Acculturating Indian Immigrant Men in New York City: Applying the Social Capital Construct to Understand Their Experiences and Health

This study qualitatively explored social capital available to individuals (N = 17) within a community-based purposive sample of adult male immigrants from India in New York City (NYC). Analysis of in-depth interview data identified possible pathways for social capital’s influences upon acculturative stress. The study defined social capital in terms of the participants’ social relationships among peers, in the workplace, and with their ethnic community. Their relationships were assessed in terms of support, trust, and reciprocity. Among the recent immigrants, hopelessness and frustration about future work prospects were associated with symptoms of depression and substance abuse. The participants identified wealth as a distinct marker of social class and they described social class as a combination of education and occupation. Social class largely determined the particular peer and community networks each participant joined. Participants relied upon ongoing connections with family in India, despite their geographic separation, to relieve acculturative stress. Social support from peers was the participants’ most useful and immediate resource for alleviating acculturative stress. For participants of lower socioeconomic status, acculturative stress was compounded by social-relationship expectations and norms from India that persisted within NYCs immigrant community. Namely, lower-SES participants were more likely to experience frustration and setbacks when they sought out intimate social relationships with women.     

A Social Network Profile and HIV Risk Among Men on Methadone: Do Social Networks Matter?

The paper describes structural and HIV-related network characteristics and examines associations between these various social network domains and HIV risk behaviors among a sample of 356 men randomly selected from a methadone maintenance treatment program (MMTP) in New York City. Multiple logistic regression analyses suggest that (1) a higher level of perceived sexual risk among network members, referred to as “alters” in this study, was associated with an increased likelihood of the participant engaging in sexual risk behaviors; (2) participants who indicated that they exchanged encouragement with a higher number of network alters about using condoms were less likely to report engaging in unprotected sex; and (3) participants who indicated that they talked about HIV risks with a higher number of network alters were less likely to engage in unprotected sex in the past 6 months. Collectively, these findings support the notion that networks may influence the adoption of risk reduction strategies in this population. Implications of the findings for HIV prevention network interventions for men in MMTPs are discussed.El-Bassel, Gilbert, Wu, and Chang are with the Social Intervention Group, Columbia University School of Social Work, New York, NY, USA.     

Brown versus New York: the Rashomon of delivering mental health services in the 1990s.

This article examines a case study of one homeless mentally ill woman in New York City to show the differing perspectives on mental illness among mental health consumers, family members, mental health professionals, and advocates. Different issues emerge, and different priorities for care become clear. The social worker as case manager must design intervention strategies based on these differing perspectives, a crucial challenge for the profession. This article reviews the current literature on case management and suggests a holistic approach that better meets the needs of mentally ill people, their family members, and the community.     

Supportive housing in Brooklyn

Since 1977, Saint Vincent Catholic Medical Centers of New York City has been creating and maintaining supportive housing offerings for at-risk populations, such as individuals with HIV/AIDS, those with substance abuse challenges, and the mentally ill. By providing a continuum of medical and social services, the organization aims to help residents stabilize and rebuild their lives. Saint Vincent sees empowerment as a key step toward helping individuals maintain their health, re-enter the community, seek employment, and pursue other goals. Some of the supportive services Saint Vincent offers in its housing communities are care coordination, counseling, peer support networks, self-help groups, leisure activities, help with finances, and referrals to community agencies offering other resources. Recognizing the importance of job training and assistance, the system also offers a unique program in which mentally ill individuals are able to work in a recycling center or office cleaning business, both of which are owned by Saint Vincent.     

Global Contexts,Social Capital,and Acculturative Stress: Experiences of Indian Immigrant Men in New York City

Immigrants depend on within-group social networks for social support during the acculturation process. Within-group social networks are linked to higher mutual concern and reciprocity, lower acculturative stress, and lower depression among immigrants Studies are limited, however, about immigrants’ social support in the contexts of global connectedness and transnational connectivity. Grounded in social capital approach and immigrant health framework, this qualitative, community-based study examined the social networks of immigrant men from India to New York City. Drawing upon the participants’ narratives, the author illustrates the ways that social capital influences social networking and acculturative stress in post-immigration sociocultural contexts along with its implications for community-based interventions.     

Men, women and friends — are there differences in relation to mental well-being?

This is a study on associations between the number of close friends and mental well-being in a nationwide sample of the Finnish general population (n = 1603). Mental well-being was assessed by means of the 12-item General Health Questionnaire. A total of 3% of the sample had no close friends and another 3% had only one. Over half of the sample (52%) reported having five or more friends. The overall prevalence of mental distress was 15% in men and 21% in women. According to multivariate analyses the risk of mental distress was increased in men among those with no friends (odds ratio [OR]: 2.70) and among those who had one (OR: 4.32) or two to four friends (OR: 1.75), as compared with those who had more friends. In women, having only one friend (OR: 2.30), insufficient family support (OR: 1.63) and insufficient support from relatives (OR: 1.77) associated with the risk of mental distress. These results suggest that mental well-being might be promoted if mentally distressed men seeking professional help were supported in building up and maintaining social networks and mentally distressed women were supported in harmonizing their family life. This revised version was published online in June 2006 with corrections to the Cover Date.     

Dynamics of change in the practice of female genital cutting in Senegambia: testing predictions of social convention theory

Recent reviews of intervention efforts aimed at ending female genital cutting (FGC) have concluded that progress to date has been slow, and call for more efficient programs informed by theories on behavior change. Social convention theory, first proposed by Mackie (1996), posits that in the context of extreme resource inequality, FGC emerged as a means of securing a better marriage by signaling fidelity, and subsequently spread to become a prerequisite for marriage for all women. Change is predicted to result from coordinated abandonment in intermarrying groups so as to preserve a marriage market for uncircumcised girls. While this theory fits well with many general observations of FGC, there have been few attempts to systematically test the theory. We use data from a three year mixed-method study of behavior change that began in 2004 in Senegal and The Gambia to explicitly test predictions generated by social convention theory. Analyses of 300 in-depth interviews, 28 focus group discussions, and survey data from 1220 women show that FGC is most often only indirectly related to marriageability via concerns over preserving virginity. Instead we find strong evidence for an alternative convention, namely a peer convention. We propose that being circumcised serves as a signal to other circumcised women that a girl or woman has been trained to respect the authority of her circumcised elders and is worthy of inclusion in their social network. In this manner, FGC facilitates the accumulation of social capital by younger women and of power and prestige by elder women. Based on this new evidence and reinterpretation of social convention theory, we suggest that interventions aimed at eliminating FGC should target women's social networks, which are intergenerational, and include both men and women. Our findings support Mackie's assertion that expectations regarding FGC are interdependent; change must therefore be coordinated among interconnected members of social networks.     

Tangled in a web of affiliation

The goal of this article is to describe the social support networks of women with co-occurring substance abuse and mental health problems who are survivors of interpersonal abuse, using baseline interview data from 2 sites (n = 644) from the national Women Co-occurring Disorders and Violence Study. The size and composition of women's networks, the tangible and socioemotional support available, and the stance of the support network toward substance use, treatment, and trauma are described. Family members are described by women as offering less emotional support and less encouragement for healing from trauma than friends. Analyses demonstrated only modest support in either sample for the hypothesis that support network characteristics moderate the effects of traumatic stress on mental health and trauma symptoms among these samples of very burdened and poor women. The results point to the need for using caution in relying on women's existing social support network to help them heal.     

Social ties and mental health

It is generally agreed that social ties play a beneficial role in the maintenance of psychological well-being. In this targeted review, we highlight four sets of insights that emerge from the literature on social ties and mental health outcomes (defined as stress reactions, psychological well-being, and psychological distress, including depressive symptoms and anxiety). First, the pathways by which social networks and social supports influence mental health can be described by two alternative (although not mutually exclusive) causal models—the main effect model and the stress-buffering model. Second, the protective effects of social ties on mental health are not uniform across groups in society. Gender differences in support derived from social network participation may partly account for the higher prevalence of psychological distress among women compared to men. Social connections may paradoxically increase levels of mental illness symptoms among women with low resources, especially if such connections entail role strain associated with obligations to provide social support to others. Third, egocentric networks are nested within a broader structure of social relationships. The notion of social capital embraces the embeddedness of individual social ties within the broader social structure. Fourth, despite some successes reported in social support interventions to enhance mental health, further work is needed to deepen our understanding of the design, timing, and dose of interventions that work, as well as the characteristics of individuals who benefit the most.     

Therapeutic networks of pregnancy care: Bengali immigrant women in New York City

The aim of this paper is to elucidate the links between place and Bengali immigrant women’s use of social networks in their efforts to live a healthy pregnancy. The literature on therapeutic landscapes has mostly emphasized characteristics of local places. I argue that social networks constituted in and beyond the places where people live are equally important. I draw on findings of a qualitative study conducted with Bengali immigrant women in New York City between 2004 and 2006 to understand the place-creating characteristics of social therapeutic networks. In-depth interviews with 40 women in selected neighborhoods in New York City show that such networks operated at multiple scales, ranging from the local to the transnational. A mix of tangible and virtual care and support were received through face-to face interaction and phone conversations. Advice on how to live a healthy pregnancy, cooking and bringing or sending food and therapeutic conversations emerged as important kinds of care and support provided by therapeutic networks. These networks worked in complex ways, reflecting: 1) the situational context of women’s lives, shaped by the temporal (e.g. length of residence) and place-based (e.g. residential geographies) aspects of migration, 2) the importance of ‘imaginative aspects’ in shaping the meanings women formed of therapeutic networks and 3) the diverse ways in which women created and sustained these networks, based on class, country of origin, religion and culture.     

Multidimensional Social Support and the Health of Homeless Individuals

Homeless individuals often suffer from serious health problems. It has been argued that the homeless are socially isolated, with low levels of social support and social functioning, and that this lack of social resources contributes to their ill health. These observations suggest the need to further explore the relationship between social networks, social support, and health among persons who are homeless. The purpose of this study was to examine the association between multidimensional (cognitive/perceived and behavioral/received) social support and health outcomes, including physical health status, mental health status, and recent victimization, among a representative sample of homeless individuals in Toronto, Canada. Multivariate regression analyses were performed on social support and health outcome data from a subsample of 544 homeless adults, recruited from shelters and meal programs through multistage cluster sampling procedures. Results indicated that participants perceived moderately high levels of access to financial, emotional, and instrumental social support in their social networks. These types of perceived social supports were related to better physical and mental health status and lower likelihood of victimization. These findings highlight a need for more services that encourage the integration of homeless individuals into social networks and the building of specific types of social support within networks, in addition to more research into social support and other social contextual factors (e.g., social capital) and their influence on the health of homeless individuals.     

Likelihood of asking for help in caregivers of women with substance use or co-occurring substance use and mental disorders

Family members are important to the well-being of their relatives with substance use disorders or co-occurring substance use and mental disorders. Many caregivers experience high levels of burden, negatively impacting their capacity to provide support to their ill family member. The Andersen health care utilization model (Andersen & Newman, 1973, 2005) was used to identify the impact of predisposing, enabling and need factors hypothesized to predict caregivers' likelihood of asking for help and support with their caregiving role. The sample include 82 women recruited from outpatient or inpatient substance abuse treatment centers and 82 family caregivers nominated by these women. Findings showed that almost half of caregivers were unlikely to ask for help. Multiple regression analysis found that two need variables were statistically signficant predictors of caregivers' likelihood to ask for help. Caregivers who had higher subject burden (worry) and caregivers who provided more assistance with daily living were more likely to ask for help. It is suggested that case managers assess the amount of worried family caregivers' experience because their worries may provide the motivation to ask for help or to participate in help when it is offered to them.     

Reaching and engaging non-gay identified,non-disclosing Black men who have sex with both men and women

Non-gay identified (NGI) Black men who have sex with both men and women (MSMW) and who use substances are at risk of acquiring and transmitting HIV to their partners. Homophobic community norms can discourage such men from disclosing their risk behaviour to female partners and others, including service providers. It is important to understand the dynamics of risk in this vulnerable population, but research is challenged by the men's need for secrecy. In this paper we report on successful efforts to recruit 33 non-disclosing, NGI Black MSMW for in-depth interviews concerning substance use, HIV risk and attitudes toward disclosing their risk behaviour. We employed targeted and referral sampling, with initial contacts and/or key informants drawn from several types of settings in New York City, including known gay venues, community organisations, neighbourhood networks and the Internet. Key informant gatekeepers and the ability to establish rapport proved central to success. Perceived stigma is a source of social isolation, but men are willing to discuss their risk behaviour when they trust interviewers to protect their privacy and engage with them in a non-judgemental manner. Findings imply that the most effective prevention approaches for this population may be those that target risk behaviours without focusing on disclosure of sexual identities.     

Social determinants of health – A question of social or economic capital? Interaction effects of socioeconomic factors on health outcomes

Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the "social" and the "economic" indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16-84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health.     

There's no place like (a) home: ontological security among persons with serious mental illness in the United States

As the homelessness 'crisis' in the United States enters a third decade, few are as adversely affected as persons with serious mental illness. Despite recent evidence favoring a 'housing first' approach, the dominant 'treatment first' approach persists in which individuals must climb a ladder of program requirements before becoming eligible for an apartment of their own. Drawing upon the concept of 'ontological security', this qualitative study examines the subjective meaning of 'home' among 39 persons who were part of a unique urban experiment that provided New York City's homeless mentally ill adults with immediate access to independent housing in the late 1990s. The study design involved purposively sampling from the experimental (housing first) group (N=21) and the control (treatment first) group (N=18) and conducting two life history interviews with each participant. Markers of ontological security-constancy, daily routines, privacy, and having a secure base for identity construction-provided sensitizing concepts for grounded theory analyses designed to also yield emergent, or new, themes. Findings revealed clear evidence of the markers of ontological security among participants living in their own apartments. This study expands upon previous research showing that homeless mentally ill persons are capable of independent living in the community. The emergent theme of 'what's next' questions and uncertainty about the future points to the need to address problems of stigma and social exclusion that extend beyond the minimal achievement of having a 'home'.     

Social network and social support among poor elderly ill in Guadalajara, Mexico

This paper examines social networks and social support among poor elderly ill in Guadalajara, Mexico. We interviewed 40 hospitalized elderly patients. The mean size of social networks was 7.5, basically involving women, multiple generations, and members of the extended family. Emotional support was more frequent than other types of social support. Elderly women had larger social networks and received more social support than men. Married elderly also had larger social networks and more social support than single patients. There were no differences between age and living arrangements with social networks and social support. Future studies are needed on the social and cultural environment of social support for the elderly.     

Gender Differences in Perceived Unmet Treatment Needs Among Persons With and Without Co-occurring Disorders

This study examined gender differences in perceived unmet treatment needs among persons with and without co-occurring substance use disorders and serious mental health conditions. Data were drawn from the 2008–2013 National Survey on Drug Use and Health (unweighted N?=?37,187) to test the hypothesis that the relationships between diagnosis and perceived unmet treatment needs differ as a function of gender. Compared to individuals with a substance use disorder or severe mental illness, those with co-occurring disorders were more likely to report perceived unmet needs for substance abuse and mental health treatment. Gender significantly moderated the relationship between diagnosis and unmet needs, suggesting that men with co-occurring disorders might be more adversely affected. Findings highlight the need for better understanding of gender-diagnosis differences with respect to unmet needs for substance abuse and mental health care.     

‘Their type of drugs’: perceptions of substance use,sex and social boundaries among young African American and Latino gay and bisexual men

Studies of sexuality have increasingly shifted their attention towards understanding the social contexts that inform and organise sexual behaviour. Building on this work, we examine how substance use and sex are socially organised and meaningful activities for young African American and Latino gay and bisexual men who use substances with sex. Drawing on 30 qualitative interviews in Los Angeles and New York, we identify the ways in which social boundaries inform substance use among these young men. We find that many of them view the gay and racial/ethnic communities they belong to as differentiated by patterns of substance use. Further, they see these communities as actively constructing group boundaries through substance use, sanctioning the use of particular substances while simultaneously discouraging the use or discussion of others. For these young men, racial/ethnic and gay communities provide salient contexts in which the use of certain substances and not others is socially meaningful. Findings demonstrate the important and heretofore unrecognised ways that perceived social boundaries inform these young men's use of substances. As both protective and marginalising influences, perceptions of communities and social identities have real consequences for the sexual health of young African American and Latino gay and bisexual men.     

Associations among social capital, parenting for active lifestyles, and youth physical activity in rural families living in upstate New York

While emerging research supports a positive relationship between social capital and youth physical activity (PA), few studies have examined possible mechanisms explaining this relationship and no studies have focused on rural youth. In this study, we examined parents' support of children's PA as an intermediary factor linking social capital and youth PA in a largely rural cross sectional sample of American children aged 6- to 19-years and their parents/guardians (N=767 families) living in upstate New York. Parents completed a self-administered survey assessing demographic factors, perceived social capital, support for children's PA, and children's PA including time spent outdoors and days per week of sufficient PA. Structural equation modeling was used to test the hypothesis that higher social capital is linked with higher parental support for PA and, in turn, higher PA in children. Analyses were conducted separately for younger (6-12 years) and older (13-19 years) children and controlled for demographic factors (child age, household education, participation in a food assistance program) and perceived neighborhood safety. Anticipated relationships among social capital, parents' activity-related support, and children's PA were identified for older, but not younger children. Findings suggest that parent support for children's PA is one possible mechanism linking social capital and youth PA and the parents of adolescents may rely more heavily on cues from their social environment to shape their approaches to supporting their children's PA than parents of younger children.     

The contextual effects of social capital on health: a cross-national instrumental variable analysis

Past research on the associations between area-level/contextual social capital and health has produced conflicting evidence. However, interpreting this rapidly growing literature is difficult because estimates using conventional regression are prone to major sources of bias including residual confounding and reverse causation. Instrumental variable (IV) analysis can reduce such bias. Using data on up to 167,344 adults in 64 nations in the European and World Values Surveys and applying IV and ordinary least squares (OLS) regression, we estimated the contextual effects of country-level social trust on individual self-rated health. We further explored whether these associations varied by gender and individual levels of trust. Using OLS regression, we found higher average country-level trust to be associated with better self-rated health in both women and men. Instrumental variable analysis yielded qualitatively similar results, although the estimates were more than double in size in both sexes when country population density and corruption were used as instruments. The estimated health effects of raising the percentage of a country's population that trusts others by 10 percentage points were at least as large as the estimated health effects of an individual developing trust in others. These findings were robust to alternative model specifications and instruments. Conventional regression and to a lesser extent IV analysis suggested that these associations are more salient in women and in women reporting social trust. In a large cross-national study, our findings, including those using instrumental variables, support the presence of beneficial effects of higher country-level trust on self-rated health. Previous findings for contextual social capital using traditional regression may have underestimated the true associations. Given the close linkages between self-rated health and all-cause mortality, the public health gains from raising social capital within and across countries may be large.