dimensions of social capital on mortality among adults of a Brazilian city.

STUDY DESIGN

This is a prospective multilevel study. Baseline data were obtained from a population-based random sample of 846 adults (aged 18 years or more) residing in 38 neighbourhoods (census blocks).

METHODS

Participants were interviewed in 2006-7 and their vital status investigated in 2013. Social capital was assessed by five scales (social cohesion, informal social control, neighbours' support, social action and political efficacy). The outcome was all-cause mortality. Data analysis used multilevel logistic regression models.

RESULTS

At the individual level social cohesion was positively related to mortality in the unadjusted model but this association lost significance after adjustment for other variables in multivariable models. At the neighbourhood level, high mortality rates were associated with low social action independently of demographic, socio-economic, behavioural and health-related variables.

CONCLUSION

We found more evidence for a contextual than individual level effect of social capital on mortality.

Strengthening Social Capital Through Residential Environment Development for Older Chinese in a Canadian Context

Among Canada's visible-minority population 65 years of age or older, nearly four out of ten are Chinese. However, little research has been devoted to the examination of the role of the housing environment in building social capital for older Chinese despite the increase in this population and related social issues. The purpose of this paper is to examine Chinese elders' experience of social capital and how it is affected by their residential environment in a Canadian context. In this qualitative study, forty-three Chinese elders in a Canadian context were interviewed with a focus group approach. Findings indicate that the environments in which these older adults lived either hindered or assisted them in building or increasing their social capital. A culturally and linguistically homogeneous residential environment does not necessarily provide positive support to older Chinese for their acquisition of social capital. Adversities in the environment, such as maltreatment or lack of support from their immediate micro environment (family), tended to motivate older adults to improve their social capital for problem-solving. The study offers implications from research findings to social work practice and concludes with an analysis of limitations.

Neighbourhood social capital: measurement issues and associations with health outcomes

We compared ecometric neighbourhood scores of social capital (contextual variation) to mean neighbourhood scores (individual and contextual variation), using several health-related outcomes (i.e. self-rated health, weight status and obesity-related behaviours). Data were analysed from 5,900 participants in the European SPOTLIGHT survey. Factor analysis of the 13-item social capital scale revealed two social capital constructs: social networks and social cohesion. The associations of ecometric and mean neighbourhood-level scores of these constructs with self-rated health, weight status and obesity-related behaviours were analysed using multilevel regression analyses, adjusted for key covariates. Analyses using ecometric and mean neighbourhood scores, but not mean neighbourhood scores adjusted for individual scores, yielded similar regression coefficients. Higher levels of social network and social cohesion were not only associated with better self-rated health, lower odds of obesity and higher fruit consumption, but also with prolonged sitting and less transport-related physical activity. Only associations with transport-related physical activity and sedentary behaviours were associated with mean neighbourhood scores adjusted for individual scores. As analyses using ecometric scores generated the same results as using mean neighbourhood scores, but different results when using mean neighbourhood scores adjusted for individual scores, this suggests that the theoretical advantage of the ecometric approach (i.e. teasing out individual and contextual variation) may not be achieved in practice. The different operationalisations of social network and social cohesion were associated with several health outcomes, but the constructs that appeared to represent the contextual variation best were only associated with two of the outcomes.

Patient perspectives on peer support for adults with type 1 diabetes: a need for diabetes-specific social capital

AIM

To explore the function of peer support from the perspective of adults with type 1 diabetes in Denmark.

METHODS

The study population consisted of 20 adults with type 1 diabetes. The sample was diverse in relation to educational background, age, sex, and cohabitation status. Inspired by action research, several methods and perspectives on peer support were explored and tested. Workshops and group and individual interviews were performed. Systematic text condensation was used to analyze data, supplemented with theory-based interpretive analysis.

RESULTS

Adults with type 1 diabetes found peer support highly relevant to reduce a burdensome feeling of diabetes-specific loneliness. Peer support showed potential to create diabetes-specific social capital not only by creating reciprocal social support between peers but also, more importantly, by creating space for genuine trust and a feeling of communality. There was a widespread feeling of the pervasive impact of diabetes on daily life and thus the relevance of discussing all aspects of life. However, participants perceived peer support as particularly relevant in relation to big changes in life, for example, in family life, at work, or through treatment events such as getting an insulin pump.

CONCLUSION

Peer support programs focusing on creating and establishing diabetes-specific social capital using participatory approaches seem highly relevant among adults with type 1 diabetes. Content, methods, and effects of peer support need further exploration in collaboration with adults with type 1 diabetes.

A Structural Equation Modeling of the Relationships between Depression, Drug Abuse and Social Support with Suicidal Ideation among Soldiers in Iran in 2015

BACKGROUND

Military service is a crucial period in the lives of young people and during this period soldier facing with multiple psychosocial problems.

OBJECTIVES

The present study aimed to explore structural analysis of the relationships between depression, drug abuse, social support and the risk of suicidal ideation among Military Medical University soldiers in Iran.

METHODS

In the present correlational research, a sample of 176 soldiers, from three units, was selected using randomly stratified sampling. Data were collected through the Social Support Questionnaire (SSQ), the Beck Depression Inventory-II (BDI-II), the Beck Scale for Suicide Ideation (BSS) and the Possibility of Drug Abuse Scale (LDAS). Structural equation modeling was used to test the fit of the model, identify direct and indirect effects of the psychosocial correlates. Data were analyzed using the SPSS and AMOS software (Verson22).

RESULTS

out of the whole subjects, 28.4% had suicidal ideation and 65.3% had degrees of depression (mild to severe). A significant reverse relationship was observed between social support and suicidal ideation (p<0.05). The strongest relationship was detected between drug abuse and suicidal ideation. The final structural model indicated that 74% of the variance in suicidal ideation was explained by the three examined variables of depression, social support and drug abuse.

CONCLUSIONS

The overall results showed that the risk of suicidal ideation, depression and drug abuse are relatively significant in Military Medical University soldiers requiring taking serious actions by the authorities and other relevant organizations in order to improve the psychosocial health status of these soldiers.

The Association Between Social Resources and Depressive Symptoms Among Chinese Migrants and Non-Migrants Living in Guangzhou, China

Background: Depression is a commonly studied mental disorder affecting Chinese internal (i.e., rural-to-urban) migrants. Social resources effectively reduce depression for many communities experiencing adversities. This study evaluated social-level risk factors for depression between internal migrant and non-migrant Chinese living in mainland China. Method: We conducted a random population-level survey among migrants and local residents living in Guangzhou, China. Data were collected using face-to-face interviews. We used items from the Social Support Rating Scale to measure social resource dimensions, including social network size, emotional support, structural social capital, and one (self-developed) item that measured belonging (an element of social cohesion). The Patient Health Questionnaire-9 measured depression. Correlation and regression analyses of the partial sample ( n = 678) were conducted to estimate the association between social resources and depression for migrants ( n = 383) and non-migrants ( n = 295). Results: Stratified regression analysis demonstrated that for migrants, greater belonging was associated with less depression, while age and larger friendship social network size was related to less depression among non-migrants. Conclusion: Differences emerged in our sample with regard to the types of social resources that are protective against depression between migrants and non-migrants. Interventions that provide opportunities for migrants to better integrate and feel welcomed into their new communities may reduce their depression symptoms.

Bonding, Bridging, and Linking Social Capital and Self-Rated Health among Chinese Adults: Use of the Anchoring Vignettes Technique

Three main opposing camps exist over how social capital relates to population health, namely the social support perspective, the inequality thesis, and the political economy approach. The distinction among bonding, bridging, and linking social capital probably helps close the debates between these three camps, which is rarely investigated in existing literatures. Moreover, although self-rated health is a frequently used health indicator in studies on the relationship between social capital and health, the interpersonal incomparability of this measure has been largely neglected. This study has two main objectives. Firstly, we aim to investigate the relationship between bonding, bridging, and linking social capital and self-rated health among Chinese adults. Secondly, we aim to improve the interpersonal comparability in self-rated health measurement. We use data from a nationally representative survey in China. Self-rated health was adjusted using the anchoring vignettes technique to improve comparability. Two-level ordinal logistic regression was performed to model the association between social capital and self-rated health at both individual and community levels. The interaction between residence and social capital was included to examine urban/rural disparities in the relationship. We found that most social capital indicators had a significant relationship with adjusted self-rated health of Chinese adults, but the relationships were mixed. Individual-level bonding, linking social capital, and community-level bridging social capital were positively related with health. Significant urban/rural disparities appeared in the association between community-level bonding, linking social capital, and adjusted self-rated health. For example, people living in communities with higher bonding social capital tended to report poorer adjusted self-rated health in urban areas, but the opposite tendency held for rural areas. Furthermore, the comparison between multivariate analyses results before and after the anchoring vignettes adjustment showed that the relationship between community-level social capital and self-rated health might be distorted if comparability problems are not addressed. In conclusion, the framework of bonding, bridging, and linking social capital helps us better understand the mechanism between social capital and self-rated health. Cultural and socioeconomic factors should be considered when designing health intervention policies using social capital. Moreover, we recommend that more studies improve the comparability of self-rated health by using the anchoring vignettes technique.

Trust and health: testing the reverse causality hypothesis

Background

Social capital research has consistently shown positive associations between generalised trust and health outcomes over 2 decades. Longitudinal studies attempting to test causal relationships further support the theory that trust is an independent predictor of health. However, as the reverse causality hypothesis has yet to be empirically tested, a knowledge gap remains. The aim of this study, therefore, was to investigate if health status predicts trust.

Methods

Data employed in this study came from 4 waves of the British Household Panel Survey between years 2000 and 2007 (N=8114). The sample was stratified by baseline trust to investigate temporal relationships between prior self-rated health (SRH) and changes in trust. We used logistic regression models with random effects, as trust was expected to be more similar within the same individuals over time.

Results

From the ‘Can trust at baseline’ cohort, poor SRH at time (t−1) predicted low trust at time (t) (OR=1.38). Likewise, good health predicted high trust within the ‘Cannot’ trust cohort (OR=1.30). These patterns of positive association remained after robustness checks, which adjusted for misclassification of outcome (trust) status and the existence of other temporal pathways.

Conclusions

This study offers empirical evidence to support the circular nature of trust/health relationship. The stability of association between prior health status and changes in trust over time differed between cohorts, hinting at the existence of complex pathways rather than a simple positive feedback loop.

Characteristics of Employees of Small Manufacturing Businesses by Occupation: Informing Evidence-Based Intervention Planning

OBJECTIVES

We examined characteristics of employees in six occupational categories in small manufacturing businesses (20-150 employees).

METHODS

We analyzed survey data from 47 businesses (n = 2577 employees; 86% response rate) and examined relationships between job type and sociodemographic, health, and organizational support characteristics. Analyses were adjusted for age and sex, and company as a random effect.

RESULTS

Smoking rates were highest for production workers (33%), production managers (27%), and support staff (28%) and lowest for managers (11%) (P <0.001). Job stress was higher for production workers and support staff than managers (P < 0.0001). Managers perceived social capital (P<0.001), safety climate (P < 0.0001) and support for smoking cessation (P < 0.001) higher than production managers, production workers, and support staff.

CONCLUSIONS

Differences in characteristics by occupation call for integrated interventions that target working class employees, leverage the influence of production managers, and enhance organizational support.

Health Behaviours As a Mechanism in the Prospective Relation between Workplace Reciprocity and Absenteeism: A Bridge too Far ?

BACKGROUND

The persistent lack of evidence on causal mechanisms between social capital and health threatens the credibility of the social capital-health association. The present study aims to address this ongoing problem by investigating whether health behaviours (i.e. smoking, alcohol consumption, and physical activity) mediate the prospective relation between workplace reciprocity and future sickness absence.

METHODS

A cohort of 24,402 Belgian employees was followed up during 12 months for sickness absence. Workplace reciprocity was measured with four indicators-colleague help, colleague interest, supervisor help, and supervisor concern. Three types of multilevel mediation models were applied.

RESULTS

Overall, workplace reciprocity negatively related to high sickness absence (≥ 10 days) mainly independently from health behaviours. Uniquely, colleague interest positively related to smoking (OR = 1.058, 95% CI = 1.019, 1.098) and smoking in turn, positively related to sickness absence (OR = 1.074, 95% CI = 1.047, 1.101). No behavioural pathways could be identified between company-level reciprocity and sickness absence, and company-level health-related behaviours did not mediate the relation between company-level reciprocity and individual sickness absence.

CONCLUSIONS

These results suggest that both social capital and health behaviours are relevant for employee health, but health behaviours seem not to be the underlying explanatory mechanism between workplace reciprocity and health.

Social Capital as a Determinant of Pregnant Mother's Place of Delivery: Experience from Kongwa District in Central Tanzania

INTRODUCTION

Maternal ill health contributes highly to the global burden of diseases in countries South of Sahara including Tanzania. Ensuring that all deliveries take place in health facilities and hence attended by skilled health personnel is one of the strategies advocated by global and national policies, including the Millennium Development Goals (MDGs). However, the number of women delivered by skilled health personnel has remained low in sub Saharan Africa despite of a number of interventions. We sought to determine the role of social capital in facilitating health facility delivery.

METHODS

We randomly selected 744 households with children aged less than five years from two randomly selected wards in a rural area in Tanzania. Mothers were enquired about place of delivery of the last child. Social capital was assessed using a modified questionnaire with both structural and cognitive aspects of social capital, administered in face-to-face interviews. Principal Component Analysis (PCA) was used to develop asocial capital index measure. Uni-variate and multivariable regression models were run using STATA 12.

RESULTS

Majority (85.9%) of the mothers reported to have delivered in a health facility during their last birth. Compared to the lowest social capital quintile, delivering in a health facility increased significantly with increase in social capital level: low (Adjusted Odds Ratio (AOR) = 2.9; Confidence Interval (CI): 1.4-6.1, p = 0.004); moderate (AOR = 5.5, CI: 2.3-13.3, p-value<0.001); high (AOR = 4.7; CI: 1.9-11.6, p-value<0.001) and highest (AOR = 5.6, CI: 2.4-13.4, p-value<0.001) and χ2-test for the trend was significant (χ2 = 17.21, p<0.001).

CONCLUSION

Overall, social capital seems to play an important role in enhancing health facility delivery that may lead to improved maternal and child health. Concerted efforts should focus on promoting and supporting effective social capital and in particular cognitive social capital.

A systematic review of social capital and chronic non-communicable diseases

Nowadays, chronic non-communicable diseases have become a significant social problem of healthcare which threatens human health along with their rapid progress of morbidity and mortality. How to develop potential, intangible resources to compensate for insufficient physical resources is urgent. By analyzing literature reporting the association between social capital and chronic non-communicable diseases systematically, evidence was found for a positive association between social capital and chronic non-communicable disease prevention and control. The social capital theory may provide a new idea to solve the problem.

Living environment matters: relationships between neighborhood characteristics and health of the residents in a Dutch municipality

Characteristics of an individual alone cannot exhaustively explain all the causes of poor health, and neighborhood of residence have been suggested to be one of the factors that contribute to health. However, knowledge about aspects of the neighborhood that are most important to health is limited. The main objective of this study was to explore associations between certain features of neighborhood environment and self-rated health and depressive symptoms in Maastricht (The Netherlands). A large amount of routinely collected neighborhood data were aggregated by means of factor analysis to 18 characteristics of neighborhood social and physical environment. Associations between these characteristics and self-rated health and presence of depressive symptoms were further explored in multilevel logistic regression models adjusted for individual demographic and socio-economic factors. The study sample consisted of 9,879 residents (mean age 55 years, 48 % male). Residents of unsafe communities were less likely to report good health (OR 0.88 95 % CI 0.80-0.97) and depressive symptoms (OR 0.81 95 % CI 0.69-0.97), and less cohesive environment was related to worse self-rated health (OR 0.81 95 % CI 0.72-0.92). Residents of neighborhoods with more car traffic nuisance and more disturbance from railway noise reported worse mental health (OR 0.79 95 % CI 0.68-0.92 and 0.85 95 % CI 0.73-0.99, respectively). We did not observe any association between health and quality of parking and shopping facilities, facilities for public or private transport, neighborhood aesthetics, green space, industrial nuisance, sewerage, neighbor nuisance or satisfaction with police performance. Our findings can be used to support development of integrated health policies targeting broader determinants of health. Improving safety, social cohesion and decreasing traffic nuisance in disadvantaged neighborhoods might be a promising way to improve the health of residents and reduce health inequalities.

The Role of School Social Environment on Dental Caries Experience in 8- to 12-Year-Old Brazilian Children: A Multilevel Analysis

Aim: Although children spend most of their time involved in activities related to school, few studies have focused on the association between school social environment and oral health. This cross-sectional study assessed individual and school-related social environment correlates of dental caries in Brazilian schoolchildren aged 8-12 years. Methods: A sample of children from 20 private and public schools (n = 1,211) was selected. Socio-economic data were collected from parents, and data regarding children characteristics were collected from children using a questionnaire. Dental examinations were performed to assess the presence of dental plaque: dental caries experience (DMFT ≥1) and dental caries severity (mean dmf-t/DMF-T). The social school environment was assessed by a questionnaire administered to school coordinators. Multilevel Poisson regression was used to investigate the association between school social environment and dental caries prevalence and experience. Results: The dental caries prevalence was 32.4% (95% confidence interval: 29.7-35.2) and the mean dmf-t/DMF-T was 1.84 (standard deviation: 2.2). Multilevel models showed that the mean dmf-t/DMF-T and DMFT ≥1 were associated with lower maternal schooling and higher levels of dental plaque. For contextual variables, schools offering after-hours sports activities were associated with a lower prevalence of dental caries and a lower mean of dmf-t/DMF-T, while the occurrence of violence and theft episodes was positively associated with dental caries. Conclusions: The school social environment has an influence on dental caries in children. The results suggest that strategies focused on the promotion of healthier environments should be stimulated to reduce inequalities in dental caries.

Social capital, mortality, cardiovascular events and cancer: a systematic review of prospective studies

BACKGROUND

Social capital is considered to be an important determinant of life expectancy and cardiovascular health. Evidence on the association between social capital and all-cause mortality, cardiovascular disease (CVD) and cancer was systematically reviewed.

METHODS

Prospective studies examining the association of social capital with these outcomes were systematically sought in Medline, Embase and PsycInfo, all from inception to 8 October 2012. We categorized the findings from studies according to seven dimensions of social capital, including social participation, social network, civic participation,social support, trust, norm of reciprocity and sense of community, and pooled the estimates across studies to obtain summary relative risks of the health outcomes for each social capital dimension. We excluded studies focusing on children, refugees or immigrants and studies conducted in the former Soviet Union.

RESULTS

Fourteen prospective studies were identified. The pooled estimates showed no association between most social capital dimensions and all-cause mortality, CVD or cancer. Limited evidence was found for association of increased mortality with social participation and civic participation when comparing the most extreme risk comparisons.

CONCLUSIONS

Evidence to support an association between social capital and health outcomes is limited. Lack of consensus on measurements for social capital hinders the comparability of studies and weakens the evidence base.

The association between social capital and quality of life among type 2 diabetes patients in Anhui province, China: a cross-sectional study

BACKGROUND

To investigate the association between social capital and quality of life among type 2 diabetes patients in Anhui province, China.

METHODS

In a cross-sectional study, 436 adults with type 2 diabetes were interviewed. The two domains of Quality of life, physical component summary (PCS) and mental component summary (MCS), were measured using the Short-Form Health Survey (SF-36). A modified instrument scale was used to measure cognitive and structural social capital. Multiple logistic regression models were used to assess the associations between social capital and quality of life, adjusting for social economic status and risk factors for health.

RESULTS

24.3 % of participants (106) were in poor PCS and 25.0 % (109) in poor MCS. The proportions of participants who had low cognitive and structural social capital were 47.0 % (205) and 64.4 % (281), respectively. Results of logistic regression models showed that cognitive social capital was positively associated with PCS (OR = 1.84; 95 % CI: 1.12, 3.02) and MCS (OR = 1.65; 95 % CI: 1.03, 2.66). However, the associations between structural social capital and PCS (OR = 0.80, 95 % CI: 0.48, 1.34) and MCS (OR = 0.62; 95 % CI: 0.38, 1.01) were not statistically significant.

CONCLUSIONS

It is the first study in China to investigate associations between quality of life and social capital in type 2 diabetes. Findings document that cognitive social capital is associated with the quality of life of type 2 diabetes patients. Our study suggests that the social capital theory may provide a new approach to increase physical resources in diabetes prevention and control, especially in Low and Middle Income countries (LMICs).

Social resources, health promotion behavior, and quality of life in adults living with HIV

PURPOSE

To describe the associations among three social resource variables (social belonging, social support networks, and social capital) and two health promotion behaviors, HIV medication adherence and physical activity, and quality of life among persons living with HIV (PLHIV).

METHOD

We conducted a cross-sectional analysis in 102 adult PLHIV. Social resource variables and quality of life were assessed using validated and widely-used instruments. Physical activity was assessed using a daily physical activity diary and medication adherence was abstracted from the participant's medical record. Spearman correlations and descriptive statistics were used to analyze associations among variables.

RESULTS

Fifty-four participants (54%) were male and most were African American (84%), single (69%), and living in poverty (82%). Participants had been living with HIV for an average of 13.6 years (+/-7) and most were living with at least one non-AIDS comorbidity (80%). Social belonging was significantly associated with HIV medication adherence (ρ=0.25, p=0.02), overall functioning (ρ=0.48, p<0.01) and life satisfaction quality of life (ρ=0.50, p<0.01). Social capital was also associated with HIV medication adherence (ρ=0.17, p=0.10) and life satisfaction quality of life (ρ=0.29, p<0.01).

CONCLUSIONS

We found that there are distinctions among various, widely-used social resource constructs. By describing these unique associations and distinctions, our study helps identify which social resources should be targeted in the development of interventions to improve health promotion and the quality of life of members of this marginalized population.

Association between social capital and self-perception of health in Brazilian adults

OBJECTIVE

To investigate the association between social capital and social capital and self-perception of health based on examining the influence of health-related behaviors as possible mediators of this relationship.

METHODS

A cross-sectional study was used with 1,081 subjects, which is representative of the population of individuals aged 40 years or more in a medium-sized city in Southern Brazil. The subjects who perceived their health as fine, bad or very bad were considered to have a negative self-perception of their health. The social capital indicators were: number of friends, people from whom they could borrow money from when needed; the extent of trust in community members; whether or not members of the community helped each other; community safety; and extent of participation in community activities. The behaviors were: physical activity during leisure time, fruits and vegetable consumption, tobacco use and alcohol abuse. The odds ratios (OR) and confidence intervals (CI) 95% were calculated by binary logistic regression. The significance of mediation was verified using the Sobel test.

RESULTS

Following adjustment for demographic and clinical variables, subjects with fewer friends (OR = 1.39, 95%CI 1.08;1.80), those who perceived less frequently help from people in the neighborhood (OR = 1.30, 95%CI 1.01;1.68), who saw the violent neighborhood (OR = 1.33, 95%CI 1.01;1.74) and who had not participated in any community activity (OR = 1.39, 95%CI 1.07;1.80) had more negative self-perception of their health. Physical activity during leisure time was a significant mediator in the relationship between all social capital indicators (except for the borrowed money variable) and self-perceived health. Fruit and vegetable consumption was a significant mediator of the relationship between the extent of participation in community activities and self-perceived health. Tobacco use and alcohol abuse did not seem to have a mediating role in any relationship.

CONCLUSIONS

Lifestyle seems to only partially explain the relationship between social capital and self-perceived health. Among the investigated behaviors, physical activity during leisure time is what seems to have the most important role as a mediator of this relationship.

Social Capital as a Determinant of Self-Rated Health in Women of Reproductive Age: A Population-Based Study

Introduction:

Recognition of the factors related to women’s health is necessary. Evidence is available that the social structure including social capital plays an important role in the shaping people’s health. The aim of the current study was to investigate the association between self-rated health and social capital in women of reproductive age.

Methods:

This study is a population-based cross-sectional survey on 770 women of reproductive age, residing in any one of the 22 municipality areas across Tehran (capital of Iran) with the multi stage sampling technique. Self-rated health (Dependent variable), social capital (Independent variable) and covariates were studied. Analysis of data was done by one-way ANOVA test and multiple linear regressions.

Results:

Depending on logistic regression analyses, the significant associations were found between self-rated health and age, educational level, crowding index, sufficiency of income for expenses and social cohesion. Data show that women with higher score in social cohesion as an outcome dimension of social capital have better self-rated health (PV = 0.001).

Conclusion:

Given the findings of this study, the dimensions of social capital manifestations (groups and networks, trust and solidarity, collective action and cooperation) can potentially lead to the dimensions of social capital outcomes (social cohesion and inclusion, and empowerment and political action). Following that, social cohesion as a dimension of social capital outcomes has positively relationship with self- rated health after controlling covariates. Therefore, it is required to focus on the social capital role on health promotion and health policies.

Neighborhood and family social capital and parent-reported oral health of children in Iowa

OBJECTIVES

A growing body of evidence supports the impact of social factors on oral health disparities in children in the United States. The goal of this study was to examine the relationship between two types of social capital-family and neighborhood-and the parent-reported oral health of Iowa's children.

METHODS

We analyzed results from a 2010 cross-sectional statewide health survey. The outcome was parent-reported child oral health status, and the five primary independent variables were neighborhood social capital and four separate indicators of family social capital. Data were analyzed using a mixed-effects linear regression with a random effect for zip code.

RESULTS

Significant positive associations were found between child oral health status and neighborhood social capital (P = 0.005) and one indicator of family social capital, family frequency of eating meals together (P = 0.02), after adjusting for covariates.

CONCLUSIONS

This study adds to the growing body of literature around the social determinants of oral health. Our findings indicate that the oral health of children may be influenced by broad social factors such as neighborhood and family social capital.

Social disorganization of neighborhoods and incidence of psychotic disorders: a 7-year first-contact incidence study

BACKGROUND

Environmental factors such as urban birth and ethnic minority position have been related to risk for psychotic disorders. There is some evidence that not only individual, but also neighborhood characteristics influence this risk. The aim of this study was to investigate social disorganization of neighborhoods and incidence of psychotic disorders.

METHOD

The research was a 7-year first-contact incidence study of psychotic disorders in The Hague. Neighborhood characteristics included continuous, dichotomous and cumulative measures of socio-economic level, residential mobility, ethnic diversity, proportion of single person households, voter turnout, population density and crime level. Using multilevel Poisson regression analysis, incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of psychotic disorders were calculated for the indicators of neighborhood social disorganization.

RESULTS

A total of 618 incident cases were identified. Neighborhood socio-economic level and residential mobility had the strongest association with incidence of psychotic disorders [individual-level adjusted Wald χ2 1 = 13.03 (p = 0.0003) and 5.51 (p = 0.02), respectively]. All but one (proportion of single person households) of the dichotomous neighborhood indicators were significantly associated with a higher IRR. The cumulative degree of neighborhood social disorganization was strongly and linearly associated with the incidence of psychotic disorders (trend test, Wald χ2 5 = 25.76, p = 0.0001). The IRR in neighborhoods with the highest degree of social disorganization was 1.95 (95% CI 1.38-2.75) compared with the lowest disorganization category.

CONCLUSIONS

The findings suggest that the risk for developing a psychotic disorder is higher for people living in socially disorganized environments. Longitudinal studies are needed to investigate causality.

Are family, neighbourhood and school social capital associated with higher self-rated health among Croatian high school students? A population-based study

OBJECTIVES

We investigated the associations between self-rated health and social capital among Croatian high school students.

DESIGN

A cross-sectional survey among high school students was carried out in the 2013-2014 school year.

SETTING

High schools in Croatia.

PARTICIPANTS

Subjects were 3427 high school students (1688 males and 1739 females), aged 17-18 years.

MAIN OUTCOME MEASURE

Self-rated health was assessed by the single item: "How do you perceive your health?". Possible responses were arranged along a five-item Likert-type scale: 1 very poor, 2 poor, 3 fair, 4 good, 5 excellent. The outcome was binarised as 'good health' (excellent, good or fair) versus 'poor health' (poor or very poor).

METHODS

We calculated ORs and 95% CIs for good self-rated health associated with family, neighbourhood and school social capital, while adjusting for gender, self-perceived socioeconomic status, psychological distress, physical activity and body mass index. We used generalised estimating equations using an exchangeable correlation matrix with robust SEs.

RESULTS

Good self-rated health was significantly associated with higher family social capital (OR 2.43; 95% CI 1.55 to 3.80), higher neighbourhood trust (OR 2.02; 95% CI 1.48 to 2.76) and higher norms of reciprocity at school (OR 1.79; 95% CI 1.13 to 2.84). When all of the social capital variables were entered simultaneously, good self-rated health remained significantly associated with higher family social capital (OR 1.98; 95% CI 1.19 to 3.30), neighbourhood trust (OR 1.77; 95% CI 1.25 to 2.51) and reciprocity at school (OR 1.71; 95% CI 1.08 to 2.73).

CONCLUSIONS

Higher levels of social capital were independently associated with higher self-rated health among youth. Intervention and policies that leverage community social capital might serve as an avenue for health promotion in youth.

The roles of outlet density and norms in alcohol use disorder

BACKGROUND

Alcohol outlet density and norms shape alcohol consumption. However, due to analytic challenges we do not know: (a) if alcohol outlet density and norms also shape alcohol use disorder, and (b) whether they act in combination to shape disorder.

METHODS

We applied a new targeted minimum loss-based estimator for rare outcomes (rTMLE) to a general population sample from New York City (N = 4000) to examine the separate and combined relations of neighborhood alcohol outlet density and norms around drunkenness with alcohol use disorder. Alcohol use disorder was assessed using the World Mental Health Comprehensive International Diagnostic Interview (WMH-CIDI) alcohol module. Confounders included demographic and socioeconomic characteristics, as well as history of drinking prior to residence in the current neighborhood.

RESULTS

Alcohol use disorder prevalence was 1.78%. We found a marginal risk difference for alcohol outlet density of 0.88% (95% CI 0.00-1.77%), and for norms of 2.05% (95% CI 0.89-3.21%), adjusted for confounders. While each exposure had a substantial relation with alcohol use disorder, there was no evidence of additive interaction between the exposures.

CONCLUSIONS

Results indicate that the neighborhood environment shapes alcohol use disorder. Despite the lack of additive interaction, each exposure had a substantial relation with alcohol use disorder and our findings suggest that alteration of outlet density and norms together would likely be more effective than either one alone. Important next steps include development and testing of multi-component intervention approaches aiming to modify alcohol outlet density and norms toward reducing alcohol use disorder.

Association between social capital and health in women of reproductive age: a population-based study

Women's health is a public health priority. The origins of health inequalities are very complex. The present study was conducted to determine the association between social capital and health status in reproductive-age women in Tehran, Iran. In this population-based, cross-sectional study, the Social Capital Integrated Questionnaire, the SF-36 and socio-demographic questionnaires were used. Analysis of data by one-way ANOVA test and stepwise multiple linear regression showed that the manifestation dimensions of social capital (groups and networks, trust and solidarity, collective action and cooperation) can potentially lead to the outcome dimensions of social capital (social cohesion and inclusion, and empowerment and political action), which in turn affect health inequities after controlling for socio-demographic differences.

Distance to retail stores and risk of being homebound among older adults in a city severely affected by the 2011 Great East Japan Earthquake

Background: after the Great East Japan Earthquake in 2011, inactivity and the homebound status of older victims in affected areas have been a serious public health concern owing to the victims' prolonged existence as evacuees in mountainous areas.

Objective: to evaluate the association between distances to retail stores and risks of being homebound.

Design: secondary analysis of cross-sectional interview survey data with a geographical information analysis.

Setting: Rikuzentakata, Iwate, a municipality seriously damaged by the 2011 earthquake and tsunami.

Subjects: all Rikuzentakata residents aged 65 or older except for those living in temporary housing (n = 2,327).

Methods: we calculated road distances between each residential address and retail stores, hawker sites and shopping bus stops, accounting for the extra load caused by walking on slopes. The prevalence ratio of being homebound adjusted for age, source of income and morbidity by road distance was estimated using Poisson regression with a generalised estimating equation.

Results: those living at distances of 1,200 m or more were 1.78 (95% confidence intervals, 1.03–3.08) times more likely to be homebound (going out only every 4 or more days a week) among men and 1.85 (1.13-3.02) among women, compared with those residing in places <400 m from retail stores or shopping bus stops. The distances were reduced by new hawker and shopping bus services, but the improvements varied greatly across the districts.

Conclusions: access to daily needs is essential to prevent homebound status. Post-disaster community diagnosis in terms of the built environment is important for strategic community restoration.

Comparing levels of social capital in three northern post-industrial UK cities

OBJECTIVES

A high level of 'excess' mortality (i.e. that seemingly not explained by deprivation) has been shown for Scotland compared to England & Wales and, in particular, for its largest city, Glasgow, compared to the similarly deprived postindustrial English cities of Liverpool and Manchester. The excess has been observed across all social classes, but, for premature mortality, has been shown to be highest in comparison of those of lowest socio-economic status (SES). Many theories have been proposed to explain this phenomenon. One such suggestion relates to potential differences in social capital between the cities, given the previously evidenced links between social capital and mortality. The aim of this study was to ascertain whether any aspects of social capital differed between the cities and whether, therefore, this might be a plausible explanation for some of the excess mortality observed in Glasgow.

STUDY DESIGN

Cross-sectional study.

METHODS

A representative survey of Glasgow, Liverpool and Manchester was undertaken in 2011. Social capital was measured using an expanded version of the Office for National Statistics (ONS) core 'Social Capital Harmonised Question Set'. Differences between the cities in five sets of social capital topics (views about the local area, civic participation, social networks and support, social participation, and reciprocity and trust) were explored by means of a series of multivariate regression models, while controlling for differences in the characteristics (age, gender, SES, ethnicity etc.) of the samples.

RESULTS

Some, but not all, aspects of social capital were lower among the Glasgow sample compared to those in Liverpool and Manchester. A number of these differences were greatest among those of higher, rather than lower, SES. Levels of social participation, trust and (some measures of) reciprocity were lower in Glasgow, particularly in comparison with Liverpool. However, assessment of any potential impact of these differences is limited by the cross-sectional nature of the data.

CONCLUSIONS

The analyses suggest it is at least possible that differences in some aspects of social capital could play some part in explaining Glasgow's excess mortality, especially among particular sections of its population (e.g. those of higher SES). However, in the absence of more detailed longitudinal data, this remains speculative.

Is there an association between traumatic dental injury and social capital, binge drinking and socioeconomic indicators among schoolchildren?

OBJECTIVES

Traumatic dental injury is defined as trauma caused by forces on a tooth with variable extent and severity. The aim of the present study was to investigate the prevalence of traumatic dental injury and its association with overjet, lip protection, sex, socioeconomic status, social capital and binge drinking among 12-year-old students.

RESEARCH DESIGN AND METHOD

A cross-sectional study was conducted with a sample of 633 12-year-old students. Data were collected through a clinical exam and self-administered questionnaires. Socioeconomic status was determined based on mother's schooling and household income. The Social Capital Questionnaire for Adolescent Students and Alcohol Use Disorders Identification Test (AUDIT-C) were used to measure social capital and binge drinking, respectively.

RESULTS

The prevalence of traumatic dental injury was 29.9% (176/588). Traumatic dental injury was more prevalent among male adolescents (p = 0.010), those with overjet greater than 5 mm (p < 0.001) and those with inadequate lip protection (p < 0.001). In the multiple logistic regression analysis, overjet [OR = 3.80 (95% CI: 2.235-6.466), p < 0.0001], inadequate lip protection [OR = 5.585 (95% CI: 3.654-8.535), p < 0.0001] and binge drinking [OR = 1.93 (95% CI: 1.21-3.06), p = 0.005] remained significantly associated with traumatic dental injury.

CONCLUSIONS

The present findings suggest that a high level of total social capital and trust are not associated with TDI in adolescents, unlike binge drinking. The effects of social and behavioral factors on TDI are not well elucidated. Therefore, further research involving other populations and a longitudinal design is recommended.

Changes in access to structural social capital and its influence on self-rated health over time for middle-aged men and women: a longitudinal study from northern Sweden

Until recently, most studies on social capital and health have been cross-sectional making it difficult to draw causal conclusions. This longitudinal study used data from 33,621 individuals (15,822 men and 17,799 women) from the Västerbotten Intervention Program, to analyse how changes in access to individual social capital influence self-rated health (SRH) over time. Two forms of structural social capital, i.e. informal socializing and social participation, were measured. Age, sex, education, marital status, smoking, snuff, physical activity, alcohol consumption, high blood pressure, and body mass index were analysed as potential confounders. The association between changes in access to structural social capital and SRH in the follow-up was adjusted for SRH at baseline, as well as for changes in the socio-demographic and health-risk variables over time. The results support that changes in access to structural social capital over time impact on SRH. Remaining with no/low level of informal socializing over time increased the odds ratio for poor SRH for both men and women (OR of 1.45; 95%CI = 1.22-1.73 among men and OR of 1.56; 95%CI = 1.33-1.84 among women). Remaining with no/low levels of social participation was also detrimental to SRH in men and women (OR 1.14; 95%CI = 1.03-1.26 among men and OR 1.18; 95%CI = 1.08-1.29 among women). A decrease in informal socializing over time was associated with poor SRH for women and men (OR of 1.35; 95%CI = 1.16-1.58 among men and OR of 1.57; 95%CI = 1.36-1.82 among women). A loss of social participation had a negative effect on SRH among men and women (OR of 1.16; 95%CI = 1.03-1.30 among men and OR of 1.15; 95%CI = 1.04-1.27 among women). Gaining access to social participation was harmful for SRH for women (OR 1.17; 95%CI = 1.05-1.31). Structural social capital has complex and gendered effects on SRH and interventions aiming to use social capital for health promotion purposes require an awareness of its gendered nature.