Social capital and risk and protective behaviors: a global health perspective

Correlates of Transactional Sex Among Black Men and Women Who Misuse Opioids

The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, and sexual risk measures. Results of chi-squares and independent samples t-tests revealed that compared to men who did not report engaging in transactional sex, men who engaged in transactional sex were less educated, reported being sexually assaulted or having an unwanted sexual experience in their lifetime, and were more likely to use opioids or cocaine before or during sex in the last year. Women who engaged in transactional sex had a history of violence, more structural barriers, higher psychological distress, and engaged in more sexual risk behaviors compared to women who did not engage in transactional sex. Implications for future research and interventions with this population are discussed.

The association between cigarette smoking attitudes and social capital among Iranian health and medical students: a cross-sectional study

Background

Smoking remains a leading public health challenge globally. As a psychosocial determinant of health, social capital can influence health attitudes and behaviors, and thus it may have the capacity to reduce smoking rates. The aim of this research was to examine the association between social capital and attitudes towards smoking among university students.

Methods

This cross-sectional study was conducted among 538 health and medical students, recruited using the proportionate sampling method. Participants’ social capital and attitudes toward smoking were assessed using the social capital questionnaire (SCQ) and the scale of cigarette smoking attitude (CSA). Data were analyzed using descriptive statistics, Pearson correlation coefficient, and the multiple regression analysis.

Results

About one in four health and medical students reported smoking, either currently or in the past, and 30% had either positive or indifferent attitudes towards smoking. The mean scores of the SCQ and the CSA were 105.1 ± 19.7 and 48.6 ± 11.2, respectively. There was a statistically significant negative association between the SCQ and the CSA scores (r = − 0.24; p < 0.001). In the regression analysis, the SCQ scores were also negatively and statistically significantly associated with the CSA scores, after controlling potential confounders (B: -0.09; 95% CI: − 0.13 to − 0.004).

Conclusions

As future healthcare providers, who are expected to take the primary role in reducing smoking rates in the community, health and medical students should be supported to develop appropriate attitudes towards smoking. Promoting positive social capital among university students has the capacity to improve their attitudes towards smoking. Possessing negative attitudes towards smoking should hopefully reduce smoking behaviors among future health professionals and improve their participation in anti-smoking campaigns.

Homeless people and health: a qualitative enquiry into their practices and perceptions

BACKGROUND

Homeless people experience poorer health and shorter life expectancies than the UK average, but their health needs and expectations have received little attention in research. This study aims to understand homeless people's health perceptions and experiences.

METHODS

Semi-structured interviews took place with 28 homeless people in Gloucestershire. The transcripts were thematically analysed drawing out key themes.

RESULTS

Homelessness was often rooted in early trauma or an unstable family unit. Participants described poor support on leaving prison, termination of a cohabiting relationship or financial issues as factors precipitating homelessness. There was an expansive and positive understanding of health and its determinants. Mental health issues were common, often linked to traumatic life-events. Substance misuse issues were expressed as a mechanism to manage mental health issues. Participants were frustrated that this co-dependency was not recognized by support services. Participants' living situation curtailed their ability to make health-enhancing choices, which was compounded by issues accessing mainstream healthcare services.

CONCLUSIONS

Mental health in homeless people must be recognized in the context of substance misuse and early trauma. Dealing with housing and addiction are critical to enable prioritisation of healthy behaviours. Healthcare services should recognize the chaotic nature of homeless people and their competing issues.

Mental Health of Chinese Online Networkers under COVID-19: A Sociological Analysis of Survey Data

This paper reports the results of a recent survey of Chinese WeChat networkers (n = 2015, August 2020) about China’s mental health conditions under COVID-19. The purpose of the survey was to measure symptoms of depression, anxiety, and somatization by using a standard 18-item battery and assess how the results were related to an individual’s socioeconomic status, lifestyle, and social capital under an ongoing pandemic. The survey reveals that the pandemic has had a significant impact, as the respondents had more serious mental symptoms when their residential communities exhibited a greater exposure to the spread of the virus. The socioeconomic status of the respondents was negatively associated with the mental symptoms. It modified the impact of COVID-19, and its effect was substantially mediated by measures of lifestyle and social capital.

Factors Related to the Behavior of People Who Have Never Used the Internet for Voluntary Reasons: Cross-Sectional Survey Study

BACKGROUND

If there are people who do not want to use the internet despite having the circumstances and conditions for using it, another policy consideration will be needed.

OBJECTIVE

The purpose of this study was to explore the factors related to the behavior of people who do not voluntarily use the internet.

METHODS

A cross-sectional survey was conducted in 2018. It used a proportional quota random sampling design to select a representative sample of Koreans. Accordingly, 6150 participants were included in the study. Multiple logistic regression methods were used to explore the predicting factors of the act of voluntarily not using the internet.

RESULTS

Age, education level, bonding and bridging social capitals, and daily life satisfaction for health status were found to be factors related to the behavior of not voluntarily using the internet. However, gender, household income, occupation, family size, and community type were not related to voluntary nonuse of the internet.

CONCLUSIONS

It was found that sociodemographic factors, such as age and education level, which are difficult to modify, along with psychosocial factors located deeper than the visible living conditions, such as social capital and life satisfaction, are involved in voluntary internet nonuse. These results also suggest that it is not desirable to proceed with policies related to information and communications technology on a separate track, but rather that they should be comprehensively approached with other social policies that design various social interventions in order to enhance equity within the society.

Enrolment of informal sector workers in the National Health Insurance System in Indonesia: A qualitative study

One of the main challenges facing the expansion of universal health coverage (UHC) in developing countries like Indonesia is the high prevalence of those working in the informal sector who must voluntarily register in the National Health Insurance System (NHIS). This condition hinders some from being covered by the NHIS. Following Bourdieu's concepts of field, capital and habitus, this research aims to analyse some aspects that influence the decision of informal sector workers to join the NHIS in Indonesia. We conducted qualitative methods, including in-depth interviews of 29 informants and Focus Group Discussion (FGD) in the three selected regions of Deli Serdang (North Sumatera), Pandeglang (Banten) and Kupang (East Nusa Tenggara). Using thematic content analysis and several triangulation processes, this study found that three main factors influence the decisions of those working in the informal sector to join the NHIS: health conditions, family and peers, and existing knowledge and experience. The stories provided by the informants regarding their decision-making processes in joining NHIS also reveal the necessary and sufficient conditions that enable informal sector workers to join the NHIS, which are individual-specific and which may differ between people, depending on individual characteristics, regional socioeconomic and demographic characteristics and belief systems. These three factors are all necessary conditions to support the joining of informal sector workers into the NHIS. This study suggests that one possible route for expanding the UHC coverage of informal sector workers is through maximising the word-of-mouth effect by engaging local or influential leaders.

Social Capital and Age at Sexual Debut: Race Differences in South Africa

Literature on social capital has long considered whether and how social capital is protective against various risk behaviors, including age at sexual debut. However, much of this literature uses data from wealthy countries in the Global North and is often cross-sectional, dampening generalizability. In this paper, we employ longitudinal South African data from adolescents in the Cape Area Panel Study to examine the longitudinal link between social capital and age at sexual debut. We first examine the overall relationship between age at sexual debut and social capital and then examine how the relationship differs by race. Results suggest that, on average, each additional activity is associated with an approximate 2 month delay in age at sexual debut. However, we observed steep racial differences. For Africans, the link between social capital and age at sexual debut was not significant, while the results for Coloureds and Whites were. For Coloureds, each additional activity translated into a 3 month delay in sexual debut, while for Whites we found a 4 month delay. We found no evidence of sex differences. Taken together, these results suggest that social capital is not equally efficacious for all South African adolescents. For Africans, social capital does not appear to be linked to age at sexual debut. In contrast, more social capital activities appear to be linked to delayed sexual debut, most particularly for Whites.

Changes in positive and negative peer influences and depressive symptoms from adolescence to young adulthood

INTRODUCTION

Peers are believed to continue as prominent sources of influence for young adults. However, having peers who use alcohol and drugs is associated with depressive symptoms in young adults and research on the effects of having peers who model positive activities beyond adolescence is scarce.

METHOD

In this 10-year study of 644 Canadian youth (52% female), we used multilevel modeling to examine the effects of within-person and between-person differences in the interplay of peer behaviours and changes in depressive symptoms between ages 14 and 25. Data were collected via face-to-face interviews and surveys for private topics.

RESULTS

Youth with close friends who used drugs and alcohol consistently reported more depressive symptoms at each age, whereas having friends who engaged in positive activities was associated with fewer depressive symptoms, especially during adolescence. Moreover, at times when youth had more substance-using peers than usual (within person variation), they also reported more symptoms.

CONCLUSIONS

Substance-using peer contexts convey both short- and long-term risks for depressive symptoms. However, the protective effects of having peers who are engaged in positive activities, while generally protective, may be reduced in young adulthood. It is possible that older youth withdraw from peers and activities as their depression worsens, and prosocial activities become less supervised by parents, more optional, and more expensive.

Self-esteem, perceived social support, social capital, and risk-behavior among urban high school adolescents in Nepal

Adolescence is not only characterized by a period of exploration and experimentation but also by vulnerability to risk-behaviors (substance-use, suicidal behavior, and sexual behavior) that can have many negative consequences. Given the lack of studies in Nepal and the variable results from international studies on the association of self-esteem, perceived social support (PSS), and social capital (SC) with risk behaviors, this study aimed to assess the role of these factors by specifying different sources of PSS (family, friends, and others) and SC (family, school, and neighbors), and controlling for demographic, socioeconomic-status (SES), family, and school related factors. A total of 943 adolescents (grades 9-11) in 8 schools from 3 provinces in Nepal participated in the study, and were selected by multi-stage, cluster, random sampling. Data were collected through a self-administered questionnaire (response rate; 91.9%). Multivariate logistic regression analysis (<0.05 significance) revealed that family SC (OR = 0.83) and PSS from family (OR = 0.95) were negatively associated with substance-use. Self-esteem (OR = 0.90), family and school SC (OR = 0.80 and 0.91, respectively), and PSS from family and friends (OR = 0.95 and 0.96, respectively) were protective against suicidal risk. None of the independent variables showed a preventive association with sexual behavior, but self-esteem was positively associated (OR = 1.11). Therefore, to improve the likelihood of adolescents becoming healthy adults, family and school level interventions to enhance self-esteem, PSS, and SC are helpful in protecting them against substance use and suicidal behavior. On the other hand, adolescents with high self-esteem are at greater risk for inappropriate sexual behavior and should therefore be monitored.

Associations between personal social capital and depressive symptoms: Evidence from a probability sample of urban residents in China

BACKGROUND:

Rapid socioeconomic changes in China present a mental health challenge and also an opportunity to investigate the relationship between social capital and depression.

MATERIALS AND METHODS:

Participants (18-45 years old, N = 1,250) were selected using a probability sampling method. The relationship between social capital (measured using the Personal Social Capital Scale) and depression (measured using the Brief Symptom Inventory Depression Subscale) was examined using bivariate analysis, followed by multiple regression to control for covariates.

RESULTS:

Of the total sample, 54.64% were female with mean age = 35.1 (standard deviation ( SD) = 7.5) years old. Depression score was 10.40 ( SD = 3.62) for males and 10.36 ( SD) = 3.30) for females. The social capital measures (including the total, bonding and bridging) were all negatively associated with depression scores, while the negative social capital was positively associated, after controlling for covariates. Subgroup analysis revealed some differences in the social capital-depression associations.

CONCLUSION:

The protective effect of social capital for mental health reported in other countries is also evident in this study. In addition, we found a positive association between negative social capital and depression. In addition to adding new knowledge, findings of this study, if verified with longitudinal design, can be used to support social and behavioral interventions in China to promote mental health by social capital enhancement.

Evidence suggests a need to rethink social capital and social capital interventions

In the 21 years since social capital first appeared in the public health literature, the evidence base has grown enormously, now reaching 28 systematic reviews encompassing more than 850 individual studies. We summarise this evidence and explain why conclusions relating to both the relationship between social capital and health, and the effectiveness of interventions to promote population health remain elusive and contradictory. A critical factor is the inadequate way that context is treated in the research, and especially how context interacts with efforts to promote health in a dynamic fashion. Of all the different types of interventions one could employ to improve the health of the public, 'social capital' interventions are likely to be the most context specific and especially affected by the boundaries placed around the context. A way forward is offered that requires a combination of insights from systems thinking, community-based participatory research, and intervention and improvement sciences. This requires renewed focus on the specific components of social capital, an understanding of how context interacts dynamically with efforts to improve health, a greater role for practice in the design, implementation, adaptation and evaluation of interventions, and the support of researchers to develop better methods for recognising and classifying the knowledge generated by complex interventions.

Perceptions of social capital and sexual behaviour among youth in South Africa

With about one quarter of new human immunodeficiency virus (HIV) infections occuring in young people, there is an on-going debate regarding the role of social capital on youth sexual behaviour. Some studies have suggested that high levels of family and community social capital may act as protective factors that lessen the likelihood of negative consequences; while others have concluded that social capital may be a risk factor for risky sexual behaviour among youth. Using data from the Third National Communications Survey (2012) conducted in South Africa, we examined the relationship between perceptions of social capital and youth sexual behaviour measured by age at first sex and condom use among 3 399 males and females (aged between 16 and 24 years). We assessed community perceptions of social capital with questions that measured trust, social participation, and support. The Cox proportional hazards regression model was used to predict the risk for early sexual debut. Logistic regression was used to predict the odds of condom use. There was no association between perceptions of social capital and youth sexual behaviour. This work reveals that youth sexual behaviour in South Africa may be influenced by socio-economic characteristics, especially at the individual level.

Examining the Relationship between Online Social Capital and eHealth Literacy: Implications for Instagram Use for Chronic Disease Prevention among College Students

Background

College students actively seek online health information and use Instagram, an image- and video-based social networking website, to build social networks grounded in trust and behavioral norms (social capital), which have the potential to prevent chronic disease.

Purpose

This study aimed to: (1) examine how intensity of Instagram use moderates the relationship between eHealth Literacy and online social capital in college students, and (2) discuss how Instagram can be used as a social awareness platform for chronic disease prevention among college students.

Methods

Hierarchical regression analyses were conducted to analyze web-based survey data from a random sample of college students (N=327).

Results

Online bridging social capital was associated with greater eHealth Literacy (P<.05) and intensity of Instagram use (P<.001), when controlling for socio-demographic variables. The relationship between eHealth Literacy and online bridging social capital was strongest among respondents' with average (P<.01) and high (P<.01) intensity Instagram use, as compared to low Instagram intensity.

Discussion

High intensity of Instagram may strengthen college students' low eHealth Literacy, especially when interacting with heterogeneous connections with weaker ties.

Translation to Health Education Practice

Health education specialists should continue to explore how college students' intensity of Instagram use can be strengthened to build bridging online social capital, and ultimately prevent chronic disease.

Does the recent intensification of nationalistic and xenophobic attitudes in Eastern European countries adversely affect public mental health?

Background

The authors postulate that the recent intensification of the nationalist and xenophobic attitude in Poland and other Eastern European countries is detrimental to public mental health. The xenophobic attitude is accompanied by a higher incidence of anxiety and depression, disputes due to the polarization of opinions, a sense of embarrassment and a sense of contradictions with so-called Christian values, unfavorable demographic predictions and reduced life satisfaction.

Discussion

The authors attempt to describe the sequence of adverse events that led to the intensification of xenophobia and characterize the current state of public mental health in European countries. They formulate and propose possible actions which could counteract the consequences of that transformation.

Short conclusion

The actions which may be undertaken to counteract the deterioration of public mental health can be based on the recommendations of so-called ‘positive psychology’ and ‘positive psychiatry’ as well as the principles of strengthening local social capital.

Social cohesion, social participation and HIV testing among men who have sex with men in Swaziland

Social cohesion and social participation are social factors that may help reduce HIV risks and optimize health-seeking behaviors. We examined the association between these factors and HIV testing in the last 12 months among men who have sex with men (MSM) in Swaziland using a cross-sectional survey conducted with 326 men, 18 years of age or older reporting having sex with another man in the last 12 months. Social capital analyses included measures of social cohesion and social participation. The social cohesion measurement scale was created through exploratory factor analysis using polychoric correlations to determine unidimensionality and Cronbach's Alpha to assess internal consistency. The measurement scale was divided at the 25th and 75th percentiles using "high," "medium" and "low" levels of social cohesion for between-group comparisons. The social participation index included four questions regarding participation, resulting in a participation index ranging from 0 to 4. In the final multivariate logistic regression model, an increase in the level of social participation was found to be significantly associated with HIV testing in the last 12 months, adjusting for age, income, reporting a casual partner, family exclusion and rejection by other MSM due to sexual orientation (adjusted odds ratio [aOR]: 1.3, 95% confidence interval [CI] 1.1-1.7, p < .01). MSM with high social cohesion had almost twice the odds of HIV testing in the last 12 months (aOR: 1.8, 95% CI 1.1-3.3, p < .05) as MSM with medium social cohesion, though the overall social cohesion variable was not found to be significant using a Wald test in either the adjusted or unadjusted logistic regression models. These data suggest that building solidarity and trust within and between groups may be a strategy to improve uptake of HIV testing.

Social Capital Role in Managing High Risk Behavior: a Narrative Review

Background:

Social capital as a social context based concept is a new component in addition to the previous factors including the biologic–environmental, the genetic and the individual behavior factors that influence health and society. Social capital refers to the information that makes people believe being interesting & being paid attention to, & respected, valued, and belonging to a network of bilateral relations. Health issue is greatly affected by the existence of social capital. High risk behaviors refer to the ones enhancing the probability of negative and devastating physical, psychological and social consequences for an individual. Negative & overwhelming results mean keeping one’s distance from social norms as a result rejection and labeling (social stigma) and finally, to distance oneself from the benefits of social life in the individuals with high risk behaviors. The present study reviews social capital in the groups having high risk behaviors.

Methods:

The present study is a narrative review in which researchers conducted their computer search in public databases like Google Scholar, and more specifically in Pubmed, Magiran, SID, Springer, Science Direct, and ProQuest using the keywords: social capital, social support, risk behaviors, addicts, HIV, AIDS, and selected the articles related to the study subject from 2004 to 2014. Overall 96 articles have been searched. Researchers reviewed the summary of all articles searched, & ultimately, they applied the data from 20 full articles to compile this review paper.

Results:

Article review results led to organizing the subjects into 6 general categories: Social capital and its role in health; Social capital in groups with high risk behaviors (Including: substance abusers, AIDS patients, the homeless and multi-partner women); Social capital in different social groups; measurement tools for social capital and risk behaviors; the role of health in helping people with risky behaviors with the focus on improving social capital and social support. The findings of this study indicate that social capital was significantly lower in the substance abusers than the non-addicts. Also, social participation, social trust and networks of social relationships were significantly lower than non-drug abusers. Social capital has interactive effects on risky behaviors and delinquency. On the one hand, high levels of social capital can be involved in preventing delinquency. On the other hand, creating negative social capital in high risk groups is also considered as the damaging effects of the negative aspects of social capital in these groups.

Conclusions:

From this review extracted findings, it can be concluded that to design risky behaviors programs and preventive interventions, social capital and social support should be considered more than before. To accept an addict or HIV sufferer is effective in reducing their psychological reactions. So with effective social interaction and social support, these people can improve their risky lifestyles. As a result, these changes are associated with higher levels of satisfaction with their lives. Finally, it is recommended to design and implement counseling programs in order to educate health-promoting behaviors in high risk groups focusing on social capital and social support.

Does Multi-morbidity Mediate the Effect of Socioeconomics on Self-rated Health? Cross-country Differences

Background:

This study explored cross-country differences in how multi-morbidity explains the effects of socioeconomic characteristics on self-rated health.

Methods:

The study borrowed data from the Research on Early Life and Aging Trends and Effects. Participants were 44,530 individuals (age > 65 years) who were sampled from 15 countries (i.e. United States, China, India, Russia, Costa Rica, Puerto Rico, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, Ghana and South Africa). Multi-morbidity was measured as number of chronic medical conditions. In Model I, main effects of socioeconomic factors on self-rated health were calculated using country-specific logistic regressions. In Model II, number of chronic conditions were also added to the models to find changes in coefficients for demographic and socioeconomic factors.

Results:

In the United States, number of chronic medical conditions explained the effect of income on subjective health. In Puerto Rico, number of chronic medical conditions explained the effect of marital status on subjective health. In Costa Rica, Argentina, Barbados, Cuba, and Uruguay, number of chronic medical conditions explained gender disparities in subjective health. In China, Mexico, Brazil, Russia, Chile, India, Ghana and South Africa, number of chronic medical conditions did not explain the effect of demographic or socioeconomic factors on subjective health.

Conclusions:

Multi-morbidity explains the effect of demographic and socioeconomic factors on subjective health in some but not other countries. Further research is needed.

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.

Measuring Social Capital Investment: Scale Development and Examination of Links to Social Capital and Perceived Stress

Individuals with greater social capital have better health outcomes. Investment in social capital likely increases one's own social capital, bearing great implications for disease prevention and health promotion. In this study, the authors developed and validated the Social Capital Investment Inventory (SCII). Direct effects of social capital investment on perceived stress, and indirect effects through social capital were examined. 397 Participants from Beijing and Wuhan, China completed surveys. Analyses demonstrated that the SCII has a single factor structure and strong internal consistency. Structural equation modeling showed that individuals who invested more in social capital had greater bonding social capital, and subsequently less perceived stress. Results suggest that disease prevention and health promotion programs should consider approaches to encourage social capital investment; individuals may be able to reduce stress by increasing their investment in social capital. Future research is needed to provide additional empirical support for the SCII and observed structural relationships.

Development and validation of a social capital questionnaire for adolescent students (SCQ-AS)

Objectives

Social capital has been studied due to its contextual influence on health. However, no specific assessment tool has been developed and validated for the measurement of social capital among 12-year-old adolescent students. The aim of the present study was to develop and validate a quick, simple assessment tool to measure social capital among adolescent students.

Methods

A questionnaire was developed based on a review of relevant literature. For such, searches were made of the Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, The Cochrane Library, ISI Web of Knowledge, International Database for Medical Literature and PubMed Central bibliographical databases from September 2011 to January 2014 for papers addressing assessment tools for the evaluation of social capital. Focus groups were also formed by adolescent students as well as health, educational and social professionals. The final assessment tool was administered to a convenience sample from two public schools (79 students) and one private school (22 students), comprising a final sample of 101 students. Reliability and internal consistency were evaluated using the Kappa coefficient and Cronbach's alpha coefficient, respectively. Content validity was determined by expert consensus as well as exploratory and confirmatory factor analysis.

Results

The final version of the questionnaire was made up of 12 items. The total scale demonstrated very good internal consistency (Cronbach's alpha: 0.71). Reproducibility was also very good, as the Kappa coefficient was higher than 0.72 for the majority of items (range: 0.63 to 0.97). Factor analysis grouped the 12 items into four subscales: School Social Cohesion, School Friendships, Neighborhood Social Cohesion and Trust (school and neighborhood).

Conclusions

The present findings indicate the validity and reliability of the Social Capital Questionnaire for Adolescent Students.

Cross-country variation in additive effects of socio-economics, health behaviors, and comorbidities on subjective health of patients with diabetes

PURPOSE

This study explored cross-country differences in the additive effects of socio-economic characteristics, health behaviors and medical comorbidities on subjective health of patients with diabetes.

METHODS

The study analyzed data from the Research on Early Life and Aging Trends and Effects (RELATE). The participants were 9,179 adults with diabetes who were sampled from 15 countries (i.e. China, Costa Rica, Puerto Rico, United States, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, India, Ghana, South Africa, and Russia). We fitted three logistic regressions to each country. Model I only included socio-economic characteristics (i.e. age, gender, education and income). In Model II, we also included health behaviors (i.e. smoking, drinking, and exercise). Model III included medical comorbidities (i.e. hypertension, respiratory disease, heart disease, stroke, and arthritis), in addition to the previous blocks.

RESULTS

Our models suggested cross-country differences in the additive effects of socio-economic characteristics, health behaviors and comorbidities on perceived health of patients with diabetes. Comorbid heart disease was the only condition that was consistently associated with poor subjective health regardless of country.

CONCLUSION

Countries show different profiles of social and behavioral determinants of subjective health among patients with diabetes. Our study suggests that universal programs that assume that determinants of well-being are similar across different countries may be over-simplistic. Thus instead of universal programs that use one protocol for health promotion of patients in all countries, locally designed interventions should be implemented in each country.

Estratégia de Saúde da Família: recursos comunitários na atenção à saúde mental

OBJETIVO: Investigar a percepção de profissionais de estratégia de saúde da família sobre recursos existentes no território para atendimento de demandas em saúde mental. MÉTODOS: Estudo transversal, qualitativo realizado com 27 profissionais da saúde de serviços de atenção primária. Os dados foram coletados utilizando entrevistas, grupos focais e observação. Após a coleta, os dados foram transcritos e submetidos à análise à luz do conceito estruturalista. RESULTADOS: Os enfermeiros referiram dispositivos formais para apoio em saúde mental, enfatizando serviços de saúde. Os coordenadores mencionaram serviços de saúde, universidade e parcerias como conselho tutelar e promotoria pública. Os agentes comunitários demonstraram maior integração com o território e conhecimento abrangente de fontes de apoio social formal e informal. Na observação do território foram identificados recursos sociais não mencionados nas entrevistas. CONCLUSÃO: A percepção dos enfermeiros em relação aos recursos comunitários centrou-se em instituições formais relacionadas à saúde ou ao ensino de cursos na área da saúde. Os coordenadores identificaram outros serviços de saúde e dispositivos de proteção social. Os agentes comunitários têm a maior percepção dos recursos existentes em saúde mental.