Teen births, income inequality, and social capital: developing an understanding of the causal pathway

Utilizing social determinants of health to identify most vulnerable neighborhoods-Latent class analysis and GIS map

OBJECTIVES

Public Health officials are often challenged to effectively allocate limited resources. Social determinants of health (SDOH) may cluster in areas to cause unique profiles related to various adverse life events. The authors use the framework of unintended teen pregnancies to illustrate how to identify the most vulnerable neighborhoods.

METHODS

This study used data from the U.S. American Community Survey, Princeton Eviction Lab, and Connecticut Office of Vital Records. Census tracts are small statistical subdivisions of a county. Latent class analysis (LCA) was employed to separate the 832 Connecticut census tracts into four distinct latent classes based on SDOH, and GIS mapping was utilized to visualize the distribution of the most vulnerable neighborhoods. GEE Poisson regression model was used to assess whether latent classes were related to the outcome. Data were analyzed in May 2021.

RESULTS

LCA's results showed that class 1 (non-minority non-disadvantaged tracts) had the least diversity and lowest poverty of the four classes. Compared to class 1, class 2 (minority non-disadvantaged tracts) had more households with no health insurance and with single parents; and class 3 (non-minority disadvantaged tracts) had more households with no vehicle available, that had moved from another place in the past year, were low income, and living in renter-occupied housing. Class 4 (minority disadvantaged tracts) had the lowest socioeconomic characteristics.

CONCLUSIONS

LCA can identify unique profiles for neighborhoods vulnerable to adverse events, setting up the potential for differential intervention strategies for communities with varying risk profiles. Our approach may be generalizable to other areas or other programs.

KEY MESSAGES

What is already known on this topic Public health practitioners struggle to develop interventions that are universally effective. The teen birth rates vary tremendously by race and ethnicity. Unplanned teen pregnancy rates are related to multiple social determinants and behaviors. Latent class analysis has been applied successfully to address public health problems. What this study adds While it is the pregnancy that is not planned rather than the birth, access to pregnancy intention data is not available resulting in a dependency on teen birth data for developing public health strategies. Using teen birth rates to identify at-risk neighborhoods will not directly represent the teens at risk for pregnancy but rather those who delivered a live birth. Since teen birth rates often fluctuate due to small numbers, especially for small neighborhoods, LCA may avoid some of the limitations associated with direct rate comparisons. The authors illustrate how practitioners can use publicly available SDOH from the Census Bureau to identify distinct SDOH profiles for teen births at the census tract level. How this study might affect research, practice or policy These profiles of classes that are at heightened risk potentially can be used to tailor intervention plans for reducing unintended teen pregnancy. The approach may be adapted to other programs and other states to prioritize the allocation of limited resources.

When everyone's doing it: The relative effects of geographical context and social determinants of health on teen birth rates

Geographic disparities in teen birth rates in the U.S. persist, despite overall reductions over the last two decades. Research suggests these disparities might be driven by spatial variations in social determinants of health (SDOH). An alternative view is that "place" or "geographical context" affects teen birth rates so that they would remain uneven across the U.S. even if all SDOH were constant. We use multiscale geographically weighted regression (MGWR) to quantify the relative effects of geographical context, independent of SDOH, on county-level teen birth rates across the U.S. Findings indicate that even if all counties had identical compositions with respect to SDOH, strong geographic disparities in teen birth rates would still persist. Additionally, local parameter estimates show the relationships between several components of SDOH and teen birth rates vary over space in both direction and magnitude, confirming that global regression techniques commonly employed to examine these relationships likely obscure meaningful contextual differences in these relationships. Findings from this analysis suggest that reducing geographic disparities in teen birth rates will require not only ameliorating differences in SDOH across counties but also combating community norms that contribute to high rates of teen birth, particularly in the southern U.S. Further, the results suggest that if geographical context is not incorporated into models of SDOH, the effects of such determinants may be interpreted incorrectly.

A systematic review and meta-analysis of the relationship between economic inequality and prosocial behaviour

How does economic inequality relate to prosocial behaviour? Existing theories and empirical studies from multiple disciplines have produced mixed results. Here we conduct a systematic review and meta-analysis to systematically synthesize empirical studies. Results from 192 effect sizes and over 2.5 million observations in 100 studies show that the relationship varies from being negative to positive depending upon the study (95% prediction interval -0.450 to 0.343). However, on average, there is a small, negative relationship between economic inequality and prosocial behaviour (r = -0.064, P = 0.004, 95% confidence interval -0.106 to -0.021). There is generally no evidence that results depend upon characteristics of the studies, participants, the way prosocial behaviour and inequality were assessed, and the publication discipline. Given the prevalence of economic inequality and the importance of prosocial behaviour, this systematic review and meta-analysis provides a timely study on the relationship between economic inequality and prosocial behaviour.

The buffering effect of social capital for daily mental stress in an unequal society: a lesson from Seoul

This study attempted to illustrate whether mental health deterioration could be alleviated by high social capital in an environment with high economic inequality. Daily mental stress was employed as a mental health factor when analyzing the association with economic inequality in the Seoul Survey data. Regarding social capital, community trust and altruism were included as cognitive dimensions, and participation and cooperation were included as structural dimensions in each model. The first finding showed a significantly positive relationship between economic inequality and daily stress, meaning that, like other mental health problems, daily mental stress is also high in regions with high economic inequality. Second, the slope of the daily stress increased in respondents with high social trust and participation was alleviated in an economically unequal environment. This indicates that social trust and participation have a buffering effect by moderating the slope of daily stress in societies with high inequality. Third, the buffering effect differs depending on the social capital factor. The buffering effect of trust and participation showed in an unequal environment, while the buffering effect of cooperation showed regardless of the unequal environment. In summary, social capital factors showed the effect of relieving daily mental stress in the relationship with economic inequality. Also, the buffering effect of social capital on mental health may show different aspects for each element.

A Bibliometric Analysis of Research on Social Cohesion from 1994–2020

Social cohesion is recognised as the glue that holds societies together and is connected to numerous positive social outcomes. Many authors have defined the term and its dimensions, leading to a wide range of different perspectives. Indeed, an array of dimensions have emerged as researchers have conceptualized social cohesion based on the theoretical assumptions of their disciplines. This wide range of disciplinary contributions has created a rich but muddled research field. In line with the growing recognition of social cohesion, there is a need to better understand social cohesion’s evolution and status within broader academic research. Thus, this study has two main objectives: (i) to analyse the nature and evolution of literature related to social cohesion and (ii) to identify the thematic areas related to social cohesion research and their connections to specific disciplines. To achieve this, a bibliometric analysis of 5027 journal articles listed in the Web of Science (WoS) was conducted. Through this, a substantial increase in research activity was noted, and the broad, multidisciplinary nature of the research is also illustrated. However, there remains room for further collaboration across disciplines as well as research exploring how different social groups and institutions contribute to social cohesion.

Effects of Social Capital and Leisure Participation on Self-Rated Health of Urban Residents in Southwest China

Background: Leisure provides opportunities for urban and rural residents to relax, recover their vitality, and improve their personal growth, development, and well-being. However, the impact of the leisure participation process, types, obstacles, participation motivation, and satisfaction on health is not very clear, especially the impact of leisure behavior on health, and is worthy of in-depth discussion.

Objective: The objective of this study was to explore the impact of social capital and leisure participation on the self-rated health of urban residents in China so as to provide an important reference for national health promotion activities.

Methods: the questionnaire on the relationship between social capital, leisure behavior, and self-rated health was compiled by ourselves. The residents participating in leisure and fitness in 25 residential fitness centers in Chengdu were investigated in the morning and evening, and the obtained data were processed by exploratory and confirmatory factor analysis.

Results: (1) Social capital had no direct influence on leisure hindrance; leisure motivation and leisure participation had no direct influence on self-rated health. (2) Leisure satisfaction has a direct positive impact on self-rated health, while leisure hindrance has a significant negative impact on self-rated health. (3) Social capital has a direct positive impact on leisure satisfaction, and social capital has a direct positive impact on self-rated health. Leisure satisfaction plays an intermediary role in the path of social capital affecting self-rated health, and the intermediary force exceeds the direct impact of social capital on self-rated health.

Conclusion: The effect of leisure satisfaction on self-rated health is higher than that of social capital, and it plays an intermediary role in the impact path of social capital on self-rated health. Therefore, how to make urban community residents with different backgrounds obtain leisure satisfaction through leisure activities is an important topic of national health promotion.

Perceptions of adolescent pregnancy in the rural context and the Colombian armed conflict: a qualitative approach based on social determination of health

Background

Adolescent pregnancy in rural areas is a persistent health problem that has still not properly been understood. Studies with qualitative perspectives that address this phenomenon as a complex social process, which involves the recognition of the voices of the actors involved and the analysis of the specific context in which it takes place, are limited.

Objective

This research explored the perceptions of young people and other social actors (municipalities of Palmira and El Cerrito in Colombia) of the social forces and dimensions of the social determination of adolescent pregnancy in the Amaime river basin. These geographic areas have been scenes of armed violence with various groups in combat within the context of a long-standing political conflict in Colombia. After the 2016 Havana agreements were signed, peacebuilding has been underway in its territories.

Methods

A qualitative study that implemented focus groups and semi-structured interviews was conducted. The theoretical approach of social determination of health proposed by Breilh was used to study the social process entailed in adolescent pregnancy. Perceptions about social conditions, specific ways of life, and lifestyles were addressed. Galtung and Fischer’s theoretical approach on violence and peacebuilding was also incorporated to enrich the understanding of the Colombian context. The analysis was conducted with approaches from phenomenology.

Results

Living conditions with strong social stigma and demand for social, political, and cultural opportunities were found. Regarding ways of life, little communication and information about sex education was perceived. As for lifestyles, there are youthful behaviors infused by sociocultural traditions that affect life projects and sexual behavior. Gender relations are precarious, and there are various types of violence that limit effective peacebuilding.

Conclusions

This study contributes to a priority issue in sexual and reproductive health, with an approach that generates analytical elements to comprehensively expand the social and health interventions required.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01568-2.

Child Language Difficulties and Internalizing and Externalizing Symptoms: A Meta-Analysis

This study conducted two meta-analyses to synthesize the association between children's language skills and two broad-band dimensions of psychopathology: internalizing and externalizing. Pooled estimates across 139 samples (externalizing k = 105; internalizing k = 90) and 147,305 participants (age range: 2-17 years old; mean % males: 53.75; mean % White participants: 55.59; mean % minority participants: 43.12) indicated small but significant associations between child language skills and externalizing problems (Hedges' g = .22) and between language skills and internalizing problems (Hedges' g = .23). The association between language difficulties and externalizing problems was stronger amongst males and in children with low versus high sociodemographic risk. Implications of the results for theory and practice are discussed.

Association Between Paternal Separation During Early Childhood and Pubertal Timing Among Girls Using Longitudinal Birth Cohort in Japan

INTRODUCTION

Previous studies have shown that paternal absence leads to earlier pubertal timing among girls in high-income countries. Despite the low divorce rate in Japan, paternal separation is commonly seen due to a unique corporation system, tanshin funin, where employees relocate with their spouses and children. We examined paternal separation, including paternal absence (due to divorce or paternal death) and paternal tanshin funin, during early childhood as a predictor of earlier girl's pubertal development, assessed as age at peak height velocity (PHV).

METHODS

This study examined 15 214 girls from a longitudinal survey conducted in Japan from 2001 to 2016 by the Ministry of Health, Labor and Welfare. Paternal separation was determined by the occurrence through annual surveys conducted at ages 0.5 to 4.5 years. Outcome was defined as age at PHV between ages 6 to 15 years. We conducted linear regression, adjusted for potential confounders and other covariates.

RESULTS

Continuous father cohabitation was seen in 88.7% of households, while paternal separation was experienced 1-2, 3-4 and 5 times (always) among 7.4%, 2.8% and 1.1% of households, respectively. Girls who confronted continuous paternal separation (5 times) experienced 0.42 years earlier [95% confidence interval (CI): -0.75, -0.10] age at PHV compared to their peers who always lived with their fathers.

CONCLUSION

Girls who experienced paternal separation throughout ages 0.5 to 4.5 years experienced PHV earlier.

Targeted High-Risk Youth in Missouri PREP: Understanding Program Impacts on Youth Sexual Behavior Intentions

Background

Missouri Personal Responsibility Education Program (PREP) provides sexual health education programs to youth with goals of reducing unintended teen pregnancies. Theories of change provide that youth improve their sexual health knowledge, intentions, attitudes, and behaviors as a result of program implementation. Program evaluations are needed to assess the degree to which PREP programs are meeting their goals of improving youth outcomes.

Objective

The purpose of this study is to examine youth sexual intentions to use a condom, engage in sexual behavior, and abstain from sex as a result of Missouri PREP program implementation. We evaluate the effectiveness of the Missouri program in modifying youth intentions toward healthier planned behaviors.

Methods

All programs required youth to take pre- and post-program surveys. For this study, we evaluate a sample of 1,335 youth's pre- and post-survey intentions related to condom use, sex, and abstention. We utilize t-tests as well as a lagged logistic regression approach to account for youth's respective pre-intentions.

Results

Youth's scores on intentions, knowledge, and attitudes rise from pre- to post-survey. Knowledge gains are salient while attitudes remain relatively high and stable. Intentions to use condoms differ from those in intentions to have or abstain from sex. Program change in intentions to use a condom are highest among the three intention outcomes.

Conclusions

Missouri PREP saw improvements in knowledge, attitudes, and intentions as a result of program implementation. Findings suggest that the Missouri PREP program is effective at positively influencing youth intentions to engage in risky or sexual behavior.

Using Social Indicators to Describe Neighborhood-Level Disparities in Adolescent Health in Baltimore City Circa 2017

PURPOSE

The purpose of this study was to use social indicators to compare adolescent health disparities across neighborhoods in Baltimore, Maryland, circa 2017. Neighborhoods heavily influence adolescent health outcomes. Baltimore remains a hypersegregated city along racial boundaries with a recently growing population of Latino immigrant youth. This segregation may promulgate adolescent health disparities, yet the magnitude of needs and how they may differ among Baltimore's minoritized adolescents remain unknown.

METHODS

The most predominantly white, black, and Latino neighborhoods in Baltimore were analyzed across six indicators relevant to adolescent health: teen birth rate, high school achievement, poverty, health insurance, youth mortality rate, and lead paint violation rate. The indicators were used to create a composite adolescent deprivation index. Measures of absolute and relative disparity were then calculated between white, black, and Latino neighborhood clusters.

RESULTS

Both black and Latino neighborhoods had similar adolescent deprivation relative to white neighborhoods. Latino neighborhoods had the highest teen birth rate and children without health insurance. Black neighborhoods had the lowest educational achievement and the highest poverty, youth mortality, and lead paint violation rate.

CONCLUSIONS

The overall magnitude of social deprivation is similar across communities of color in Baltimore. However, black adolescents tend to live in neighborhoods with greater physical deprivation and youth mortality that limits within-group bonding capacity, whereas Latino adolescents tend to live in neighborhoods with limited health and social resources that prevent between-group bridging capacity. These indicators thus orient policies and programs to promote differential asset-based strategies for positive youth development.

Income inequality and social gradients in children's height: a comparison of cohort studies from five high-income countries

BACKGROUND

Health and well-being are better, on average, in countries that are more equal, but less is known about how this benefit is distributed across society. Height is a widely used, objective indicator of child health and predictor of lifelong well-being. We compared the level and slope of social gradients in children's height in high-income countries with different levels of income inequality, in order to investigate whether children growing up in all socioeconomic circumstances are healthier in more equal countries.

METHODS

We conducted a coordinated analysis of data from five cohort studies from countries selected to represent different levels of income inequality (the USA, UK, Australia, the Netherlands and Sweden). We used standardised methods to compare social gradients in children's height at age 4-6 years, by parent education status and household income. We used linear regression models and predicted height for children with the same age, sex and socioeconomic circumstances in each cohort.

RESULTS

The total analytic sample was 37 063 children aged 4-6 years. Gradients by parent education and household income varied between cohorts and outcomes. After adjusting for differences in age and sex, children in more equal countries (Sweden, the Netherlands) were taller at all levels of parent education and household income than children in less equal countries (USA, UK and Australia), with the greatest between-country differences among children with less educated parents and lowest household incomes.

CONCLUSIONS

The study provides preliminary evidence that children across society do better in more equal countries, with greatest benefit among children from the most disadvantaged socioeconomic groups.

Contextual Variation in Early Adolescent Childbearing: A Multilevel Study From 33,822 Communities in 44 Low- and Middle-Income Countries

PURPOSE

Existing literature calls for a deeper examination into how local context influences adolescent sexual and reproductive health outcomes. We seek to describe individual and contextual variation in early adolescent childbearing (younger than 16 years) in 44 low- and middle-income countries by (1) examining the role of individual-level social disadvantage, (2) exploring the ecological influence of context at the country and community level, and (3) assessing whether ecological effects vary according to a woman's wealth.

METHODS

We used nationally representative data from 33,822 communities in 44 low- and middle-income countries. We employed multilevel modeling to examine the variation in early adolescent childbearing apportioned to the individual, community, and country levels.

RESULTS

Globally, poverty and low educational attainment are associated with early adolescent childbearing. After accounting for individual-level characteristics, significant residual variance remains at both the community and country levels. Routine, individual-level covariates explain 46.4% of the total variance at the community level and 21.3% of the total variance at the country level in relation to the baseline, age-adjusted model. The variance apportioned to the community level is estimated to equal 43.5% (95% confidence interval: .40, .49) of the total variance among the poorest women compared with 32.6% (95% confidence interval: .25, .39) among the richest women. Across countries, we find substantial heterogeneity in the variance observed at the community level.

CONCLUSIONS

Our results point to the need for a continued focus on multilevel interventions that include approaches to target both the individual and population levels. More research is needed to identify the mechanisms through which local context influences adolescent sexual and reproductive health outcomes.

Community social capital and individual functioning in the post-disaster context

Disasters can have severe and long-lasting consequences for individuals and communities. While scholarly evidence indicates that access to social support can ameliorate their negative impacts, less understood is whether or not neighbourhood social capital can facilitate recovery. This study uses two waves of survey data-collected before and after a significant flood in Brisbane, Australia, in 2011-to examine the relationship between the severity of the event at the individual and neighbourhood level, access to neighbourhood social capital and individual-level social support, and functioning in the post-disaster environment. In line with previous research, the results indicate that the severity of the flood is the most salient predictor of post-disaster functioning. No evidence was unearthed to show that neighbourhood social capital amassed before the flood leads to better functioning subsequently, but the findings do suggest that individual-level social support can moderate the effect of flood severity on functioning.

Behavioral Health and Adult Milestones in Young Adults With Perinatal HIV Infection or Exposure

BACKGROUND

Young adults living with perinatally acquired HIV infection (PHIVYAs) are at risk for poor biomedical and behavioral health outcomes. Few studies offer a comprehensive overview of the functioning of this population in young adulthood and the role of HIV.

METHODS

Data come from the Child and Adolescent Self-Awareness and Health Study, a longitudinal behavioral health cohort study of PHIVYAs and perinatally HIV-exposed but uninfected young adults (PHEUYAs) who are compared on psychiatric and neurocognitive functioning, sexual and substance use behaviors, health and reproductive outcomes, and young adult milestones.

RESULTS

Overall, 27% of participants met criteria for a psychiatric disorder, including mood (11%), anxiety (22%), and substance use (28%), with no HIV status differences. PHIVYAs performed worse on 2 neurocognitive tests. There were no HIV status differences in condomless sex (41%) or pregnancies (41% women; 38% men). Both groups exhibited similar adult milestones: 67% graduated high school or an equivalent, 19% were in college, and 42% were employed. However, 38% were neither in school or working, 12% reported incarceration, and 16% were ever homeless. Among PHIVYAs, 36% were viremic (>200 copies per mL), and 15% were severely immunocompromised (CD4+ cell count <100 cells per mm3).

CONCLUSIONS

Many PHIVYAs achieve adult milestones related to school, employment, sexual relationships, and starting families. However, they and PHEUYAs have high rates of psychiatric and substance use disorders and behavioral risks, which can jeopardize long-term health and adult functioning, particularly in the context of HIV. These findings underscore an urgent need to escalate interventions.

How Neighborhood Effects Vary: Childbearing and Fathering among Latino and African American Adolescents

This study examines what neighborhood conditions experienced at age 15 and after are associated with teen childbearing and fathering among Latino and African American youth and whether these neighborhood effects vary by gender and/or ethnicity. Administrative and survey data from a natural experiment are used for a sample of 517 Latino and African American youth whose families were quasi-randomly assigned to public housing operated by the Denver (CO) Housing Authority (DHA). Characteristics of the neighborhood initially assigned by DHA to wait list applicants are utilized as identifying instruments for the neighborhood contexts experienced during adolescence. Cox Proportional Hazards (PH) models reveal that neighborhoods having higher percentages of foreign-born residents but lower levels of social capital robustly predict reduced odds of teen parenting though the magnitude of these effects was contingent on gender and ethnicity. Specifically, the presence of foreign-born neighbors on the risk of teen parenting produced a stronger dampening effect for African American youth when compared to Latino youth. Additionally, the effects of social capital on teen parenting were stronger for males than females.

Impact of social service and public health spending on teenage birth rates across the USA: an ecological study

OBJECTIVE

To examine whether greater state-level spending on social and public health services such as income, education and public safety is associated with lower rates of teenage births in USA.

DESIGN

Ecological study.

SETTING

USA.

PARTICIPANTS

50 states.

PRIMARY OUTCOME MEASURE

Our primary outcome measure was teenage birth rates. For analyses, we constructed marginal models using repeated measures to test the effect of social spending on teenage birth rates, accounting for several potential confounders.

RESULTS

The unadjusted and adjusted models across all years demonstrated significant effects of spending and suggested that higher spending rates were associated with lower rates of teenage birth, with effects slightly diminishing with each increase in spending (linear effect: B=-0.20; 95% CI -0.31 to 0.08; p<0.001 and quadratic effect: B=0.003; 95% CI 0.002 to 0.005; p<0.001).

CONCLUSION

Higher state spending on social and public health services is associated with lower rates of teenage births. As states seek ways to limit healthcare costs associated with teenage birth rates, our findings suggest that protecting existing social service investments will be critical.

Global Trends in Adolescent Fertility, 1990-2012, in Relation to National Wealth, Income Inequalities, and Educational Expenditures

PURPOSE

National wealth, income inequalities, and expenditures on education can profoundly influence the health of a nation's women, children, and adolescents. We explored the association of trends in national socioeconomic status (SES) indicators with trends in adolescent birth rates (ABRs), by nation and region.

METHODS

An ecologic research design was employed using national-level data from the World Bank on birth rates per 1,000 women aged 15-19 years, national wealth (per capita gross domestic product or GDP), income inequality (Gini index), and expenditures on education as a percentage of GDP (EduExp). Data were available for 142 countries and seven regions for 1990-2012. Multiple linear regression for repeated measures with generalized estimating equations was used to examine independent associations.

RESULTS

ABRs in 2012 varied >200-fold-with the highest rates in Sub-Saharan Africa and lowest rates in the Western Europe/Central Asia region. The median national ABR fell 40% from 72.4/1,000 in 1990 to 43.6/1,000 in 2012. The largest regional declines in ABR occurred in South Asia (70%), Europe/Central Asia (63%), and the Middle East/North Africa (53%)-regions with lower income inequality. In multivariable analyses considering change over time, ABRs were negatively associated with GDP and EduExp and positively associated with greater income inequality.

CONCLUSIONS

ABRs have declined globally since 1990. Declines closely followed rising socioeconomic status and were greater where income inequalities were lower in 1990. Reducing poverty and income inequalities and increasing investments in education should be essential components of national policies to prevent adolescent childbearing.

Social Determinants and Teen Pregnancy Prevention: Exploring the Role of Nontraditional Partnerships

Addressing the social determinants of health (SDOH) that influence teen pregnancy is paramount to eliminating disparities and achieving health equity. Expanding prevention efforts from purely individual behavior change to improving the social, political, economic, and built environments in which people live, learn, work, and play may better equip vulnerable youth to adopt and sustain healthy decisions. In 2010, the Centers for Disease Control and Prevention in partnership with the Office of Adolescent Health funded state- and community-based organizations to develop and implement the Teen Pregnancy Prevention Community-Wide Initiative. This effort approached teen pregnancy from an SDOH perspective, by identifying contextual factors that influence teen pregnancy and other adverse sexual health outcomes among vulnerable youth. Strategies included, but were not limited to, conducting a root cause analysis and establishing nontraditional partnerships to address determinants identified by community members. This article describes the value of an SDOH approach for achieving health equity, explains the integration of such an approach into community-level teen pregnancy prevention activities, and highlights two project partners' efforts to establish and nurture nontraditional partnerships to address specific SDOH.

Early parenthood as a link between childhood disadvantage and adult heart problems: A gender-based approach

Drawing on conceptual models of critical periods, major life transitions, and life pathways, we proposed that the life-course features of parenthood are important, but understudied, mechanisms for explaining possibly gendered heart-health outcomes. Using three waves from the Midlife in the U.S. Study (MIDUS), we investigated (a) gender differences in the timing of the transition to parenthood as a pathway linking childhood SES disadvantage to onset of heart problems and (b) life-course factors (which vary by gender) that link the timing of the transition to parenthood to adult heart problems. We found that individuals who were disadvantaged in childhood were more likely to have their first child as teenagers or in early young adulthood. For women only, an early transition to parenthood partially explained the association between childhood disadvantage and onset of heart problems. Furthermore, women who had their first child at younger ages, particularly in their teens, had lower rates of college graduation, more financial difficulties, higher levels of depressive symptoms, and greater risk of smoking and obesity in midlife. These factors partially accounted for the association between early parenthood and onset of heart problems in later life. Our findings underscore the significance of the timing of the transition to parenthood in specifying the associations between childhood disadvantage and adult heart problems. Various factors are involved, including low adult SES, psychological distress, and unhealthy lifestyles.

Community social capital on the timing of sexual debut and teen birth in Nicaragua: a multilevel approach

Background

Community attributes have been gradually recognized as critical determinants shaping sexual behaviors in young population; nevertheless, most of the published studies were conducted in high income countries. The study aims to examine the association between community social capital with the time to sexual onset and to first birth in Central America.

Methods

Building upon the 2011/12 Demographic and Health Survey conducted in Nicaragua, we identified a sample of 2766 community-dwelling female adolescents aged 15 to 19 years. Multilevel survival analyses were performed to estimate the risks linked with three domains of community social capital (i.e., norms, resource and social network).

Results

Higher prevalence of female sexual debut (norms) and higher proportion of secondary school or higher education (resource) in the community are associated with an earlier age of sexual debut by 47 % (p < 0.05) and 16 %, respectively (p < 0.001). Living in a community with a high proportion of females having a child increases the hazard of teen birth (p < 0.001) and resource is negatively associated with teen childbearing (p < 0.05). Residential stability and community religious composition (social network) were not linked with teen-onset sex and birth.

Conclusions

The norm and resource aspects of social capital appeared differentially associated with adolescent sexual and reproductive behaviors. Interventions aiming to tackle unfavorable sexual and reproductive outcomes in young people should be devised and implemented with integration of social process.

Searching for social capital: historical perspectives on health, poverty and culture

Social capital has been seen as having a positive effect on health, and the concept of social capital has been viewed as of central importance to debates about healthy, sustainable communities. More generally, behaviour and its relationship with health has become much more central to policy-making, as illustrated in the Choosing Health White Paper (2005), and the concept of social capital has been one influence on the concept of social exclusion. Robert Putnam’s arguments, both those expressed in Making Democracy Work (1993) and the revised version seen in Bowling Alone (2000) have been taken up by numerous social scientists and policy-makers. But despite the explicitly historical perspective that Putnam employs in Bowling Alone in particular, the history of social capital remains rather neglected in the available literature. This article is concerned with providing a historical perspective on social capital, especially the ways in which social investigators have viewed the relationships between health, poverty and behaviour. The article puts social capital alongside that of ‘underclass’ concepts such as the culture of poverty thesis, and examines how the latter has been invented and reinvented in the UK and the USA over the last 120 years. It argues that there are important similarities between the culture of poverty and social capital, but also significant differences, and these have implications for current policy initiatives. One way of analysing concepts like social capital and social exclusion more rigorously is by locating them within this longer-term history of social investigation, in which debates about health, poverty, and culture have been of key significance.

Neighborhood income inequality, social capital and emotional distress among adolescents: A population-based study

Theory holds that income inequality may harm adolescent mental health by reducing social capital within neighborhood communities. However, research on this topic has been very limited. We use multilevel data on 102 public schools and 5958 adolescents in Iceland (15 and 16 years old) to examine whether income inequality within neighborhoods is associated with emotional distress in adolescents. Moreover, we test whether indicators of social capital, including social trust and embeddedness in neighborhood social networks, mediate this contextual effect. The findings show that neighborhood income inequality positively influences emotional distress of individual adolescents, net of their personal household situations and social relations. However, although the indicators of social capital negatively influence emotional distress, they do not mediate the contextual effect of neighborhood income inequality. The study illustrates the role of economic disparities in adolescent mental health, but calls for more research on the underlying social and social-psychological mechanisms.

The Relative State Model: Integrating Need-Based and Ability-Based Pathways to Risk-Taking

Who takes risks, and why? Does risk-taking in one context predict risk-taking in other contexts? We seek to address these questions by considering two non-independent pathways to risk: need-based and ability-based. The need-based pathway suggests that risk-taking is a product of competitive disadvantage consistent with risk-sensitivity theory. The ability-based pathway suggests that people engage in risk-taking when they possess abilities or traits that increase the probability of successful risk-taking, the expected value of the risky behavior itself, and/or have signaling value. We provide a conceptual model of decision-making under risk-the relative state model-that integrates both pathways and explicates how situational and embodied factors influence the estimated costs and benefits of risk-taking in different contexts. This model may help to reconcile long-standing disagreements and issues regarding the etiology of risk-taking, such as the domain-generality versus domain-specificity of risk or differential engagement in antisocial and non-antisocial risk-taking.

Changing Sociodemographic Factors and Teen Fertility: 1991-2009

This study analyzed the roles of trends in sociodemographic factors known to be related to the risk of a teen birth. The goal was to analyze the roles of these trends in maternal education, family structure and mother's age at first birth in the likelihood of adolescents becoming teen mothers across multiple birth cohorts of women covering the years since 1991. Data are from the 1995, 2002, 2006-2010 and 2011-2013 National Surveys of Family Growth (NSFG). Consecutive birth cohorts of female respondents were constructed and retrospectively followed to estimate the risk of a teen birth for each cohort. Logistic regression models estimate the odds of a teen birth across cohorts and within strata of the predictors across cohorts. Maternal education rose across cohorts; the proportion who were non-Hispanic white declined. In general, the likelihood of an adolescent birth did not change within categories of the predictors that are considered at higher risk for a teen birth across birth cohorts. Specifically, there was no change in the odds of a teen birth among women whose mothers did not finish high school, those born to teen mothers and those not from two-parent families. The odds of a birth declined across cohorts for black women. The findings suggest that much of the decline in teen birth rates is due to declines in the proportion of teens in higher risk categories, rather than to declines within those categories.

Inequality and Risk-Taking

Inequality has been associated with risk-taking at the societal level. However, this relationship has not been directly investigated at the individual level. Risk-sensitivity theory predicts that decision makers should increase risk-taking in situations of disparity between one's present state and desired state. Economic inequality creates such a disparity. In two experiments, we examined whether imposed economic inequality affects risk-taking. In Experiment 1, we examined whether victims of inequality engaged in greater risk-taking compared to beneficiaries of inequality and those not experiencing inequality. In Experiment 2, we examined whether ameliorating inequality for victims reduced risk-taking. In both experiments, victims of inequality engaged in greater risk-taking compared to beneficiaries of inequality and those not experiencing inequality. Among victims, amelioration of inequality contributed to decreased risk-taking. These findings provide further evidence in support of risk-sensitivity theory and suggest that reductions in economic inequality may lead to lower risk-taking.

Income inequality is associated with adolescent fertility in Brazil: a longitudinal multilevel analysis of 5,565 municipalities

Background

Brazil has one of the highest adolescent fertility rates in the world. Income inequality has been frequently linked to overall adolescent health, but studies that analyzed its association with adolescent fertility have been performed only in developed countries. Brazil, in the past decade, has presented a rare combination of increasing per capita income and decreasing income inequality, which could influence future desirable pathways for other countries.

Methods

We analyzed every live birth from 2000 and from 2010 in each of the 5,565 municipalities of Brazil, a total of 6,049,864 births, which included 1,247,145 (20.6%) births from women aged 15 to 19. Income inequality was assessed by the Gini Coefficient and adolescent fertility by the ratio between the number of live births from women aged 15 to 19 and the number of women aged 15 to 19, calculated for each municipality. We first applied multilevel models separately for 2000 and 2010 to test the cross-sectional association between income inequality and adolescent fertility. We then fitted longitudinal first-differences multilevel models to control for time-invariant effects. We also performed a sensitivity analysis to include only municipality with satisfactory birth record coverage.

Results

Our results indicate a consistent and positive association between income inequality and adolescent fertility. After controlling for per capita income, college access, youth homicide rate and adult fertility, higher income inequality was significantly associated with higher adolescent fertility for both 2000 and 2010. The longitudinal multilevel models found similar results. The sensitivity analysis indicated that the results for the association between income inequality and adolescent fertility were robust. Adult fertility was also significantly associated with adolescent fertility in the cross-sectional and longitudinal models.

Conclusion

Income inequality is expected to be a leading concern for most countries in the near future. Our results suggest that changes in income inequality are positively and consistently associated with changes in adolescent fertility.

Decision-Making Under Risk: Integrating Perspectives From Biology, Economics, and Psychology

Decision-making under risk has been variably characterized and examined in many different disciplines. However, interdisciplinary integration has not been forthcoming. Classic theories of decision-making have not been amply revised in light of greater empirical data on actual patterns of decision-making behavior. Furthermore, the meta-theoretical framework of evolution by natural selection has been largely ignored in theories of decision-making under risk in the human behavioral sciences. In this review, I critically examine four of the most influential theories of decision-making from economics, psychology, and biology: expected utility theory, prospect theory, risk-sensitivity theory, and heuristic approaches. I focus especially on risk-sensitivity theory, which offers a framework for understanding decision-making under risk that explicitly involves evolutionary considerations. I also review robust empirical evidence for individual differences and environmental/situational factors that predict actual risky decision-making that any general theory must account for. Finally, I offer steps toward integrating various theoretical perspectives and empirical findings on risky decision-making.

Improving adolescent health policy: incorporating a framework for assessing state-level policies

Many US policies that affect health are made at the state, not the federal, level. Identifying state-level policies and data to analyze how different policies affect outcomes may help policy makers ascertain the usefulness of their public policies and funding decisions in improving the health of adolescent populations. A framework for describing and assessing the role of federal and state policies on adolescent health and well-being is proposed; an example of how the framework might be applied to the issue of teen childbearing is included. Such a framework can also help inform analyses of whether and how state and federal policies contribute to the variation across states in meeting adolescent health needs. A database on state policies, contextual variables, and health outcomes data can further enable researchers and policy makers to examine how these factors are associated with behaviors they aim to impact.

Social capital at work: psychometric analysis of a short scale in Spanish among Mexican health workers

Most studies on social capital and health are carried out with large home-based surveys, neglecting that many interactions among individuals occur in the workplace. The objective of this study was to explore the psychometric properties of a scale in Spanish used to measure social capital at work. The scale designed by Kouvonen et al was translated into Spanish and tested under classical test theory, item response theory, and confirmatory factorial analysis; 152 public health workers from different socio-cultural contexts participated in the survey. Internal consistency was high (Chronbach's alpha = 0.88). Social capital at work correlated properly with two Job Content Questionnaire dimensions. A ceiling effect was detected and item difficulty was quantified. The confirmatory factor analysis showed the expected theoretical components of social capital: bonding, bridging and trust. The scale has acceptable psychometric properties, thus it can be used in future studies.

Does neighbourhood social capital aid in levelling the social gradient in the health and well-being of children and adolescents? A literature review

Background

Although most countries in the European Union are richer and healthier than ever, health inequalities remain an important public health challenge. Health-related problems and premature death have disproportionately been reported in disadvantaged neighbourhoods. Neighbourhood social capital is believed to influence the association between neighbourhood deprivation and health in children and adolescents, making it a potentially interesting concept for policymakers.

Methods

This study aims to review the role of social capital in health inequalities and the social gradient in health and well-being of children and adolescents. A systematic review of published quantitative literature was conducted, focussing on (1) the mediating role of neighbourhood social capital in the relationship between socio-economic status (SES) and health-related outcomes in children and adolescents and (2) the interaction between neighbourhood social capital and socio-economic characteristics in relation to health-related outcomes in children and adolescents. Three electronic databases were searched. Studies executed between 1 January 1990 and 1 September 2011 in Western countries (USA, New Zealand, Australia and Europe) that included a health-related outcome in children or adolescents and a variable that measured neighbourhood social capital were included.

Results

Eight studies met the inclusion criteria for the review. The findings are mixed. Only two of five studies confirmed that neighbourhood social capital mediates the association between neighbourhood deprivation and health and well-being in adolescents. Furthermore, two studies found a significant interaction between neighbourhood socio-economic factors and neighbourhood social capital, which indicates that neighbourhood social capital is especially beneficial for children who reside in deprived neighbourhoods. However, two other studies did not find a significant interaction between SES and neighbourhood social capital. Due to the broad range of studied health-related outcomes, the different operationalisations of neighbourhood social capital and the conceptual overlap between measures of SES and social capital in some studies, the factors that explain these differences in findings remain unclear.

Conclusions

Although the findings of this study should be interpreted with caution, the results suggest that neighbourhood social capital might play a role in the health gradient among children and adolescents. However, only two of the included studies were conducted in Europe. Furthermore, some studies focussed on specific populations and minority groups. To formulate relevant European policy recommendations, further European-focussed research on this issue is needed.

The association of neighbourhood and individual social capital with consistent self-rated health: a longitudinal study in Brazilian pregnant and postpartum women

BACKGROUND

Social conditions, social relationships and neighbourhood environment, the components of social capital, are important determinants of health. The objective of this study was to investigate the association of neighbourhood and individual social capital with consistent self-rated health in women between the first trimester of pregnancy and six months postpartum.

METHODS

A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two groups: 1. Good SRH--good SRH at baseline and follow-up, and, 2. Poor SRH--poor SRH at baseline and follow-up. Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable), individual social capital (social support and social networks), demographic and socioeconomic characteristics, health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to test the association between neighbourhood and individual social capital and SRH, adjusted for covariates.

RESULTS

The Good SRH group reported higher scores of social support and social networks than the Poor SRH group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association was not significant when individual socio-demographic variables were included in the model. In the final model, women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37-0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house.

CONCLUSIONS

Low individual social capital during pregnancy, considered here as social support and social network, was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women's SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of individual social capital explained better the consistency of SRH over time than neighbourhood social capital.

Pregnancy desire among a sample of young couples who are expecting a baby

CONTEXT

Adolescents' desire for a pregnancy has been explored more among females than among males. A more comprehensive understanding of teenagers' pregnancy desires is needed to inform pregnancy prevention efforts and to support couples as they undergo the transition to parenthood.

METHODS

In an observational cohort study conducted in 2007-2011 at clinics in Connecticut, data were collected from 296 couples (females aged 14-21 and their partners) who were expecting a baby. The degree to which each partner had wanted the pregnancy and partners' perceptions of each other's pregnancy desires were assessed. Multilevel regression models examined associations between pregnancy desire and individual, partner, family and community characteristics, and between desire and life and relationship satisfaction.

RESULTS

Forty-nine percent of females and 53% of males reported having wanted the pregnancy. Pregnancy desire scores were positively associated with being male, expecting a first baby, perceived partner desire and parental response to the pregnancy; scores were negatively associated with being in school, being employed and parental support. Females' perceptions of their partners' pregnancy desires were slightly more accurate than males' (kappas, 0.36 and 0.28, respectively). Pregnancy desire was positively associated with both life and relationship satisfaction, particularly among males.

CONCLUSIONS

Adolescents' pregnancy desires require further attention as a possible focus of pregnancy prevention efforts, and health care providers may want to ensure that young couples with unwanted pregnancies are offered additional psychological and social services as they transition to parenthood.

Adolescence and the social determinants of health

The health of adolescents is strongly affected by social factors at personal, family, community, and national levels. Nations present young people with structures of opportunity as they grow up. Since health and health behaviours correspond strongly from adolescence into adult life, the way that these social determinants affect adolescent health are crucial to the health of the whole population and the economic development of nations. During adolescence, developmental effects related to puberty and brain development lead to new sets of behaviours and capacities that enable transitions in family, peer, and educational domains, and in health behaviours. These transitions modify childhood trajectories towards health and wellbeing and are modified by economic and social factors within countries, leading to inequalities. We review existing data on the effects of social determinants on health in adolescence, and present findings from country-level ecological analyses on the health of young people aged 10-24 years. The strongest determinants of adolescent health worldwide are structural factors such as national wealth, income inequality, and access to education. Furthermore, safe and supportive families, safe and supportive schools, together with positive and supportive peers are crucial to helping young people develop to their full potential and attain the best health in the transition to adulthood. Improving adolescent health worldwide requires improving young people's daily life with families and peers and in schools, addressing risk and protective factors in the social environment at a population level, and focusing on factors that are protective across various health outcomes. The most effective interventions are probably structural changes to improve access to education and employment for young people and to reduce the risk of transport-related injury.

Flexibility in reproductive timing in human females: integrating ultimate and proximate explanations

From an ultimate perspective, the age of onset of female reproduction should be sensitive to variation in mortality rates, and variation in the productivity of non-reproductive activities. In accordance with this prediction, most of the cross-national variation in women's age at first birth can be explained by differences in female life expectancies and incomes. The within-country variation in England shows a similar pattern: women have children younger in neighbourhoods where the expectation of healthy life is shorter and incomes are lower. I consider the proximate mechanisms likely to be involved in producing locally appropriate reproductive decisions. There is evidence suggesting that developmental induction, social learning and contextual evocation may all play a role.

Family care-giving and decisions about entry to care: a rural perspective

The aim of this qualitative study was to explore rural family carers' experiences of the nursing home placement of an older relative. The study was undertaken in a large Health and Social Care Trust in Northern Ireland using a grounded theory approach. Purposive sampling was used to initiate data collection and thereafter theoretical sampling was employed. Semi-structured interviews were conducted with 29 relatives of nursing home residents and the resultant data were recorded, transcribed and analysed using constant comparisons. The software package, QSR NVivo, was used to facilitate data management and retrieval. Older people had deep attachments to their homes and entry to care was a last resort. Rural family carers had close relationships with health- and social-care practitioners and felt supported in the decision-making process. The choice of home was a foregone conclusion for carers who had a strong sense of familiarity with the nursing homes in their area. This familiarity was influenced by the relatively rural communities in which respondents resided and by an efficient ‘grapevine’, which seemed to thrive in these small communities. This familiarity, in turn, influenced the choice of nursing home, timing of the placement and responses of family carers. The findings indicate that issues such as rurality and familiarity warrant a more detailed exploration in future research on entry to care.

Income inequality, trust, and population health in 33 countries

OBJECTIVES

I examined the association between income inequality and population health and tested whether this association was mediated by interpersonal trust or public expenditures on health.

METHODS

Individual data on trust were collected from 48 641 adults in 33 countries. These data were linked to country data on income inequality, public health expenditures, healthy life expectancy, and adult mortality. Regression analyses tested for statistical mediation of the association between income inequality and population health outcomes by country differences in trust and health expenditures.

RESULTS

Income inequality correlated with country differences in trust (r = -0.51), health expenditures (r = -0.45), life expectancy (r = -0.74), and mortality (r = 0.55). Trust correlated with life expectancy (r = 0.48) and mortality (r = -0.47) and partly mediated their relations to income inequality. Health expenditures did not correlate with life expectancy and mortality, and health expenditures did not mediate links between inequality and health.

CONCLUSIONS

Income inequality might contribute to short life expectancy and adult mortality in part because of societal differences in trust. Societies with low levels of trust may lack the capacity to create the kind of social supports and connections that promote health and successful aging.

Beyond the income inequality hypothesis and human health: a worldwide exploration

OBJECTIVE: To analyze whether the relationship between income inequality and human health is mediated through social capital, and whether political regime determines differences in income inequality and social capital among countries. METHODS: Path analysis of cross sectional ecological data from 110 countries. Life expectancy at birth was the outcome variable, and income inequality (measured by the Gini coefficient), social capital (measured by the Corruption Perceptions Index or generalized trust), and political regime (measured by the Index of Freedom) were the predictor variables. Corruption Perceptions Index (an indirect indicator of social capital) was used to include more developing countries in the analysis. The correlation between Gini coefficient and predictor variables was calculated using Spearman's coefficients. The path analysis was designed to assess the effect of income inequality, social capital proxies and political regime on life expectancy. RESULTS: The path coefficients suggest that income inequality has a greater direct effect on life expectancy at birth than through social capital. Political regime acts on life expectancy at birth through income inequality. CONCLUSIONS: Income inequality and social capital have direct effects on life expectancy at birth. The "class/welfare regime model" can be useful for understanding social and health inequalities between countries, whereas the "income inequality hypothesis" which is only a partial approach is especially useful for analyzing differences within countries.

Differences in income-related inequality and horizontal inequity in ambulatory care use between rural and non-rural areas: using the 1998-2001 U.S. National Health Interview Survey data

Background

To better understand income-related inequalities in health care use, it is imperative to identify sources of inequalities and assess the extent to which health care use is still related to income after differences in need across the income distribution are accounted for. Little is known regarding rural-urban differences in income-related inequalities and subgroup variation in horizontal inequities in health care use. This study decomposes income-related inequalities in ambulatory care use into contributions of need and non-need factors and compares horizontal inequities of subgroups in rural and non-rural areas.

Methods

This analysis used non-elderly adult samples from the 1998 to 2001 U.S. National Health Interview Survey data. The area of residence was categorized as rural for non-Metropolitan Statistical Area (MSA) and non-rural for MSA. Concentration indices of ambulatory care use were used to gauge income-related inequalities and decomposed into contributing factors. Horizontal inequities were measured using two methods and the results were compared.

Results

Ambulatory care use was disproportionately concentrated in the poor before need adjustment. However, the results of decomposition and horizontal inequity analyses indicate that the pro-poor concentration of health care use was due to greater health care need in low-income groups. Adjusting for need, ambulatory care use was distributed favoring the better-off, to a larger degree in non-rural areas. Health-related variables were the major contributors to income-related inequalities. Non-need factors, including socioeconomic factors, health insurance, and usual source of care, also contributed to income-related inequalities. There were variation in determinants' contributions to income-related inequalities between rural and non-rural populations and subgroup differences in horizontal inequities. Horizontal inequities were greater within non-whites, high school graduates, individuals with private health insurance, and those without a usual source of care with some geographic variation.

Conclusions

Our analysis shows that seemingly pro-poor income-related inequalities in ambulatory care use were largely due to greater health care need among low-income groups. The results demonstrate different contributions of determinants to income-related inequalities and variation in horizontal inequities by subgroup and locale. The findings of this study should help identify targets for policy intervention for each rural and non-rural area.

Neighborhood racial composition, social capital and black all-cause mortality in Philadelphia

Neighborhood characteristics such as racial composition and social capital have been widely linked to health outcomes, but the direction of the relationship between these characteristics and health of minority populations is controversial. Given this uncertainty, we examined the relationship between neighborhood racial composition, social capital, and black all-cause mortality between 1997 and 2000 in 68 Philadelphia neighborhoods. Data from the U.S. Census, the Philadelphia Health Management Corporation's 2004 Southeast Pennsylvania Community Health Survey, and city vital statistics were linked by census tract and then aggregated into neighborhoods, which served as the unit of analysis. Neighborhood social capital was measured by a summative score of respondent assessments of: the livability of their community, the likelihood of neighbors helping one another, their sense of belonging, and the trustworthiness of their neighbors. After adjustment for the sociodemographic characteristics of neighborhood residents, black age-adjusted all-cause mortality was significantly higher in neighborhoods that had lower proportion of black residents. Neighborhood social capital was also associated with lower black mortality, with the strongest relationship seen for neighborhoods in the top half of social capital scores. There was a significant interaction between racial composition and social capital, so that the effect of social capital on mortality was greatest in neighborhoods with a higher proportion of black residents and the effect of racial composition was greatest in neighborhoods with high social capital. These results demonstrate that age-adjusted all-cause black mortality is lowest in mostly black neighborhoods with high levels of social capital in Philadelphia.

Examining the influences of gender, race, ethnicity, and social capital on the subjective health of adolescents

We investigate the factors that influence adolescent self-assessed health, based upon surveys conducted between 2000 and 2004 of high-school seniors in Washington State (N=6853). A large proportion of the sample (30%) was first and second generation immigrants from Asia, Latin America, and Eastern Europe. Findings include a robust negative effect of female gender on self-reported health that is largely unmodified by demographic, developmental, social capital, and parental support variables, gender differences in the covariates of self-reported health, and the tendency of male adolescents of Cambodian and Vietnamese origin to report lower levels of self-reported health despite controls for other health-related individual characteristics. Social capital dimensions such as positive school affiliation, social network cohesion, and a safe learning environment were found to covary with the self-reported health of adolescent females.

Measuring neighborhood connection and the association with violence in young adolescents

PURPOSE

The objectives of this study were to construct measures of adolescent neighborhood connection and test the association of these measures with violence-related behaviors.

METHODS

This study uses data from the baseline Lead Peace-Plus evaluation survey completed by sixth-grade students (n = 118). The survey was conducted in Fall 2006 in four urban community schools with similar ethnically diverse and economically disadvantaged student bodies. The survey instrument, tailored for adolescents, included questions about violence involvement in the past year, as well as youth perceptions of and interactions with others in their neighborhood. Exploratory factor analysis was employed to construct neighborhood connectedness scales. Mixed-model logistic regression was used to examine relationships of these scales with students' violent behaviors, adjusting for age, gender and ethnicity.

RESULTS

Exploratory factor analysis yielded two factors. The first factor, intention to contribute, was composed of five items (alpha = .86) that indicated whether adolescents value and intend to work to improve their neighborhoods. The factor, neighborhood social resources, was composed of eight items (alpha = .76) that reflected adolescents' familiarity with neighbors and perceptions that their neighbors could provide support. Students with lower levels of both neighborhood connection measures were more likely to report violent behaviors in the past year. However, the trends were statistically significant only for relationships between intention to contribute and violence indicators.

CONCLUSIONS

Neighborhood connection can be measured with reliability in middle school students. Cultivating young adolescents' intentions to contribute to their neighborhoods may be an effective strategy for reducing youth violence.

“Around here, they roll up the sidewalks at night”: A qualitative study of youth living in a rural Canadian community

The paper is based on an ethnographic study conducted in a rural community in British Columbia, Canada. The study examined the impact of community culture on youth's development as sexual beings. We describe how social and geographical forces intersect to affect youth's lives and trace the ways in which deprivation of various forms of capital as well as social practices contribute to some youth being located in undesirable social positions. Our findings illustrate how the effects of stigmatisation, self-segregation, and other forms of symbolic violence can extend beyond health impacts and into the broader social realm.

The problems of relative deprivation: why some societies do better than others

In this paper, we present evidence which suggests that key processes of social status differentiation, affecting health and numerous other social outcomes, take place at the societal level. Understanding them seems likely to involve analyses and comparisons of whole societies. Using income inequality as an indicator and determinant of the scale of socioeconomic stratification in a society, we show that many problems associated with relative deprivation are more prevalent in more unequal societies. We summarise previously published evidence suggesting that this may be true of morbidity and mortality, obesity, teenage birth rates, mental illness, homicide, low trust, low social capital, hostility, and racism. To these we add new analyses which suggest that this is also true of poor educational performance among school children, the proportion of the population imprisoned, drug overdose mortality and low social mobility. That ill health and a wide range of other social problems associated with social status within societies are also more common in more unequal societies, may imply that income inequality is central to the creation of the apparently deep-seated social problems associated with poverty, relative deprivation or low social status. We suggest that the degree of material inequality in a society may not only be central to the social forces involved in national patterns of social stratification, but also that many of the problems related to low social status may be amenable to changes in income distribution. If the prevalence of these problems varies so much from society to society according to differences in income distribution, it suggests that the familiar social gradients in health and other outcomes are unlikely to result from social mobility sorting people merely by prior characteristics. Instead, the picture suggests that their frequency in a population is affected by the scale of social stratification that differs substantially from one society to another.

New directions in European public health research: report of a workshop

Public health draws from a range of academic disciplines, social, medical and statistical, and answers questions relevant to improving the health of populations. We have initiated a Europe-wide study, Strengthening Public Health Research in Europe, to assess the development and use of public health research in both public policy and local decision making. The contemporary challenge for public health research is to integrate the capabilities of different academic disciplines to address policies for health. We have considered the development of public health research in five fields: political epidemiology, community health, health services, economics, and evaluation evidence and synthesis. The organisation and funding of research in Europe should be able to support new research fields and issues, to contribute to policy development and public health practice.

Obesity, physical activity, and the urban environment: public health research needs

Persistent trends in overweight and obesity have resulted in a rapid research effort focused on built environment, physical activity, and overweight. Much of the focus of this research has been on the design and form of suburbs. It suggests that several features of the suburban built environment such as low densities, poor street connectivity and the lack of sidewalks are associated with decreased physical activity and an increased risk of being overweight. But compared to suburban residents, inner city populations have higher rates of obesity and inactivity despite living in neighborhoods that are dense, have excellent street connectivity and who's streets are almost universally lined with sidewalks. We suggest that the reasons for this apparent paradox are rooted in the complex interaction of land use, infrastructure and social factors affecting inner city populations. Sometimes seemingly similar features are the result of very different processes, necessitating different policy responses to meet these challenges. For example, in suburbs, lower densities can result from government decision making that leads to restrictive zoning and land use issues. In the inner city, densities may be lowered because of abandonment and disinvestment. In the suburbs, changes in land use regulations could result in a healthier built environment. In inner cities, increasing densities will depend on reversing economic trends and investment decisions that have systematically resulted in distressed housing, abandoned buildings and vacant lots. These varying issues need to be further studied in the context of the totality of urban environments, incorporating what has been learned from other disciplines, such as economics and sociology, as well as highlighting some of the more successful inner city policy interventions, which may provide examples for communities working to improve their health. Certain disparities among urban and suburban populations in obesity and overweight, physical activity and research focus have emerged that are timely to address. Comparable research on the relationship of built environment and health is needed for urban, especially inner city, neighborhoods.

Capital social e a agenda de pesquisa em epidemiologia

Capital social é definido como as características da organização social, tais como confiança interpessoal, normas de reciprocidade e redes solidárias, que capacitam os participantes a agir coletivamente e mais eficientemente, na busca de objetivos e metas comuns. Um número crescente de pesquisas, em sua maioria produzidas em países industrializados, sugere que sociedades com altos níveis de capital social possuem taxas mais baixas de mortalidade, maior expectativa de vida, são menos violentas e avaliam melhor a sua saúde. O principal objetivo deste artigo é revisar a relação entre capital social e saúde. Primeiramente, capital social é conceituado e as críticas que têm sido feitas quanto ao seu uso são discutidas. Em seguida, são apresentados os principais instrumentos de aferição adotados. Logo após é descrito o relacionamento entre capital social e saúde e, por último, considerações são feitas quanto ao seu uso na realidade brasileira. Capital social, se utilizado com maior rigor e atenção às dificuldades teórico-metodológicas que apresenta, pode ampliar a agenda de pesquisa em epidemiologia, contribuindo para um melhor entendimento de como enfrentar efetivamente as desigualdades em saúde.

Social environment and physical activity: a review of concepts and evidence

The rapidly growing and evolving literature on the social environment and its influence on health outcomes currently lacks a clear taxonomy of dimensions of the social environment and the differing mechanisms through which each influences health-related behavior. This paper identifies five dimensions of the social environment-social support and social networks, socioeconomic position and income inequality, racial discrimination, social cohesion and social capital, and neighborhood factors-and considers each in the context of physical activity to illustrate important differences between them. Increasing the specificity of terminology and methods in social environmental research on health will enable more systematic inquiry and accelerate the rate of scientific discovery in this important area.