Social capital and social inequality in adolescents' health in 601 Flemish communities: a multilevel analysis

Although it is widely acknowledged that community social capital plays an important role in young people’s health, there is limited evidence on the effect of community social capital on the social gradient in child and adolescent health. Using data from the 2005–2006 Flemish (Belgium) Health Behavior among School-aged Children survey (601 communities, n = 10,915), this study investigated whether community social capital is an independent determinant of adolescents’ perceived health and well-being after taking account of individual compositional characteristics (e.g. the gender composition within a certain community). Multilevel statistical procedures were used to estimate neighborhood effects while controlling for individual level effects. Results show that individual level factors (such as family affluence and individual social capital) are positively related to perceived health and well-being and that community level social capital predicted health better than individual social capital. A significant complex interaction effect was found, such that the social gradient in perceived health and well-being (i.e. the slope of family affluence on health) was flattened in communities with a high level of community social capital. Furthermore it seems that socioeconomic status differences in perceived health and well-being substantially narrow in communities where a certain (average) level of community social capital is present. This should mean that individuals living in communities with a low level of community social capital especially benefit from an increase in community social capital. The paper substantiates the need to connect individual health to their meso socioeconomic context and this being intrinsically within a multilevel framework.     

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.     

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.     

Neighborhood social capital and individual health

Neighborhood social capital is increasingly considered to be an important determinant of an individual's health. Using data from the Netherlands we investigate the influence of neighborhood social capital on an individual's self-reported health, while accounting for other conditions of health on both the level of the neighborhood and the individual. We use national representative data ('The Housing and Living Survey', 2006) on the Netherlands with 61,235 respondents in 3273 neighborhoods. The cross-sectional data were combined with information provided by Statistics Netherlands on neighborhoods, i.e., the percentage of residents in the highest income quintile per neighborhood and the municipality's degree of urbanity. The association of neighborhood social capital with individual health was assessed by multilevel logistic regression analysis. Our results show that neighborhood social capital is positively associated with health. Interestingly, residents in urban neighborhoods benefit particularly from their neighborhood social capital.     

The mechanisms that associate community social capital with post-disaster mental health: A multilevel model

Many scholars have advocated that the time has come to provide empirical evidence of the mechanisms that associate community social capital with individual disaster mental health. For this purpose we conducted a study (n = 232) one year after a flood (2008) in Morpeth, a rural town in northern England. We selected posttraumatic stress as an indicator of disaster mental health. Our multilevel model shows that high community social capital is indirectly salutary for individual posttraumatic stress. In particular, in communities (defined as postcode areas) with high structural social capital, the results suggest that individuals confide in the social context (high cognitive social capital) to address disaster-related demands (high collective efficacy), and employ less individual psychosocial resources (i.e. coping strategies and social support). This “conservation of individual psychosocial resources” in a salutary social context decreases the association between the appraisal of the disaster and posttraumatic stress. As a result of this mechanism, individuals suffer less from posttraumatic stress in communities with high social capital. These findings provide new insights how intervention policies aimed at strengthening both objective and subjective dimensions of social capital may reduce post-disaster mental health.     

Individual and neighbourhood determinants of social participation and social capital: a multilevel analysis of the city of Malmö, Sweden

The aim of this study was to analyse the impact of neighbourhood on individual social capital (measured as social participation). The study population consisted of 14,390 individuals aged 45–73 that participated in the Malmö diet and cancer study in 1992–1994, residing in 90 neighbourhoods of Malmö, Sweden (population 250,000). A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second level, was performed. The study analysed the effect (intra-area correlation and cross-level modification) of the neighbourhood on individual social capital after adjustment for compositional factors (e.g. age, sex, educational level, occupational status, disability pension, living alone, sick leave, unemployment) and, finally, one contextual migration factor. The prevalence of low social participation varied from 23.0% to 39.7% in the first and third neighbourhood quartiles, respectively. Neighbourhood factors accounted for 6.3% of the total variance in social participation, and this effect was reduced but not eliminated when adjusting for all studied variables (−73%), especially the occupational composition of the neighbourhoods (−58%). The contextual migration variable further reduced the variance in social participation at the neighbourhood level to some extent. Our study supports Putnam's notion that social capital, which is suggested to be an important factor for population health and possibly for health equity, is an aspect that is partly contextual in its nature.     

NEIGHBOURHOOD SOCIAL CAPITAL AND INDIVIDUAL SELF‐RATED HEALTH IN WALES

Although neighbourhood social capital can be beneficial for individual health, supporting evidence in the UK is scant. We aim to find the net effect of neighbourhood social capital and deprivation on individual health beyond sociodemographic composition of neighbourhood. We propose a multilevel path analytic model of health to delineate complex pathways involving neighbourhoods (measured as local super output area) and individuals. Analysis of the most recent data containing independent measures of neighbourhood social capital shows that neighbourhood social capital appears to be associated with benefits in some aspects of individual health in the Welsh setting. The improvement stands beyond individual determinants and neighbourhood deprivation. Social scientists and public health officials have reason to continue focusing on the neighbourhoods as well as the individuals to improve the health of the population. Copyright © 2011 John Wiley & Sons, Ltd.     

Jabbing together? The complementarity between social capital,formal public health rules,and COVID-19 vaccine rates in the United States

COVID-19 vaccine rates provide a unique opportunity to explore vaccine hesitancy and potential interactions between social capital and individual, normative values, namely for public health and/or personal freedom. While economists and public health scholars realize the independent effects social capital and stringent public health rules have on prevalence and mortality rates, few recognize how these factors influence vaccination rates. We advance this literature with a novel framework to analyze these interactions. With county-level data on COVID-19 vaccinations, social capital, and measures of the values people have for personal freedom and public health, we find that vaccination rates depend on individual values, the level of social capital, and the interaction between the two. Social capital mediates the values people hold dear, which can influence vaccination rates in positive and negative ways. Our results are robust to the inclusion of relevant controls and under multiple specifications. These results suggest that individuals and the communities people enter into and exit out of play an important role in decisions to vaccinate, which are independent of formal, governmental public health measures.     

Social capital and self-rated health: results from the US 2006 social capital survey of one community

Using data from the 2006 Social Capital Community Survey in Duluth, Minnesota, and Superior, Wisconsin, USA, we investigate associations between individual social capital measures (attitudes on trust, formal group involvement, informal socializing, organized group interaction, social support and volunteer activity) and self-rated health after controlling for individual and economic characteristics. In particular, we address issues of social capital as an endogenous determinant of self-reported health using instrumental variables probit estimation. After accounting for the endogeneity of these various measures of individual social capital, we find that individual social capital is a significant predictor of self-rated health.     

The flip-side of social capital: the distinctive influences of trust and mistrust on health in rural China

Despite increasing evidence that social capital is positively associated with health, the pathways that link social capital to health are not definitive and invite further investigation. This paper uses household survey data from 22 villages in China in 2002 to test the relationship between social capital and the self-reported health status of the rural population. Focusing on the cognitive dimension of social capital, this paper complements current social capital research by introducing an overlooked distinction between trust and mistrust. Trust and mistrust are measured at the individual and aggregate levels, and the distinct ways in which they affect general and mental health are explored. We adopt an ordered logistic regression using survey procedures in SAS version 9.1 to account for the stratified and clustered data structure. The results suggest that: (1) individual-level trust and mistrust are both associated with self-reported health in rural China--trust is positively associated with both general health and mental health, while mistrust is more powerfully associated with worse mental health; and (2) the effects of individual-level trust and mistrust are dependent on village context--village-level trust substitutes for individual-level trust, while individual-level mistrust interacts positively with village-level mistrust to affect health. However, an unexpected protective health effect of mistrust is found in certain types of villages, and this unique result has yet to be examined. Overall, this study suggests the conceptual difference between trust and mistrust and the differential mechanisms by which trust and mistrust affect health in rural China. It also suggests that effective policies should aim at enhancing trust collectively or reducing mistrust at the personal level to improve health status in rural areas of China.     

Self-rated health and social capital in transitional countries: Multilevel analysis of comparative surveys in Armenia, Azerbaijan, and Georgia

The objective of this study is to analyze the effect of social capital on self-rated health in transitional countries of the South Caucasus region. The study is based on recent, 2009, cross-sectional nationally-representative surveys of 2082 respondents in Armenia, 2014 in Azerbaijan, and 1837 in Georgia with response rate of 78-80%. Two-level random-coefficient ordered logistic regression, modeling individual and community variations in subjective health was estimated to account for the hierarchical structure of the data set which includes individuals nested within communities. The results allow several interesting conclusions to be drawn. First, a proportion of the total variation in self-rated health explained at the community level is 0.23 for Azerbaijan, 0.10 for Georgia, and 0.08 for Armenia. These findings highlight the importance of more decentralized community-based healthcare interventions in the region. Second, human capital covariates remained significant predictors of health status even after controlling for social capital both at individual and community levels. Likewise, social capital variables are significant predictors of health status when used alone and when they are controlled by human capital covariates. These findings suggest that human capital and social capital influence health status independently of each other. Finally, this study sheds light on whether social capital collectively benefits members of a community in transitional countries beyond the individual benefits. In Armenia and Azerbaijan, community level differences in health status are rooted in "compositional" differences between social capital of individuals in the communities rather than at the community "contextual" level. In Georgia, by contrast, the beneficial effect of social capital can be simultaneously observed at the individual "compositional", and community "contextual" levels. These findings suggest that neither "compositional" nor "contextual" models of the social capital effect of health status can apply to all transitional societies universally.     

Access to health care and community social capital

OBJECTIVE: To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community. DATA SOURCES: The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources. STUDY DESIGN: The design is cross-sectional. Self-reported access to care problems is the dependent variable. Independent variables include individual sociodemographic variables, community-level health sector variables, and social capital variables. DATA COLLECTION/EXTRACTION METHODS: Data are merged from the various sources and weighted to be population representative and are analyzed using hierarchical categorical modeling. PRINCIPAL FINDINGS: Persons who live in metropolitan statistical areas featuring higher levels of social capital report fewer problems accessing health care. A higher HMO penetration rate in a metropolitan statistical area was also associated with fewer access problems. Other health sector variables were not related to health care access. CONCLUSIONS: The results observed for 22 major U.S. cities are consistent with the hypothesis that community social capital enables better access to care, perhaps through improving community accountability mechanisms.     

Perceptions of social capital and the built environment and mental health

There has been much speculation about a possible association between the social and built environment and health, but the empirical evidence is still elusive. The social and built environments are best seen as contextual concepts but they are usually estimated as an aggregation of individual compositional measures, such as perceptions on trust or the desirability to live in an area. If these aggregated compositional measures were valid measures, one would expect that they would evince correlations at higher levels of data collection (e.g., neighbourhood). The aims of this paper are: (1) to investigate the factor structure of a self-administered questionnaire measuring individual perceptions of trust, social participation, social cohesion, social control, and the built environment; (2) to investigate variation in these factors at higher than the individual level (households and postcodes) in order to assess if these constructs reflect some contextual effect; and (3) to study the association between mental health, as measured by the General Health Questionnaire-12 (GHQ-12), and these derived factors. A cross-sectional household survey was undertaken during May-August 2001 in a district of South Wales with a population of 140,000. We found that factor analysis grouped our questions in factors similar to the theoretical ones we had previously envisaged. We also found that approximately one-third of the variance for neighbourhood quality and 10% for social control was explained at postcode (neighbourhood) level after adjusting for individual variables, thus suggesting that some of our compositional measures capture contextual characteristics of the built and social environment. After adjusting for individual variables, trust and social cohesion, two key social capital components were the only factors to show statistically significant associations with GHQ-12 scores. However, these factors also showed little variation at postcode levels, suggesting a stronger individual determination. We conclude that our results provide some evidence in support of an association between mental health (GHQ-12 scores) and perceptions of social capital, but less support for the contextual nature of social capital.     

Family social capital and health – a systematic review and redirection

The level (or scale) at which social capital can be conceptualised and measured ranges potentially from the macro‐level (regional or country level), to the meso‐level (neighbourhoods, workplaces, schools), down to the individual level. However, one glaring gap in the conceptualisation of social capital within the empirical literature has been the level of the family. Our aim in this review is to examine the family as the ‘missing level’ in studies on social capital and health. To do so, we conducted a systematic review on the use and measurement of this notion in the health literature, with the final intention of articulating a direction for future research in the field. Our findings are consistent with the notion that family social capital is multidimensional and that its components have distinct effects on health outcomes. Further investigation is needed to understand the mechanisms through which family social capital is related to health, as well as determining the most valid ways to measure family social capital.     

Individual social capital, neighbourhood deprivation, and self-rated health in England

Individual social capital is increasingly considered to be an important determinant of an individual's health. This study examines the extent to which individual social capital is associated with self-rated health and the extent to which individual social capital mediates t.he relationship between neighbourhood deprivation and self-rated health in an English sample. Individual social capital was conceptualized and operationalized in both the social cohesion- and network resource tradition, using measures of generalized trust, social participation and social network resources. Network resources were measured with the position generator. Multilevel analyses were applied to wave 2 and 3 of the Taking Part Surveys of England, which consist of face-to-face interviews among the adult population in England (N(i) = 25,366 respondents, N(j) = 12,388 neighbourhoods). The results indicate that generalized trust, participation with friends and relatives and having network members from the salariat class are positively associated with self-rated health. Having network members from the working class is, however, negatively related to self-rated health. Moreover, these social capital elements are partly mediating the negative relationship between neighbourhood deprivation and self-rated health.     

A life-cycle approach to the analysis of the relationship between social capital and health in Britain

I examine to what extent social capital can promote individual well-being in the form of good physical and mental health. Our analysis is based on multiple waves of data from the National Child Development Survey and the British Cohort Study, two large cohort studies following the lives of children who were born in Britain in one particular week in 1958 and 1970. I use waves that are comparable across the surveys in childhood and adulthood to explore the association between aspects of social capital and several measures of health when adopting a life-cycle approach. The findings suggest that individuals with high levels of social capital generally fare better than individuals with lower levels of social capital and that such associations are robust to the inclusion of controls such as physical and mental health in childhood and circumstances of the family of origin.     

A four year (1996–2000) analysis of social capital and health status of Canadians: The difference that love makes

Despite extensive research on the relationship between social capital and health, the specific pathways through which social capital is related to health have not been fully elucidated. Moreover, research has generally been cross-sectional, particularly in Canada, and hence not clearly attentive to the causal relationship between social capital and health. In this study we have examined the importance of multiple forms of individual social capital for the functional health status of adult Canadians, employing the Canadian National Population Health Survey (NPHS). We examine changes in health between 1996 and 2000, using individual level variables from 1996 as predictors. In our final model, the key aspect of social capital affecting changes in health status is being loved by someone. This is predicted by being married, frequency of family contacts, religious service attendance and being born in Canada. Insecurity about food also has a direct effect on changes in health status. The latter is affected by income, daily smoking and age. The results suggest that policies to support family stability and family unification, for example through immigration, and efforts to minimize the disruptions of divorce could contribute to the health of Canadians.     

Does social capital enhance health and well-being? Evidence from rural China

Despite increasing acknowledgement that social capital is an important determinant of health and overall well-being, empirical evidence regarding the direction and strength of these linkages in the developing world is limited and inconclusive. This paper empirically examines relationships between social capital and health and well-being-as well as the suitability of commonly used social capital measures-in rural China, where rapid economic growth coexists with gradual and fundamental social changes. To measure social capital, we adopt a structural/cognitive distinction, whereby structural social capital is measured by organizational membership and cognitive social capital is measured by a composite index of trust, reciprocity, and mutual help. Our outcome measures included self-reported general health, psychological health, and subjective well-being. We adopt multi-level estimation methods to account for our conceptualization of social capital as both an individual- and contextual-level resource. Results indicate that cognitive social capital (i.e., trust) is positively associated with all three outcome measures at the individual level and psychological health/subjective well-being at the village level as well. We further find that trust affects health and well-being through pathways of social network and support. In contrast, there is little statistical association or consistent pattern between structural social capital (organizational membership) and the outcome variables. Furthermore, although organizational membership is highly correlated with collective action, neither is associated with health or well-being. Our results suggest that policies aimed at producing an environment that enhances social networks and facilitates the exchange of social support hold promise for improving the health and well-being of the rural Chinese population. In addition, China may not have fully taken advantage of the potential contribution of structural social capital in advancing health and well-being. A redirection of collective action from economic to social activities may be worth considering.     

The measurement of social capital

Social capital has been defined as the resources available to individuals and groups through membership in social networks. The definition is consistent with either an individualistic approach, i.e. resources (such as information or instrumental assistance) that are accessed by individuals through their network connections; or a collective approach, e.g. the benefits accruing to members of a group – such as the ability of a community to engage in collective action – as a consequence of the existence of cohesive relationships. While research often restricts itself to a single level of analysis, the benefits (and downsides) of social capital accrue to both the individual as well as to the network to which he belongs. In the Dictionary of Epidemiology both the individual and collective levels of analysis were recognized in the definition of social capital.     

Do bonding and bridging social capital affect self-rated health,depressive mood and cognitive decline in older Japanese? A prospective cohort study

Little is known regarding the longitudinal effects of bonding and bridging social capital on health. This study examined the longitudinal associations of bonding and bridging social capital with self-rated health, depressive mood, and cognitive decline in community-dwelling older Japanese. Data analyzed in this study were from the 2010 (baseline) and 2012 (follow-up) Hatoyama Cohort Study. Bonding social capital was assessed by individual perception of homogeneity of the neighborhood (the level of homogeneity among neighbors) and of networks (the amount of homogeneous personal networks) in relation to age, gender, and socioeconomic status. Bridging social capital was assessed by individual perception of heterogeneity of networks (the amount of heterogeneous personal networks) in relation to age, gender, and socioeconomic status. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the effects of baseline social capital on poor health outcome at follow-up by logistic regression analysis. In total, 681 people completed baseline and follow-up surveys. The mean age of participants was 71.8 ± 5.1 years, and 57.9% were male. After adjusting for sociodemographics, lifestyle factors, comorbidity, functional capacity, baseline score of each outcome, and other bonding/bridging social capital, stronger perceived neighborhood homogeneity was inversely associated with poor self-rated health (OR = 0.55, 95% CI = 0.30–1.00) and depressive mood assessed by the Geriatric Depression Scale (OR = 0.58, 95% CI = 0.34–0.99). When participants who reported a depressive mood at baseline were excluded, stronger perceived heterogeneous network was inversely associated with depressive mood (OR = 0.40, 95% CI = 0.19–0.87). Neither bonding nor bridging social capital was significantly associated with cognitive decline assessed by the Mini-Mental State Examination. In conclusion, bonding and bridging social capital affect health in different ways, but they both have beneficial effects on the health of older Japanese. Our findings suggest that intervention focusing on bonding and bridging social capital may improve various health outcomes in old age.