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

Cognitive social capital as a health-enabling factor for STI testing among young men in Stockholm, Sweden: A cross-sectional population-based study

Objective

To assess whether different forms of cognitive social capital increased the relative probability of testing for sexually transmitted infections (STIs) among young men living in Stockholm, Sweden.

Methods

A population-based cross-sectional study was conducted in 2017 with men aged 20-29 years living in Stockholm County, Sweden (n = 523). The main outcome was STI testing patterns (never tested, tested only within a12-monthperiod, tested only beyond a12-monthperiod, repeatedly tested). The main exposure were two forms of cognitive social capital: social support (having received help, having someone to share inner feelings with) and institutionalized trust (in school, healthcare, media). Data were analyzed using weighted multivariable multinomial logistic regression to obtain adjusted weighted relative probability ratio (aRPR).

Results

After adjusting for confounding factors, receiving help (aRPR: 5.2, 95% CI: 1.7-16.2) and having someone to share inner feelings with (aRPR: 3.1, 95% CI: 1.2-7.7) increased the relative probabilities of young men testing for STIs, but only for those testing beyond a 12-month period. Trust in media increased the relative probability of STI testing for those testing only within a 12-month period (aRPR: 2.6, 95% CI: 1.1-6.1) and for those testing repeatedly (aRPR: 3.6, 95% CI: 1.5-8.8).

Conclusion

Young men in Stockholm County exhibit distinct STI testing patterns. Social support and trust in media were factors that increased the probability of being tested for STIs, with this effect varying according to the young men's STI testing pattern. Further studies are required to explore how trust in media might promote STI testing in this population.

The Relationship Between Social Capital and Hypertension Among Type 2 Diabetes Mellitus Patients: The Moderating Effect of Depressive Symptoms

PURPOSE

This study aimed to evaluate the relationship between social capital (SC) and hypertension among type 2 diabetes mellitus (T2DM) patients, considering the moderation effects of depressive symptoms.

PATIENTS AND METHODS

A total of 1761 Chinese T2DM patients completed measure scales of social capital and epidemiological survey depression scale (CES-D). The Bootstrap methods PROCESS program is employed to test the moderation model.

RESULTS

The prevalence of hypertension among T2DM patients was 39.3%. The SC was negatively correlated with the CES-D score (r=-0.18, P<0.01); the SC was also negatively correlated with diastolic blood pressure (r=-0.05, P<0.05); and the CES-D score was positively correlated with systolic blood pressure (r=0.05, P<0.05). Both logistic regression analysis and the Bootstrap method showed that depressive symptoms weakened the protective effect of SC on hypertension, there existed a moderating effect of depressive symptoms on the relationship between SC and hypertension among T2DM patients.

CONCLUSION

Depressive symptoms may be one crucial moderator of the relationship between SC and hypertension in a representative sample of Chinese diabetes patients. The findings indicate that improving SC and mental health may help manage hypertension among T2DM patients.

Community social capital and the health-related quality of life among empty-nest elderly in western China: moderating effect of living arrangements

BACKGROUND

At present, the empty nest phenomenon is becoming more and more serious in the world, especially in China, and its health problems deserve attention. Therefore, the purpose of this study is to explore the impact of community social capital on the health-related quality of life of empty-nest elderly.

METHODS

The study used data collected from a survey study conducted between 2018 and 2019 in Sichuan province, China, with 638 empty-nest elderly meeting our criteria. SF-12 scale and self-made social capital scale were used to evaluate the health-related quality of life and community social capital of empty-nest elderly. Through descriptive statistical analysis, bivariate analysis and hierarchical multiple regression model, this study analyzes the relationship between community social capital and health-related quality of life of empty-nest elderly. Considering the role of living arrangements, this study further uses the simple effect analysis method to explore the moderating role of living arrangements.

RESULTS

After controlling the relevant variables, the cognitive social capital (CSC) of empty-nest elderly had a positive relationship with the physical health summary (PCS) (β = 0.188, p＜0.001) and mental health summary (MCS) (β = 0.205, p＜0.001). No effect of structural social capital on quality of life was found as a result. Living arrangements played a moderation effect on the relationship between CSC and MCS (β=-2.018, p＜0.05). The MCS score of high CSC group (55.516 ± 0.757) was significantly higher than that of low CSC group (49.383 ± 0.722).

CONCLUSION

The results suggest empty-nest elderly has poorer physical health and weaker structural social capital, while the cognitive social capital has a greater positive impact on their quality of life. Targeted interventions to enhance community social capital may be beneficial to improve health status of this vulnerable population.

Adolescent connectedness: cornerstone for health and wellbeing

Approaches to youth development that enhance connectedness and opportunities for young people are key to adolescent health and wellbeing argue Robert Blum and colleagues

Current curative expenditure of non-communicable diseases changed in Dalian, China from 2017 to 2019: a study based on 'System of Health Accounts 2011'

OBJECTIVES

To analyse the current curative expenditure (CCE) of NCDs in China from 2017 to 2019.

DESIGN

A cross-sectional study. Medical institutions were collected by multistage stratified random sampling from 2017 to 2019.

SETTING

Dalian, China PARTICIPANTS: 408 institutions and 8 104 233 valid items were included in the study. NCDs patients were selected according to International Classification of Diseases-10.

PRIMARY AND SECONDARY OUTCOME MEASURES

CCE for NCDs was measured based on the System of Health Accounts 2011. Influenced factors were analysed by linear regression. All analyses and calculations were performed by STATA V.15.0.

RESULTS

The CCE of NCDs was ¥14.929 billion in 2017, ¥16.377 billion in 2018 and ¥18.055 billion in 2019, which accounted for more than 65% of total expenditure spent each year. More than 60% came from public financing. The proportion of family health financing continued to decline, reaching 31.16% in 2019. The expenditures were mainly in general hospitals, above 70%. Elderly patients account for the majority. Diseases of the circulatory system, diseases of the digestive system and neoplasms were the main NCDs. Year, age, gender, length of stay, surgery, insurance and institution level affected hospitalisation expenses.

CONCLUSIONS

NCDs are the main CCE of diseases in China, and their resources are not allocated reasonably. To reduce the CCE of NCDs, the government needs to optimise resource allocation and rationalise institutional flows and functions.

Environmental risk factors of type 2 diabetes-an exposome approach

Type 2 diabetes is one of the major chronic diseases accounting for a substantial proportion of disease burden in Western countries. The majority of the burden of type 2 diabetes is attributed to environmental risks and modifiable risk factors such as lifestyle. The environment we live in, and changes to it, can thus contribute substantially to the prevention of type 2 diabetes at a population level. The 'exposome' represents the (measurable) totality of environmental, i.e. nongenetic, drivers of health and disease. The external exposome comprises aspects of the built environment, the social environment, the physico-chemical environment and the lifestyle/food environment. The internal exposome comprises measurements at the epigenetic, transcript, proteome, microbiome or metabolome level to study either the exposures directly, the imprints these exposures leave in the biological system, the potential of the body to combat environmental insults and/or the biology itself. In this review, we describe the evidence for environmental risk factors of type 2 diabetes, focusing on both the general external exposome and imprints of this on the internal exposome. Studies provided established associations of air pollution, residential noise and area-level socioeconomic deprivation with an increased risk of type 2 diabetes, while neighbourhood walkability and green space are consistently associated with a reduced risk of type 2 diabetes. There is little or inconsistent evidence on the contribution of the food environment, other aspects of the social environment and outdoor temperature. These environmental factors are thought to affect type 2 diabetes risk mainly through mechanisms incorporating lifestyle factors such as physical activity or diet, the microbiome, inflammation or chronic stress. To further assess causality of these associations, future studies should focus on investigating the longitudinal effects of our environment (and changes to it) in relation to type 2 diabetes risk and whether these associations are explained by these proposed mechanisms.

Social capital in the prevention and management of non-communicable diseases among migrants and refugees: a systematic review and meta-ethnography

Globally, the burden of non-communicable diseases (NCDs) falls disproportionately on underserved populations. Migrants and refugees are particularly vulnerable due to economic instability and systemic poverty. Despite the myriad of health risks faced by migrants and refugees, access to appropriate healthcare is hindered by structural, cultural and socioeconomic barriers. We conducted a systematic review and meta-ethnography to obtain critical insight into how the interplay of social capital and structural factors (eg, state policies and socioeconomic disadvantage) influences the prevention and treatment of NCDs in migrant and refugee populations. We included 26 studies of 14 794 identified articles, which reported qualitative findings on the structure and functions of social capital in NCD prevention and management among migrants and refugees. We synthesised findings, using the process outlined by Noblit and Hare, which indicated that migrants and refugees experienced weakened social networks in postmigration settings. They faced multiple barriers in healthcare access and difficulty navigating healthcare systems perceived as complex. Family as the core of social capital appeared of mixed value in their NCD prevention and management, interacting with cultural dissonance and economic stress. Community organisations were integral in brokering healthcare access, especially for information diffusion and logistics. Healthcare providers, especially general practitioners, were important bridges providing service-user education and ensuring a full continuum of quality care. While social capital reduced immediate barriers in healthcare access for NCD prevention and management, it was insufficient to address structural barriers. System-level interventions appear necessary to achieve equitable healthcare access in host countries. PROSPERO registration number: CCRD42020167846.

The challenge of assessing social cohesion in health impact assessment

Health impact assessment (HIA) is a method by which a policy, programme or project falling outside traditional health fields, may be judged as to its potential effects on the health of a population to mitigate negative impacts and strengthen the positive ones. Proposals are analysed from the perspective of all the determinants of health. In France, HIAs are mainly applied to urban development projects where social cohesion (SCo) is a major issue. Although the HIA method is well structured as a step-by-step process, there are no guidelines for assessing SCo. This article opens with literature review to clarify the concept of SCo and to understand how the built environment influences SCo and how social environment influence health. Drawing on this work, this paper presents an analytical framework to assess SCo, integrating both the spatial and physical dimensions of urban design and the perceptions of the neighbourhood characteristics. Following a brief overview of the key findings from applying this framework to HIA of an urban development project, the paper discusses its related strengths and weaknesses. The framework could be a useful tool for HIA as it embraces knowledge from both urban planning and social sciences. It also allows for an overall analysis of all the indicators without relying on a checklist. Nevertheless, it should be tested further to improve its validity.

Physical Multimorbidity and Social Participation in Adult Aged 65 Years and Older From Six Low- and Middle-Income Countries

OBJECTIVES

Multimorbidity is common among older adults from low- and middle-income countries (LMICs). Social participation has a role in protecting against negative health consequences, yet its association with multimorbidity is unclear, particularly in LMICs. Thus, this study investigated the relationship between physical multimorbidity and social participation among older adults across 6 LMICs.

METHOD

Cross-sectional, community-based data including adults aged 65 years and older from 6 LMICs were analyzed from the WHO Study on Global AGEing and adult health survey. The association between 11 individual chronic conditions or the number of chronic conditions (independent variable) and social participation (range 0-10 with higher scores indicating greater social participation; dependent variable) was assessed by multivariable linear regression analysis.

RESULTS

14,585 individuals (mean age 72.6 [SD 11.5] years; 54.9% females) were included. Among individual conditions, hearing problems, visual impairment, and stroke were significantly associated with lower levels of social participation. Overall, an increasing number of chronic conditions was dose-dependently associated with lower levels of social participation (e.g., ≥4 vs 0 conditions: β = -0.26 [95% CI = -0.39, -0.13]). The association was more pronounced among males than females.

DISCUSSION

Older people with multimorbidity had lower levels of social participation in LMICs. Future longitudinal studies are warranted to further investigate temporal associations, and whether addressing social participation can lead to better health outcomes among older people with multimorbidity in LMICs.

Social-capital determinants of the women with diabetes: a population-based study

Introduction

Social-capital level contributes to clinical factors and health outcomes of patients suffering from diabetes. Considering the social determinants of type 2 diabetes patients could benefit to prevention of diabetes complications especially in women population. This study aims to determine social capital determinants in women with diabetes.

Methods

Four hundred and thirty-five women with diabetes take-part in this cross-sectional, multi-centric study. The data was completed by a demographic questionnaire and the Social Capital instrument (SC-IQ). This study is investigating demographic (age, gender, BMI, marital, educational and social-economic status), and lifestyle factors (physical activity, nutrition), Diabetes status (HbA1c Level, medications, complications, duration of diabetes), general health status (life satisfaction, self-rated health, physical activity, and depression) and Social capital items (Value of life, Tolerance of Diversity, Neighborhood network, Family and Friends Connections, Work connections, Community participation, Feeling of trust and Safety and Proactivity). The descriptive statistics and linear regression models were used to assess the associations between social capital and determinants.

Results

The mean age of participants was 50 (SD: 7.7), range 28-71 year. The mean social capital score was 77.8 (SD: 15.8). In linear regression analysis, results showed that women who had the greater score in total social-capital (ß: 3.7, SE: 1.5) and Feeling of trust and Safety (ß: 0.87, SE: 0.42) had vigorous physical activity and also women who had greater score in Neighborhood Connections had moderate physical activity in comparison with patients who had low physical activity. (ß: 0.67, SE: 0.26 and ß: 0.61, SE: 0.26).Also, the findings showed that women who had had a lower score in total social-capital (ß: 6, SE: 1.47), Community participation (ß: 1.44, SE: 0.37), Value of life (ß: 1.71, SE: 0.24), Family and Friends Connections (ß: 0.88, SE: 0.25) and proactivity (ß: 0.71, SE: 0.25) had depression in comparison with patients who had no depression. The findings revealed that instead of each year increase in the duration of diabetes, the total social-capital score had decreased about the half score (ß: 0.48, SE: 0.21).

Conclusions

Important social factors that make diabetes control are alterable to health interventions. The results of the current study suggest that social capital status may determine how effectively the women with diabetes have been managed. This initial finding permits subsequent experimental investigations to identify social strategies that can be valuable to improve diabetes control.

Establishing how social capital is studied in relation to cardiovascular disease and identifying gaps for future research-A scoping review protocol

Introduction

Though the relationship between social capital and health has been widely studied, the evidence of this relationship in cardiovascular disease is limited, with varied and inconsistent measures. This scoping review seeks to address this gap by answering the following questions: (1) How has social capital been characterized and measured in the literature related to cardiovascular disease? and (2) What gaps exist in the evaluation of the relationship between social capital and cardiovascular disease?

Materials and methods

A scoping review will be used to answer the research questions. The scoping review will apply established methods described by Arksey and O’Malley, Levac and colleagues, and the Joanne Briggs Institute: (1) identifying the research question(s); (2) identifying relevant studies; (3) selecting the studies; (4) charting the data; and (5) collating, summarizing, and reporting the results.

Results

Our findings will be reported in accordance with the guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement.

Discussion

The synthesis of this evidence base is intended to provide a framework for how social capital has been defined and measured in the cardiovascular literature, with additional guidance for future research and evaluation. The findings will be disseminated through peer-reviewed publication and presentations at relevant seminars.

Sociodemographic Determinants of Acute Myocardial Infarction Hospitalization Risks in Florida

Background Identifying social determinants of myocardial infarction (MI) hospitalizations is crucial for reducing/eliminating health disparities. Therefore, our objectives were to identify sociodemographic determinants of MI hospitalization risks and to assess if the impacts of these determinants vary by geographic location in Florida. Methods and Results This is a retrospective ecologic study at the county level. We obtained data for principal and secondary MI hospitalizations for Florida residents for the 2005-2014 period and calculated age- and sex-adjusted MI hospitalization risks. We used a multivariable negative binomial model to identify sociodemographic determinants of MI hospitalization risks and a geographically weighted negative binomial model to assess if the strength of associations vary by location. There were 645 935 MI hospitalizations (median age, 72 years; 58.1%, men; 73.9%, white). Age- and sex-adjusted risks ranged from 18.49 to 69.48 cases/10 000 persons, and they were significantly higher in counties with low education levels (risk ratio [RR]=1.033, P<0.0001) and high divorce rate (RR, 0.995; P=0.018). However, they were significantly lower in counties with high proportions of rural (RR, 0.996; P<0.0001), black (RR, 1.026; P=0.032), and uninsured populations (RR, 0.983; P=0.040). Associations of MI hospitalization risks with education level and uninsured rate varied geographically (P for non-stationarity test=0.001 and 0.043, respectively), with strongest associations in southern Florida (RR for <high school education, 1.036-1.041; RR for uninsured rate, 0.971-0.976). Conclusions Black race, divorce, rural residence, low education level, and lack of health insurance were significant determinants of MI hospitalization risks, but associations with the latter 2 were stronger in southern Florida. Thus, interventions for addressing MI hospitalization risks need to prioritize these populations and allocate resources based on empirical evidence from global and local models for maximum efficiency and effectiveness.

Income Inequality and Self-Reported Health Among Older Adults in Brazil

This study analyzes the association between income inequality and self-reported health (SRH) in older adults, and separately for the young-old and very-old groups, residing in each of the 27 Brazilian capitals. The sample consisted of 4,912 individuals aged 60 or older residing in Brazilian capitals in 2013. Bayesian multilevel models were applied to the whole sample and separately for individuals aged 60 to 79 (young-old), and 80 or more (very-old). Our results show significant associations between income inequality and SRH, even after controlling for individual and contextual factors. We found greater odds of poor SRH among older adults living in areas with medium (odds ratio [OR] = 1.66, 95% confidence interval [CI]: 1.49-1.86) and high-income inequality (OR = 2.21, 95% CI: 2.05-2.38). The negative association between income inequality and health, independently of the individual and contextual characteristics, suggests that living in unequal areas can have a detrimental effect on the health of older adults.

Social capital is associated with improved subjective well-being of older adults with chronic non-communicable disease in six low- and middle-income countries

BACKGROUND

Non-communicable diseases (NCDs) are increasingly contributing to the morbidity and mortality burden of low and-middle income countries (LMIC). Social capital, particularly participation has been considered as a possible protective factor in the prevention and management of chronic conditions. It is also largely shown to have a negative effect on the well-being of patients. The current discourse on the well-being of individuals with NCDs is however focused more on a comparison with those with no NCDs without considering the difference between individuals with one chronic condition versus those with multiple chronic conditions (MCC).

METHOD AND OBJECTIVE

We employed a multinomial logit model to examine the effect of social capital, particularly social participation, on the subjective well-being (SWB) of older adults with single chronic condition and MCC in six LMIC.

FINDINGS

Social capital was associated with increased subjective well-being of adults in all the six countries. The positive association between social capital and subjective well-being was higher for those with a single chronic condition than those with multiple chronic conditions in India and South Africa. Conversely, an increase in the likelihood of having higher subjective well-being as social capital increased was greater for those with multiple chronic conditions compared to those with a single chronic condition in Ghana.

DISCUSSION

The findings suggest that improving the social capital of older adults with chronic diseases could potentially improve their subjective well-being. This study, therefore, provides valuable insights into potential social determinants of subjective well-being of older adults with chronic diseases in six different countries undergoing transition. Additional research is needed to determine if these factors do in fact have causal effects on SWB in these populations.

Chinese Hospitalized Cardiovascular Patients' Attitudes Towards Self-Management: A Qualitative Study

PURPOSE

This study is aiming to investigate cardiovascular patients' attitudes towards self-management during hospitalization in China.

PATIENTS AND METHODS

Twenty-nine individuals living with cardiovascular disease from one designated Cardiology Department in Hangzhou, China, were recruited through a purposive sampling procedure. A qualitative descriptive methodology was used. Semi-structured interviews were also used to gain attitudes toward self-management. The interviews were audio-recorded, transcribed and analyzed by thematic analysis to develop the results.

RESULTS

Four themes were identified from the qualitative data: (1): Responsibilities of self-management; (2): Reflections on self-management; (3): Acknowledgement of self-management support; (4): Challenges in implementing and adherence to self-management. Additionally, interview data were also given to illustrate these main themes emerging during the analysis. Patients gradually took their responsibilities to manage chronic symptoms. During their self-management process, they did reflections to help correct their regiments through supportive interactions. Health system responsiveness, health disparities, social capital, and cultural setting were the main external factors influencing better self-management implementation and adherence.

CONCLUSION

This study revealed the hospitalized cardiovascular patients' attitudes towards self-management in China. These findings emphasized the importance of patients' responsibility, reflections, and various social support receiving and pointed out specific external factors influencing the health outcomes and their quality of life. This study also proves the guide for the policymakers and health system better instructions to develop individually and culturally tailored advanced self-management interventions and programs.

Social capital and health: A systematic review of systematic reviews

There are many systematic reviews on social capital (SC) and various health outcomes, but each of these reviews shows one piece of the larger SC and health puzzle. The aim of this research was to systematically review systematic reviews on SC and health, in order to provide an overview of existing evidence and to identify strategies for future research. Nine databases were searched for key words that could fall under the broad umbrella of SC and health outcomes. We screened 4941 titles and abstracts and read 187 reviews before retaining 20 of them. A critical appraisal of each review was conducted. The reviews show there is good evidence to suggest that SC predicts better mental and physical health, and indicators of SC are protective against mortality. At the same time, many reviews also found numerous non-significant and negative relationships that are important to consider. It was unclear whether SC interventions for health were really improving SC, or other aspects of the social environment. Overall, this research shows that evidence on how various aspects of SC affect different health outcomes for different actors remains unclear. Intergroup and lifecourse perspectives could help clarify this link. Future research could benefit from conceptualizing the link between SC and health in a what, who, where, when, why and how framework.

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Social capital predicts better health.

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Other aspects of social capital should also be considered in health research.

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Recommendations on how to improve social capital and health research are made.

Network-based and cohesion-based social capital and variations in depressive symptoms among Taiwanese adults

BACKGROUND

Network- and cohesion-based social capital may play an important role in improving mental health. However, there is limited understanding about these relationships among adults in Taiwan.

AIM

The aim of this study was to examine the association between individual-level network and cohesion-based social capital and depressive symptoms among a population-based sample of Taiwanese adults.

METHODS

Data were obtained from the 1997 Taiwan Social Change Survey (n = 2,598). The 20-item Center for Epidemiological Studies Depression Scale was used to measure depressive symptom scores; ⩾16 represented high depressive symptoms. Network-based social capital was measured using a position generator. Two dimensions of cohesion-based social capital were assessed: cognitive (perceived neighborhood trust and reciprocity) and structural (local community participation and organizational participation). Multivariable log-binomial regression models, weighted to account for the complex sampling design and adjusted for confounders, estimated prevalence ratios and 95% confidence intervals (CIs) to examine the association between each social capital measure and depressive symptoms.

RESULTS

In this study, 29.6% of respondents were classified as having high depressive symptom scores. Higher scores of composite cognitive social capital (adjusted Prevalence Ratios (aPR)  = 0.92, 95% CI = [0.90, 0.95]) and structural social capital (aPR = 0.80, 95% CI = [0.65, 0.99]) were associated with a lower likelihood of high depressive symptom scores after controlling for confounders. However, there was no association between network social capital and depressive symptoms.

CONCLUSION

The findings suggest that the relationship between social capital and depressive symptoms in Taiwan differs according to the specific dimension of social capital assessed. Differentiating between network- and cohesion-based social capital merits greater attention to inform our understanding of building social capital to promote and improve mental health outcomes.

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.

What is the association between social capital and diabetes mellitus? A systematic review

Social capital has been included as an element that could influence the self-perception of health, mortality and mental diseases. We systematically reviewed papers that studied the influence of social capital in the control of diabetes mellitus (DM). We included studies published up to Feb. 16, 2017, without restriction of time or year of publication. Quantitative studies were included since they presented one well-defined parameter to evaluate DM and specifically measured social capital. We used the PRISMA and STROBE guidelines to perform this review and to evaluate the quality of papers. Only three papers met the inclusion criteria. All studies adopted cross-sectional design. The population, the instruments used to measure social capital, and the statistical analysis were different among the papers. In conclusion, although social capital seems to be related to DM, more studies are necessary to understand which dimensions are more important in this association, if the association is the same at the individual or neighborhood level, and what kind of population in terms of education, poverty and culture would be more influenced by social capital in DM control.

Epstein-Barr virus antibody titer as a stress biomarker and its association with social capital in rural Fujian communities, China

OBJECTIVES

There has been little research on the association between social capital and psychological stress measured by a biomarker, particularly in developing countries. Our objective was to investigate the association between Epstein-Barr virus (EBV) antibody titer, an indicator of cellular immune function previously shown to be associated with psychological stress, and social capital among rural community dwellers in Fujian Province, China.

METHODS

We conducted a cross-sectional survey in seven rural communities in Fujian in 2015. We used questionnaire data and dried blood spot samples for the measurement of biomarkers collected from 734 local residents for the analysis. We conducted a mixed effects regression analysis to investigate the association between EBV antibody titer and four social capital variables, which included cognitive and structural social capital assessed both at individual and community levels.

RESULTS

Community-level structural social capital was inversely associated with psychological stress (coefficient = -0.96, 95% confidence interval [CI] = -1.91, -0.01) while individual-level structural social capital was positively associated with it (coefficient = 0.21, 95% CI = 0.07, 0.36). Neither individual- nor community-level cognitive social capital was associated with psychological stress status.

CONCLUSIONS

In rural Fujian, China, social capital seemed to be an important determinant of psychological health. While living in a community with active social interaction may benefit the residents psychologically, social interaction in the form of strongly bonded relationships may be a source of psychological stress at the individual level due to the potential demands and obligations that may be associated with such connections.

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.

The relationship between social capital components and control of type 2 diabetes: A path analysis model

Background: Social capital is an important interpersonal organizational resource that may affect health behaviors and seems to be an important factor in chronic diseases. Considering the lack of evidence on this topic, in the present study, we aimed at investigating the association between components of social capital, socioeconomic condition, and controlling Type 2 diabetes mellitus in Iran.

Methods: This study was conducted on 300 patients with Type 2 diabetes in Tehran, Iran. In this study, simple random sampling method was used for data collection. Path analysis model was used to examine the potential association between social capital components and to determine the factors that control Type 2 diabetes.

Results: In the present study, most of the participants were female (70.7%) and married (78.7%). Path coefficients were calculated by a series of multiple regression analyses based on the conceptual model. The final model had a proper fit with Chi-square = 2.08 (DF = 1, P = 0.049), GFI = 0.542, AGFI = 0.915, NFI = 0.228, RFI = 0.284, IFI = 0.299, TLI = 0.292, CFI = 0.219, and RMSEA = 0.033. The Groups and networks (network) (β = 0.051, p = 0.036) and trust and solidarity (β = -0.018, p = 0.028) had a direct positive and negative effect on HbA1C, respectively. The results also revealed that education levels had a direct positive effect on groups and networks (network) (β = 0.118, p = 0.036), trust and solidarity (β = 0.082, p = 0.007), information and communication (β = 0.037, p = 0.027), and contribution in team works and public activities (β = 0.064, p = 0.003). In addition, education levels had an indirect positive effect on HbA1C through their effect on groups and networks (network), trust and solidarity, and information and communication.

Conclusion: Social capital has a significant relationship with diabetes. Although it was not specified clearly which components of social capital were associated with diabetes, trust and solidarity showed a negative direct effect on HbA1C, respectively. Therefore, developing and implementing local and collective programs to build trust and increase the standards of social trust in patients with diabetes can be effective in controlling HbA1C.

Two Mechanisms: The Role of Social Capital and Industrial Pollution Exposure in Explaining Racial Disparities in Self-Rated Health

This study provides an empirical test of two mechanisms (social capital and exposure to air pollution) that are theorized to mediate the effect of neighborhood on health and contribute to racial disparities in health outcomes. To this end, we utilize the Social Capital Benchmark Study, a national survey of individuals nested within communities in the United States, to estimate how multiple dimensions of social capital and exposure to air pollution, explain racial disparities in self-rated health. Our main findings show that when controlling for individual-confounders, and nesting within communities, our indicator of cognitive bridging, generalized trust, decreases the gap in self-rated health between African Americans and Whites by 84%, and the gap between Hispanics and Whites by 54%. Our other indicator of cognitive social capital, cognitive linking as represented by engagement in politics, decreases the gap in health between Hispanics and Whites by 32%, but has little impact on African Americans. We also assessed whether the gap in health was explained by respondents' estimated exposure to toxicity-weighted air pollutants from large industrial facilities over the previous year. Our results show that accounting for exposure to these toxins has no effect on the racial gap in self-rated health in these data. This paper contributes to the neighborhood effects literature by examining the impact that estimated annual industrial air pollution, and multiple measures of social capital, have on explaining the racial gap in health in a sample of individuals nested within communities across the United States.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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