US state- and county-level social capital in relation to obesity and physical inactivity: a multilevel, multivariable analysis

Social capital and physical activity: a literature review up to March 2024

Background

Social capital, as a multidimensional social science concept, plays a crucial role in promoting physical activity. Despite numerous studies exploring the relationship between social capital and physical activity, there is still a lack of systematic understanding of how different dimensions of social capital influence physical activity levels. This study aims to systematically review the literature up to 2024 on the relationship between social capital and physical activity, uncover the role of social capital in promoting physical activity, and identify its multidimensional impacts.

Methods

We used a combination of search terms including "social capital" and "physical activity" to search the Web of Science, PubMed, Scopus, SportDiscus, and PsychINFO databases for English literature published up to March 1, 2024.

Results

We identified 2,021 unique articles and reviewed 115 studies that met our inclusion criteria. These studies evaluated various dimensions of social capital, with key dimensions including social participation (34%), social networks (30%), social cohesion (30%), social trust (29%), overall social network (26%), social support (19%), safety (19%), norms of reciprocity (13%), social control (10%), satisfaction with the environment (8%), collective efficacy (4%), norms for physical activity (3%), and voting (1%). In studies exploring the relationship between social capital and physical activity, the majority of positive results in the hypothesized direction were observed in dimensions such as social cohesion, trust, participation, reciprocity, satisfaction with the environment, and overall social networks. In contrast, dimensions such as voting, collective efficacy, safety, control, and physical activity norms predominantly showed null or negative results. The results for social support were mixed, displaying positive, negative, and null outcomes, while findings for social networks were also predominantly mixed.

Conclusion

This study reveals the significant role of social capital in promoting physical activity, particularly in the dimensions of social cohesion, social trust, social participation, norms of reciprocity, satisfaction with environment, and overall social network. When designing public health interventions in the future, it is crucial to tailor strategies to different populations and contexts to better leverage social capital in promoting physical activity.

Obesity: current state of the problem, multidisciplinary approach. (based on the consensus of the World Gastroenterological Organization “Obesity 2023” and the European guideline on obesity care in patients with gastrointestinal and liver diseases, 2022)

Obesity is the largest pandemic in the world, and its prevalence continues to increase. The purpose of the presented publication is to raise awareness of doctors about modern methods of diagnosing obesity and approaches to therapy, using an interdisciplinary team approach similar to that used in other chronic diseases, such as diabetes, heart disease and cancer. The article presents data from the World Gastroenterological Organization (2023) and the European Guidelines for the Treatment of Obesity in patients with diseases of the gastrointestinal tract and liver (2022). According to modern approaches, obesity should be considered as a chronic recurrent progressive disease, the treatment of which requires a comprehensive interdisciplinary approach involving psychologists and psychiatrists, nutritionists/nutritionists, therapists, endoscopists and surgeons, including lifestyle changes, a well-defined diet and exercise regimen, drug therapy, endoscopic or surgical methods of treatment. Conclusions. In order to stop the growing wave of obesity and its many complications and costs, doctors, insurance companies and health authorities should make systematic efforts to raise public awareness of both the adverse health risks associated with obesity and the potential reduction of risks through a comprehensive approach to therapy.

Neighborhood Social Environment and Body Mass Index: The Mediating Role of Mental Wellbeing

The association between neighborhood-built environment and body mass index (BMI) is well-characterized, whereas fewer studies have explored the mechanisms underlying the relationship between neighborhood social environment and obesogenic behaviors. Using data from a random sample of 16,820 residents ≥18 years from all 169 Connecticut towns and seven ZIP Codes in New York, this study examines the influence of neighborhood social environment on residents' mental wellbeing, physical activity, and BMI. Structural equation modeling was conducted to estimate direct and indirect effects of neighborhood social environment on BMI, using mental wellbeing and physical activity as intermediate variables. There were significant total [β(SE) = 0.741 (0.170), p < 0.0001], direct [β(SE) = 0.456 (0.1890), p = 0.016], and indirect [β(SE) = 0.285 (0.061), p < 0.0001] effects of neighborhood social environment on BMI. Low physical activity was a partial mediator of the effect of non-favorable neighborhood social environment on BMI [β(SE) = -0.071 (0.011), p < 0.0001]. The association between neighborhood social environment and BMI was also mediated by mental wellbeing [β(SE) = 0.214 (0.060), p < 0.0001], and by mental wellbeing through physical activity [β(SE) = 0.071 (0.011), p < 0.0001]. Study findings provide further support for building strong social environments to improve population health and suggest that strategies prioritizing mental wellbeing may benefit behavioral interventions aimed at reducing obesity risk and should be a focus of prevention efforts in and of itself.

Factors Related to Physical Activity among Older Adults Who Relocated to a New Community after the Kumamoto Earthquake: A Study from the Viewpoint of Social Capital

Previous studies have shown an association between social capital and physical activity in older adults. Older adults who relocated after the Kumamoto earthquake may become physically inactive, and the extent of this inactivity may be buffered by social capital. Accordingly, this study applied the social capital perspective to examine factors that affect the physical activity of older adults who relocated to a new community after the Kumamoto earthquake. We conducted a self-administered mail questionnaire survey with 1494 (613 male, 881 female, mean age 75.12 ± 7.41 years) evacuees from temporary housing in Kumamoto City, aged 65 years and above, who relocated to a new community after the earthquake. We performed a binomial logistic regression to examine the factors affecting participants' physical activity. The results showed that physical inactivity (decreased opportunities for physical activity, decreased walking speed, and no exercise habits) was significantly associated with non-participation in community activities, lack of information about community activities, and being aged 75 years and over. Lack of social support from friends was significantly associated with lack of exercise habits. These findings encourage participation in community activities, alongside giving and receiving social support in health activities that target older adults who relocated to new communities after the earthquake.

Assessing Hispanic/Latino and Non-Hispanic White Social Determinants of Obesity Among a Community Sample of Residents in the Rural Southeast US

Employing an ecological approach, we sought to identify social determinants of obesity among Hispanics/Latinos and non-Hispanic whites living in the Southeast US. Data on social determinants of obesity (individual, family, community and cultural/contextual) were collected from 217 participants [106 Hispanics/Latinos; 111 non-Hispanic whites]; height and weight  were objectively measured. We compared prevalence of overweight and obese between ethnic groups and BMI values within each group by social determinants. Hispanics had a 1.9-fold increase (OR 1.93, 95% CI: 1.05-3.55) in overweight prevalence compared to non-Hispanic whites after adjusting for age and gender. We found positive estimates between unfavorable family-level determinants and BMI among Hispanic/Latinos. In contrast, non-Hispanic whites who reported unfavorable neighborhood characteristics had higher BMI's. Findings highlight the need for targeted approaches for the prevention and control of obesity.

Factors Associated with Body Weight Gain among Korean Adults during the COVID-19 Pandemic

Background

Obesity is of grave concern as a comorbidity of coronavirus disease 2019 (COVID-19). We examined the factors associated with weight gain among Korean adults during the COVID-19 pandemic.

Methods

We conducted an online survey of 1,000 adults (515 men and 485 women aged 20-59 years) in March 2021. Multivariable logistic regression analysis was performed to evaluate the factors associated with weight gain. The analysis was adjusted for sex, age, region, depressive mood, anxiety, eating out, late-night meals, alcohol consumption, exercise, sleep disturbance, meal pattern, subjective body image, comorbidities, marital status, living alone, and income.

Results

After adjusting for confounding variables, the odds for weight gain increased in the group aged 20-34 years compared with the group aged 50-59 years (1.82; 95% confidence interval [CI], 1.01-3.32). Women were more associated with the risk of weight gain compared with men. The odds for weight gain increased in the lack of exercise group compared with the exercise group (4.89; 95% CI, 3.09-7.88). The odds for weight gain increased in the eating-out and late-night meal groups compared with that in the groups not eating out and not having late-night meals. Individuals watching a screen for 3-6 hr/day were more associated with the risk of weight gain compared with those who rarely watched a screen. The odds for weight gain increased in participants who considered themselves obese compared with those who did not consider themselves obese.

Conclusion

A healthy diet and regular physical activity tend to be the best approach to reduce obesity, a risk factor for COVID-19.

Economic inequality in malnutrition: a global systematic review and meta-analysis

OBJECTIVE

To describe the evidence on global and regional economic inequality in malnutrition, and the associations between economic inequality and malnutrition.

METHODS

We conducted a systematic review and meta-analysis. Between 1 November 2020 and 22 January 2021, we searched Medline, Embase, Global Health, Eldis, Web of Science and EBSCO Discovery Service. We contacted 39 experts and tracked citations. We included any study reporting a concentration index (CIX) relating economic status and nutritional status and any multilevel study reporting an association between economic inequality and nutritional status. Nutritional status was measured as stunting, wasting, anaemia, or overweight in children (<5 years), or underweight, overweight or obesity, or anaemia in adults (15-49 years). We had no study date or language restriction. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). We mapped estimates and pooled them using multilevel random-effects meta-analyses.

RESULTS

From 6185 results, 91 studies provided 426 CIX (>2.9 million people) and 47 associations (~3.9 million people). Stunting (CIX -0.15 (95% CI -0.19 to -0.11)) and wasting (-0.03 (95% CI -0.05 to -0.02)) are concentrated among poor households. Adult overweight and obesity is concentrated in wealthier households (0.08 (95% CI -0.00 to 0.17)), particularly in South Asia (0.26 (95% CI 0.19 to 0.34)), but not in Europe and Central Asia (-0.02 (95% CI -0.08 to 0.05)) or North America (-0.04 (95% CI -0.10 to 0.03)). We found no association between 0.1 increase in Gini coefficient and adult underweight (OR 1.03 (95% CI 0.94 to 1.12)) or overweight and obesity (0.92 (95% CI 0.80 to 1.05)).

CONCLUSIONS

There is good evidence that the prevalence of malnutrition varies by levels of absolute economic status. Undernutrition is concentrated in poor households, whereas concentration of overweight and obesity by economic status depends on region, and we lack information on economic inequalities in anaemia and child overweight. In contrast, links between malnutrition and relative economic status are less clear and should not be assumed; robust evidence on causal pathways is needed.

PROSPERO REGISTRATION NUMBER

CRD42020201572.

Role of bariatric surgery in a COVID-19 era: a review of economic costs

Obesity has rapidly become a significant public health issue. As the prevalence of obesity continues to rise, so does its economic burden as a result of both direct and indirect costs. Likewise, since 2019, the coronavirus disease of 2019 (COVID-19) has become a global pandemic with rising infection rates carrying significant economic costs associated with treatment of the disease and the reduction in economic activity due to government regulations. The COVID-19 pandemic has had a detrimental impact on obesity, not only creating an increasingly obesogenic environment but also reducing access to bariatric care and treatment of obesity-related diseases. In this article, we form a compelling argument for the resumption of bariatric services as soon as it is safe to do so because bariatric surgery brings significant additional medical and economic benefits. Medically, obesity is a risk factor for increased severity of COVID-19 infections, and therefore, treatment of obesity should be a priority in the current pandemic. Additionally, bariatric surgery has been shown to be a cost-saving procedure in the long term and thus has significant economic benefit in reducing the costs of obesity in the future as we recover from the economic collapse following the global pandemic.

Income Inequality and Obesity among US Adults 1999-2016: Does Sex Matter?

Obesity is a major public health problem that varies by income and sex, yet there is little evidence to determine the association between income inequality and obesity. We examined the association between income and obesity in adults ages 20 years and older and tested whether this relationship differs by sex in the United States. We used the 1999-2016 National Health and Nutrition Examination Survey (NHANES). We defined obesity if the body mass index was ≥30 kg/m2, and calculated the Gini coefficient (GC) to measure income inequality by using the Poverty Income Ratio. We examined the association between income and obesity using a Modified Poisson regression in a sample of 36,665 adults. We adjusted the models according to age, racial/ethnic groups, marital status, education, health behaviors, health insurance, self-reported health, and household structure. The association between income and obesity was consistently more significant among middle-income quintile and higher-income quintile men than among lower-income quintile men. The same association was not found for women; women in the highest income quintile were less likely to suffer from obesity than among lower-income quintile women. Our results suggest that policymakers should consider strategies to reduce structural inequality and encourage access to healthy foods and community-supported agricultural programs as nutritional interventions in low-income population settings.

Leisure-time physical activity is associated with socio-economic status beyond income - Cross-sectional survey of the Northern Finland Birth Cohort 1966 study

We apply neoclassical economic modelling augmented with behavioral aspects to provide a detailed empirical investigation into indicators of socio-economic status (SES) as determinants of leisure-time physical activity. We utilize the data from the Northern Finland Birth Cohort 1966 obtained at the most recent time point during 2012-2014 (response rate 67 %), at which time the participants were approximately 46 years old. Our final study sample consists of 3,335 employed participants (1520 men, 1815 women; 32.3 % of the target population). We apply logistic regression methods for estimating how the probability of being physically active is related to various indicators of socio-economic status, taking into account physical activity at work and individual lifestyle, family- and health-related factors. Overall, our findings show that belonging to a higher socio-economic group, whether defined by income level, educational attainment, or occupational status, is associated with higher leisure-time physical activity. However, when we analyze different socio-economic groups, defined in terms of education, income and occupation, separately, we find that income is not a significant determinant of leisure-time physical activity within any of the particular SES groups. Further, we find that leisure-time physical activity is negatively associated with higher screen time (i.e., watching TV and sitting at a computer), and other aspects of unhealthy lifestyle, and positively associated with self-assessed health. In addition, we note that proxies for individual motivational factors and childhood physical activity, such as the grade point average and the grade achieved in physical education when leaving basic education, are strongly correlated with leisure-time physical activity in middle age among men, but not among women. Our results are in line with behavioral economics reasoning that social comparisons and environments affect behaviors. We emphasize the importance of considering behavioral economic factors when designing policies to promote physical activity.

County-Level Social Capital and Bacterial Sexually Transmitted Infections in the United States

BACKGROUND

The association between county-level social capital indices (SCIs) and the 3 most commonly reported sexually transmitted infections (STIs) in the United States is lacking. In this study, we determined and examined the association between 2 recently developed county-level SCIs (ie, Penn State Social Capital Index [PSSCI] vs United States Congress Social Capital Index [USCSCI]) and the 3 most commonly reported bacterial STIs (chlamydia, gonorrhea, and syphilis) using spatial and nonspatial regression techniques.

METHODS

We assembled and analyzed multiyear (2012-2016) cross-sectional data on STIs and 2 SCIs (PSSCI vs USCSCI) on counties in all 48 contiguous states. We explored 2 nonspatial regression models (univariate and multiple generalized linear models) and 3 spatial regression models (spatial lag model, spatial error model, and the spatial autoregressive moving average model) for comparison.

RESULTS

Without exception, all the SCIs were negatively associated with all 3 STI morbidities. A 1-unit increase in the SCIs was associated with at least 9% (P < 0.001) decrease in each STI. Our test of the magnitude of the estimated associations indicated that the USCSCI was at least 2 times higher than the estimates for the PSSCI for all STIs (highest P value = 0.01).

CONCLUSIONS

Overall, our results highlight the potential benefits of applying/incorporating social capital concepts to STI control and prevention efforts. In addition, our results suggest that for the purpose of planning, designing, and implementing effective STI control and prevention interventions/programs, understanding the communities' associational life (as indicated by the factors/data used to develop the USCSCI) may be important.

State- and County-Level Social Capital as Predictors of County-Level Suicide Rates in the United States: A Lagged Multilevel Study

From 1999 through 2017, age-adjusted suicide rates in the United States rose by 33% (from 10.5 to 14.0 per 100 000 population). Social capital, a key social determinant of health, could protect against suicide, but empirical evidence on this association is limited. Using multilevel data from the Centers for Disease Control and Prevention, we explored state- and county-level social capital as predictors of age-adjusted suicide rates pooled from 2010 through 2017 across 2112 US counties. In addition, we tested for causal mediation of these associations by state-level prevalence of depression. A 1-standard deviation increase in state-level social capital predicted lower county-level suicide mortality rates almost 2 decades later (0.87 fewer suicides per 100 000 population; P = .04). This association was present among non-Hispanic Black people and among men but not among non-Hispanic White people and women. We also found evidence of partial mediation by prevalence of depression. Our findings suggest that elevating state- and county-level social capital, such as through policy and local initiatives, may help to reverse the trend of rising suicide rates in the United States.

Will the COVID-19 pandemic worsen the obesity epidemic?

The sudden outbreak and global spread of COVID-19 represents one of the most profound societal and public health challenges in modern times. In this Comment, we call attention to the possibility that the societal strategies implemented to oppose COVID-19 might have long-term, negative effects on the obesity epidemic.

Do Sports Clubs Contribute to the Accumulation of Regional Social Capital?

Social capital (SC) affects quality of life, sport behaviours and health in individual and community context. The aim was to analyse how sports activity (SA) contributes to SC accumulation in a post-transformation country. A combination of four longitudinal, nationwide datasets was used. Instrumental variable method was applied. Results show that in 19+ Poles, on a regional level, SA improves SC. This suggest that sports clubs and at least some types of sports infrastructure can constitute a valid tool for social policies aiming at improving social involvement. The self-triggering character of SA is a valuable asset for social impact regionally and beyond. It is important to estimate the changes in a long-term perspective, due to the inertness of the SC.

Impact of sports activity on Polish adults: Self-reported health, social capital & attitudes

The aim of our study was a quasi-experimental estimation of the relationship between sports activity and social capital, and an assessment made at an individual level of the impact of sports activity on health, beliefs and the social situation of Polish adults. Matching estimation method and Social Diagnosis data were used. The dataset enables not only an analysis of the self-reported health, but also of social capital. The panel structure of the data and the applied method allow for stratifying the sample using past characteristics, including past sports activity, as well as for assessing outcomes after the treatment—engaging in sports activity—takes place. Both allow for an interpretation of the results as reflections of a causal relationship. Even though publications applying matching estimation or IV estimation to assess the impact of sports activity have recently been increasing in number, ours is the first to concentrate on the effects on multidimensional social capital for adults using panel data and matching estimation. It is also the first to focus on a country that is neither one of the most developed in the world or one of the least developed. The results obtained suggest significant heterogeneity in terms of age, gender and place of living. We also found that sports contributed to building social networks and being socially active. Our research indicates that sports activity enhances social health. It can be used as a tool for a policy of social activation and strengthening the health potential of adults, especially those over 40.

Relationship between Dental Caries Experience and Social Capital among Children - A Pilot Study

Background:

The effect of larger and distal environmental and societal factors on oral health is established and the concept of social capital (SC) is gaining importance.

Aim:

The aim of the study is to evaluate the association of dental caries (DC) experience of children with parental social SC.

Methods:

A cross-sectional survey was conducted among 200 pairs of 5–12-year-old children and their parents of Kaloor (65^th division), Kerala. A 30-item self-administered neighborhood SC Index questionnaire. DC of children was assessed as per the WHO guidelines.

Results:

The final analysis included 186 pairs of children and parents, out of which 54.8% were boys. The mean caries experience of children was 3.3 ± 3.7. A significantly higher proportion of parents rated their children as “poor oral health” in caries experienced group than caries-free group (P = 0.006). No other significant differences were found with total SC and demographic variables except for “frequency of having meal together.” Regression analysis showed that trust, control, and political domains were significant with carious status. On adjusting the confounders that were significant in bivariate analysis, only control domain of the SC remained significant.

Conclusion:

The social control domain (family members or neighbors actions that seek to correct deviant behavior) of SC was associated with caries experience of the children. Distal factors such as SC can influence the caries status of children.

The importance of social capital for young People's active transport and independent mobility in rural Otago, New Zealand

Social capital influences adolescents' licenses for active transport and independent mobility, through parental decision making and safety concerns, and may contribute to increasing adolescents' physical activity. Drawing on 20 parental interviews and 11 focus groups (73 adolescents) from rural New Zealand, this paper shows the importance of social capital and social trust for active transport and independent mobility in an under researched rural context. Change over time in social capital, social trust and parental safety concerns limited adolescents' active transport and independent mobility. Health policy should incorporate social capital measures to increase adolescents' active transport, independent mobility and physical activity.

Evaluating the Influence of Social Engagement on Cognitive Impairment and Mobility Outcomes Within the Boston RISE Cohort Study

OBJECTIVE

We investigated the associations between mild cognitive impairment (MCI), social engagement (SE), and mobility.

DESIGN

We evaluated data from a cohort study of older adult primary care patients (N = 430). Outcomes included self-reported function (Late-Life Function Instrument [LLFI]) and performance-based mobility (Short Physical Performance Battery score [SPPB]). Linear regression models evaluated the association between MCI and mobility, MCI and SE, mobility measures and SE, and whether SE mediated the association between MCI status and mobility.

RESULTS

Participants with MCI had significantly lower mobility and lower SE as compared with those without MCI (LLFI: 53.5 vs. 56.9, P < 0.001; SPPB: 7.9 vs. 9.3, P < 0.001; SE score: 44.9 vs. 49.0, P < 0.001). Mild cognitive impairment was significantly associated with both LLFI and SPPB (LLFI β = -2.93, P < 0.001; SPPB β = -1.26, P < 0.001) and SE (β = -3.20, P < 0.001). Social engagement was significantly associated with both LLFI and SPPB (LLFI β = 0.22; P < 0.001; SPPB β = 0.08; P < 0.001). There was a positive association between SE and mobility (P< 0.05). A mediator effect of SE was supported when evaluating the association between MCI and mobility.

CONCLUSIONS

Among older adult primary care patients at risk for mobility decline, higher levels of SE mitigate the association between MCI and mobility.

Associations of Socio-demographic, Family, and Neighborhood Factors with Physical Activity-Related Parenting Practices Among Hong Kong Preschoolers' Parents

Objectives Regular engagement in physical activity (PA) has numerous health benefits in young children. Young children's parents can influence their children's PA behavior through different PA-related parenting practices. This cross-sectional study examined the independent contributions of socio-demographic, family/home and parent-perceived neighborhood environmental characteristics explaining PA-related parenting practices encouraging or discouraging PA among Hong Kong preschool-aged children (3-5 years-old). Methods Hong Kong Chinese preschoolers' parents were recruited from pre-selected kindergartens and Maternal and Child Health Centers located in areas stratified by residential density and socio-economic status. They self-completed socio-demographic, family/home and perceived neighborhood characteristics and PA-related parenting practices questionnaires. Generalized linear models were used to examine associations of socio-demographic, family/home and neighborhood variables with PA-related parenting practices. Results Socio-demographic and family/home characteristics were significantly correlated with parenting practices encouraging and discouraging PA. Parent-perceived neighborhood characteristics were significantly correlated with parenting practices discouraging PA only. Conclusions for Practice This study identified correlates of PA-related parenting practices among parents of Hong Kong Chinese preschoolers. The findings suggest future PA-promoting interventions among Chinese preschoolers via the promotion of parenting practices encouraging children's PA should consider multiple factors, including family relationships and childcare sharing, promotion of PA and its benefits among parents, and neighborhood social cohesion, traffic safety and safety from crime.

Intra-urban patterns of neighborhood-level social capital: a pilot study

Background: Social capital is a construct of interaction and social trust in one’s fellow community members. These interactions can provide a safety net for individuals in terms of information, social support, and adherence to social norms. While a number of studies have previously examined the relationship between social capital and health outcomes, few have examined the theparallel relationship of social capital and geographic "place" with respect to health outcomes.

Methods: Considering social capital as facilitated by specific structures, we evaluate the relationship between neighborhood-level social capital and disability rates in a major Southern US city. Disability rates were collected through neighborhood-level data via the AmericanCommunity Survey (ACS) and compared to a geocoded map of neighborhood-level social capital measures during spring, 2016.

Results: Higher social capital within a neighborhood coincided with lower disability rates in that neighborhood (r=-0.14, P=0.016) when compared to random assortment models.

Conclusion: Findings from this research add evidence to the value of the built environment, not only providing resources and shaping choices, but for facilitating important social relationships.

The association of county-level socioeconomic factors with individual tobacco and alcohol use: a longitudinal study of U.S. adults

Background

Place-based factors have been implicated as root causes of socioeconomic disparities in risky health behaviors such as tobacco and alcohol use. Yet few studies examine the effects of county-level socioeconomic characteristics, despite the fact that social and public health policies are often implemented at the county level. In this study, we tested the hypothesis that county-level socioeconomic disadvantage was associated with individual tobacco and alcohol use.

Methods

The sample included a panel of participants from the National Longitudinal Survey of Youth (N = 9302). The primary predictors were three time-varying measures of socioeconomic disadvantage in an individual’s county of residence: educational attainment, percent unemployment, and per capita income. We first conducted traditional ordinary least squares (OLS) models, both unadjusted and adjusted for individual-level covariates. We then conducted fixed effects (FE) models to adjust for confounding by unmeasured time-invariant individual-level factors.

Results

OLS and FE models yielded contrasting results: higher county-level per capita income was associated with decreased drinking in OLS models and increased drinking in FE models, while decreased county-level educational attainment was associated with decreased smoking in OLS models and more cigarettes per day in FE models. The findings from FE models suggest that OLS models were confounded by unobserved time-invariant characteristics. Notably, the point estimates for the county-level measures were small, and in many cases they may not represent a clinically meaningful effect except at the population level.

Conclusions

These results suggest that county-level socioeconomic characteristics may modestly influence tobacco and alcohol use. Future work should examine the effects of specific county policies that might explain these findings.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6700-x) contains supplementary material, which is available to authorized users.

The Association Between Social Engagement, Mild Cognitive Impairment, and Falls Among Older Primary Care Patients

OBJECTIVES

To examine associations between mild cognitive impairment (MCI) and falls among primary care patients, and to investigate whether social engagement (SE) modifies these associations.

DESIGN

Cross sectional analysis using baseline data from an observational cohort study.

SETTING

Primary care.

PARTICIPANTS

Community-dwelling older adults (N=430) at risk of mobility decline with a mean age of 76.6 years (range 65-96y).

MAIN OUTCOME MEASURES

The number of falls in the past year was reported at the baseline interview. MCI was identified using a cutoff of 1.5 SD below the age-adjusted mean on at least 2 of the standardized cognitive performance tests. SE (eg, keeping in touch with friends and family, volunteering, participating social activities…) was assessed with the Late Life Function and Disability Instrument, and required a score above the median value 49.5 out of 100.

RESULTS

MCI was present among 42% of participants and 42% reported at least 1 fall in the preceding year. Using generalized estimating equations, MCI was associated with a 77% greater rate of falls (P<.05). There was a statistically significant interaction between SE and MCI on the rate of falls (P<.01), such that at a high level of SE, MCI was not statistically associated with falls (P=.83). In participants with lower levels of SE, MCI is associated with 1.3 times greater rate of falls (P<.01).

CONCLUSIONS

While MCI is associated with a greater risk for falls, higher levels of SE may play a protective role.

Social Participation Modifies the Effect of a Structured Physical Activity Program on Major Mobility Disability Among Older Adults: Results From the LIFE Study

Objectives

To investigate whether baseline social participation modifies the effect of a long-term structured physical activity (PA) program on major mobility disability (MMD).

Methods

1,635 sedentary adults (70-89 years) with physical limitations were randomized to either a structured PA or health education (HE) intervention. Social participation was defined categorically at baseline. High social participation was defined as attending organized group functions at least once per week and visiting with noncohabitating friends and family ≥7 hr per week. Anything less was considered limited social participation. Participants performed a standardized walking test at baseline and every 6 months for up to 42 months. MMD was defined as the loss in the ability to walk 400 m.

Results

There was a significant intervention by social participation interaction (p = .003). Among individuals with high levels of social participation, those randomized to PA had significantly lower incidence of MMD (hazard ratio [HR], 0.43 [95% confidence interval (CI), 0.27-0.68]; p < .01) than those randomized to HE. Individuals with limited social participation showed no mobility benefit of the PA intervention when compared with their HE counterparts (HR, 0.92 [95% CI, 0.77-1.11]; p = .40).

Discussion

Our findings suggest that baseline social participation is an important factor for the success of a PA intervention aimed at delaying mobility disability.

The Influence of Neighborhood Social Capital on Leisure-Time Physical Activity: a Population-Based Study in Brazil

Environmentally targeted approaches to promote physical activity are emerging in recent years as a complementary strategy to the traditional individual approaches. This study explored the relation between community social capital and leisure-time physical activity in an adult population-based sample in Brazil. We applied a generalized estimating equation approach to analyze a cross-sectional survey of 3667 adults living in 149 neighborhoods. Social capital was assessed by scales that measured collective efficacy and social cohesion in the neighborhood. We find that individuals living in areas with higher level of social cohesion were more likely to be physically active even after controlling for potentially confounding individual and area-level covariates (PR = 1.56; 95% CI = 1.13, 2.16). Collective efficacy was not significantly associated with leisure-time physical activity. Interventions to strengthen social cohesion in the community may be an avenue for promoting physical activity.

Social Capital, Community Capacity, and Health

The capacity to practice health behavior is different for each individual. Community capacity and social capital deal with understanding the relationship between community members and with the factors that promote or delay collective activities. This study examines existing literature in relation to social capital, health, and community capacity. Bonding social capital shows the average value of the extent to which individuals trust each other and participate in groups, whereas bridging social capital shows the average value of the extent to which individuals participate in different formal groups. Community capacity seeks mutual cooperation based on trust, and cohesion minimizes community problems, and it has become evident that such capacity is a useful tool for health improvement.

Perceived neighborhood walkability and physical exercise: An examination of casual communication in a social process

Despite the accumulated evidence for the environmental correlates of physical activity, social processes underlying this association are not entirely clear. This study positions communication characterized by weak ties as a social mechanism linking neighborhood walkability with physical exercise. Data from a survey of Chicago residents show that perceived neighborhood walkability is positively related to frequency of weak-tie communication. Frequency of weak-tie communication is related positively to perceived social cohesion and negatively to anonymity, both of which are significantly related to frequency of physical exercise in the neighborhood. Data also show a sequential indirect relationship involving perceived neighborhood walkability, weak-tie communication, anonymity, and physical exercise. Implications are discussed in terms of the role of communication in promoting locality-based physical exercise.

Body size reference norms and subjective weight status: A gender and life course approach

This paper uses data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) to describe county-level variation in norms regarding physical weight among adolescents in the United States. We demonstrate that regardless of one's physical size, those residing in counties with a heavier weight norm are significantly less likely to see themselves as overweight than those residing in counties with a light weight norm. We further show that the local weight norm during adolescence (Wave 1) is associated with individuals' weight perceptions through adolescence and into young adulthood (Wave 4), though these associations attenuate in strength as respondents age. Our results suggest that weight norms have a stronger influence on weight perceptions among women compared to men and that the role of gender is particularly important during adolescence. We encourage life course researchers to consider the normative health environment during adolescence as an important context for understanding disparities in health and health lifestyles as people age.

Social capital and health in China: exploring the mediating role of lifestyle

Background

Although social capital as a key determinant of health has been well established in various studies, little is known about how lifestyle factors mediate this relationship. Understanding the cross-relationships between social capital, health, and lifestyle factors is important if health promotion policies are to be effective. The purpose of this study is to explore whether different dimensions of social capital and lifestyle factors are related, and whether lifestyle factors mediate the association between social capital and self-rated health (SRH) and psychological well-being (PWB) in China.

Methods

This study used nationally representative data from the 2014 China Family Panel Studies (n = 28,916). The data reported on three dimensions of individual-level social capital: social trust, social relationship and Chinese Communist Party (CCP) membership. Health was assessed using SRH and PWB. Five lifestyle indicators were recorded: healthy diet, physical activity, smoking, sleeping, and non-overweight status. Logistic regression was used to examine the associations between social capital and lifestyle factors, and whether there was a mediating role of lifestyle. Odds ratios relating health status to social capital were reported before and after adjustment for lifestyle factors. Mediation analysis was then used to calculate the total, direct and indirect effects of social capital on SRH and PWB.

Results

The results show that social trust was significantly associated with all five lifestyle factors. Social relationship was significantly associated with four of the five: healthy diet, physical activity, sleeping and non-overweight. CCP membership was only significantly associated with two lifestyle factors: physical activity and non-overweight. Social trust and social relationship were significantly related to both SRH and PWB. CCP membership was only significantly related to SRH. Mediation analysis found modest evidence that lifestyle factors influenced the relationship between all three types of social capital and SRH. In contrast, only social trust and social relationship, but not CCP membership, were mediated by lifestyle factors with respect to PWB.

Conclusions

This study is the first to explore the mediating role of lifestyle factors in the relationship between social capital and health in China. The overall findings suggest that lifestyle factors modestly mediate the association between social capital and health. The degree of mediating effect varies across different dimensions of social capital. Social capital-based health promotion policies would benefit from taking lifestyle factors into account.

Social media indicators of the food environment and state health outcomes

OBJECTIVES

Contextual factors can influence health through exposures to health-promoting and risk-inducing factors. The aim of this study was to (1) build, from geotagged Twitter and Yelp data, a national food environment database and (2) to test associations between state food environment indicators and health outcomes.

STUDY DESIGN

This is a cross-sectional study based upon secondary analyses of publicly available data.

METHODS

Using Twitter's Streaming Application Programming Interface (API), we collected and processed 4,041,521 food-related, geotagged tweets between April 2015 and March 2016. Using Yelp's Search API, we collected data on 505,554 unique food-related businesses. In linear regression models, we examined associations between food environment characteristics and state-level health outcomes, controlling for state-level differences in age, percent non-Hispanic white, and median household income.

RESULTS

A one standard deviation increase in caloric density of food tweets was related to higher all-cause mortality (+46.50 per 100,000), diabetes (+0.75%), obesity (+1.78%), high cholesterol (+1.40%), and fair/poor self-rated health (2.01%). More burger Yelp listings were related to higher prevalence of diabetes (+0.55%), obesity (1.35%), and fair/poor self-rated health (1.12%). More alcohol tweets and Yelp bars and pub listings were related to higher state-level binge drinking and heavy drinking, but lower mortality and lower percent reporting fair/poor self-rated health. Supplemental analyses with county-level social media indicators and county health outcomes resulted in finding similar but slightly attenuated associations compared to those found at the state level.

CONCLUSIONS

Social media can be utilized to create indicators of the food environment that are associated with area-level mortality, health behaviors, and chronic conditions.

Building a National Neighborhood Dataset From Geotagged Twitter Data for Indicators of Happiness, Diet, and Physical Activity

Background

Studies suggest that where people live, play, and work can influence health and well-being. However, the dearth of neighborhood data, especially data that is timely and consistent across geographies, hinders understanding of the effects of neighborhoods on health. Social media data represents a possible new data resource for neighborhood research.

Objective

The aim of this study was to build, from geotagged Twitter data, a national neighborhood database with area-level indicators of well-being and health behaviors.

Methods

We utilized Twitter’s streaming application programming interface to continuously collect a random 1% subset of publicly available geolocated tweets for 1 year (April 2015 to March 2016). We collected 80 million geotagged tweets from 603,363 unique Twitter users across the contiguous United States. We validated our machine learning algorithms for constructing indicators of happiness, food, and physical activity by comparing predicted values to those generated by human labelers. Geotagged tweets were spatially mapped to the 2010 census tract and zip code areas they fall within, which enabled further assessment of the associations between Twitter-derived neighborhood variables and neighborhood demographic, economic, business, and health characteristics.

Results

Machine labeled and manually labeled tweets had a high level of accuracy: 78% for happiness, 83% for food, and 85% for physical activity for dichotomized labels with the F scores 0.54, 0.86, and 0.90, respectively. About 20% of tweets were classified as happy. Relatively few terms (less than 25) were necessary to characterize the majority of tweets on food and physical activity. Data from over 70,000 census tracts from the United States suggest that census tract factors like percentage African American and economic disadvantage were associated with lower census tract happiness. Urbanicity was related to higher frequency of fast food tweets. Greater numbers of fast food restaurants predicted higher frequency of fast food mentions. Surprisingly, fitness centers and nature parks were only modestly associated with higher frequency of physical activity tweets. Greater state-level happiness, positivity toward physical activity, and positivity toward healthy foods, assessed via tweets, were associated with lower all-cause mortality and prevalence of chronic conditions such as obesity and diabetes and lower physical inactivity and smoking, controlling for state median income, median age, and percentage white non-Hispanic.

Conclusions

Machine learning algorithms can be built with relatively high accuracy to characterize sentiment, food, and physical activity mentions on social media. Such data can be utilized to construct neighborhood indicators consistently and cost effectively. Access to neighborhood data, in turn, can be leveraged to better understand neighborhood effects and address social determinants of health. We found that neighborhoods with social and economic disadvantage, high urbanicity, and more fast food restaurants may exhibit lower happiness and fewer healthy behaviors.

Leveraging geotagged Twitter data to examine neighborhood happiness, diet, and physical activity

OBJECTIVES

Using publicly available, geotagged Twitter data, we created neighborhood indicators for happiness, food and physical activity for three large counties: Salt Lake, San Francisco and New York.

METHODS

We utilize 2.8 million tweets collected between February-August 2015 in our analysis. Geo-coordinates of where tweets were sent allow us to spatially join them to 2010 census tract locations. We implemented quality control checks and tested associations between Twitter-derived variables and sociodemographic characteristics.

RESULTS

For a random subset of tweets, manually labeled tweets and algorithm labeled tweets had excellent levels of agreement: 73% for happiness; 83% for food, and 85% for physical activity. Happy tweets, healthy food references, and physical activity references were less frequent in census tracts with greater economic disadvantage and higher proportions of racial/ethnic minorities and youths.

CONCLUSIONS

Social media can be leveraged to provide greater understanding of the well-being and health behaviors of communities-information that has been previously difficult and expensive to obtain consistently across geographies. More open access neighborhood data can enable better design of programs and policies addressing social determinants of health.

"It's Not What You Know but Who You Know": Role of Social Capital in Predicting Risky Injection Drug Use Behavior in a Sample of People who Inject Drugs in Baltimore City

BACKGROUND

Injection drug use is the third highest risk factor for HIV transmission. Injection drug users, marginalized population, continue to be at threat for several health problems, including HIV, Hepatitis B & C and drug overdose. The area of social capital and risk behaviors is understudied. The current study aims to prospectively assess the relationship between social capital and the risk behaviors associated with injection drug use.

METHODS

The sample of the present study is a subset of 130 drug users who reported injection drug use (IDU) at both baseline and first follow-up wave for assessing the relationship between social capital and needle sharing in the city of Baltimore, MD. Factor analysis, structural equation modeling and multivariate logistic regression were conducted to explore these relationships.

RESULTS

A single-factor model fit well with factor loadings ranging from .20 to .95. Social capital is shown to be significantly and inversely associated (p<.05) with 35% decreased odds of the risk of sharing needles with every unit increase in social capital (AOR: 0.65, 95% CI: 0.06, 0.84).

CONCLUSION

The result from this study can be used to inform and fill gaps in the field of harm reduction. The interplay between social support, social participation and norms of trust, reciprocity generated from the index's social network and its relationship with behavior of needle sharing demonstrates that these leverage points should be emphasized in future harm reduction interventions.

Neighbourhood social capital: measurement issues and associations with health outcomes

We compared ecometric neighbourhood scores of social capital (contextual variation) to mean neighbourhood scores (individual and contextual variation), using several health-related outcomes (i.e. self-rated health, weight status and obesity-related behaviours). Data were analysed from 5,900 participants in the European SPOTLIGHT survey. Factor analysis of the 13-item social capital scale revealed two social capital constructs: social networks and social cohesion. The associations of ecometric and mean neighbourhood-level scores of these constructs with self-rated health, weight status and obesity-related behaviours were analysed using multilevel regression analyses, adjusted for key covariates. Analyses using ecometric and mean neighbourhood scores, but not mean neighbourhood scores adjusted for individual scores, yielded similar regression coefficients. Higher levels of social network and social cohesion were not only associated with better self-rated health, lower odds of obesity and higher fruit consumption, but also with prolonged sitting and less transport-related physical activity. Only associations with transport-related physical activity and sedentary behaviours were associated with mean neighbourhood scores adjusted for individual scores. As analyses using ecometric scores generated the same results as using mean neighbourhood scores, but different results when using mean neighbourhood scores adjusted for individual scores, this suggests that the theoretical advantage of the ecometric approach (i.e. teasing out individual and contextual variation) may not be achieved in practice. The different operationalisations of social network and social cohesion were associated with several health outcomes, but the constructs that appeared to represent the contextual variation best were only associated with two of the outcomes.

Psychosocial environment: definitions, measures and associations with weight status--a systematic review

Socio-ecological models suggest that many elements of the social environment act as upstream determinants of obesity. This systematic review examined definitions, measures and strength of associations between the psychosocial environment and adult weight status. Studies were included if they were conducted on adults, the outcome was weight status, carried out in any developed country and investigated at least one psychosocial environmental construct. Six databases for primary studies were searched: EMBASE, MEDLINE, PsycINFO, Scopus, Web of Science and the Cochrane Library. We restricted our search to studies published in English between January 1995 and February 2015. An adapted 'Quality Assessment Tool for Quantitative Studies' was used to evaluate risk of bias of included studies. Out of 14,784 screened records, 42 articles were assessed using full text. A total of 19 studies were included. The strongest associations with weight status were found for social capital and collective efficacy, although few studies found significant associations. There was heterogeneity in the definitions and metrics of psychosocial environmental constructs. There is limited evidence that greater social capital and collective efficacy are associated with healthier weight status. The research conducted to date has not robustly identified relations. We highlight challenges to undertaking research and establishing causality in this field and provide recommendations for further research.

Associations of Neighborhood and School Socioeconomic and Social Contexts With Body Mass Index Among Urban Preadolescent Students

OBJECTIVES

We examined independent and synergistic effects of school and neighborhood environments on preadolescent body mass index (BMI) to determine why obesity rates nearly double during preadolescence.

METHODS

Physical measures and health surveys from fifth and sixth graders in 12 randomly selected schools in New Haven, Connecticut, in 2009 were matched to student sociodemographics and school- and residential census tract-level data, for a total of 811 urban preadolescents. Key independent variables included school connectedness, neighborhood social ties, and school and neighborhood socioeconomic status. We estimated cross-classified random-effects hierarchical linear models to examine associations between key school and neighborhood characteristics with student BMI.

RESULTS

Greater average connectedness felt by students to their school was significantly associated with lower BMI. This association was stronger among students living in neighborhoods with higher concentrations of affluent neighbors.

CONCLUSIONS

How schools engage and support students may affect obesity rates preferentially in higher-income neighborhoods. Further research should explore the associations between multiple environments to which children are exposed and obesity-related behaviors and outcomes. This understanding of the multiple social-spatial contexts that children occupy has potential to inform comprehensive and sustainable child obesity prevention efforts.

Interrelation of Sport Participation, Physical Activity, Social Capital and Mental Health in Disadvantaged Communities: A SEM-Analysis

BACKGROUND

The Health through Sport conceptual model links sport participation with physical, social and psychological outcomes and stresses the need for more understanding between these outcomes. The present study aims to uncover how sport participation, physical activity, social capital and mental health are interrelated by examining these outcomes in one model.

METHODS

A cross-sectional survey was conducted in nine disadvantaged communities in Antwerp (Belgium). Two hundred adults (aged 18-56) per community were randomly selected and visited at home to fill out a questionnaire on socio-demographics, sport participation, physical activity, social capital and mental health. A sample of 414 adults participated in the study.

RESULTS

Structural Equation Modeling analysis showed that sport participation (β = .095) and not total physical activity (β = .027) was associated with better mental health. No association was found between sport participation and community social capital (β = .009) or individual social capital (β = .045). Furthermore, only community social capital was linked with physical activity (β = .114), individual social capital was not (β = -.013). In contrast, only individual social capital was directly associated with mental health (β = .152), community social capital was not (β = .070).

CONCLUSION

This study emphasizes the importance of sport participation and individual social capital to improve mental health in disadvantaged communities. It further gives a unique insight into the functionalities of how sport participation, physical activity, social capital and mental health are interrelated. Implications for policy are that cross-sector initiatives between the sport, social and health sector need to be supported as their outcomes are directly linked to one another.

Social Capital as a Determinant of Self-Rated Health in Women of Reproductive Age: A Population-Based Study

Introduction:

Recognition of the factors related to women’s health is necessary. Evidence is available that the social structure including social capital plays an important role in the shaping people’s health. The aim of the current study was to investigate the association between self-rated health and social capital in women of reproductive age.

Methods:

This study is a population-based cross-sectional survey on 770 women of reproductive age, residing in any one of the 22 municipality areas across Tehran (capital of Iran) with the multi stage sampling technique. Self-rated health (Dependent variable), social capital (Independent variable) and covariates were studied. Analysis of data was done by one-way ANOVA test and multiple linear regressions.

Results:

Depending on logistic regression analyses, the significant associations were found between self-rated health and age, educational level, crowding index, sufficiency of income for expenses and social cohesion. Data show that women with higher score in social cohesion as an outcome dimension of social capital have better self-rated health (PV = 0.001).

Conclusion:

Given the findings of this study, the dimensions of social capital manifestations (groups and networks, trust and solidarity, collective action and cooperation) can potentially lead to the dimensions of social capital outcomes (social cohesion and inclusion, and empowerment and political action). Following that, social cohesion as a dimension of social capital outcomes has positively relationship with self- rated health after controlling covariates. Therefore, it is required to focus on the social capital role on health promotion and health policies.

Social capital, socioeconomic status, and health-related quality of life among older adults in Bogotá (Colombia)

OBJECTIVE

The main goal of this study was to evaluate the relationship between levels of cognitive social capital and health-related quality of life (HRQOL).

METHODS

A multilevel, cross-sectional study was conducted in 2007 in Bogotá Colombia. A total of 1,907 older adults completed the Spanish version of the Short Form of Health Survey (SF-8) to assess HRQOL. Cognitive dimension of social capital was assessed. Hierarchical linear regressions were conducted to determine the associations between social capital variables and HRQOL.

RESULTS

Only 20% to 25% of the population reported trust in others and shared values. A total of 93% percent reported that people in their neighborhood would try to take advantage of them if given a chance. Higher social capital indicators were positively associated with the mental and physical dimensions of HRQOL.

DISCUSSION

Results from this study support evidence on the disintegration of the Colombian society, which may be influenced by high levels of social inequality.

The Interaction Between an Individual's Acculturation and Community Factors on Physical Inactivity and Obesity: A Multilevel Analysis

OBJECTIVES

We examined whether the interactions between primarily speaking English at home and community-level measures (median household income and immigrant composition) are associated with physical inactivity and obesity.

METHODS

We pooled the 2005 and 2007 Los Angeles County Health Survey data to construct a multilevel data set, with community-level median household income and immigrant density as predictors at the community level. After controlling for individual-level demographic variables, we included the respondent's perceived community safety as a covariate to test the hypothesis that perceived public safety mediates the association between acculturation and health outcomes.

RESULTS

The interaction between community median household income and primarily speaking English at home was associated with lower likelihoods of physical inactivity (odds ratio [OR] = 0.644; 95% confidence interval [CI] = 0.502, 0.825) and obesity (OR = 0.674; 95% CI = 0.514, 0.882). These odds remained significant after we controlled for perceived community safety.

CONCLUSIONS

Resources in higher-income areas may be beneficial only to residents fully integrated into the community. Future research could focus on understanding how linguistic isolation affects community-level social learning and access to resources and whether this differs by family-level acculturation.

Structural social capital and health in Italy

This paper presents the first empirical assessment of the causal relationship between social capital and health in Italy. The analysis draws on the 2000 wave of the Multipurpose Survey on Household conducted by the Italian Institute of Statistics on a representative sample of the population (n=46,868). Our measure of social capital is the frequency of meetings with friends. Based on IV and bivariate probit estimates, we find that individuals who meet friends every day or more time times a week are approximately 11-16% more likely to report good health.

Moderators of the longitudinal relationship between the perceived physical environment and outside play in children: the KOALA birth cohort study

OBJECTIVES

Promoting unstructured outside play is a promising vehicle to increase children's physical activity (PA). This study investigates if factors of the social environment moderate the relationship between the perceived physical environment and outside play.

STUDY DESIGN

1875 parents from the KOALA Birth Cohort Study reported on their child's outside play around age five years, and 1516 parents around age seven years. Linear mixed model analyses were performed to evaluate (moderating) relationships among factors of the social environment (parenting influences and social capital), the perceived physical environment, and outside play at age five and seven. Season was entered as a random factor in these analyses.

RESULTS

Accessibility of PA facilities, positive parental attitude towards PA and social capital were associated with more outside play, while parental concern and restriction of screen time were related with less outside play. We found two significant interactions; both involving parent perceived responsibility towards child PA participation.

CONCLUSION

Although we found a limited number of interactions, this study demonstrated that the impact of the perceived physical environment may differ across levels of parent responsibility.