文章基本信息

标题：Social Capital and Health: Civic Engagement, Community Size, and Recall of Health Messages
本地全文：下载
作者：Kasisomayajula Viswanath ; Whitney Randolph Steele ; John R. Finnegan Jr 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：8
页码：1456-1461
DOI：10.2105/AJPH.2003.029793
语种：English
出版社：American Public Health Association
摘要：Objectives . We explored the effects of community integration and pluralism on recall of cardiovascular disease health information messages. Methods . With 1980–1983 data from the Minnesota Heart Health Program, we examined whether ties to community groups were associated with recall of health messages, and whether this relation was modified by size and degree of differentiation of the community. Results . A higher level of civic engagement through ties to community groups was associated with better recall of health messages. Ties to community groups independently contributed to better message recall even after control for gender, education, and other variables. The moderating role of community size was non-significant but intriguing. Conclusions . Community group membership could increase exposure to health messages, providing a critical pathway for social capital to influence health promotion and, thus, public health outcomes. In the past decade, public health researchers have begun to explore the relation between social capital and health outcomes, 1 ^– 10 and the topic has engendered much debate and controversy on the meaning of social capital. 3 ^, 11 ^– 16 Social capital is an oft-contested concept whose definition is fluid and the measurement of which varies across studies. 1 ^– 16 This research and debate was stimulated by a resurgence of interest in the link between social capital, “the ways in which we connect with friends and neighbors and strangers,” 17 ^(p27) and the declining levels of civic engagement among the American public observed by Putnam and described by his “Bowling Alone” hypothesis. 17 ^– 19 Social capital is usually understood to embody several dimensions, including norms of reciprocity, interpersonal trust, solidarity, and cooperation, that seem to depend on social networks and civic engagement. 3 ^– 6 ^, 14 ^, 17 ^, 20 ^, 21 Several studies have documented the protective effects of social capital, showing it to reduce stressful conditions, risky behaviors, mortality, and psychological distress and to improve self-rated health. 3 ^– 8 ^, 12 ^, 22 Before this recent surge of interest by public health researchers, social capital, often studied in the context of community integration (the patterns and processes that bind different components of the community together), was an important area of study in the fields of communication and sociology. This previous work in sociology and communication identified social capital as a dimension of community integration that is a product of people’s ties to their communities’ institutions and social networks. 23 Communication has long been identified as playing a vital role in integrating people into their communities by helping to support and maintain their community ties and to promote interpersonal trust. 23 ^, 24 Studies specifically looking for an association between community integration and media use find consistent and broad evidence for such an association. 25 ^– 31 For example, newspaper readership is associated with community involvement and engagement such as membership in volunteer groups, churches, and similar organizations. 25 ^, 27 ^– 30 ^, 32 In at least 1 study, subscription to cable television was related to community group membership. 25 A little-explored factor with potentially important influence on the association between community integration and media use is community pluralism . Pluralism is characterized by community size and degree of structural differentiation and essentially is a measure of general heterogeneity, with more pluralistic communities usually being larger and more differentiated. Community size and degree of community differentiation influence interactions among people and groups, though the precise nature of the these interactions needs further investigation. Some of these interactions are potential determinants of social capital. In general, more pluralistic communities are characterized by greater diversity in both impersonal and interpersonal networks of information. The degree of community pluralism modifies the relation between community integration and media use. 32 ^, 33 In more pluralistic communities, people are more likely to rely on nonpersonal (vs interpersonal) channels of communication such as mass media, compared with residents of less pluralistic communities, who rely more on interpersonal channels. What is less clear is how social capital is influenced by community pluralism, given that social capital is a product of individual-level interaction with networks and organizations in the community and that pluralistic communities are likely to contain more networks and organizations than are less pluralistic communities. Although the relation between community ties and media use is well documented, 23 the role of community integration in affecting exposure to messages from the media and other sources is less clear. Specifically, we were interested in whether the findings associating media use with community integration and its consequences (such as social capital) be extended to recall of specific content from the information environment. We were especially interested in the recall of cardiovascular disease (CVD) health messages. Thus, the focus of our study went beyond examining media use to refining our understanding of how people who differ in degree of involvement in their communities differ in health message recall, particularly recall of messages regarding CVD. Greater integration in the form of community ties may have “primed” study respondents to attend to information about community events in general, to act as sources of information themselves, and to function as contacts in interpersonal networks. 34 ^, 35 In addition, membership in organizations may render messages in the environment more salient through more frequent interpersonal discussions that may even reinforce these messages. 36 Moreover, interpersonal contacts within an association could help frame health messages and provide background learning that may enhance reception and retention of health messages. 37 ^– 39 We specifically wondered whether community pluralism modifies the interaction between community ties and CVD message recall. On the basis of a close analysis of the public health and media studies literature, and to explore the relations between community integration (community group ties), message and media exposure and the possible effects of community pluralism (community size and character), we formed 3 research questions. (1) Does degree of community integration or civic engagement influence people’s recall of CVD health messages? We hypothesized that a greater number of ties would be related to a greater number of CVD health messages. (2) Is the relation between community integration and message recall moderated by community pluralism? We hypothesized that a greater degree of pluralism would be positively related to message recall, possibly because of the greater diversity of interpersonal networks and media and other information sources in pluralistic communities. (3) Does the nature of the organizations to which one belongs and the depth of one’s involvement matter? That is, is being an active or nonactive member in community groups with specialized health information activities positively associated with recall of specific heart disease prevention messages? We hypothesized that even nonactive members of groups providing health information would recall a greater number of specific messages than would active members of groups that did not provide CVD information.