A multilevel analysis of social capital and self-rated health: Evidence from China

We investigate relationship between social capital and self-rated health (SRH) in urban and rural China. Using a nationally representative data collected in 2005, we performed multilevel analyses. The social capital indicators include bonding trust, bridging trust, social participation and Chinese Communist Party membership. Results showed that only trust was beneficial for SRH in China. Bonding trust mainly promoted SRH at individual level and bridging trust mainly at county level. Moreover, the individual-level bridging trust was only positively associated with SRH of urban residents, which mirrored the urban–rural dual structure in China. We also found a cross-level interaction effect of bonding trust in urban area. In a county with high level of bonding trust, high-bonding-trust individuals obtained more health benefit than others; in a county with low level of bonding trust, the situation was the opposite.     

Measuring dimensions of social capital: evidence from surveys in poor communities in Nicaragua

A dominant perspective in social capital research emphasizes a "structural" dimension of social capital, consisting of network connections, and a "cognitive" dimension, consisting of attitudes toward trust. Correspondingly, membership in organizations (i.e., membership density) and general trust in people (i.e., social trust) are two indicators commonly used to relate structural and cognitive social capital, respectively, to a variety of health and other outcomes. This study analyzed relationships between membership density, social trust and a more comprehensive set of household-level social capital indicators as well as selected civic and health behaviors in the context of Nicaragua. The sample of respondents was drawn from 6 communities and interviews were conducted with 482 heads of households, resulting in data on 2882 individuals. Factor analyses suggest that membership density loaded strongly (loading=0.81) onto an "organizational participation" factor which contained a number of qualitative characteristics of involvement, including bridging social capital. Further, this structural dimension of social capital appears to be a construct consisting of more than just informal social networks. However, factor analyses suggest that distinctions between levels of trust are warranted in Nicaragua: social trust loaded weakly (loading=0.32) onto a factor characterized by institutional trust in a factor analysis of trust items, and well below 0.30 in a factor analysis of both structural and cognitive dimensions of social capital. A nuanced understanding of these household-level indicators of structural and cognitive social capital held implications for civic and health behaviors. While membership density and institutional trust were positively related to an index of political engagement, social trust was either not related or negatively associated (among urban respondents). Similarly, social trust was associated with over 50% reduced odds of an additional childhood vaccinations whereas institutional trust was associated with increased odds (OR=1.7) of an additional vaccination. The findings highlight the complexity of social capital and the importance of exploring more comprehensive indicators.     

The measurement of bridging social capital in population health research

Social capital is defined as the resources available to individuals and groups through membership in social networks. The definition is consistent with either an individualistic approach or a collective approach. Social capital can be further classified according to bonding versus bridging social capital (e.g. relationships between individuals who are homogeneous or heterogeneous with respect to social class, race/ethnicity, or other attributes). We conducted a systematic review via Pubmed, the ISI web of knowledge and OVID of the studies that examined bridging social capital in public health settings. Our results indicate lack of consistency or uniformity in the operationalization of bridging social capital. We identify some promising approaches to measurement that should be further investigated in future studies.     

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

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

Bonding versus bridging social capital and their associations with self rated health: a multilevel analysis of 40 US communities

STUDY OBJECTIVE: Few studies have distinguished between the effects of different forms of social capital on health. This study distinguished between the health effects of summary measures tapping into the constructs of community bonding and community bridging social capital. DESIGN: A multilevel logistic regression analysis of community bonding and community bridging social capital in relation to individual self rated fair/poor health. SETTING: 40 US communities. PARTICIPANTS: Within community samples of adults (n = 24 835), surveyed by telephone in 2000-2001. MAIN RESULTS: Adjusting for community sociodemographic and socioeconomic composition and community level income and age, the odds ratio of reporting fair or poor health was lower for each 1-standard deviation (SD) higher community bonding social capital (OR = 0.86; 95% = 0.80 to 0.92) and each 1-SD higher community bridging social capital (OR = 0.95; 95% CI = 0.88 to 1.02). The addition of indicators for individual level bonding and bridging social capital and social trust slightly attenuated the associations for community bonding social capital (OR = 0.90, 95% CI = 0.84 to 0.97) and community bridging social capital (OR = 0.96, 95% CI = 0.89 to 1.03). Individual level high formal bonding social capital, trust in members of one's race/ethnicity, and generalised social trust were each significantly and inversely related to fair/poor health. Furthermore, significant cross level interactions of community social capital with individual race/ethnicity were seen, including weaker inverse associations between community bonding social capital and fair/poor health among black persons compared with white persons. CONCLUSIONS: These results suggest modest protective effects of community bonding and community bridging social capital on health. Interventions and policies that leverage community bonding and bridging social capital might serve as means of population health improvement.     

Individual-level analysis of social capital and health: a comparison of Arab and Jewish Israelis

Discrepancies exist in existing research regarding the association between social capital and self-rated health, most of which has been undertaken in the developed world. The aim of this study is first to assess the levels of the various variables describing individual social capital in Jews and Arab residing in Israel, and second to assess the association between individual social capital and self-rated health in these two population groups. The data were obtained from an Israeli health interview survey (knowledge, attitudes and practices (KAP)) conducted during 2004-2005, which is based on 3,365 interviews with adult Jews and 985 adult Arabs. Social capital measures included social trust, neighborhood safety, perceived helpfulness, trust in local and national authorities and social support. Data were also obtained on self-rated health and socioeconomic and demographic variables. Multivariate logistic regression revealed that Jews reported higher levels of social trust, perceived helpfulness, trust in authorities, and social support compared to Arabs, after adjusting for demographic and socioeconomic variables. Social contacts, however, were reported more frequently in the Arab population. Neighborhood safety was similar in the two population groups. Among Jews, those reporting higher levels of individual social capital reported better self-rated health after adjusting for demographic and socioeconomic variables. Among Arabs, only those reporting higher levels of social support reported better self-rated health. In Israel, individual levels of social capital seem to be lower in the Arab minority than in the Jewish majority. Individual social capital was associated with better self-rated health mainly in the Jewish population and less so in the Arab population. Social capital factors may be associated with health to a higher extent in affluent populations with relatively high social capital and less so in low social capital and more traditional communities. More research is needed to verify these differences.     

Intergenerational understandings of personal,social and community assets for health

Connecting local citizens of different ages in productive social activity is considered a pathway towards greater health. This research explores how older adults and young people interpret and access assets from their geographical community in relation to their well-being and the extent to which a process of intergenerational bridging contributes to the creation of additional assets for health. Data is presented from a process of place-mapping, interviews, observations and arts-based approaches to: a) understand how personal, social and community assets supported perceived health and wellbeing for the young children and older adults who participated; and b) explore the impact of intergenerational connection on enhancing social capital. The research utilised bonding, bridging and linking forms of social capital, across several interactions amongst 41 individuals who reside in the same geographical community (Victoria, Australia). Assets for health, common across generations and located within the same geographical community were identified. Social connections were strengthened through conversations, reflections and an integration of ideas facilitated through an arts-based approach. Findings suggest that through intergenerational connection and sharing of resources to support health, including the sharing of community assets, progress can be made towards community strengthening with implications for health and wellbeing.     

A Multilevel Analysis of Key Forms of Community- and Individual-Level Social Capital as Predictors of Self-Rated Health in the United States

Communities may be rich or poor in a variety of stocks of social capital. Studies that have investigated relations among these forms and their simultaneous and combined health effects are sparse. Using data on a sample of 24,835 adults (more than half of whom resided in core urban areas) nested within 40 U.S. communities from the Social Capital Benchmark Survey, correlational and factor analyses were applied to determine appropriate groupings among eight key social capital indicators (social trust, informal social interactions, formal group involvement, religious group involvement, giving and volunteering, diversity of friendship networks, electoral political participation, and non-electoral political participation) at each of the community and individual levels. Multilevel logistic regression models were estimated to analyze the associations between the grouped social capital forms and individual self-rated health. Adjusting the three identified community-level social capital groupings/scales for one another and community- and individual-level sociodemographic and socioeconomic characteristics, each of the odds ratios of fair/poor health associated with living in a community one standard deviation higher in the respective social capital form was modestly below one. Being high on all three (vs. none of the) scales was significantly associated with 18% lower odds of fair/poor health (odds ratio = 0.82, 95% confidence interval = 0.69–0.98). Adding individual-level social capital variables to the model attenuated two of the three community-level social capital associations, with a few of the former characteristics appearing to be moderately significantly protective of health. We further observed several significant interactions between community-level social capital and one's proximity to core urban areas, individual-level race/ethnicity, gender, and social capital. Overall, our results suggest primarily beneficial yet modest health effects of key summary forms of community social capital, and heterogeneity in some of these effects by urban context and population subgroup.     

Associations between social capital and trust in general practitioners among the elderly people: Empirical evidence from China

Elderly individuals’ trust in general practitioners (GPs) is conducive to enhancing their health outcomes and promote healthy ageing. However, this trust has been declining in recent decades. Social capital is associated with patients’ trust in healthcare providers in several countries, which make it a potential path for improving the trust of the elderly people in GPs in China, but it is not yet validated. The objective of this study was to explore how social capital influences elderly individuals’ trust in GPs in China. The data were collected through a survey conducted with 2,754 people aged 60 and over in China, 2018. Multilevel regression models were employed to analyse the impact of social capital on the trust of the elderly people in GP in China. The results revealed that individual social capital (ISC) and community social capital (CSC) had significant positive correlations with the trust of the elderly people in GPs in China. In addition, CSC has more impact than ISC on the trust of the elderly people in GP. Additionally, older people, women and patients whose highest level of education was junior high school and who had participated in the New Cooperative Medical Scheme tended to have higher trust in GPs. In conclusion, more social capital, especially CSC, contributed more trust of the elderly people in GPs in China.     

Social assets and mental distress among the homeless: exploring the roles of social support and other forms of social capital on depression

This paper explores the role of social capital in mediating the effects of stressors on depression among a disadvantaged population. Utilizing a survey of 155 homeless people in a mid-sized southern U.S. city, the authors address the relevance of social capital for quality of life. The paper provides a critical test of whether social support and other forms of social capital matter when monetary and human capital is extremely limited. Under these resource-restricted circumstances does social capital add to our understanding of the distress process or does it merely restate the well established relationship between social support and quality of life outcomes? Various forms of social capital are measured: religious social capital, group participation, social trust, and bridging social capital along with a commonly used measure of social support -- perceived strong tie support. Findings suggest that social capital matters for even the most resource poor populations. In addition, social capital variables add significantly to the variance explained in depressive symptomatology over and above that traditionally explained by perceived social support.     

Social assets and mental distress among the homeless: Exploring the roles of social support and other forms of social capital on depression

This paper explores the role of social capital in mediating the effects of stressors on depression among a disadvantaged population. Utilizing a survey of 155 homeless people in a mid-sized southern U.S. city, the authors address the relevance of social capital for quality of life. The paper provides a critical test of whether social support and other forms of social capital matter when monetary and human capital is extremely limited. Under these resource-restricted circumstances does social capital add to our understanding of the distress process or does it merely restate the well established relationship between social support and quality of life outcomes? Various forms of social capital are measured: religious social capital, group participation, social trust, and bridging social capital along with a commonly used measure of social support -- perceived strong tie support. Findings suggest that social capital matters for even the most resource poor populations. In addition, social capital variables add significantly to the variance explained in depressive symptomatology over and above that traditionally explained by perceived social support.     

Social capital: an individual or collective resource for health?

Although it is now widely acknowledged that the social environment plays an important role in people's health and well-being, there is considerable disagreement about whether social capital is a collective attribute of communities or societies, or whether its beneficial properties are associated with individuals and their social relationships. Using data from the European Social Survey (22 countries, N = 42,358), this study suggests that, rather than having a contextual influence on health, the beneficial properties of social capital can be found at the individual level. Individual levels of social trust and civic participation were strongly associated with self-rated health. At the same time, the aggregate social trust and civic participation variables at the national level were not related to people's subjective health after controlling for compositional differences in socio-demographics. Despite the absence of a main contextual effect, the current study found a more complex cross-level interaction for social capital. Trusting and socially active individuals more often report good or very good health in countries with high levels of social capital than individuals with lower levels of trust and civic participation, but are less likely to do so in countries with low levels of social capital. This suggests that social capital does not uniformly benefit individuals living in the same community or society.     

Social trust and self-rated health in US communities: a multilevel analysis

This study assessed the contextual and individual effects of social trust on health. Methods consisted of a multilevel regression analysis of self-rated poor health among 21,456 individuals nested within 40 US communities included in the 2000 Social Capital Community Benchmark Survey. Controlling for demographic covariates, a strong income and education gradient was observed for self-rated health. Higher levels of cominunity social trust were associated with a lover probability of reporting poor health. Individual demographic and socioeconomic preditors did not explain the association of community social trust with self-rated health. Controlling for individual trust perception, however, rendered the main effect of community social trust statistically insignificant, but a complex interaction effect was observed, such that the health-promoting effect of community social trust was significantly greater for high-trust individuals. For low-trust individuals, the effect of community social trust on self-rated health was the opposite. Using the latest data available on community social trust, we conclude that the role of community social trust in explaining average population health achievements and health inequalities is complex and is contingent on individual perceptions of social trust. Future multilevel investigations of social capital and population health should routinely consider the cross-level nature of community or neighborbood effects.     

Gender differences in relationships between social capital and individual smoking and drinking behavior in Taiwan

Despite the concept of social capital receiving great attention in the area of health research, few studies have analyzed the differential effects of social capital between genders. This article assesses gender differences in the relationships between social capital and smoking and drinking behavior in Taiwan. Data on individual sociodemographic characteristics, smoking, drinking, and social capital were obtained from the Taiwan Social Change Survey conducted in 1995 and in 2000. The overall response rate was 67%. In total, 3713 women and men aged over 20 years living in 204 neighborhoods were interviewed. Social capital indicators were aggregated at the neighborhood level, and included neighborhood closeness, political influence, social contact, social trust, and social participation. The data were analyzed with multilevel binomial regression models. Gender differences were found in some aspects of social capital. Stronger effects of social trust on smoking were found for women than for men, whereas stronger effects of neighborhood closeness on drinking were found for women than for men. Social participation was positively associated with drinking in both genders. The findings of this study provide new evidence for the differential effects of social capital by gender in Taiwan, suggesting that more studies are needed to understand social capital's effects in Asian societies and the mechanisms by which the effects may vary with gender.     

Community resilience and health: the role of bonding, bridging, and linking aspects of social capital

The current study draws on data from the 2007 and 2009 Citizenship Survey collected in England (n=17,572) to explore the role of social capital in building community resilience and health, using the bonding, bridging, and linking social capital framework of Szreter and Woolcock (2004). The results show that the indicators of the different types of social capital are only weakly interrelated, suggesting that they capture different aspects of the social environment. In line with the expectations, most indicators of bonding, bridging, and linking social capital were significantly associated with neighbourhood deprivation and self-reported health. In particular bonding and bridging social cohesion, civic participation, heterogeneous socio-economic relationships, and political efficacy and trust appeared important for community health after controlling for neighbourhood deprivation. However, no support was found for the hypothesis that the different aspects help buffer against the detrimental influences of neighbourhood deprivation.     

Reconsidering the Effects of Poverty and Social Support on Health: A 5-Year Longitudinal Test of the Stress-Buffering Hypothesis

Prior research in the general population has found that social support can buffer the adverse effects of stressors on health. However, both stressors and social support may be qualitatively different for those living in urban poverty. We examined the effects of social support and poverty-specific stressors on self-rated health. We used data from the Welfare Client Longitudinal Survey (WCLS), a 5-year longitudinal study of 718 public aid recipients. We measured received social support and “net social support,” defined as the difference between support received and that given to others. We used restricted cubic splines to model the stress-buffering effects of social support on self-rated health as a function of stressful life events and neighborhood disorder. Increased exposure to stressors was associated with poorer self-rated health. Evidence of stress buffering was confined to those with the heaviest exposure to stressors, and its effects decreased across increasing levels of social support. Analyses using net social support had generally more modest effects than those using received social support. Social support does not buffer the effects of stressors on health uniformly for individuals living in conditions of urban poverty. Researchers and policymakers should be cautious in overestimating the beneficial effects that social support may have on health for marginalized populations.     

Self-rated health and trust in low-income Mexican-origin individuals in Texas

The evidence suggests that trust is an important determinant of health. Trust tends to be lower in low-income and minority individuals, who already suffer from worse health. Therefore, it is particularly important to investigate the predictors of trust in disadvantaged individuals. In this article we use multilevel models to investigate the individual and neighborhood predictors of trust in Mexican-Americans living in low-income neighborhoods (defined as census block groups) in Texas. Detailed survey data on 1754 Mexican-origin respondents provided information on self-rated health and individual characteristics including sociodemographic and sociocultural personal characteristics (frequency of association with people of other races/ethnicities, social support, perceived racism, perceived personal opportunity, and religiosity). Neighborhood heterogeneities and socioeconomic status, computed from census data, were supplemented by community social characteristics (collective efficacy and public disorder) obtained from survey data. Trust was a significant predictor of self-rated health in our sample. This study suggests that Mexican-Americans tend to trust more those with whom there is likely to be a personal acquaintance than other Mexican-Americans. Furthermore, while the results of this study support that people tend to trust more those who are like themselves, for Mexican-Americans, the identification of who is more alike is not based exclusively on racial/ethnic identity, but is a complex process based also on linguistic and socioeconomic similarities. In our sample, linguistic fragmentation, but not racial/ethnic diversity nor neighborhood impoverishment, correlated with trust. Ease of communication seemed to be more important than racial/ethnic homogeneity in encouraging interpersonal trust among Mexican-Americans at the neighborhood level. The findings in this study imply it may be possible to develop neighborhood level interventions, focusing on encouraging social interaction in racially/ethnically and linguistically diverse communities, with the aim of promoting trust to improve health outcomes.     

Self-rated health and trust in low-income Mexican-origin individuals in Texas

The evidence suggests that trust is an important determinant of health. Trust tends to be lower in low-income and minority individuals, who already suffer from worse health. Therefore, it is particularly important to investigate the predictors of trust in disadvantaged individuals. In this article we use multilevel models to investigate the individual and neighborhood predictors of trust in Mexican-Americans living in low-income neighborhoods (defined as census block groups) in Texas. Detailed survey data on 1754 Mexican-origin respondents provided information on self-rated health and individual characteristics including sociodemographic and sociocultural personal characteristics (frequency of association with people of other races/ethnicities, social support, perceived racism, perceived personal opportunity, and religiosity). Neighborhood heterogeneities and socioeconomic status, computed from census data, were supplemented by community social characteristics (collective efficacy and public disorder) obtained from survey data. Trust was a significant predictor of self-rated health in our sample. This study suggests that Mexican-Americans tend to trust more those with whom there is likely to be a personal acquaintance than other Mexican-Americans. Furthermore, while the results of this study support that people tend to trust more those who are like themselves, for Mexican-Americans, the identification of who is more alike is not based exclusively on racial/ethnic identity, but is a complex process based also on linguistic and socioeconomic similarities. In our sample, linguistic fragmentation, but not racial/ethnic diversity nor neighborhood impoverishment, correlated with trust. Ease of communication seemed to be more important than racial/ethnic homogeneity in encouraging interpersonal trust among Mexican-Americans at the neighborhood level. The findings in this study imply it may be possible to develop neighborhood level interventions, focusing on encouraging social interaction in racially/ethnically and linguistically diverse communities, with the aim of promoting trust to improve health outcomes.     

Further development of an Australian-based measure of social capital in a US sample

Social capital is an increasingly popular construct in research examining social and behavioral determinants of health and well-being. Yet, comparing the results of social capital research is inhibited by inconsistencies in labeling, different definitions and subsequent disagreement on level of analysis, and limited evaluation of the psychometric properties of measures of social capital. This study examined the psychometric properties of the Social Capital Questionnaire (Journal of Applied Behavioral Science 36(1) (2000) 23). In the current study, the original Australian-based instrument was modified for telephone administration with a US sample. Exploratory factor analysis revealed a similar factor structure to that found during initial survey development. These findings lend support to the notion of social capital as a meaningful construct and suggest the Onyx and Bullen instrument deserves further attention as a practical tool for health researchers and community agencies interested in social capital.