Two theoretical strands of social capital, and total, cardiovascular, cancer and other mortality: A population-based prospective cohort study

Association of Social Capital With Tuberculosis: A Community-Based Cross-Sectional Analytical Study in South India

BACKGROUND

Social capital denotes the relationships, networks, norms and values in the community. A high level of social capital positively improves health through a supportive social system. Illnesses affect health and social relationships. One such disease is tuberculosis (TB), known for its social stigma. India has the highest burden of morbidity and mortality due to TB. The assessment of social capital would highlight the importance of a supportive environment in reducing the disease burden and bringing better treatment outcomes.

METHODS

A cross-sectional exploratory analytical study was conducted in two primary health centers in Puducherry between February 2020 and March 2021. Considering the feasibility and resource constraints, we assessed the social capital between 50 newly diagnosed pulmonary tuberculosis (PTB) patients, their age- and gender-matched 50 household contacts (HHCs) and 50 PTB patients who completed treatment a year before. The HHC was either the marital partner or sibling of the newly diagnosed PTB patients selected for comparison as their exposure to infection would be similar to those diseased but did not develop the illness. Social capital and its domains were assessed using the World Bank's social capital questionnaire. Sociodemographic characteristics and social capital domains were compared using a chi-squared test. Mean standardized Z-scores of the domains were compared using one-way analysis of variance (ANOVA). A p-value of <0.05 is taken as significant.

RESULTS

Most participants from each group belonged to lower socioeconomic strata and were males (80%). The overall level of social capital was low among the newly diagnosed PTB patients, especially the group and network and trust and solidarity domains. The mean standardized Z-scores of social capital were the highest among the HHCs, followed by the treatment-completed PTB patients. There was no consistent pattern, but the trust and solidarity domain showed a statistically significant difference.

CONCLUSION

A low level of social capital and its domains were seen among the newly diagnosed PTB patients. However, better scores among the HHCs and the treatment-completed patients infer a negative association between social capital and TB. Thus, higher social capital preserves and improves health. Therefore, caregivers and disease-cured patients can be utilized as a social support system for current diseased patients and improve their health status.

Religious service attendance and mortality: A population-based prospective cohort study in southern Sweden

Aims

The aim is to investigate associations between attendance in religious service during the past year and all-cause, cardiovascular (CVD), cancer and other cause mortality.

Study design

Prospective cohort study.

Methods

A public health survey with three reminders was sent to a stratified random sample of the adult 18-80 population in southernmost Sweden in 2008. The response rate was 54.1%, and 24,855 participants were included in this study. The cross-sectional baseline survey was connected to mortality data with 8.3-year follow-up. Analyses were conducted in Cox regression models.

Results

13.9% had attended religious service at least once during the past year, and 86.1% had not attended. The group with religious attendance contained significantly higher proportions of women, high and medium position non-manual employees, participants born abroad, never alcohol consumers, respondents with high trust in others and respondents with high social participation. It also contained significantly lower proportions with low leisure-time physical activity (LTPA) and daily smokers. Religious service attendance during the past year was significantly associated with lower hazard rate ratios (HRRs) of all-cause mortality compared to non-attendance until social participation items were introduced in the final model. HRRs of CVD mortality were significantly lower for religious attendance in the multiple models until BMI and health-related behaviors were introduced. No significant results were observed for cancer and other cause mortality.

Conclusions

The results suggest that religious service attendance in a highly secularized country such as Sweden is significantly associated with lower all-cause mortality, which may be explained by a social network pathway in this highly secularized population.

Leisure-time physical activity, desire to increase physical activity, and mortality: A population-based prospective cohort study

The aim was to investigate associations between leisure-time physical activity (LTPA) and mortality, and associations between desire to increase LTPA and mortality within the low LTPA group. A public health survey questionnaire was sent in 2008 to a stratified random sample of the population aged 18-80 in southernmost Sweden, yielding a 54.1% response rate. Baseline 2008 survey data with 25,464 respondents was linked to cause of death register data to create a prospective cohort with 8.3-year follow-up. Associations between LTPA, desire to increase LTPA and mortality were analyzed in logistic regression models. An 18.4% proportion performed regular exercise (at least 90 min/week, leading to sweating), 23.2% moderate regular exercise (once or twice a week at least 30 min/occasion, leading to sweating), 44.3% moderate exercise (more than two hours walking or equivalent activity/week) and 14.1% reported low LTPA (less than two hours walking or equivalent activity/week). These four LTPA groups were significantly associated with covariates included in the multiple analyses. The results showed significantly higher all-cause, cardiovascular (CVD), cancer and other cause mortality for the low LTPA group but not for the moderate regular exercise and moderate exercise groups compared to the regular exercise group. Both the "Yes, but I need support" and the "No" fractions within the low LTPA group had significantly increased ORs of all-cause mortality compared to the "Yes, and I can do it myself" reference, while no significant associations were observed for CVD mortality. Physical activity promotion is particularly warranted in the low LTPA group.

Trust Dynamics of Community Health Workers in Frontier Food Banks and Pantries: a Qualitative Study

BACKGROUND

Medical mistrust has had devastating consequences during the COVID-19 pandemic, particularly in rural communities. Community Health Workers (CHWs) have been shown to build trust, but there is little research on trust-building by CHWs in rural communities.

OBJECTIVE

This study aims to understand the strategies that CHWs use to build trust with participants of health screenings in frontier Idaho.

DESIGN

This is a qualitative study based on in-person, semi-structured interviews.

PARTICIPANTS

We interviewed CHWs (N=6) and coordinators of food distribution sites (FDSs; e.g., food banks and pantries) where CHWs hosted a health screening (N=15).

APPROACH

Interviews were conducted with CHWs and FDS coordinators during FDS-based health screenings. Interview guides were initially designed to assess facilitators and barriers to health screenings. Trust and mistrust emerged as dominant themes that determined nearly every aspect of the FDS-CHW collaboration, and thus became the focus of interviews.

KEY RESULTS

CHWs encountered high levels of interpersonal trust, but low institutional and generalized trust, among the coordinators and clients of rural FDSs. When working to reach FDS clients, CHWs anticipated confronting mistrust due to their association with the healthcare system and government, especially if CHWs were perceived as "outsiders." Hosting health screenings at FDSs, which were trusted community organizations, was important for CHWs to begin building trust with FDS clients. CHWs also volunteered at FDS locations to build interpersonal trust before hosting health screenings. Interviewees agreed that trust building was a time- and resource-intensive process.

CONCLUSIONS

CHWs build interpersonal trust with high-risk rural residents, and should be integral parts of trust building initiatives in rural areas. FDSs are vital partners in reaching low-trust populations, and may provide an especially promising environment to reach some rural community members. It is unclear whether trust in individual CHWs also extends to the broader healthcare system.

Construction and validation of CAPSES scale as a composite indicator of SES for health research: an application to modeling social determinants of cardiovascular diseases

BACKGROUND

The main objective of this study was to construct and validate a composite socioeconomic status indicator containing material capital, human capital, and social capital (CAPSES scale) and also appropriate it for CVDs in a large population-based study.

METHODS

This cross-sectional study, the Urban HEART-2 project, was conducted in Tehran, Iran, in 2011. A total of 34,116 households covering 118,542 individuals were assessed in this study. A 14-parts questionnaire was completed for all selected households. All the gathered data were based on the participants' self-reports. Literacy, wealth index, expenditure, skill level, and Townsend index were used as SES indexes. CVDs, including Hypertension, Myocardial infarction, and stroke, were considered the main outcomes. A structural equation model (SEM) was used to construct a CAPSES scale and a composition index of SES. Criterion validity and Construct validity were used to assess this scale.

RESULTS

A total of 91,830 subjects consisting of 33,884 (49%) men were included in this analysis. The mean age of the participants was 41.5 ± 11.37 years. Among the assessed participants, 5904(6.4%) reported hypertension, 1507(1.6%) myocardial infarction, and 407(0.4%) strokes. The overall weighted prevalence of self-reported cardiovascular events (hypertension, stroke, and MI) was 8.03% (95%CI: 7.8-8.2). Inverse associations were seen between the CAPSES scale and its domains with CVDs, adjusted for sex, age, BMI, smoking, and diabetes by a multiple logistic regression model.

CONCLUSION

The CAPSES scale was significantly associated with stroke and hypertension. Our findings showed that the CAPSES index could be useful for public health research.

Psychosocial stress and social capital pathways and health: Perspectives from Lund University, Malmö

AIMS

The aim of this Commentary is to outline a few steps of the process by which psychosocial stress and later social capital have been investigated as health determinants at Lund University, Malmö since the 1980s. References to the international literature and literature from Malmö from the mid-1980s and onwards will be used.

RESULTS

The development of research on psychosocial factors and social capital has followed international progress, with a complementary focus on social capital from the late 1990s onwards. Social participation, entailing a number of social activities, seems to be both the common connection between psychosocial stress theory and social capital and the common denominator between cohesion and structural/network approaches to social capital and health.

CONCLUSIONS

The impact of this research area has been considerable in Sweden. Both psychosocial factors and social capital have been acknowledged as health determinants in national Swedish health policy, although a setback may be discerned in recent years.

Social capital, population health, and the gendered statistics of cardiovascular and all-cause mortality

Scholars in the field of population health need to be on the constant lookout for the danger that their tacit ideological commitments translate into systematic biases in how they interpret their empirical results. This contribution illustrates this problematic by critically interrogating a set of concepts such as tradition, trust, social capital, community, or gender, that are routinely used in population health research even though they carry a barely acknowledged political and ideological load. Alongside this wider deconstruction of loaded concepts, I engage critically but constructively with Martin Lindström et al.'s paper “Social capital, the miniaturization of community, traditionalism and mortality: A population-based prospective cohort study in southern Sweden” to evaluate the extent to which it fits with other empirical findings in the extant literature. Taking as a point of departure the intriguing finding that social capital predicts cardiovascular and all-cause mortality only for men, but not for women, I argue that future research on the nexus of social capital, health, and mortality needs to frame gender not only as a demographic and statistical variable, but also as an ontological conundrum and as an epistemological sensibility.

Social capital, the miniaturization of community, traditionalism and mortality: A population-based prospective cohort study in southern Sweden

Objectives

To investigate associations between social capital, miniaturization of community and traditionalism and all-cause, cardiovascular (CVD), cancer and other causes mortality.

Study design

Prospective cohort study.

Methods

The 2008 public health survey in Scania in the southernmost part of Sweden was conducted with a postal questionnaire posted to a stratified random sample aged 18–80. The response rate was 54.1%. The baseline survey was linked to 8.3-year prospective public death register data. Analyses were conducted with survival analyses, adjusting for relevant factors.

Results

Among women 37.9% had low social participation and 37.8% low trust. Among men 40.9% had low social participation and 35.7% low trust. Low social capital (low social participation/low trust) and traditionalism (low social participation/high trust) have significantly higher total and cardiovascular mortality among women and men combined and among men, but not among women in the final models. The results for women are not significant in the full models for all-cause, CVD, cancer and all other causes mortality. Miniturization of community (high social participation/low trust) displays no statistically significant associations in the adjusted models. Social participation and trust, respectively, and total mortality show consistent Schoenfeld residuals over 8.3 years.

Conclusions

The associations between low social capital, traditionalism and mortality are stronger for men than for women, and may be partly mediated by health-related behaviors.

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Combinations of cognitive (trust) and structural (social participation) social capital were analyzed.

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Traditionalism and low social capital are associated higher all-cause and CVD mortality among men.

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High social participation/low trust combination does not differ mortality from high social capital combination.

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It may be possible to analyze social capital using intersectional statistical aproaches.

Association between social trust and the risk of cardiovascular disease in older adults in Korea: a nationwide retrospective cohort study

Background

Although social capital has been shown to be one of the important social determinants of health, the association between social trust and the risk of cardiovascular disease (CVD) is not clear yet. We aimed to investigate the association of social trust with CVD risk using a large Korean population based data.

Methods

The data of this study was derived from the Korean National Health Insurance Service database. Community-level social trust was determined from the Korean Community Health Survey. The study population consisted of 2,156,829 participants. According to social trust index measured in the area of residence during 2011, participants were followed-up from 1 January 2012 to 31 December 2016. Multivariate Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk according to quintiles of social trust.

Results

Compared to participants with the lowest quintile of social trust, those within the highest quintile had lower risk for CVD (aHR 0.91, 95% CI = 0.89 to 0.93), CHD (aHR 0.92, 95% CI = 0.89 to 0.95), and stroke (aHR 0.90, 95% CI = 0.87 to 0.93). The risk-reducing association of high social trust on CVD risk was preserved after additional adjustments for lifestyle behaviors including smoking, alcohol consumption, and physical activity.

Conclusion

Higher social trust was associated with reduced risk of CVD even after considering lifestyle behaviors. Social trust in a community level is an important determinant of CVD and enhancing social trust may lead to reduced risk of CVD.

Understanding the association between osteoarthritis and social participation: a CLSA population-based study

OBJECTIVE

The focus on disability in osteoarthritis (OA) has largely been on performing specific activities, neglecting wider implications for social participation (SP). We investigated the association between OA and SP considering activity limitations (AL) and instrumental supports (IS) as intervening variables in the association.

METHODS

Data were from 21,214 respondents aged 45-85 from cycle 1, Canadian Longitudinal Study on Aging. The questionnaire elicited: self-reported doctor-diagnosed OA; difficulty with 14 activities; perceived availability and receipt of IS; and 17 SP activities. Structural equation modeling was used.

PRIMARY OUTCOME

SP; Primary predictor: OA; Intervening variables: AL, received IS, perceived IS. Latent variables were developed for intervening and SP variables. Covariates: age, sex, body mass index, income, education, smoking, comorbidity count.

RESULTS

Mean age was 63 years, 51% were female, and 26.5% reported OA. Two distinct SP indicators were identified, SP-Diversity and SP-Intensity. Without considering intervening variables, minimal/no association was found between OA and SP. When considered, unique pathways linking OA and SP were found. The overall negative association between AL and SP was, in part, direct and, in part, buffered by both receipt and perceived availability of IS. Absent AL, OA was associated with greater SP.

CONCLUSIONS

Enhanced SP in people with OA without AL may reflect proactive steps taken by those with mild OA to maintain activity and social engagement. For those with AL, findings highlight the need for interventions to mitigate limitations and draw particular attention to the importance of both provision and awareness of available IS in maintaining SP.

Toward an institutional perspective on social capital health interventions: lay community health workers as social capital builders

This article argues that social capital health research should move beyond a mere focus on social cohesion and network perspectives to integrate an institutional approach into the development of social capital health interventions. An institutional perspective, which is unique in its emphasis on linking social capital in addition to the bonding and bridging forms, contextualises social capital, allowing researchers to confront the complexity of social relationships. This perspective allows for the construction of interventions that draw on the resources of diverse actors, particularly the state. One intervention strategy with the potential to create community linkages involves lay community health workers (LCHWs), individuals who are trained to perform a variety of health-related functions but lack a formal professional health education. This article begins with a review of the institutional social capital-building literature. It then goes on to briefly review the social capital and health literature and discuss the state of intervention research. Thereafter, it describes LCHWs and discusses studies that have utilised LCHWs to tackle community health problems. In doing so, this article presents an institutional-based systematic framework for how LCHWs can build social capital, including a discussion of the ways in which LCHWs can successfully promote bonding, bridging and linking social capital.