U.S. State-Level Social Capital and Health-Related Quality of Life: Multilevel Evidence of Main, Mediating, and Modifying Effects
Introduction
Apart from physical resources and amenities, broad social characteristics of the environment, including social capital, are hypothesized to play critical roles in the development of disease and promotion of health (1). Social capital has been conceptualized at both the collective and individual levels, while its greatest currency resides at the collective level (2), where it has been defined as the features of social organization, including social trust, civic participation, and norms of reciprocity that facilitate cooperation for mutual benefit 3, 4.
Several hypotheses have been postulated for how collective social capital produces health benefits 1, 5. Rogers' diffusion of innovations theory (6) has been used to posit that within communities and neighborhoods, social capital may promote the diffusion of knowledge about health-related innovations (e.g., smoking cessation). Drawing on evidence relating collective efficacy to crime (7), social capital may further contribute to informal social control over health-related behaviors, and may plausibly facilitate collective action among residents to ensure access to local services and amenities that may be relevant to health (e.g., green spaces). Additionally, social capital may act through psychosocial processes, including the provision of affective support and mutual respect 1, 5. At higher levels of aggregation such as states, social capital may conceivably improve health through greater political participation, leading to social policies that support spending on public goods such as education and health care 4, 8.
Recent studies have investigated the health effects of state-level social capital by using a comprehensive index developed by the political scientist Robert Putnam (4). These investigations have primarily focused on specific disease or behavioral end points 9, 10, 11 rather than health-related quality of life (HRQOL) outcomes (e.g., self-reported activity limitation). Raising HRQOL and the life expectancy of Americans correspond to one of the two overarching goals of Healthy People 2010 (12). HRQOL measures have also been incorporated into several national and state-based report cards to identify and track health disparities and population trends (13).
Individual-level characteristics including older age, lower income and lack of social support, and behaviors such as smoking and sedentarism have been shown to predict poorer HRQOL 14, 15, 16, 17. Furthermore, mean HRQOL estimates vary by state and region within the United States (14). Such variations may be partly attributed to geographic differences in socioeconomic deprivation, which at the neighborhood level have been empirically linked to HRQOL (18).
To date, only one multilevel analysis (19) has examined the potential mediation of the effects of state-level income inequality on individual health via the erosion of social capital. Moreover, few studies have explored potential interactions between collective social capital and individual-level predictors of health [e.g., race/ethnicity (20)] or area-level socioeconomic status. Identifying such interactions are important because the effects of social capital may not necessarily apply uniformly across population subgroups or geographic regions.
In the present study, applying a multilevel approach, we addressed gaps in the literature by examining whether: 1) U.S. state-level social capital is associated with better individual-level HRQOL outcomes, after accounting for individual- and other state-level characteristics; 2) state-level social capital potentially mediates the association between state-level income inequality and HRQOL; and 3) the estimated returns of state-level social capital to HRQOL are modified (i.e., vary) by state-level mean income and individual-level age and race/ethnicity.
Section snippets
Data Sources
All individual-level measures were obtained from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) survey (21). State-level measures for 48 U.S. states (all states except Alaska and Hawaii) were created using data from the Roper Social and Political Trends Archive (years 1990–1994) (22), General Social Surveys (GSS; 1974–1994) (4), DDB Needham Life Style Archive (1994–1998) (23), New Non-Profit Almanac and Desk Reference (1998) (24), U.S. Statistical Abstract (1996, 2000), U.S.
Results
Table 1 provides descriptive statistics for the final sample (173,236 individuals within 48 states); 14.3% of the sample reported being in fair to poor general health, whereas on average there were 3.5, 3.4, and 2.0 days of poor physical health, mental health, and activity limitation over the previous month, respectively.
Discussion
The results of this U.S. study suggest state-level contextual effects of social capital on the HRQOL of adults. Adjusting for individual- and state-level factors, living in a state intermediate or high (vs. low) in social capital of each type was associated with 10% to 11% lower odds of fair to poor self-rated health. Residing in a state higher in ‘SC1’ and in ‘SC2’ was each associated with fewer recent days of poor physical health, poor mental health, and activity limitation. While these
References (37)
- et al.
Social determinants of tuberculosis case rates in the United States
Am J Prev Med
(2004) - et al.
Associations between recommended levels of physical activity and health-related quality of life: findings from the 2001 Behavioral Risk Factor Surveillance System
Prev Med
(2003) - et al.
Does the state you live in make a difference? Multilevel analysis of self-rated health in the U.S.
Soc Sci Med
(2001) - et al.
Social cohesion, social capital, and health
- et al.
Commentary: reconciling the three accounts of social capital
Int J Epidemiol
(2004) - et al.
Social capital, income inequality, and mortality
Am J Public Health
(1997) Bowling Alone: The Collapse and Revival of American Community
(2000)Unhealthy Societies: The Afflictions of Inequality
(1996)Diffusion of Innovations
(2003)- et al.
Neighborhoods and violent crime: a multilevel study of collective efficacy
Science
(1997)
The Health of Nations: Why Inequality Is Harmful to Your Health
Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS in the United States
Sex Transm Infect
Social capital as a predictor of adolescents' sexual risk behavior: a state-level exploratory study
AIDS Behav
Healthy People 2010: Understanding and Improving Health
The Centers for Disease Control and Prevention's Healthy Days Measures: population tracking of perceived physical and mental health over time
Health Qual Life Outcomes
Measuring Healthy Days
Social support and health-related quality of life among older adults: Missouri, 2000
MMWR
Smoking status and health-related quality of life: findings from the 2001 Behavioral Risk Factor Surveillance System Data
Am J Health Promot
Cited by (99)
The impact of social capital on business development in Ghana: Experiences of local-level businesses in the Kumasi Metropolitan Area
2024, Social Sciences and Humanities OpenRacial/ethnic health disparities among children with special health care needs in Boston, Massachusetts
2022, Disability and Health JournalSocial capital and physical health: An updated review of the literature for 2007–2018
2019, Social Science and MedicineCitation Excerpt :Mukoswa et al. found significant associations with infectious diseases for some measures of social capital (network diversity), but not others (trust) (Mukoswa et al., 2017). A total of 83 studies of social capital and self-rated health met inclusion criteria for the present study (Ahnquist et al., 2012; Baheiraei et al., 2015; Baron-Epel et al., 2008; Beaudoin, 2009; Borges et al., 2010; Borgonovi, 2010; Bowen and Luy, 2016; Boyce et al., 2008; Campos-Matos et al., 2016; Chemaitelly et al., 2013; Chen and Meng, 2015; Chen et al., 2017; Chola and Alaba, 2013; Chuang et al., 2013; Cramm and Nieboer, 2011; Delaney et al., 2007; Elgar et al., 2011; Engström et al., 2008; Eriksson and Ng, 2015; Ferlander and Mäkinen, 2009; Gele and Harsløf, 2010; Giordano et al., 2012; Giordano and Lindstrom, 2010; Glanville and Story, 2018; Habibov and Cheung, 2017; Habibov and Afandi, 2011; Han, 2013; Hibino et al., 2012; Ichida et al., 2009; Inaba et al., 2015; Iwase et al., 2012; Jung and Viswanath, 2013; Kim and Harris, 2013; Kim and Kawachi, 2007; Kim, 2018; Kishimoto et al., 2013; Kobayashi et al., 2013; Kumar et al., 2012; Lamarca et al., 2013; Lau and Ataguba, 2015; Lindén-Boström et al., 2010; Lyytikäinen and Kemppainen, 2016; Maass et al., 2016; Mackenbach et al., 2016; Mansyur et al., 2008; Mathis et al., 2015; Miyamoto et al., 2015; Moore et al., 2011; Morgan and Eastwood, 2014; Murayama et al., 2013, 2012; Nieminen et al., 2013, 2010; Nogueira, 2009; Novak et al., 2015; Nummela et al., 2009; Nyqvist et al., 2014; O’Doherty et al., 2017; Orban et al., 2017; Oshio, 2016; Plascak et al., 2016; Ramlagan et al., 2013; Riumallo-Herl et al., 2014; Saint Onge et al., 2018; Saito et al., 2017; Sapag et al., 2008; Schultz et al., 2008; Shen et al., 2014; Shin and Shin, 2016; Sibai et al., 2017; Snelgrove et al., 2009; Tampubolon et al., 2013; Tobiasz-Adamczyk and Zawisza, 2017; Verhaeghe et al., 2012; Verhaeghe and Tampubolon, 2012; Vincens et al., 2018; Waverijn et al., 2014; Williams and Ronan, 2014; Xue and Cheng, 2017). Of these, 24 (29%) showed only positive findings, 52 (63%) showed mixed findings, and 7 (8%) showed strictly null results.
Social capital and perceived stress: The role of social context
2019, Journal of Affective Disorders