Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Capitalism”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed2004

Family, friend or foe? Critical reflections on the relevance and role of social capital in health promotion and community development.

Social capital has been the focus of considerable academic and policy interest in recent years. Despite this interest, the concept remains undertheorized: there is an urgent need for a critical engagement with this literature that goes beyond summary. This paper lays a foundation for a critical dialogue between social capital and health promotion, by examining problematics in the conceptualization and practice of social capital building and linking these to models of community development, a cornerstone health promotion strategy. In so doing, the paper contributes to the existing literature by providing a theoretical exposition and critique of various threads in social capital discourse, and linking these threads explicitly to community development practice. Distinctions between communitarian, institutional and critical approaches to social capital are elaborated, and the relationships between these three approaches and three models of community development-social planning, locality development, and social action-are discussed. The existing social capital literature is then critically examined in relation to three key themes common to both literatures: community integration, public participation, and power relations. This examination suggests that social capital cannot be conceived in isolation from economic and political structures, since social connections are contingent on, and structured by, access to material resources. This runs counter to many current policy discourses, which focus on the importance of connection and cohesion without addressing fundamental inequities in access to resources. This paper posits that approaches to community development and social capital should emphasise the importance of a conscious concern with social justice. A construction of social capital which explicitly endorses the importance of transformative social engagement, while at the same time recognising the potential negative consequences of social capital development, could help community organizers build communities in ways that truly promote health.

Canada↗
PubMed2006

Does social capital enhance health and well-being? Evidence from rural China.

Despite increasing acknowledgement that social capital is an important determinant of health and overall well-being, empirical evidence regarding the direction and strength of these linkages in the developing world is limited and inconclusive. This paper empirically examines relationships between social capital and health and well-being-as well as the suitability of commonly used social capital measures-in rural China, where rapid economic growth coexists with gradual and fundamental social changes. To measure social capital, we adopt a structural/cognitive distinction, whereby structural social capital is measured by organizational membership and cognitive social capital is measured by a composite index of trust, reciprocity, and mutual help. Our outcome measures included self-reported general health, psychological health, and subjective well-being. We adopt multi-level estimation methods to account for our conceptualization of social capital as both an individual- and contextual-level resource. Results indicate that cognitive social capital (i.e., trust) is positively associated with all three outcome measures at the individual level and psychological health/subjective well-being at the village level as well. We further find that trust affects health and well-being through pathways of social network and support. In contrast, there is little statistical association or consistent pattern between structural social capital (organizational membership) and the outcome variables. Furthermore, although organizational membership is highly correlated with collective action, neither is associated with health or well-being. Our results suggest that policies aimed at producing an environment that enhances social networks and facilitates the exchange of social support hold promise for improving the health and well-being of the rural Chinese population. In addition, China may not have fully taken advantage of the potential contribution of structural social capital in advancing health and well-being. A redirection of collective action from economic to social activities may be worth considering.

Adolescent↗
PubMed2006

Social capital and mental health: a comparative analysis of four low income countries.

Women and the poor are disproportionately affected by common mental disorders (CMD), and women in low income countries are particularly at risk. Social capital may explain some of the geographical variation in CMD, but the association between social capital and CMD in low income countries has rarely been studied. This paper aims to explore the relationship between individual and ecological measures of social capital and maternal CMD in four low income countries. Cross-sectional data from the Young Lives (YL) study with information across 234 communities in Peru, Ethiopia, Vietnam and Andhra Pradesh (India) were used. The mental health of mothers of one-year-old children (n=6909), and the individual cognitive and structural social capital of all respondents was assessed. Ecological social capital was calculated by aggregating individual responses to the community level. Multi-level modelling was used to explore the association between individual and ecological (community level) social capital and maternal CMD in each of the four countries, adjusting for a wide range of individual and community level confounders. The analysis shows that individual cognitive social capital is associated with reduced odds of CMD across all four countries. The results for structural social capital are more mixed and culturally specific, with some aspects associated with increased odds of CMD. This suggests that structural social capital has context-specific effects and cognitive social capital more universal effects on maternal CMD.

Adolescent↗
PubMed2003

Social capital and neighborhood mortality rates in Chicago.

Several empirical studies have suggested that neighborhood characteristics influence health, with most studies having focused on neighborhood deprivation or aspects of the physical environment, such as services and amenities. However, such physical characteristics are not the only features of neighborhoods that potentially affect health. Neighborhoods also matter because of the nature of their social organization. This study examined social capital as a potential neighborhood characteristic influencing health. Using a cross-sectional study design which linked counts of death for persons 45-64 years by race and sex to neighborhood indicators of social capital and poverty for 342 Chicago neighborhoods in the USA, we tested the ecological association between neighborhood-level social capital and mortality rates, taking advantage of the community survey data collected as part of the Project on Human Development in Chicago Neighborhoods. We estimated a hierarchical generalized linear model to examine the association of race and sex specific mortality rates to social capital. Overall, neighborhood social capital-as measured by reciprocity, trust, and civic participation-was associated with lower neighborhood death rates, after adjustment for neighborhood material deprivation. Specifically, higher levels of neighborhood social capital were associated with lower neighborhood death rates for total mortality as well as death from heart disease and "other" causes for White men and women and, to a less consistent extent, for Blacks. However, there was no association between social capital and cancer mortality. Although, the findings from this study extend the state-level findings linking social capital to health to the level of neighborhoods, much work remains to be carried out before social capital can be widely applied to improve population health, including establishing standards of measurement, and exploring the potential "downsides" of social capital.

Cause of Death↗
PubMedDate not supplied

Social capital and psychiatry: review of the literature.

Social capital is an umbrella term used to describe aspects of social networks, relations, trust, and power, as a function of either the individual or a geographical entity (e.g., a city neighborhood). Increased attention is being paid to the role that social capital can play in determining a variety of physical health outcomes, though less attention has been paid to its role in determining mental health outcomes. This relative inattention continues despite a long historical tradition in psychiatry of exploring the role that socio-environmental factors can play in the etiology and course of mental illness. In this review, we begin by tracing the historical development of the concept of social capital, describing and analyzing competing definitions. We then proceed to review the published studies that examine the relationship between social capital and mental health-looking first at studies that focus on depression and anxiety, and second at studies that focus on psychoses. After briefly exploring whether social capital can have a detrimental effect on mental health, we discuss how knowledge regarding social capital may aid the clinician and mental health services. We go on to make a number of suggestions relevant to methodological, theoretical, and empirical advancement. These suggestions include refining the definitions of social capital, paying attention to communities without propinquity, and constructing contextual indicators of social capital. We conclude by remarking that social capital may be a promising heuristic for studies in community psychiatry and may even help individual clinicians in designing treatment plans. Despite all this promise, however, there is a lack of strong evidence supporting the hypothesis that social capital protects mental health.

Cognition↗
PubMed2006

Atypical and typical (idiopathic) slipped capital femoral epiphysis. Reconfirmation of the age-weight test and description of the height and age-height tests.

BACKGROUND: The age-weight test was described to aid the clinician in defining demographic predictors of an atypical slipped capital femoral epiphysis. We wished to retest the accuracy and applicability of the age-weight test and height differences in children with atypical and typical slipped capital femoral epiphyses. METHODS: A retrospective review of the records for all children with slipped capital femoral epiphysis from 1998 through 2003 was performed. Gender, race, chronological age, weight, height, the duration of symptoms, and the laterality of the slip were recorded. The slip angle was classified as mild (< 30 degrees), moderate (30 to 50 degrees), or severe (> 50 degrees). Statistical analyses were performed. RESULTS: The study included 105 children (thirty-eight girls and sixty-seven boys) with 141 slipped capital femoral epiphyses; ten children had fifteen atypical slipped capital femoral epiphyses, and ninety-five children had 126 typical slipped capital femoral epiphyses. Sixty-nine children had unilateral involvement, and thirty-six had bilateral involvement. The average age at the time of presentation for the first slipped capital femoral epiphysis was 12.1 +/- 2.0 years. The average duration of symptoms was 3.7 +/- 5.5 months. In the group of 128 slipped capital femoral epiphyses for which the slip angle was known, there were ninety-three mild, twenty-seven moderate, and eight severe slips. The average slip angle was 24 degrees +/- 18 degrees. The age-weight test demonstrated a sensitivity of 50%, a specificity of 89%, a positive predictive value of 33%, and a negative predictive value of 94%. The age-height test, involving the same definition as the age-weight test except that the percentiles apply to height and not weight, demonstrated a sensitivity of 88%, a specificity of 73%, a positive predictive value of 30%, and a negative predictive value of 98%. The height test, which was defined as positive if the child's height was at or below the tenth percentile for age and as negative if it was above the tenth percentile, demonstrated a sensitivity of 75%, a specificity of 97%, a positive predictive value of 75%, and a negative predictive value of 97%. CONCLUSIONS: The present study reaffirmed the accuracy and applicability of the age-weight test for differentiating between typical and atypical slipped capital femoral epiphyses, and it further defined the age-height and height tests. If the height of a child can be obtained, the height test is likely to be most useful for differentiating between typical and atypical slipped capital femoral epiphysis. When height is not known, the age-weight test will result in a similar negative predictive value but with a lower sensitivity, specificity, and positive predictive value. LEVEL OF EVIDENCE: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2004

Capital optimization: linking investment with strategic intent.

With operating margins showing some improvement in 2003, Y2K being a distant memory, and many critical capital investment decisions delayed as long as possible, hospitals have been on a relative spending spree, building new facilities, renovating operating rooms and inpatient units, and investing in new medical and information technologies. However, with pressure on both cost and revenue expected to continue, if not increase, this spending spree may be short-lived, and hospitals must improve their capital planning efforts; align them with their mission, vision, and strategies; and ensure that capital is available when unplanned or even expected needs arise. This article explores some of the challenges that hospitals face in their capital planning efforts and, more importantly, suggests the necessity for hospitals to integrate capital and strategic planning. Capital planning must be driven by an organization's strategies; however, we also argue that an organization's ability to execute its strategies is highly dependent on the existence of a cohesive capital prioritization and planning process. In this article, we explore a number of issues critical to developing a comprehensive capital plan, including estimating capital costs, evaluating and designing strategies to contend with risk, saving for the proverbial "rainy day," and recognizing the role and value of philanthropy, while challenging some conventional thinking of hospital executives with respect to investment, growth, and planning.

Capital Expenditures↗
PubMed1993

Capitation payments based on prior hospitalizations.

In many countries the concept of capitating health care insurers is receiving increasing attention. In a competitive environment, capitation should induce insurers to concentrate more on cost containment instead of indulging in risk selection. The necessary premium-replacing capitation payments should account for predictable variations in annual per-person health care expenditures as far as these are related to health status. Various studies have shown that crude capitation models based on e.g. age, sex and place of residence, do not reflect expected costs accurately. This implies inefficient pricing possibly leading to risk selection and windfall profits or losses for insurers, thereby undermining the objectives of a capitation system. Using Dutch micro data on some 200,000 individuals, this article stimulates various alternative capitation models based on, among others, diagnostic information from previous hospitalizations. Results suggest that the problems of both risk selection and windfall profits/losses may be mitigated substantially by using this type of information together with data on prior costs. These results are not only relevant for situations where competing insurers are capitated, as intended in the Netherlands, but also when providers are capitated, as in the UK, or when HMOs are capitated, as in the US.

Capitation Fee↗
PubMed1992

Towards a capitation formula for competing health insurers. An empirical analysis.

In many countries the concept of capitating health care insurers is receiving increasing attention. The main reason is, that capitation may induce health care insurers in a competitive environment to concentrate more on cost containment. However, if the adjusters on which capitation payments are based, are too global, there may be ample room for risk selection by the insurers whilst also an unfair distribution of funds over the insurers may result, thereby undermining the objectives of capitation. The prime motivation for the present study is, that the Dutch government, as part of proposals for a new, market oriented structure of health care system, is considering to capitate insurers on the basis of global parameters like age, gender and location. Our analysis based on panel data of some 35,000 individuals, shows that the proportion of variance in annual health care expenditures that can be predicted (R2) by such a global capitation formula, is only 0.024. This is less than 1/5 of our estimate of the theoretically maximum achievable R2 which amounts to 0.138, implying the existence of abundant selection opportunities, e.g. on the basis of past expenditures or other health indicators. Alternative capitation formulae incorporating prior-year's costs and reaching about 3/5 of the maximum obtainable R2, effectively remove the profitableness of selection on the basis of past expenditures. The findings suggest, however, that selection via (chronic) health status may still be profitable to some extent. Therefore, we also analyzed data from the Dutch Health Interview Survey (N approximately 20,000) which comprised better health indicators. It appeared that a capitation formula based on the global adjusters mentioned above as well as three health status indicators and several background characteristics, yields an R2 of about 0.114, which probably accounts for 3/4 of our estimate of the maximum obtainable R2. The main conclusion is, that in the short term information on prior expenditures, which is available in the files of most insurers and thus may be used for risk selection, should be included in the capitation formula. For the more distant future, the formula should be expanded with indicators of chronic health status, possibly based on diagnostic information from previous, non-discretionary hospitalizations.

Age Factors↗
PubMed2003

Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rates in the United States.

BACKGROUND: Social capital has been related to a number of important public health variables such as child welfare, mortality, and health status. However, the relation of social capital to infectious diseases has received relatively little attention. The relation of social capital to health measures is often posited to be related to the key societal variables of poverty and income inequality. Therefore, any exploration of the correlation between social capital and infectious diseases should also include examination of the association with poverty and income inequality. OBJECTIVE: This study examined the state level association between social capital, poverty, income inequality, and four infectious diseases that have important public health implications given their long term sequelae: gonorrhoea, syphilis, chlamydia, and AIDS. METHOD: A state level, correlational analysis (including bivariate linear correlational analysis, and multivariate linear stepwise regression analysis) was carried out. 1999 state level rates of gonorrhoea, syphilis, chlamydia, and AIDS were the main outcome measures. RESULTS: In bivariate analyses, poverty was significantly correlated with chlamydia; income inequality was significantly correlated with chlamydia and AIDS case rates; and social capital was significantly correlated with all outcome measures. In stepwise multiple regression analyses, social capital was always the strongest predictor variable. CONCLUSIONS: These results suggest that social capital is highly predictive of at least some infectious diseases. The results indicate the need for further research into this relation, and suggest the potential need for structural interventions designed to increase social capital in communities.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Managerial perceptions of the incentives inherent in National Health Service capital charging.

Capital charging was introduced into the National Health Service (NHS) in 1991 in order to stop capital being treated as a 'free' good and to encourage managers to use their assets more efficiently. This article seeks to examine the extent to which managerial thinking has been influenced. It uses as evidence interviews with NHS managers conducted in Scotland in 1994. The following uses of capital charges data are explored: capital programme; disposal programme; maintenance programme; contract pricing; and budgetary devolution. New capital programmes required more justification and capital charges were seen as relevant to estate rationalization. Less effect was found with regard to the maintenance programme, though this may have been due to a downgrading of the estates function in most Trusts. Although the capital charge costs included in contract prices affect the competitive position of providers, there was criticism of the lack of development of the purchasing function. Budgetary devolution was proceeding relatively slowly but, among those Trusts which had devolved capital charges, evidence was found that some clinicians were becoming aware of the full costs of equipment use. This article concludes, with cautious optimism, that capital charges are beginning to influence decisions and that, despite some incentives being dysfunctional, they will lead to a better managed NHS.

Budgets↗
PubMedDate not supplied

Venture capitalism at the Veterans Administration.

This article outlines the implementation of a venture capitalism program in a 519-bed Veterans Administration tertiary care medical center. Venture capitalism at the VA West Side Medical Center in Chicago, Illinois is realized through a pool of capital within the budget, for the trial implementation of various ideas and programs that demonstrate a potential to reduce costs or increase revenues. Through this adaptation of venture capitalism, the principles of entrepreneurship can be applied. Employees submit a proposal to management that describes what they wish to accomplish. The proposal includes the time schedule required for implementation and how much capital will be needed to make the proposal operational. If the proposal is successful and becomes self-sufficient, the original venture capital is returned to the pool and used for other ventures. If the proposal does not meet expectations, support is withdrawn and the remaining capital is returned to the venture capital pool. In conclusion, several successful ventures are described to demonstrate the practicality of using the concepts of entrepreneurship and venture capitalism within the budget constraints of the federal government.

Capital Financing↗
PubMed1999

Capitation and its effects on physician satisfaction.

OBJECTIVE: Capitation is an increasingly common method of paying physicians, but few data exist on its impact on physician satisfaction. This study examines the perceived effects of capitation on physician satisfaction at a large, academic medical center. STUDY DESIGN: Survey of physicians at a single, tertiary care hospital. METHODS: Physicians in a physician hospital organization were surveyed at an urban teaching hospital which received capitation for 5% of patients at the time of the survey but was preparing for a sharp increase in capitation. We used a 5-point Likert scale to assess physicians' satisfaction with their practice, and to compare satisfaction under fee-for-service and expected satisfaction under capitation. RESULTS: Of the 734 physicians surveyed, 147 were excluded because they had no direct patient care responsibilities. Of the remaining 587 physicians, 363 replied, giving a response rate of 62%. Overall, 57% of physicians were satisfied with their practice. Compared to their satisfaction under fee-for-service reimbursement, they were much less satisfied with their ability to care for capitated patients (17 of 19 questions, p < 0.05). The greatest differences were for freedom to order necessary tests and freedom to obtain referrals (0.9 and 0.8 on the 5-point scale, respectively, both p < 0.0001). Multiple logistic regression analyses revealed four independent predictors of overall satisfaction: patient load (OR = 2.7, 95% CI = 1.9-3.9), efficiency in resource utilization (OR = 1.5, 95% CI = 1.1-2.1), perceived employment stability (OR = 1.7, 95% CI = 1.3-2.2), and control over clinical time schedule (OR = 1.6, 95% CI = 1.2-2.0). CONCLUSIONS: Physicians initially encountering capitation payment have strong negative perceptions about it, even for areas in which some policy experts expect capitation to benefit patient care. Physician education and focusing on management relations may help smooth the transition to capitated reimbursement.

Academic Medical Centers↗
PubMed2002

Capitation payment, length of visit, and preventive services: evidence from a national sample of outpatient physicians.

OBJECTIVE: To test the hypothesis that capitation payment to physicians reduces the length of physician-patient encounters but increases use of preventive and health counseling services. STUDY DESIGN: Cross-sectional analysis of data from the National Ambulatory Medical Care Survey of outpatient physicians and their office staff (1997 and 1998). PATIENTS AND METHODS: A random national sample of 46,320 ambulatory care visits was used. Weight-adjusted multivariate regression techniques were utilized to examine the effects of capitation on duration of physician visit and number of preventive and health counseling services. RESULTS: Physicians spent 5.6% less time (P < .01) with patients in capitated plans than with those in noncapitated plans. The effect of payment method on length of visit was 3.5 times stronger among physicians receiving only capitated payment, compared with physicians receiving only noncapitated payment. Patients in capitated plans were 17% more likely to receive health counseling services (P < .01) than patients in noncapitated plans. Patients under capitation were 3% more likely to receive preventive services compared to patients in non-health maintenance organizations, noncapitated plans (P < .05). CONCLUSIONS: Capitation is associated with a modest decrease in the amount of time physicians spend with their patients and with increased receipt of preventive and health counseling services, on average. These trends are driven by physicians who receive capitated payment predominantly. Physicians with a mix of patients from capitated and noncapitated plans spend approximately equal time with each type of patient, which reflects an ethic of impartiality in medical judgment.

Aged↗
PubMed1997

Neandertal capitate-metacarpal articular morphology.

Neandertal capitate-metacarpal 2 and 3 articulations have been observed to differ in orientation and shape from those of more recent humans. To evaluate this, we tested for differences in capitate-metacarpal 2 (MC2) and MC2-capitate facet orientations and MC2 and MC3 robusticity indices, and for multivariate shape equivalence of the capitate-MC2/MC3 facets and the MC3 diaphysis and styloid process between samples of Neandertals and recent humans. Canonical discriminant functions of log size- and-shape and log shape transformed measurements were run on variables of the capitate-MC2 and MC3 facets, and these plus MC3 diaphysis and styloid process variables. The null hypothesis of shape equivalence is rejected for both variable sets. Modern human capitate-MC morphology results from nonallometric increases in distal capitate breadth and the projection of the MC3 styloid process, and reductions in MC2 facet height and MC3 facet breadth. These shape changes are associated with a significantly less parasagittal orientation of the capitate-MC2 facets in recent humans, but are only trivially correlated with MC 2 and 3 robusticity indices. The recent human capitate-MC 2 and 3 morphology may reflect a shift in habitual joint reaction forces from more axial to more oblique forces while maintaining similar pronation/supination of the MC2. However, the full behavioral implications of these contrasts remain unclear.

Animals↗
PubMed2005

Is social capital a protective factor against obesity and diabetes? Findings from an exploratory study.

PURPOSE: The aim of this exploratory study is to examine the relationship between social capital and the important public health variables of obesity and diabetes in the adult population in the United States. METHODS: State-level correlational analyses were conducted. Predictor variables included social capital (Putnam's measure), income inequality, and poverty. Outcome variables were state-level rates of obesity and diabetes as reported by the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. RESULTS: Social capital and poverty had significant bivariate relationships with obesity and diabetes; multivariate linear regression showed social capital to be the strongest predictor of both outcome variables (explaining 10% of the variance in obesity and 44% of the variance in diabetes). Social capital was related inversely to both variables, indicating a protective effect. Sensitivity analyses showed that an alternate measure of income inequality had a bivariate relationship with diabetes, but was not as strong a predictor as social capital in multivariate analyses. CONCLUSIONS: These exploratory study results suggest that greater levels of social capital are protective against obesity and diabetes. This initial finding warrants subsequent empirical investigations designed to identify strategies that can be used to foster the creation of social capital in areas of the United States with an especially high prevalence of obesity and diabetes. In addition, these investigations should operate at multiple levels, examining individual, social-network, and community-level measures of social capital.

Adult↗
PubMed2006

Neighborhood social capital and adult health: an empirical test of a Bourdieu-based model.

Drawing upon Bourdieu's [1986. The forms of capital. In: Richardson, J.G. (Ed.), Handbook of Theory and Research for the Sociology of Education. Greenwood, New York, pp. 241-258.] social capital theory, I test a conceptual model of neighborhood conditions and social capital - considering relationships between neighborhood social capital forms (social support, social leverage, informal social control, and neighborhood organization participation) and adult health behaviors (smoking, binge drinking) and perceived health, as well as interactions between neighborhood social capital and individuals' access to that social capital. Analyzing Los Angeles Family and Neighborhood Survey data linked with tract level census data, results suggest that specific social capital forms were directly associated with both positive and negative health outcomes. Additionally, residents' neighborhood attachment moderated relationships between various social capital forms and health. Future studies should consider social capital resources and the role of differential access to such resources for promoting or compromising health.

Adult↗
PubMed2006

Measuring dimensions of social capital: evidence from surveys in poor communities in Nicaragua.

A dominant perspective in social capital research emphasizes a "structural" dimension of social capital, consisting of network connections, and a "cognitive" dimension, consisting of attitudes toward trust. Correspondingly, membership in organizations (i.e., membership density) and general trust in people (i.e., social trust) are two indicators commonly used to relate structural and cognitive social capital, respectively, to a variety of health and other outcomes. This study analyzed relationships between membership density, social trust and a more comprehensive set of household-level social capital indicators as well as selected civic and health behaviors in the context of Nicaragua. The sample of respondents was drawn from 6 communities and interviews were conducted with 482 heads of households, resulting in data on 2882 individuals. Factor analyses suggest that membership density loaded strongly (loading=0.81) onto an "organizational participation" factor which contained a number of qualitative characteristics of involvement, including bridging social capital. Further, this structural dimension of social capital appears to be a construct consisting of more than just informal social networks. However, factor analyses suggest that distinctions between levels of trust are warranted in Nicaragua: social trust loaded weakly (loading=0.32) onto a factor characterized by institutional trust in a factor analysis of trust items, and well below 0.30 in a factor analysis of both structural and cognitive dimensions of social capital. A nuanced understanding of these household-level indicators of structural and cognitive social capital held implications for civic and health behaviors. While membership density and institutional trust were positively related to an index of political engagement, social trust was either not related or negatively associated (among urban respondents). Similarly, social trust was associated with over 50% reduced odds of an additional childhood vaccinations whereas institutional trust was associated with increased odds (OR=1.7) of an additional vaccination. The findings highlight the complexity of social capital and the importance of exploring more comprehensive indicators.

Adolescent↗