A multilevel study of the role of social capital in shaping chronic disease risk behavior

Most current approaches to the prevention of chronic disease focus on individual agency. These individualized, acontextualized high-risk strategies have had limited success, partly due to the reliance on behavioral change to the exclusion of considerations of context. Research indicates that there are macro-level structural and contextual influences on population health that cannot be reduced to individual or compositional effects. This multilevel study investigated the associations between community social context and residents' self-reported behavior linking secondary data (2001 Behavioral Risk Factor Surveillance System, 2000 Social Capital Community Benchmark Study), in order for individuals (N = 25,932) to be placed in their respective communities (N = 27). Dimensions of social capital included social trust, informal social engagement, organizational activism, and mutual aid. Three common risk factors of study included physical inactivity, being overweight or obese, and smoking. Although little evidence was found demonstrating an association between social capital and obesity or smoking, findings did support the role of social capital in influencing physical activity. Specifically, compelling evidence was found for one dimension of social capital, with those living in communities with stronger social trust reporting lower odds of inactivity (OR 0.55, 95% CI 0.33-0.93). Public health implications of these findings include prevention efforts aimed at wider levels of influence which may inhibit or promote behavior, possibly through policy initiatives aimed at enhancing community capacity. By using data expressly collected to study the effects of social capital, this study provides additional knowledge on the contextual influences in which risk behavior occurs.