Social capital, the miniaturization of community and cannabis smoking among young adults

OBJECTIVES: The impact of social participation, trust and the miniaturization of community, i.e. the combination of high social participation and low trust, on cannabis smoking was investigated. METHODS: The 2000 public health survey in Scania is a cross-sectional study. A total of 13,715 persons aged 18-80 years, of which 3,978 persons aged 18-34 years were included in this study, answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the association between the social capital variables and ever having experienced cannabis smoking. The multivariate analysis was performed to investigate the importance of possible confounders (age, country of origin and education) on the differences in having experienced cannabis smoking according to social participation, trust and their four combination categories. RESULTS: Cannabis smoking is not associated with social participation, but positively associated with low trust among both men and women, and the miniaturization of community, i.e. the combination of high social participation and low trust, among men. CONCLUSIONS: This study suggests that the miniaturization of community, i.e. the combination of high social participation and low levels of generalized trust of other people, may enhance the experience of cannabis smoking.     

Social capital, institutional (vertical) trust and smoking: a study of daily smoking and smoking cessation among ever smokers

OBJECTIVES: The associations between vertical (institutional) trust in the healthcare system and the mass media (newspapers and television), and daily smoking and smoking cessation were investigated. METHODS: The 2004 public-health survey in Scania is a cross-sectional study. A total of 27,757 persons aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the associations between institutional trust in the healthcare system and the mass media, and daily smoking and smoking cessation. A multivariate analysis was performed to investigate the importance of possible confounders (age, country of origin, education, economic stress, generalized trust in other people) on the differences in daily smoking and smoking cessation according to trust in the healthcare system and the mass media. RESULTS: 14.9% of the men and 18.1% of the women were daily smokers. Middle-aged respondents were daily smokers to a significantly higher extent than the young. Respondents with low trust in the healthcare system had significantly higher odds ratios of daily smoking, 1.88 (95% CI 1.38-2.57) among men and 2.05 (95% CI 1.51-2.78) among women, while respondents with low trust in the mass media had no significant odds ratios of daily smoking, 1.01 (0.67-1.52) among men and 1.55 (0.97-2.47) among women, after multiple adjustments. CONCLUSIONS: Institutional (vertical) trust in the healthcare system but not the mass media was significantly associated with lower odds of daily smoking and higher odds of having quit smoking if ever smoker. The healthcare system seems to be a potent arena for tobacco prevention.     

Social capital, the miniaturization of community and high alcohol consumption: a population-based study

AIMS: To study the impact of social participation, trust, and the miniaturization of community, i.e. high social participation/low trust, on the risk of high alcohol consumption. METHODS: The Scania 2000 public health survey is a cross-sectional, postal questionnaire study. A total of 13 604 persons aged 18-80 years were included. A logistic regression model was used to investigate the association between the social capital variables and high alcohol consumption (168.0 g/week or more for men and 108.0 g/week or more for women). The multivariate analyses analysed the importance of confounders (age, country of origin, education, and economic stress) on the risk of high alcohol consumption according to the social capital variables. RESULTS: A 14.0% proportion of all men and 7.8% of all women had an alcohol consumption above recommended levels. High alcohol consumption above recommended levels was not associated with social participation but negatively associated with trust among men. The miniaturization of community category, i.e. high social participation/low trust, had significantly higher risks of high alcohol consumption compared to the high social capital (high social participation/high trust) category among men. CONCLUSION: High social participation combined with low trust, i.e. the miniaturization of community, is positively associated high alcohol consumption among men. A structural/social factor which may affect the amount of alcohol consumed has thus been identified in this study.     

Social capital and the miniaturization of community among daily and intermittent smokers: a population-based study

BACKGROUND: The impact of social participation, trust, and the miniaturization of community on daily and intermittent smoking was investigated. METHODS: The 2000 public health survey in Scania is a cross-sectional study. A total of 13,715 persons answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the association between the social capital variables and daily and intermittent smoking. The multivariate analysis was performed by using a logistic regression model to investigate the importance of possible confounders (age, country of origin, education, and snuff consumption) on the differences in daily and intermittent smoking between high versus low social participation, trust, and their four combination categories. The differences in the prevalences of the 13 social participation subitems between the high social capital and miniaturization of community categories were compared by t tests. RESULTS: Daily smoking is negatively associated with both social participation and trust, while intermittent smoking is positively associated with social participation and negatively associated with trust. This latter combination, named "the miniaturization of community," is an indirect measure of the ideologically and culturally increasingly narrow forms of social participation that excludes generalised trust to other people. Study circles, meetings of organisations, theatre/cinema, arts exhibition, and gathering of relatives are more prevalent in the high social capital category, while visit(s) to night club/entertainment is more prevalent in the miniaturization of community category. CONCLUSIONS: Low social capital is associated with daily smoking. "The miniaturization of community," i.e., high social participation and low trust, is significantly associated with intermittent smoking. The results have direct implications for smoking prevention strategies.     

Social capital, the miniaturisation of community and consumption of homemade liquor and smuggled liquor during the past year. A population-based study

BACKGROUND: To study the impact of social participation, trust and the miniaturisation of community, i.e. high social participation/low trust, on consumption of homemade liquor and smuggled liquor during the past year. METHODS: The Scania 2000 public health survey is a cross-sectional, postal questionnaire study. A total of 13,604 persons aged 18-80 years were included. A logistic regression model was used to investigate the association between the social capital variables and illegal alcohol consumption. The multivariate analyses analysed the importance of confounders (age, country of origin, education and economic stress) on the differences in consumption of homemade and smuggled liquor according to the social capital variables. RESULTS: A 28.2% proportion of all men and 14.9% of all women had consumed homemade liquor during the past year. The proportions who had consumed smuggled liquor during the past year were even higher, 40.1% among men and 21.4% among women. Both forms of illegal alcohol consumption were significantly positively associated with social participation and negatively associated with trust. The miniaturisation of community category, i.e. high social participation/low trust, had significantly higher risks of consumption during the past year of the consumption of both forms of illegally provided alcohol compared to the high social capital (high social participation/high trust) category, while the low social participation/high trust category had significantly lower risks. CONCLUSION: High social participation combined with low trust is positively associated with consumption of illegally provided alcohol. The results have implications for alcohol prevention programs, because structural/social factors that may hinder information and norms concerning illegal alcohol have been identified in this study.     

Social participation, trust and self-rated health: a study among ageing people in urban, semi-urban and rural settings

This study examined associations between self-rated health and combinations of social participation and trust among ageing people in three living areas of Finland (N=2815, 66% response rate). Social participation and trust combinations were: low social capital (low participation/low trust), traditionalism (low/high), "the miniaturisation of community" (high/low) and high social capital (high/high). The highest rate of good self-rated health was found among the high social capital group, but after adjusting for background variables, statistical significance remained only in the urban area. High social capital measured at an individual level may thus promote health among ageing people.     

Social capital, anticipated ethnic discrimination and self-reported psychological health: a population-based study

This study investigates the association between anticipated ethnic discrimination and self-reported psychological health, taking generalized trust in other people into consideration. The 2004 Public Health Survey in Skåne, Sweden, is a cross-sectional postal questionnaire study including a total of 27,757 respondents aged 18–80 with a 59% response rate. Multivariate analyses of anticipated discrimination and self-reported psychological health were performed using logistic regressions in order to investigate the importance of possible confounders (age, country of origin, education and horizontal trust). Poor psychological health was reported by 13.0% of men and 18.9% of women, and 44.8% and 44.7%, respectively, reported that 50% or more of employers would discriminate according to race, colour of skin, religion, or cultural background. Respondents in younger age groups, born abroad, with high education, low trust and high levels of self-reported anticipated discrimination, had significantly higher levels of poor self-reported psychological health. There was a significant association between anticipated discrimination and low horizontal trust. After multiple adjustments for age, country of origin and education, the addition of trust in the model reduced the odds ratio of poor self-reported psychological health in the “most employers” category from 1.8 (1.4–2.1) to 1.5 (1.3–1.9) among men and from 2.2 (1.8–2.6) to 1.8 (1.5–2.2) among women. Generalized trust in other people may be a confounder of the association between anticipated discrimination and poor psychological health. Anticipated discrimination may have effects on the mental health of not only the affected minorities, but also on the mental health of the general population.     

Social capital,political trust and self-reported psychological health: A population-based study

This study investigates the association between political trust (an aspect of institutional trust) in the Riksdag (the national parliament in Sweden) and self-reported psychological health, taking generalized (horizontal) trust in other people into account. The 2004 public health survey in Skåne in Southern Sweden is a cross-sectional postal questionnaire study that was answered by 27,757 respondents aged 18–80 yielding a 59% response rate. A logistic regression model was used to investigate the associations between political trust and self-reported psychological health adjusting for possible confounders (age, country of origin, education, economic stress and generalized trust in other people i.e. horizontal trust). We found that 13.0% of the men and 18.9% of the women reported poor psychological health. A total of 17.3% and 11.6% of the male and female respondents, respectively, reported that they had no trust at all in the national parliament, and another 38.2% and 36.2%, respectively, reported that their political trust was not particularly high. Respondents in younger age groups, born abroad, with high education, high levels of economic stress, low horizontal trust and low political trust had significantly higher levels of self-reported poor psychological health. There was a significant association between low political trust and low horizontal trust. After adjustments for age, country of origin, education and economic stress, the inclusion of horizontal trust reduced the odds ratios of self-reported poor psychological health in the “no political trust at all” category compared to the “very high political trust” category from 1.6 to 1.4 among men and from 1.7 to 1.4 among women. It is concluded that low political trust in the Riksdag seems to be significantly and positively associated with poor mental health.     

Social capital, trust in the health-care system and self-rated health: the role of access to health care in a population-based study

This paper investigates the relationship between institutional trust in the health-care system, i.e. an institutional aspect of social capital, and self-rated health, and whether the strength of this association is affected by access to health-care services. The 2004 public health survey in the Scania region of Sweden is a cross-sectional study; a total of 27,963 respondents aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. Logistic regression model was used to investigate the association between institutional trust and self-rated health. Multivariate analyses of self-rated health were performed in order to investigate the importance of possible confounders (age, country of origin, education, economic stress, generalized trust in other people, and care-seeking behaviour) on this association. A 28.7% proportion of the men and 33.2% of the women reported poor self-rated health. A total of 15.0% and 58.3% of the respondents reported "very high" and "rather high" trust in the health-care system, respectively. Almost one-third of all respondents reported low institutional trust. Respondents born outside Sweden, with low/medium education, low generalized trust and low institutional trust had significantly higher odds ratios of poor self-rated health. Multiple adjustments for age, country of origin, education, economic stress, and horizontal trust had some effect on the significant relationship between institutional trust and poor self-rated health, for both men and women, but the additional introduction of care-seeking behaviour in the model substantially reduced the odds ratios. In conclusion, low trust in the health-care system is associated with poor self-rated health. This association may be partly mediated by "not seeking health care when needed". However, this is a cross-sectional exploratory study and the causality may go in both directions.     

Social capital, political trust and experience of cannabis smoking: a population-based study in southern Sweden

OBJECTIVE: To investigate whether political mistrust in the Riksdag (the national parliament in Sweden) is an independent characteristic of cannabis smokers, or whether it reflects low confidence in people in general, and therefore low social capital. METHOD: The 2004 public health survey in Sk?ne is a cross-sectional postal questionnaire study answered by 27,757 respondents aged 18-80 with a 59% response rate providing data on political trust, cannabis smoking, and potential confounders. RESULTS: 13.9% of the men and 8.3% of the women had smoked cannabis; 17.3% of the male and 11.6% of the female respondents reported no trust at all in the Riksdag, and another 38.2% and 36.2%, respectively, reported a moderate political trust. Young age, high education, unemployment, low generalized trust in other people, and lower levels of political trust were associated with cannabis smoking, even after multiple adjustments. The groups men with no trust at all in the Riksdag, and women with high trust, not particularly high political trust and no political trust at all had significantly higher odds ratios of cannabis smoking than the very high trust reference category. The results thus somewhat differed between men and women. CONCLUSION: Low political trust is associated with cannabis smoking, independently of trust in people in general.     

Psychosocial work conditions, unemployment, and leisure-time physical activity: a population-based study

OBJECTIVE: To investigate the association between psychosocial work conditions and unemployment, and low leisure-time physical activity. DESIGN/SETTING/PARTICIPANTS/MEASUREMENTS: The 2000 public health survey in Scania is a cross-sectional postal questionnaire study with a 59% participation rate. A total of 5,180 persons aged 18-64 years who belonged to the workforce and the unemployed were included in this study. Logistic regression models were used to investigate the associations between psychosocial factors at work and unemployment, and low leisure-time physical activity. Psychosocial conditions at work were defined according to the Karasek-Theorell demand-control/decision latitudes into relaxed, active, passive, and job strain categories. The multivariate analyses included age, country of birth, education, economic stress, and social participation. RESULTS: In total, 16.1% of men and 14.8% of women had low leisure-time physical activity. The job strain (high demands/low control) and unemployed categories had significantly higher odds ratios of low leisure-time physical activity among both men and women compared with the relaxed (low demands/high control) reference category. However, the significant differences between the job strain, the unemployed, and the relaxed categories disappeared in the multivariate models. CONCLUSIONS: Respondents with job strain or unemployment have significantly higher odds ratios of low leisure-time physical activity than the relaxed category. However, after adjustments for education in particular the differences disappear. Nevertheless, the results suggest that the association between psychosocial work conditions, which are often dependent on education, and leisure-time physical activity may be interesting to study in more detail.     

Social capital and lack of belief in the possibility to influence one's own health: a population-based study

OBJECTIVES: To study the impact of social capital (social participation and trust) on lack of belief in possibility to influence health. METHODS: The Scania 2000 public-health survey is a cross-sectional, postal questionnaire study including 13,604 persons aged 18-80 years which was conducted in 2000 by the regional healthcare authorities in Region Sk?ne, southern Sweden, to investigate health-related risk factors in the population. A logistic regression model was used to investigate the association between social capital and lack of belief in possibility to influence health. The multivariate analyses analysed the importance of confounders on the differences in lack of belief in possibility to influence health according to the social capital variables. RESULTS: In total, 31.0% of all men and 33.5% of all women lack belief in the possibility to influence their own health. Lack of belief in possibility to influence health was positively associated with both low social participation and low trust, although stronger for social participation than for trust. CONCLUSIONS: Low levels of social capital, particularly low social participation, is positively associated with lack of belief in the possibility to influence one's own health.     

Ethnic differences in anticipated discrimination, generalised trust in other people and self-rated health: a population-based study in Sweden

This paper investigates the relationship between anticipation that employers may discriminate against certain people (not specified, but not specifically the respondent) according to race, colour of skin, religion or cultural background, and self-rated health, adjusting for social capital in the form of generalised (horizontal) trust in other people. It also investigates ethnic differences in anticipated discrimination in relation to self-rated health. The 2004 Public Health Survey in the Scania region of Sweden is a cross-sectional study. Twenty-seven thousand nine hundred and sixty-three respondents aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to assess the association between anticipated discrimination and self-rated health. Multivariate analyses of self-rated health were performed in order to investigate the importance of possible confounders (age, country of origin, education, economic stress, and generalised trust) on this association. Of the men and the women, 28.7 and 33.2%, respectively, rated their health as poor. Of the respondents, 16.0 and 28.7% reported that they anticipated that 'most employers' or 'approximately 50% of employers' would discriminate, respectively. Respondents with high age, born outside Sweden, with low/medium education, economic stress, low horizontal trust, and with anticipation that most or approximately 50% of employers (among men born in Sweden and all women) would discriminate had significantly higher odds ratios of poor self-rated health. Multiple adjustments had a slight effect on the significant relationship between anticipated discrimination and poor self-rated health for both men and women. The introduction of generalised trust in the models reduced the odds ratios to a limited extent. In conclusion, the anticipation that employers may discriminate against certain people (not the respondent) according to race, colour of skin, religion or cultural background is associated with poor self-rated health. However, this is a cross-sectional exploratory study and causality may go in both directions.     

Psychosocial work conditions, unemployment and self-reported psychological health: a population-based study

AIM: To investigate the association between psychosocial conditions at work, unemployment and self-reported psychological health. METHODS: A cross-sectional postal questionnaire for the 2000 public health survey in Scania was administered to both working and unemployed people aged 18-64 years. Logistic regression models were used to investigate the association between psychosocial factors at work/unemployment and self-reported psychological health (General Health Questionnaire 12). Psychosocial conditions at work were classified according to the Karasek-Theorell demand-control/decision latitudes into relaxed, active, passive and job strain. The multivariate analyses included age, country of origin, education, economic stress and social participation. RESULTS: A total of 5180 people returned their questionnaire, giving a participation rate of 59%. Fifteen per cent of men and 20% of women reported poor psychological health. Those with high demands and high control (active category), those with high demands and low control (job strain category) and the unemployed had significantly higher odds ratios of poor psychological health compared to those with low demands and high control (relaxed category). Those with low demands and low control (passive category) did not differ significantly from the relaxed category. The associations remained in the multivariate analyses. CONCLUSIONS: The study found that certain psychosocial work factors are associated with higher levels of self-reported psychological ill-health and illustrates the great importance of psychosocial conditions in determining psychological health at the population level. As found elsewhere, being unemployed was an even stronger predictor of psychological ill-health.     

GENDER,SELF-REPORTED HEALTH,AND HEALTH-RELATED LIFESTYLES IN POLAND

Little is known about gender differences in the health of individuals in the former Eastern Europe. Determinants of health and health-related lifestyles may operate differently there than in the West. Data from the 1994 Polish General Social Survey (PGSS) are used to estimate structural and psychosocial effects on self-reported health, risk behaviors, and social participation for women and men. Employment improves the chance of better health for men, whereas marital happiness increases the probability of better health for women; smoking declines with education among men but not among women; and excessive drinking increases for unhappily married men. Religiosity protects the health of both women and men. This research sheds light on the possible sources of gender differences in health in Poland.     

Gender, self-reported health, and health-related lifestyles in Poland

Little is known about gender differences in the health of individuals in the former Eastern Europe. Determinants of health and health-related lifestyles may operate differently there than in the West. Data from the 1994 Polish General Social Survey (PGSS) are used to estimate structural and psychosocial effects on self-reported health, risk behaviors, and social participation for women and men. Employment improves the chance of better health for men, whereas marital happiness increases the probability of better health for women; smoking declines with education among men but not among women; and excessive drinking increases for unhappily married men. Religiosity protects the health of both women and men. This research sheds light on the possible sources of gender differences in health in Poland.     

Social capital, the miniaturisation of community and self-reported global and psychological health

Social capital is often operationalised as social participation in the activities of the formal and informal networks of civil society and/or as generalised trust. Social participation and trust are two aspects of social capital that mutually affect each other, according to the literature. In recent years there has been an increased attention to the fact that generalised trust decreases for every new birth cohort that reaches adulthood in the USA, while social participation may take new forms such as ideologically much narrower single-issue movements that do not enhance trust. The phenomenon has been called "the miniaturisation of community". The effects of similar patterns in Sweden on self-reported health and self-reported psychological health are analysed. The odds ratios of bad self-reported global health are highest in the low-social capital category (low-social participation/low trust), but the miniaturisation of community and low-social participation/high-trust categories also have significantly higher odds ratios than the high-social capital category (high-social participation/high trust). The odds ratios of bad self-reported psychological health are significantly higher in both the low-social capital category and the miniaturisation of community category compared to the high-social capital category, while the low-social participation/high-trust category does not differ from the high-social capital reference group.     

Individual and contextual determinants of self-reported poor psychological health: a population-based multilevel analysis in southern Sweden

OBJECTIVE: To investigate the influence of contextual and individual factors on self-reported psychological health. DESIGN/SETTING/PARTICIPANTS/MEASUREMENTS: The 2000 public health survey in Scania is a cross-sectional postal questionnaire study with a 59% participation rate. A total of 13,715 persons aged 18-80 answered the questionnaire. A multilevel logistic regression model, with individuals at the first level and municipalities/city quarters at the second, was performed. The effect (intra-class correlation, cross-level modification, and odds ratios) of individual and municipality/city quarter factors on self-reported psychological health was analysed. RESULTS: The crude variance between municipalities/city quarters was small but significant. It was particularly affected and lowered by individual civil status, country of origin, economic stress, and social participation. The inclusion of all individual factors age, sex, civil status, country of origin, education, economic stress, and social participation lowered the between municipality variance to not-significant levels, which is the reason why no contextual variables were included in the calculations. CONCLUSIONS: The results of this study suggest that poor self-reported psychological health is affected mainly by individual characteristics of the population and not by contextual factors at the municipality/city quarter level.     

Current or lifetime smoking? Consequences for explaining educational inequalities in self-reported health

BACKGROUND: Studies explaining educational differences in health often employ current smoking as a mediator. To what extent does lifetime smoking mediate the association between education and self-reported health better than current smoking? METHODS: Analysis of cross-sectional data from a representative general population sample of Dutch men and women (n = 1,561) with complete retrospective smoking histories. RESULTS: Educational differences in smoking over the life course are more pronounced than educational differences in current smoking, especially among men. The association between education and self-reported health is reduced when controlling for smoking for men. Among women, smoking is not such a mediator. The odds ratio for men with primary education to report less than good health is reduced from 2.94 (95% CI: 1.20-6.30) to 2.62 (95% CI: 1.13-6.05) when current smoking is taken into account and to 2.14 (95% CI: 0.90-5.04) when lifetime smoking is controlled for. This reduction in the difference between the highest and lowest educated is approximately 30% and statistically significant. For women, reductions are smaller and non-significant. CONCLUSIONS: Educational differences in smoking among men are underestimated if current instead of lifetime smoking is studied. Consequently, the contribution of smoking to bringing about social inequalities in health is underestimated if current smoking is measured.     

Ethnic differences in daily smoking in Malmö, Sweden. Varying influence of psychosocial and economic factors

BACKGROUND: The aim was to investigate ethnic differences in daily smoking in Malm?, Sweden, and whether these differences could be explained by psychosocial and economic conditions. METHODS: The public health survey in Malm? 1994 is a cross-sectional study. A total of 5,600 individuals aged 20-80 years were randomly chosen to respond to a postal questionnaire. The participation rate was 71%. The study population was divided into seven categories according to country of birth; Sweden, Denmark/Norway, other Western countries, former Yugoslavia, Poland, Arabic-speaking countries and all other countries. A multivariate analysis was performed using a logistic regression model in order to investigate the importance of possible confounders on the ethnic differences in daily smoking. Finally, variables measuring social network, social support and economic conditions were introduced. RESULTS: The prevalence of daily smoking was significantly higher among both men and women born in Denmark/Norway (39.1% and 37.0%), men born in other Western countries (32.9%), Poland (34.0%) and Arabic-speaking countries (36.4%) than among Swedish men (21.7%) and women (23.8%). Women born in Arabic-speaking countries had a significantly lower smoking prevalence (7.1%). The multivariate analysis, including age, education and snuff, did not affect these results. A reduction of the odds ratio of daily smoking was observed for men born in Arabic-speaking countries and Poland after the introduction of the psychosocial and economic factors in the model. Only small changes were observed for women. CONCLUSION: There were significant ethnic group differences in daily smoking. Psychosocial and economic conditions in Sweden may be of importance in some ethnic groups.