Loosening the link between childhood poverty and adolescent smoking and obesity: the protective effects of social capital

Health practices, behaviours and quality of life of low-income preschoolers: A community-based cross-sectional comparison study in Singapore

Introduction

Children from low-income (LI) families often suffer from poor health, with sub-optimal health practices. This cross-sectional study examined the differences in health habits and health-related quality of life (HRQoL) of LI preschool children compared to non-low-income preschool peers (PPG).

Method

Using data from the social-health Circle of Care-Health Development Screening Programme (CoC-HDSP) in Singapore, 118 LI children and 304 PPG children aged 18 months to 6 years old and their families were recruited from 13 government-funded preschools. Health practices examined included screen time habits, sleep, nutrition, dental health and the children's HRQoL using PedsQL 4.0 Generic Core Scales.

Results

Majority of the children were aged 4-6 years in kindergarten 1 and 2. There were more Malay children in the LI than the PPG (61.9% versus [vs] 29.3%, P<0.001). Low-income children were more likely to have lower-educated parents (P<0.001). The completed vaccination rate in the LI group was lower than those in PPG (84.7% vs 98.0%, P<0.001). More in the LI group utilised emergency services for acute illnesses (P<0.05). Fewer LI children had ever visited a dentist (47.4% vs 75.4%, P<0.001), and more LI children consumed sweetened drinks daily (33.3% vs 8.6%, P<0.001). The LI group reported poorer-quality sleep (48.3% vs 27.2%, P<0.001), though both groups exceeded the daily recommended screen viewing duration. The LI group scored higher in the social (mean 92.4±12.2 vs 84.3±15.3, P<0.001) and emotional (mean 85.2±15.1 vs 76.6±17.3, P<0.001) domains of the PedsQL 4.0 when compared to PPG.

Conclusion

Low-income children have poorer health practices, receive less preventive paediatric care, and utilise more emergency services for acute illnesses. These findings are important for developing interventions that work towards improving the health of LI children.

Medical conspiracy theories: cognitive science and implications for ethics

Although recent trends in politics and media make it appear that conspiracy theories are on the rise, in fact they have always been present, probably because they are sustained by natural dispositions of the human brain. This is also the case with medical conspiracy theories. This article reviews some of the most notorious health-related conspiracy theories. It then approaches the reasons why people believe these theories, using concepts from cognitive science. On the basis of that knowledge, the article makes normative proposals for public health officials and health workers as a whole, to deal with conspiracy theories, in order to preserve some of the fundamental principles of medical ethics.

Social capital, gender, and health: an ethnographic analysis of women in a Mumbai slum

OBJECTIVE

Quantitative studies have demonstrated that social capital can positively impact community health, but qualitative explorations of the factors mediating this relationship are lacking. Furthermore, while the world's poor are becoming increasingly concentrated in the cities of lower-middle income countries, most of the existing literature on social capital and health explores these variables in Western or rural contexts. Even fewer studies consider the impact of social constructs like race, gender, or class on the creation of social capital and its operationalization in health promotion.Our study aimed to address these gaps in the literature through an ethnographic exploration of social capital among women living in Kaula Bandar (KB) - a marginalized slum on the eastern waterfront of Mumbai, India. We then sought to identify how these women leveraged their social capital to promote health within their households.

METHODS

This was a mixed-method, qualitative study involving participant observation and 20 in-depth, semi-structured, individual interviews over a nine-month period. Field notes and interview transcripts were manually analyzed for recurring content and themes.

RESULTS

We found that women in KB relied heavily on bonding social capital for both daily survival and survival during a health crisis, but that the local contexts of gender and poverty actively impeded the ability of women in this community to build forms of social capital - namely bridging or linking social capital - that could be leveraged for health promotion beyond immediate survival.

CONCLUSIONS

These findings illustrate the context-specific challenges that women living in urban poverty face in their efforts to build social capital and promote health within their households and communities. Community-based qualitative studies are needed to identify the macro- and micro-level forces, like gender and class oppression, in which these challenges are rooted. Directly addressing these structural inequalities significantly increases the potential for health promotion through social capital formation.

Social capital and physical health: An updated review of the literature for 2007-2018

PURPOSE

Social capital is frequently indicated as a determinant of population health. Despite an increase in the frequency of public health studies including such measures, our understanding of social capital's effects on health remains unclear. In 2008, a systematic review of the "first decade" of research on social capital and health was published in the textbook Social Capital and Health. Our study intends to update and expand upon this original review to account for developments in the literature over the second decade of research on social capital and health.

METHODS

We employed a systematic review of empirical studies investigating the relationship between measures of social capital and physical health outcomes published between January 1, 2007 and December 31, 2018. To identify potential studies, we conducted searches of PubMed, Embase, and PsychINFO databases in January 2019 using combinations of "social capital" and "physical health" search terms.

RESULTS

We identified 1,608 unique articles and reviewed 145 studies meeting our inclusion criteria. The most frequently examined health condition was self-reported health (57%), followed by mortality (12%), cardiovascular diseases (10%), obesity (7%), diabetes (6%), infectious diseases (5%), and cancers (3%). Of these studies, 127 (88%) reported at least partial support for a protective association between social capital and health. However, only 41 (28%) reported exclusively positive findings. The majority (59%) of results were mixed, suggesting a nuanced relationship between social capital and health. This finding could also be indicative of differences in study design, which showed substantial variation.

CONCLUSIONS

Despite limitations in the literature, our review chronicles an evolution in the field of social capital and health in terms of size and sophistication. Overall, these studies suggest that social capital may be an important protective factor for some physical health outcomes, but further research is needed to confirm and clarify these findings.

Social Capital and Tobacco Retail Outlet Density: An Empirical Test of the Relationship

PURPOSE

To examine the relationship between tobacco outlet density and social capital.

PARTICIPANTS

Parents of at least one teen (N = 2734) in a representative sample of US households with teens (ages 13-16).

DESIGN

Population-based, cross-sectional survey of a web panel of adolescent-parent pairs matched with spatial data for address to characterize household neighborhoods.

SETTING

US households identified by latitude and longitude with a 50-ft random shift.

MEASURES

Perceived social capital (trust and informal social control as reported by parents), tobacco outlet density (retailers per land area in 1/2-mile buffer around each household), neighborhood demographics (derived from American Community Survey), and parent demographics.

ANALYSIS

Multivariable regression examined the relationship between tobacco outlet density and social capital controlling for household buffer and individual-level covariates, including correlates of social capital.

RESULTS

Tobacco outlet density was inversely correlated with perceived trust in neighbors (B = -1.12, P = .0004), but not social control (B = 0.11, P = .731).

CONCLUSION

This study is the first we are aware of to find that social capital is related to tobacco outlet density. The results imply that individuals with low social capital may benefit from policies regulating tobacco outlet density and may benefit from policies that address neighborhood inequality by increasing social capital and reducing poverty.

The Relationship between Social Capital within Its Different Contexts and Adherence to a Mediterranean Diet Among Lithuanian Adolescents

The eating habits of adolescents are a serious current public health problem. Scientists call attention to the availability of social resources for enhancing healthy eating behavior. Social capital defines those resources as trust, reciprocity, social participation, integrity, and coherence, and they are supposed to help people achieve their life goals, in general, and health goals, in particular. Our aim is to investigate the relationship between social capital within its different contexts and adherence to a Mediterranean diet (MD) among Lithuanian adolescents. The nationally representative cross-sectional study included 1863 students (906 boys and 957 girls). The KIDMED index questionnaire (Mediterranean Diet Quality Index in children and adolescents) was used to evaluate the adherence to an MD. Family, neighborhood, and school contexts of social capital were assessed using six items indicating family support, neighborhood trust, social control, vertical trust, horizontal trust, and reciprocity at school. Covariates such as gender, physical activity, parental education, and body mass index were also included in the analysis. Descriptive results showed that only 14% of Lithuanian adolescents followed an MD. Linear regression analysis indicated that family support (β = 0.096) and trust in school teachers (β = 0.074) were related to better rates of adherence, especially regarding the consumption of fruits, vegetables, cereals, fish, and the use of olive oil as a main source of fat. More adolescents who perceived family support and trust in their teachers used these products regularly and were less likely to skip breakfast. These findings could be used as a base for further developing nutrition education programs aimed at enhancing support and trust among families and schoolteachers.

Neighbourhood social capital and obesity: a systematic review of the literature

Social capital, defined as the resources accessed by individuals and groups through social connections, has been posited to be a social determinant of obesity. However, empirical evidence for this association has been inconsistent - namely, some studies have found a protective association while others have reported no correlation. We sought to conduct a systematic review on the relation between neighbourhood social capital and obesity, considering potential differences on the results based on the measures used and the covariates and mediators included in the studies. PRISMA statement guidelines were followed. Our results indicate that an association between neighbourhood social capital and obesity exists, but that it depends on the measures and covariates used in the study design. Understanding the role of social capital in the development and/or maintenance of obesity will require the use of strong methodological designs and a thorough conceptualization of how this relationship may arise.

The relationship between children's flourishing and being overweight

This study examined the effect of children's flourishing on the pandemic of obesity from various aspects such as age, gender, race, family, school, and community. By using a subsample of the 2011-2012 National Survey of Children's Health, the Flourishing scale analyses were performed with a total of 45,309 children. Childhood obesity was diagnosed by calculating the percentile of the body mass index. Hispanic Americans were more likely to be overweight (P<0.01). Nonoverweight children were more likely to participate in after-school activities, less likely to have sedentary behavior, more likely to miss school, to be more active, and had more of flourishing than their counterpart (P<0.01). Parent's marital and health status also positively affect children's obesity status (P<0.01). Social capital and neighbor amenities significantly affect children's weight status (P<0.01). A multifaceted understanding of the role of family, school, and community (with proving children's flourishing environment) in terms of how and what could contribute to children's obesity status is important in order to bring about positive impact.

The Relationship between Air Pollution and Depression in China: Is Neighbourhood Social Capital Protective?

There is increasing evidence from the developed world that air pollution is significantly related to residents’ depressive symptoms; however, the existence of such a relationship in developing countries such as China is still unclear. Furthermore, although neighbourhood social capital is beneficial for health, whether it is a protective factor in the relationship between health and environment pollution remains unclear. Consequently, we examined the effects of cities’ PM_2.5 concentrations on residents’ depressive symptoms and the moderating effects of neighbourhood social capital, using data from the 2016 wave of China Labourforce Dynamics Survey and the real-time remote inquiry website of Airborne Fine Particulate Matter and Air Quality Index. Results showed that PM_2.5 concentrations and neighbourhood social capital may increase and decrease respondents’ depressive symptoms, respectively. Notably, neighbourhood social capital decreased the negative effect of PM_2.5 concentrations on respondents’ depressive symptoms. These analyses contributed to the understanding of the effect of air pollution on mental health in China and confirmed that neighbourhood social capital were protective factors in the relationship between health and environment hazards.

Future Directions in the Study of Early-Life Stress and Physical and Emotional Health: Implications of the Neuroimmune Network Hypothesis

Early-life stress is associated with increased vulnerability to physical and emotional health problems across the lifespan. The recently developed neuroimmune network hypothesis proposes that one of the underlying mechanisms for these associations is that early-life stress amplifies bidirectional crosstalk between the brain and the immune system, contributing to several mental and physical health conditions that have inflammatory underpinnings, such as depression and coronary heart disease. Neuroimmune crosstalk is thought to perpetuate inflammation and neural alterations linked to early-life stress exposure, and also foster behaviors that can further compromise health, such as smoking, drug abuse and consumption of high-fat diets. The goal of the present review is to briefly summarize the neuroimmune network hypothesis and use it as a starting point for generating new questions about the role of early-life stress in establishing a dysregulated relationship between neural and immune signaling, with consequences for lifespan physical and emotional health. Specifically, we aim to discuss implications and future directions for theory and empirical research on early-life stress, as well as for interventions that may improve the health and well-being of children and adolescents living in adverse conditions.

Relationships between County Health Rankings and child overweight and obesity prevalence: a serial cross-sectional analysis

Background

The County Health Rankings (CHR) system provides health rankings for U.S. counties. These factors may have utility for evaluating and predicting health outcomes. This study examined the association between CHR factors and the prevalence of child overweight/obesity (OWOB) in the state of Pennsylvania over 3 years.

Methods

The prevalence of childhood OWOB was obtained for all Pennsylvania school districts for the 2009-10 through 2011-12 school years. Correlational and inferential statistical analyses were used to examine the associations between the prevalence of OWOB in grades K-6 (OWOB1) and 7-12 (OWOB2) and z-score for the overall CHR Health Factors rank, as well as for individual predictive factors (Health Behaviors, Clinical Care, Social and Economic Factors and Physical Environment).

Results

Low to moderate correlations (0.29–0.43) were found between OWOB1 and CHR factors. Weaker and less consistent correlations were found for adolescents. There was a significantly higher prevalence of OWOB in counties with poorer CHR scores.

Conclusions

County-level adult indicators of health are significantly associated with levels of child obesity. Future studies should examine the relationship between CHR and other health outcomes.

Hospitality Invites Sociability, Which Builds Cohesion: a Model for the Role of Main Streets in Population Mental Health

The aim of this study was to investigate the contribution of main streets to community social cohesion, a factor important to health. Prior work suggests that casual contact in public space, which we call "sociability," facilitates more sustained social bonds in the community. We appropriate the term "hospitality" to describe a main street's propensity to support a density of such social interactions. Hospitality is a result of the integrity and complex contents of the main street and surrounding area. We examine this using a typology we term "box-circle-line" to represent the streetscape (the box), the local neighborhood (the circle), and the relationship to the regional network of streets (the line). Through field visits to 50 main streets in New Jersey and elsewhere, and a systematic qualitative investigation of main streets in a densely interconnected urban region (Essex County, New Jersey), we observed significant variation in main street hospitality, which generally correlated closely with sociability. Physical elements such as street wall, neighborhood elements such as connectivity, inter-community elements such as access and perceived welcome, and socio-political elements such as investment and racial discrimination were identified as relevant to main street hospitality. We describe the box-circle-line as a theoretical model for main street hospitality that links these various factors and provides a viable framework for further research into main street hospitality, particularly with regard to geographic health disparities.

The relation of socio-ecological factors to adolescents’ health-related behaviour

Purpose

– The purpose of this paper is to identify and describe adolescents’ health-related behaviours from a socio-ecological perspective. Socio-ecological factors have been widely shown to be related to health behaviours (smoking, alcohol consumption, physical activity and diet) in adolescence and to affect health. The review integrates evidence with socio-ecological factors (social relationships, family, peers, schooling and environment).

Design/methodology/approach

– The data were collected from electronic databases and by manual search consisting of articles (n=90) published during 2002-2014. The selected articles were analysed using inductive content analysis and narrative synthesis.

Findings

– The findings suggest that there was a complex set of relations connected to adolescent health behaviours, also encompassing socio-ecological factors. The authors tentatively conclude that socio-ecological circumstances influence adolescents’ health-related behaviour, but that this review does not provide the full picture. There seemed to be certain key factors with a relation to behavioural outcomes that might increase health inequality among adolescents.

Practical implications

– School health education is an important pathway for interventions to reduce unhealthy behaviours among adolescents including those related to socio-ecological factors.

Originality/value

– Some socio-ecological factors were strongly related to health behaviours in adolescence, which may indicate an important pathway to current and future health. This paper may help schoolteachers, nurses and other school staff to understand the relationships between socio-ecological factors and health-related behaviours, which may be useful in developing health education to reduce health disparities during adolescence.

The impact of the experience of childhood poverty on adult health-risk behaviors in Japan: a mediation analysis

Background

The experience of childhood poverty has a long-lasting, adverse impact on physical health outcomes in adulthood. We examined the mediating effects of adult socioeconomic status (SES) and social support on the association between childhood poverty and adult health-risk behaviors.

Methods

Cross-sectional data collected from Japanese community residents (N = 3836) were used. A binary indicator of the experience of childhood poverty was constructed by utilizing retrospectively assessed standard of living at age 15 and a set of parental SES variables. The associations of childhood poverty with smoking, lack of exercise, poor dietary habits, and excessive drinking at the time of survey were examined by logistic regression analysis. A mediation analysis was conducted to estimate the magnitudes of the mediating effects of adult SES and social support on these associations.

Results

Adult SES and social support together mediated 64.0, 29.4 and 30.6 % of the impacts of the experience of childhood poverty on smoking, lack of exercise, and poor dietary habits, respectively. Educational attainment had the largest mediating effect (58.2 %) on the impact of the experience of childhood poverty on smoking.

Conclusions

The results suggest that interventions and policies for supporting children living in poverty should aim to enhance their future SES and provide better social support, as this might improve their overall health.

Linking electronic health records with community-level data to understand childhood obesity risk

BACKGROUND

Environmental and socioeconomic factors should be considered along with individual characteristics when determining risk for childhood obesity.

OBJECTIVES

To assess relationships and interactions among the economic hardship index (EHI) and race/ethnicity, age and sex in regard to childhood obesity rates in Wisconsin children using an electronic health record dataset.

METHODS

Data were collected using the University of Wisconsin (UW) Public Health Information Exchange database, which links electronic health records with census-derived community-level data. Records from 53,775 children seen at UW clinics from 2007 to 2012 were included. Mixed-effects modelling was used to determine obesity rates and the interaction of EHI with covariates (race/ethnicity, age, sex). When significant interactions were determined, linear regression analyses were performed for each subgroup (e.g. by age groups).

RESULTS

The overall obesity rate was 11.7% and significant racial/ethnic disparities were detected. Childhood obesity was significantly associated with EHI at the community level (r = 0.62, P < 0.0001). A significant interaction was determined between EHI and both race/ethnicity and age on obesity rates.

CONCLUSIONS

Reducing economic disparities and improving environmental conditions may influence childhood obesity risk in some, but not all, races and ethnicities. Furthermore, the impact of EHI on obesity may be compounded over time. Our findings demonstrate the utility of linking electronic health information with census data to rapidly identify community-specific risk factors in a cost-effective manner.

Does the association between different dimension of social capital and adolescent smoking vary by socioeconomic status? a pooled cross-national analysis

OBJECTIVES

To analyze how dimensions of social capital at the individual level are associated with adolescent smoking and whether associations differ by socioeconomic status.

METHODS

Data were from the 'Health Behaviour in School-aged Children' study 2005/2006 including 6511 15-year-old adolescents from Flemish Belgium, Canada, Romania and England. Socioeconomic status was measured using the Family Affluence Scale (FAS). Social capital was indicated by friend-related social capital, participation in school and voluntary organizations, trust and reciprocity in family, neighborhood and school. We conducted pooled logistic regression models with interaction terms and tested for cross-national differences.

RESULTS

Almost all dimensions of social capital were associated with a lower likelihood of smoking, except for friend-related social capital and school participation. The association of family-related social capital with smoking was significantly stronger for low FAS adolescents, whereas the association of vertical trust and reciprocity in school with smoking was significantly stronger for high FAS adolescents.

CONCLUSIONS

Social capital may act both as a protective and a risk factor for adolescent smoking. Achieving higher levels of family-related social capital might reduce socioeconomic inequalities in adolescent smoking.

Smoking and (Not) Voting: The Negative Relationship Between a Health-Risk Behavior and Political Participation in Colorado

INTRODUCTION

Considerable evidence suggests that cigarette smokers are an increasingly marginalized population, involved in fewer organizations and activities and with less interpersonal trust than their nonsmoking counterparts. However, only two previous studies, both among Swedish populations, have investigated smokers' attitudes toward political systems and institutions. The current, cross-sectional study examines smoking in relation to voting, a direct behavioral measure of civic and political engagement that at least partly reflects trust in formal political institutions.

METHODS

Secondary analyses were conducted of interview data from 11 626 respondents in the Colorado Tobacco Attitudes and Behaviors Survey. Data were collected via telephone between October 2005 and mid-April 2006 and included respondents' reported voting behavior in the 2004 national election; the participation rate was 89.7%. Balanced multiple logistic regression was used to examine associations between smoking and voting while controlling for other covariates known to be associated with both variables.

RESULTS

In the final model, daily smokers were less than half as likely as nonsmokers to report having voted in the election.

CONCLUSIONS

The results suggest possible consonance with previous work linking smoking with political mistrust. Possible causal mechanisms are discussed. This study is the first to link a health-risk behavior with electoral participation, and provides initial evidence that smoking is negatively associated with political participation. Future research should investigate how public health might enhance tobacco control efforts by taking nonvoting behavior into consideration, or creatively combining smoking cessation interventions with voter registration and other civic engagement work, particularly among socioeconomically disadvantaged populations.

Duration of U.S. residence and suicidality among racial/ethnic minority immigrants

PURPOSE

The immigration experience embodies a range of factors including different cultural norms and expectations, which may be particularly important for groups who become racial/ethnic minorities when they migrate to the U.S. However, little is known about the correlates of mental health indicators among these groups. The primary and secondary aims were to determine the association between duration of U.S. residence and suicidality, and 12-month mood, anxiety, and substance use disorders, respectively, among racial/ethnic minority immigrants.

METHODS

Data were obtained from the National Survey of American Life and the National Latino and Asian American Survey. Multivariable logistic regression was used to determine the association between duration of US residence, and suicidality and 12-month psychopathology.

RESULTS

Among Afro-Caribbeans, there was a modest positive association between duration of U.S. residence and 12-month psychopathology (P linear trend = 0.016). Among Asians there was a modest positive association between duration of US residence and suicidal ideation and attempts (P linear trend = 0.018, 0.063, respectively). Among Latinos, there was a positive association between duration of US residence, and suicidal ideation, attempts and 12-month psychopathology (P linear trend = 0.001, 0.012, 0.002, respectively). Latinos who had been in the U.S. for >20 years had 2.6 times greater likelihood of suicidal ideation relative to those who had been in the U.S. for <5 years (95% CI 1.01-6.78).

CONCLUSIONS

The association between duration of US residence and suicidality and psychopathology varies across racial/ethnic minority groups. The results for Latino immigrants are broadly consistent with the goal-striving or acculturation stress hypothesis.

Childhood maternal support and social capital moderate the regulatory impact of social relationships in adulthood

For this functional magnetic resonance imaging (fMRI) study, we assessed the impact of early social experiences on the social regulation of neural threat responding in a sample of 22 individuals that have been followed for over a decade. At 13 years old, a multidimensional measure of neighborhood quality was derived from parental reports. Three measures of neighborhood quality were used to estimate social capital-the level of trust, reciprocity, cooperation, and shared resources within a community. At 16 years old, an observational measure of maternal emotional support behavior was derived from a mother/child social interaction task. At 24 years old, participants were asked to visit our neuroimaging facility with an opposite-sex platonic friend. During their MRI visit, participants were subjected to the threat of electric shock while holding their friend's hand, the hand of an anonymous opposite-sex experimenter, or no hand at all. Higher adolescent maternal support corresponded with less threat-related activation during friend handholding, but not during the stranger or alone conditions, in the bilateral orbitofrontal cortex, inferior frontal gyrus and left insula. Higher neighborhood social capital corresponded with less threat-related activation during friend hand-holding in the superior frontal gyrus, supplementary motor cortex, insula, putamen and thalamus; but low childhood capital corresponded with less threat-related activation during stranger handholding in the same regions. Exploratory analyses suggest that this latter result is due to the increased threat responsiveness during stranger handholding among low social capital individuals, even during safety cues. Overall, early maternal support behavior and high neighborhood quality may potentiate soothing by relational partners, and low neighborhood quality may decrease the overall regulatory impact of access to social resources in adulthood.

Cumulative socioeconomic status risk, allostatic load, and adjustment: a prospective latent profile analysis with contextual and genetic protective factors

The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at ages 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A latent profile analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence.

Understanding maternal smoking during pregnancy: does residential context matter?

The goal of this paper was to investigate whether or not the factors beyond individual characteristics were associated with maternal smoking during pregnancy. Social capital has been found to have both negative and positive implications for health behaviors, and this study attempted to understand its association with maternal smoking during pregnancy. Specifically, the association between county-level social capital and rurality and maternal smoking during pregnancy was investigated. In this study, Putman's definition of social capital was used (e.g., connections among individuals-social networks and the norms of reciprocity and trustworthiness that arise from them). The ecological dimension of rurality was used to define rurality, where rural areas are smaller in population size and are less densely populated when compared to non-rural areas. Using data for all women who gave birth during the year 2007 in the United States, we implemented a series of multilevel logistic regression models. The results showed that social capital was significantly associated with maternal smoking during pregnancy. Specifically, higher social capital in a county was associated with higher odds that women smoked during their pregnancy. However, in rural counties, higher social capital was associated with a decrease in the odds that a woman smoked during her pregnancy. A one unit increase in the social capital index was found to reduce the risk of smoking during pregnancy among those women living in rural counties by 11 percent. The results also showed that improvement of the socioeconomic status of the counties in which women live reduced the risk of maternal smoking during pregnancy. As this study found that factors beyond individual characteristics are important for reducing the risk that women smoked during pregnancy, county characteristics should be taken into account when developing policies focused on intervening maternal smoking during pregnancy.

Community social structure, social capital and adolescent smoking: a multi-level analysis

Using a sample of 6818 individuals in 83 public school districts in Iceland, this study explored the influence of three community characteristics: Residential mobility, proportion of single-parent families, and poverty on adolescent daily smoking. Building on Coleman's social capital theory, we also examined the mediating and moderating role of several measures of social capital. Both self-reported and official data were used to measure key variables. The main findings are consistent with theoretical predictions showing that social capital partly mediates the association between community characteristics and adolescent daily smoking both on the community and individual levels. Likewise, the findings show that the association between individual level poverty and adolescent daily smoking varies across levels of neighborhood social capital.

Capital Relations and Health: Mediating and Moderating Effects of Cultural, Economic, and Social Capitals on Mortality in Alameda County, California

Inspired by Bourdieu's theories on various forms of capital, conversions among them, and the fields (social spaces) delineated by possession of them, the authors investigate distinct and interconnected effects of cultural, economic, and social capitals on risk of mortality. Using 35 years of longitudinal data from the Alameda County Study (n = 6,157), they created discrete-time hazard models to predict all-cause mortality from educational attainment (institutionalized cultural capital), household income (economic capital), and different forms of personal ties (social capital). The results show that education, income, having three or more close friends, regularity of church attendance, and participation in social/recreational groups were all negatively and significantly associated with risk of mortality. Income mediated a significant portion of the education effect. None of the personal ties variables mediated the effects of education or income. Relative composition of the sum total of education and income did not have an effect. Lastly, examination of statistical interactions between capitals determined that protective effects of church attendance and participation in community betterment groups applied only to non-wealthy people. These findings speak to the structure of the U.S. social space within which health-delimiting relationally defined social classes may be made manifest.