Integrating community social capital concepts into behavioral theories and interventions

Health behavior theories state that social environments influence health behaviors, but theories of how this occurs are under-developed. For example, collective efficacy is an isolated community level construct, despite growing evidence that related social capital concepts are associated with health behaviors. We explore community social capital concepts, defined as resources available within community social networks, and discuss their utility in behavioral theories and interventions. A systematic literature review produced 53 studies examining the relationships between community social capital concepts and avoidance of smoking (19 studies), engaging in physical activity (38 studies), and consuming a healthy diet (2 studies). Only 2 of 6 studies found that individuals were more likely to engage in physical activity or to smoke if the community social norms supported it, but modeling of physical activity in the neighborhood was consistently associated with increased activity in 15 studies. Trusting community members was consistently associated with health behaviors in 18 studies. Living in an area with a good sense of community was positively associated with physical activity in only 5 of 16 studies. Reciprocal helpfulness of neighbors, measured in 10 studies, was positively associated with health behaviors in 3 studies, but negatively associated in one study. Likewise, neighborhood collective efficacy was inconsistently associated with health behaviors in 22 studies. In summary, social capital shows both positive and negative associations with health behaviors. Behavioral theories will be strengthened by inclusion, rigorous measurement and testing of social capital concepts in interventions. Also, interventions should be tailored to community social capital.