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Whether it’s loaning out the lawn mower or ferrying kids to school in a pinch, helping out the nice folks next door is the American way. Studies also show that communities in which residents have high levels of social interaction—a form of valuable social capital—generally have better health. That’s why Richard Carpiano, PhD, MPH, was surprised to find that high levels of neighborhood social support had the opposite effect on oral health.
“We found that as social support—defined as favor exchange—increased, the people in those neighborhoods were less likely to see a dentist,” explained Carpiano, a 2004-2006 Robert Wood Johnson Foundation (RWJF) Health & Society Scholar and associate professor of sociology at the University of British Columbia.
Carpiano began to explore the topic as an RWJF grantee. “One of my fascinations is how community surroundings contribute to our health and well-being. I essentially see communities as a black box that can shape how we use resources, whether it’s food, parks, transportation, or other parts of the environment.”
Testing the Power of Social Networks
To explore their original theory—that adults in neighborhoods with high levels of social capital were more likely to seek dental care, Carpiano and his colleague, Donald Chi, DDS, PhD, an assistant professor in the department of oral health sciences at the University of Washington, analyzed data on 1,800 Los Angeles adults.
Their work was published in the article “Neighborhood Social Capital, Neighborhood Attachment, and Dental Care Use for Los Angeles Family and Neighborhood Survey Adults,” in the April 2013 American Journal of Public Health. Using the Los Angeles Family and Neighborhood Survey, Chi and Carpiano looked at how often adults ages 18 to 64, from 65 neighborhoods, decided to visit a dentist over a 12-month period. They measured levels of social capital in the form of social support and neighborhood attachment (levels of social interaction).
“We looked at four measures of social capital and found that social support had the largest impact on oral health,” said Chi, who is also an investigator at the Northwest Center to Reduce Oral Health Disparities. “Social support can be defined as how much you and your neighbors can rely on each other for assistance.”
The study sample included low- and high-income communities, “but the median household income of respondents was $30,000,” Chi continued. “We adjusted the data to keep income steady. The study population was 55 percent Hispanic, 10 percent African American, and 26 percent White. Ten percent were classified as other ethnic background, including Asian, Pacific Islander, and Native American.”
Carpiano and Chi found that social support had a negative, not positive, impact on oral health. Adults in neighborhoods with high levels of social support, meaning they often did favors for each other, were significantly less likely (15%) to use dental care. Neighbors who were most likely to socialize with each other (neighborhood attachment) were slightly more likely (5%) to seek dental care.
“There’s a lot we still do not understand about how the social environment and other contextual factors affect health outcomes and health behaviors such as visiting the dentist,” Chi said. “Typically, we think that communities that are wealthier or have higher levels of social capital are healthier. But that can also produce bad outcomes. Studies show that close social networks can encourage social drinking or social smoking. Or, as is possible in this case, produce high levels of demand on residents to help others and those demands can produce stress,” Carpiano added.
Looking closely at the possible meaning of social support in the study, Carpiano and Chi thought that several factors might play a role in why adults would not take the time to visit a dentist in a year. “People who do more for others may spend less time on self care. Or, it may be a shared community norm to not address small amounts of dental discomfort or keep up with preventive dental care. Cultural norms may also influence behavior,” Carpiano said.
Both Carpiano and Chi agree that ongoing research “should identify the oral health–related attitudes, beliefs, norms, and practices in neighborhoods, as well as other behavioral and cultural factors that influence the relationship between social capital and dental care use.” They will be exploring many of these topics in their upcoming research.