(Mis)Use of social cohesion as a health indicator in predominantly African-American neighborhoods

Background: Research suggests neighborhood social cohesion is linked to health outcomes. However, the mechanisms are not well known and this construct has not been widely studied among African-American neighborhoods, especially using qualitative methods. The study purpose was to assess the utility of social cohesion as a determinant of health within African-American neighborhoods.

Methodology: Residents from eight historically-disadvantaged neighborhoods in Greenville, SC were engaged in a mixed-methods study throughout 2014. First, 76 residents participated in eight focus groups where they described their neighborhood context as it relates to their health. Next, 411 adults completed a household survey measuring social cohesion (5-item scale), self-rated health (SRH), and demographics. Factor analysis examined the inter-correlation between five social cohesion items and regression analyses tested the association between social cohesion and SRH.

Results: Participants portrayed their neighborhood as a family, whom they trusted but with whom they did not necessarily get along. Residents reported higher levels of willingness to help their neighbors (M=3.40), and lower levels of shared values with their neighbors (M=3.05). While higher values of social cohesion were associated with better SRH (b=2.50, p<.01), the factor analysis supported a two-factor solution (eigenvalues>1.0).

Conclusion:  Findings from this study suggest that while social cohesion is associated with SRH in residents living in historically-disadvantaged neighborhoods, the construct measures various aspects of the social environment and its association with health should be interpreted cautiously. Such findings have relevance for public health policies and practices aiming to intervene on social cohesion to reduce health disparities in diverse communities.