Journal of Urban Health

, Volume 79, Supplement 1, pp S21–S34 | Cite as

Social trust and self-rated health in US communities: a multilevel analysis

  • S. V. Subramanian
  • Daniel J. Kim
  • Ichiro Kawachi

Abstract

This study assessed the contextual and individual effects of social trust on health. Methods consisted of a multilevel regression analysis of self-rated poor health among 21,456 individuals nested within 40 US communities included in the 2000 Social Capital Community Benchmark Survey. Controlling for demographic covariates, a strong income and education gradient was observed for self-rated health. Higher levels of cominunity social trust were associated with a lover probability of reporting poor health. Individual demographic and socioeconomic preditors did not explain the association of community social trust with self-rated health. Controlling for individual trust perception, however, rendered the main effect of community social trust statistically insignificant, but a complex interaction effect was observed, such that the health-promoting effect of community social trust was significantly greater for high-trust individuals. For low-trust individuals, the effect of community social trust on self-rated health was the opposite. Using the latest data available on community social trust, we conclude that the role of community social trust in explaining average population health achievements and health inequalities is complex and is contingent on individual perceptions of social trust. Future multilevel investigations of social capital and population health should routinely consider the cross-level nature of community or neighborbood effects.

References

  1. 1.
    Coleman JS. Foundations of Social Theory, Cambridge, MA: Harvard University Press; 1990.Google Scholar
  2. 2.
    Portes A. Social capital: its origins and applications in modern sociology. Annu Rev Sociol. 1998;24:1–24.CrossRefGoogle Scholar
  3. 3.
    Harpam T, Grant E, Thomas E. Measuring social capital within health surveys: key issues. Health Policy Plan. 2002;17:106–111.CrossRefGoogle Scholar
  4. 4.
    Putnam RD. Bowling alone: the collapse and revival of American community New York: Simon and Schuster; 2000.Google Scholar
  5. 5.
    Kawachi I, Berkman LF. Social cohesion, social capital, and health. In: Berkman LF, Kawachi I, eds. Social Epidemiology. New York. Oxford University Press; 2000:174–190.Google Scholar
  6. 6.
    Lochner K, Kawachi I, Kennedy BP. Social capital: a guide to its measurement. Health Place, 1999;5:259–270.CrossRefPubMedGoogle Scholar
  7. 7.
    Kawachi I, Kennedy BP, Lochner K, Prothrow-Stith D. Social capital, income inequality and mortality. Am J Public Health. 1997;87:1491–1498.PubMedCrossRefGoogle Scholar
  8. 8.
    Kawachi I, Kennedy BP, Glass R. Social capital and self-rated health: a contextual analysis. Am J Public Health. 1999;89:1187–1193.PubMedGoogle Scholar
  9. 9.
    Subramanian SV, Kawachi I, Kennedy BP. Does the state you live in make a difference? Multilevel analysis of self-rated health in the US. Soc Sci Med. 2001;53:9–19.CrossRefGoogle Scholar
  10. 10.
    Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science, 1997;277:918–924.CrossRefPubMedGoogle Scholar
  11. 11.
    Lochner K, Kawachi I, Brennan RT, Buka SL. Social capital and neighborhood mortality rates in Chicago, Soc Sci Med. 2002. In press.Google Scholar
  12. 12.
    Subramanian, SV, Lochner K, Kawachi I. Neighborhood differences in social capital in the US: compositional artifact or a contextual construct? Health Place. In press.Google Scholar
  13. 13.
    Research TRCfPO. The Social Capital Benchmark Survey (Data Codebook). Storrs, CT: The Roper Center for Public Opinion Research; 2002.Google Scholar
  14. 14.
    Bryk AS, Raudenbush SW, Hierarchical Linear Models: Applications and Data Analysis Methods. Newbury Park, England: Sage Publications; 1992.Google Scholar
  15. 15.
    Goldstein H. Multilevel Statistical Models: 2nd ed. London: Arnold; 1995.Google Scholar
  16. 16.
    Subramanian SV, Jones K, Duncan C. Multilevel methods for public health research. In: Kawachi I, Berkman LF, eds. Neighborboods and Health. New York: Oxford University Press. In press.Google Scholar
  17. 17.
    Goldstein H. Nonlinear multilevel models, with an application to discrete response data. Biometrika. 1991;78:45–51.CrossRefGoogle Scholar
  18. 18.
    Rasbash I, Browne W, Goldstein H, et al. A User's Guide to MLwiN, Version 2.1 London: Multilevel Models Project, Institute of Education, University of London; 2000.Google Scholar
  19. 19.
    Goldstein H, Rasbash J. Improved approximations for multilevel models with binary responses. J R Stat Soc A. 1996;159:505–513.Google Scholar
  20. 20.
    Lynch J, Due P, Muntaner C. Social capital—is it a good investment strategy for public health. J Epidemiol Community Health, 2000;54:404–408.CrossRefPubMedGoogle Scholar
  21. 21.
    Macintyre S, Ellaway A. Ecological approaches: rediscovering the role of physical and social environment. In: Berkman LF, Kawachi I, eds, Social Epidemiology, New York: Oxford Press; 2000:332–348.Google Scholar
  22. 22.
    Gladwell M. The Tipping Point. Boston, MA: Little, Brown and Company; 2000.Google Scholar
  23. 23.
    Crane J. The epidemic theory of ghettos and neighborhood effects on dropping out and teenage childbearing. Am J Sociol. 1989;95:1226–1259.Google Scholar
  24. 24.
    Ellen IG, Mijanovich T, Dillman K-N. Neighborhood effects on health: exploring the links and assessing the evidence. J Urban Aff. 2001;23:391–408.CrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2002

Authors and Affiliations

  • S. V. Subramanian
    • 1
  • Daniel J. Kim
    • 1
  • Ichiro Kawachi
    • 1
  1. 1.Department of Health and Social BehaviorHarvard School of Public HealthBoston

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