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In 2016, Minnesota implemented a new pay-for-performance reimbursement scheme for Medicaid residents in nursing homes, known as Value-Based Reimbursement (VBR). This study seeks to understand whether there is an association between VBR and quality improvement. We use data from 2013 to 2019 including Centers for Medicare and Medicaid Services, Nursing Home Compare, and Long-term care Facts in the US. Using multivariate regression with commuting zone fixed effects, we compare five long-stay and two short-stay clinical quality metrics in Minnesota nursing homes to nursing homes bordering states, before and after VBR was implemented. We find minimal significant changes in quality in Minnesota nursing homes after VBR. Minnesota should reconsider its pay-for-performance efforts.

BackgroundSocial capital is a well-known health determinant with both relational and geographic aspects. It can help mitigate adverse events and has been shown to impact behaviors and responses during the COVID-19 pandemic. Mental health has declined during the COVID-19 pandemic, and social capital, may serve to buffer those declines.MethodsBuilding from this, we assessed whether pre-pandemic social capital and contemporaneous social policy, which included indicators of social trust, civic participation, and presence of mask mandates, affected pandemic mental health, measured as the percent of the population experiencing symptoms of depression and anxiety at the state level.ResultsGeneralized social trust and state mask mandates were significantly associated with lower levels of depression and anxiety. Conversely, states with greater civic engagement prior to the pandemic experienced more anxiety and depression.ConclusionsFindings suggest that existing social capital, particularly social trust, may protect against anxiety and depression and contribute to community resilience during times of adversity. States should invest in policies and programs that increase social trust.

Background The 2007 reauthorization of the Prescription Drug User Fee Act empowered the Food and Drug Administration (FDA) to require and enforce postmarketing studies to monitor the safety of prescription drugs, an increasing number of which are approved under expedited development or review programs. However, compliance rates for postmarketing requirements are low, and the FDA has not exercised its enforcement authority, allowing the very safety concerns that prompted the expansion of its power to continue. Prior evaluations have found that the FDA lacks reliable, timely, and readily accessible data for tracking postmarket safety issues, and that it has failed to enforce the postmarket surveillance measures it requires of the pharmaceutical industry. Objective This study provides an updated evaluation of FDA oversight of postmarketing requirements and commitments and assesses whether there have been improvements since 2010. Methods This study utilized data from the FDA's annual Report on the Performance of Drug and Biologics Firms in Conducting Postmarketing Requirements and Commitments. It evaluated studies opened in FY 2011–2014 and tracked their status through the FDA's FY 2018 report (data as of September 30, 2018), thereby allowing the pharmaceutical industry 4–7 years to complete a given PMR/PMC. Descriptive statistics were calculated, and differences in the status of postmarketing requirements and postmarketing commitments between FYs 2011–2014 and FY 2009–2010 were evaluated. Results During fiscal years 2011–2014, there was little difference in the FDA's oversight of postmarketing studies compared to fiscal years 2009–2010. While there were some year-to-year significant differences, the overall trend indicated no change. Conclusions The FDA's oversight of postmarketing studies has not improved since 2010. This paper discusses implications for providers and patients who unduly assume the responsibility of postmarketing surveillance due to the lack of FDA oversight.

Purpose Rural communities have unique economic and social structures, different disease burdens, and a more patchworked healthcare delivery system compared to urban counterparts. Yet research into addressing social determinants of health has focused on larger, urban, integrated health systems. Our study sought to understand capacities, facilitators, and barriers related to addressing social health needs across a collaborative of independent provider organizations in rural Northeastern Minnesota and Northwestern Wisconsin. Methods We conducted qualitative, semi-structured interviews with a purposive sample of 37 key informants from collaborative members including 4 stand-alone critical access hospitals, 3 critical access hospitals affiliated with primary care, 1 multi-clinic system, and 1 integrated regional health system. Findings Barriers were abundant and occurred at the organizational, community and policy levels. Rural providers described a lack of financial, labor, Internet, and community-based social services resources, a limited capacity to partner with other organizations, and workflows that were less than optimal for addressing SDOH. State Medicaid and other payer policies posed challenges that made it more difficult to use available resources, as did misaligned incentives between partners. While specific payer programs and organizational innovations helped facilitate their work, nothing was systemic. Relationships within the collaborative that allowed sharing of innovations and information were helpful, as was the role leadership played in promoting value-based care. Conclusions Policy change is needed to support rural providers in this work. Collaboration among rural health systems should be fostered to develop common protocols, promote value-based care, and offer economies of scale to leverage value-based payment. States can help align incentives and performance metrics across rural health care entities, engage payers in promoting value-based care, and bolster social service capacity.

OBJECTIVE: Given the increased use of hydroxychloroquine (HCQ), chloroquine (CQ), and azithromycin (AZM) during the early months of the coronavirus disease 2019 (COVID-19) pandemic, there is a need to evaluate the associated safety concerns. The objective of this study was to summarize the adverse drug events (ADEs) associated with HCQ, CQ, and AZM use during the national COVID-19 emergency and compare the results with known adverse reactions listed in the drugs' package inserts. METHODS: A cross-sectional study design was used. The publicly available Food and Drug Administration Adverse Event Reporting System quarterly data extract files from January 1, 2020 to June 30, 2020 were downloaded. A disproportionality analysis was conducted using the proportional reporting ratio to identify possible ADE signals. A Poisson regression was used to assess if the number of ADE reports for the 3 drugs increased over time. RESULTS: There was a statistically significant increasing trend in the reported ADEs for both HCQ (P < 0.001) and AZM (P < 0.001). Before the declaration of the national emergency, there were 592 reported drug-ADE pairs for the 3 drugs compared with 2492 drug-ADE pairs reported after March 13, 2020. These 2492 drug-ADE pairs represented 848 ADEs across the 3 drugs, of which 114 (13.4%) were identified as potential signals including 55 (48.2%) that were not listed in the prescribing information. CONCLUSIONS: Our results showed that the reported ADEs for HCQ and AZM have increased during the COVID-19 pandemic. Differences were observed in both the type of and frequency of the highest reported ADEs for the 3 selected drugs before and after the national emergency declaration. Although causation cannot be determined from ADE reports, further investigation of some reports may be warranted. Our results highlight the need for pharmacovigilance and education of health care professionals on the safety of these drugs when being used for COVID-19 prophylaxis or treatment.

Purpose The purpose of this paper is to examine the relationship between employees’ perceptions of organizational support for employee health (OSEH) and employees’ turnover intention and job performance, with a focus on the possible mediating roles of affective commitment and wellness program participation in these relationships. Design/methodology/approach Data were collected from surveys of employees at a public university that provides employees with a variety of wellness program options. Conditional procedural analysis was conducted to test the model. Findings Results showed that employees’ perceptions of OSEH positively related to both turnover intention and job performance and that affective commitment fully mediated the relationships between OSEH perceptions and both dependent variables. Research limitations/implications Cross-sectional data were collected on OSEH, affective commitment, employees’ intent to remain in the organization and job performance. Future studies based on panel data would be helpful to establish the causal relationships in the model. Practical implications Our findings show that employees’ perceptions of OSEH are likely to affect behavioral outcomes through affective commitment, suggesting that managers should ensure that employees are aware of organizational support for health promotion. Our findings also suggest that organizations move beyond a focus on design of wellness programs to include an emphasis on the overall OSEH. Originality/value This research study is the first empirical examination on the two possible channels through which organizational health support may influence employees’ intent to remain and job performance – participation in wellness programs and affective organizational commitment. The results are of value to researchers, human resource management managers, employees and executives who are seeking to develop practices that promote employee health at the workplace.

Background Social capital is a multilevel construct impacting health. Community level social capital, beyond the neighborhood, has received relatively less attention. Moreover, the measurement of community level social capital has tended to make use of aggregated individual data, rather than observable community characteristics. Methods Herein, metropolitan religious adherence, as an observable community-level measure of social capital, is used. We match it to city of residence for 2826 women in the Fragile Families Childhood Wellbeing Study (a cohort study) who have lived continuously in that city during a nine-year period. Using ordered logistic regression with clustered standard errors to account for area effects, we look at the relationship between metropolitan religious adherence and self-rated health, while controlling for lagged individual, neighborhood, and socioeconomic factors, as well as individual level religious attendance. Results Religious adherence at the community level is positive and statistically significant; every 1% increase in area religiosity corresponds to a 1.2% increase in the odds of good health. Conclusions These findings shed light on a possible pathway by which social capital may improve health, perhaps acting as a stress buffer or through spillover effects of reciprocity generated by exposure to religion.

The authors used a cross-sectional survey and zero-inflated ordered probit modeling to investigate individual psychosocial-, interpersonal-, organizational-, and community-level determinant...

Depression is the world’s most common mental health disorder and its prevalence is higher among women and the poor. This article seeks to examine the effect that social capital has on mental health...

Background The Union Construction Workers' Compensation Program (UCWCP) was developed in 1996 as an alternative workers' compensation arrangement. The program includes use of a preapproved medical and rehabilitation network and alternative dispute resolution (ADR), and prioritizes a quick and safe return-to-work. The aim of this study is to determine if differences in recovery-related outcomes exist between UCWCP and the statutory workers' compensation system (SWCS). Methods Claims data from 2003 to 2016 were classified as processed through UCWCP or SWCS. Outcomes included: temporary total disability (TTD), vocational rehabilitation (VR), claim duration and costs, and permanent partial disability (PPD). The relative risk of incurring TTD, VR, and PPD in UCWCP vs SWCS was calculated using log-binomial regression. Linear regression examined the relationship between programs and continuous outcomes including costs and duration. Estimates were adjusted for age, sex, wage, and severity. Results The UCWCP processed 15.8% of claims; higher percentages of UCWCP claimants were older and earned higher wages. Results point to positive findings of decreased TTD incidence and cost, lower risk of TTD extending over time, higher likelihood of VR participation, and less attorney involvement and stipulation agreements associated with UCWCP membership. Differences were more apparent in workers who suffered permanent physical impairment. Conclusion Findings suggest that the defining programmatic elements of the UCWCP, including its medical provider and rehabilitation network and access to ADR, have been successful in their aims. Claims with increased severity exhibited more pronounced differences vs SWCS, potentially due, in part, to greater use of programmatic elements.

Introduction The construction industry experiences severe injuries. When an employee is injured, the goal is to minimise long-term disability and efficiently return the employee to work. The Union Construction Workers Compensation Program (UCWCP) of Minnesota provides an alternative, collectively-bargained system administered by workers’ compensation insurance providers. The program includes exclusive provider network for medical care and access to alternative dispute resolution process. The goal of this study is to determine injury outcome differences for UCWCP members. Methods Workers’ compensation claims were examined over a ten year period. UCWCP membership and date of enrollment were determined. Claims were stratified by medical or lost-time status. Multiple measures of severity and outcome were examined, including claim rate and duration, time to return-to-work, and permanent partial disability status. We calculated rates and comparative risk based on UCWCP. A logistic model will estimate rate ratios (RR) and 95% confidence intervals (CI) as a function of claim rate. Time-to-event models will assess differences in duration of disability based on UCWCP. Proportional hazards regression estimated hazard ratios (HR) and 95% CI. Results UCWCP employers had a lower rate of lost-time claims. Compared to non-UCWCP employers, UCWCP-membership was associated with a 9% increased likelihood of claim closure for both medical and lost-time claims (HR=1.09, CI=1.05–1.13; HR=1.09, CI=1.02–1.17). Most differences occurred in the first 90 days. Return-to-work likelihood and reduced permanent disability appeared to be related to UCWCP. Conclusions Alternative workers’ compensation arrangements may include elements that collectively protect workers’ interests, reduce injury severity, and are cost-effective for insurers.

Background Obesity prevention efforts typically involve changing eating and exercise behaviors as well as the physical and social environment in which those behaviors occur. Due to existing social networks, worksites are a logical choice for implementing such interventions. Purpose This article describes the development and implementation of a peer helper intervention, which was part of a multicomponent obesity prevention program conducted at a hospital worksite. It also presents qualitative evaluation findings of peer helper perceptions, roles, and institutional outcomes. Methods Fifty-one male and female employees were recruited to promote healthy eating and physical activity amongst their peers. They received health and communication skill-building training. Semistructured interviews were conducted with 20 peer helpers to evaluate this component of the intervention. Results Findings showed that peer helpers took on many helping roles, became effective role models, and contributed to creating health-pro...

Background While it appears that social capital has a positive effect on mental health, most studies have been cross-sectional in nature and/or employ weak measures of social capital or mental health. Even less attention has been paid to vulnerable populations, such as low-income women with children. Thus, our objective was to explore how different dimensions of social capital impact depression in this population. Methods We used data from the Fragile Families and Child Wellbeing Study, which has followed a cohort of children born in large US cities to mostly minority, unmarried parents for over 9 years. These families tend to be at greater risk for falling into poverty. Four separate measures of social capital were constructed, using measures that are reliable and that offer evidence of validity including social support and trust, social participation, perceptions of neighbourhood social cohesion and perceptions of neighbourhood social control. The temporal effect of social capital on mental health, as measured by a standardised screening for depression was investigated using logistic regression. Results After controlling for relevant socioeconomic and demographic factors, prior depression, and prior self-rated health, the social capital dimensions of social support and trust and perceived neighbourhood social cohesion are significant predictors of depression. Conclusions These results suggest that social and neighbourhood environments play an important role in mental health status. Intervention and policy initiatives that increase social capital may be viable for improving mental health among low-income urban, minority women.

Background Worksite obesity prevention interventions using an ecological approach may hold promise for reducing typical weight gain. The purpose of this study was to examine the effectiveness of Go!, an innovative 12-month multi-component worksite obesity prevention intervention. Methods A quasi-experimental non-equivalent control group design was utilized; 407 eligible hospital employees (intervention arm) and 93 eligible clinic employees (comparison arm) participated. The intervention involved pedometer distribution, labeling of all foods in the worksite cafeteria and vending machines (with calories, step equivalent, and a traffic light based on energy density signaling recommended portion), persuasive messaging throughout the hospital, and the integration of influential employees to reinforce healthy social norms. Changes in weight, BMI, waist circumference, physical activity, and dietary behavior after 6 months and 1 year were primary outcomes. Secondary outcomes included knowledge, perceptions of employer commitment to employee health, availability of information about diet, exercise, and weight loss, perceptions of coworker support and frequency of health discussions with coworkers. A process evaluation was conducted as part of the study. Results Repeated measures ANCOVA indicated that neither group showed significant increases in weight, BMI, or waist circumference over 12 months. The intervention group showed a modest increase in physical activity in the form of walking, but decreases in fruit and vegetable servings and fiber intake. They also reported significant increases in knowledge, information, perceptions of employer commitment, and health discussions with peers. Employees expressed positive attitudes towards all components of the Go! intervention. Conclusions This low-intensity intervention was well-received by employees but had little effect on their weight over the course of 12 months. Such results are consistent with other worksite obesity prevention studies using ecological approaches. Implementing low-impact physical activity (e.g., walking, stair use) may be more readily incorporated into the worksite setting than more challenging behaviors of altering dietary habits and increasing more vigorous forms of physical activity. Trial Registration This study was registered with clinicaltrials.gov (NCT01585480) on April 24, 2012. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2828-0) contains supplementary material, which is available to authorized users.

Objective: The goal of this study was to identify factors that college students perceived as contributing to healthy and unhealthy eating patterns, physical activity (PA) levels, and weight change. Participants: Forty-nine 18- to 22-year-old students at a midwestern university participated. Methods: Six focus groups (3 with each gender) were conducted, and data were analyzed using qualitative software to code and categorize themes and then reduce these to clusters according to commonly practiced methods of qualitative analysis. Results: Eating and PA behaviors appear to be determined by a complex interplay between motivations and self-regulatory skills as well as the unique social and physical environment comprising college life. Moreover, there appear to be gender differences in how these determinants impact behavior. Conclusions: Future research should examine these interactions in the college context in order to further our understanding of potential interventions or environmental modification...

To address the recent trend in the increasing use of wellness programs at the workplace, this study examined the relationship between employees’ perceptions of organizational support for employee h...

Although the incidence of HIV each year remains steady, prevention funding is increasingly competitive. Programs need to justify costs in terms of evaluation outcomes, including economic ones. Threshold analyses set performance standards to determine program effectiveness relative to that threshold. This method was used to evaluate the potential cost savings of a national capacity–building program for HIV prevention organizations. Program costs were compared with the lifetime treatment costs of HIV, yielding an estimate of the HIV infections that would have to be prevented for the program to be cost saving. The 136 persons who completed the capacity–building program between 2000 and 2003 would have to avert 41 cases of HIV for the program to be considered cost saving. These figures represent less than one tenth of 1% of the 40,000 new HIV infections that occur in the United States annually and suggest a reasonable performance standard. These data underscore the resources needed to prevent HIV.

Community-based organizations (CBOs), particularly minority-based CBOs, are instrumental in the delivery of HIV/AIDS prevention programs and services. Despite a tremendous need, many CBOs lack the capacity to plan, implement, and evaluate targeted prevention interventions to serve culturally diverse populations. This article describes a comprehensive, innovative curriculum for building capacity within CBOs providing HIV prevention programming. An overview of the process through which the Centers for Disease Control and Prevention/Association of Schools of Public Health Institute for HIV Prevention Leadership evolved is discussed. The development of the curriculum occurred in four phases: needs assessment, curricular design, implementation, and evaluation. A description of the Institute's evaluation strategies and procedures are described. Selected preliminary evaluation results from two cohorts of participants indicate significant knowledge gains and high levels of satisfaction with the Institute sessions, assignments, and faculty. The Institute's model shows promise for the provision of capacity building education at the individual and organizational level for community-based professionals implementing HIV prevention programs.

Currently, over 48 million people in the United States lack health insurance (DeNavas-Walt, Proctor, & Smith, 2012). Further, recent research suggests that nearly half of the adult population is either uninsured, experienced uninsurance at least once in the past year, or were not protected from extraordinary out-of-pocket medical costs associated with high deductible individual plans in 2012 (Collins, Robertson, Garber, & Doty, 2013). Close to 25% of those 18-24 and 28% of those 25-34 are uninsured, whereas only 14.7% of the overall population are uninsured (Cohen & Martinez, 2013). Review of the Literature It is well documented that a lower income is associated with not having health insurance (Schwartz & Schwartz, 2008) and it is costly to purchase health insurance in the open market (meaning the market outside of employer-sponsored coverage). However, even employed young adults face significant barriers to having health insurance. Young adults are more likely to be un- or under-employed and thus less likely to have employer-sponsored insurance or to afford the premiums associated with health insurance. Research suggests that close to one-quarter of young adults offered employer-sponsored insurance turn it down due to the expense. Young adults also tend to have lower wages even in full time jobs and face hurdles imposed by employers (e.g. having to work for a certain period of time before becoming eligible; Holahan & Keeney, 2008; Collins et al., 2013). A lack of a college education can compound the problem. Uninsured young adults are more than twice as likely as privately insured young adults to have no education beyond high school. Furthermore, people with less education are less likely to seek employment with large firms, which are more likely to provide health insurance as a benefit (Schwartz & Schwartz, 2008). Young adults are less likely to enroll in employer-sponsored insurance because of good health and the attitude that health insurance is not important. Compared to adults 27 years and older, adults 26 years and younger are less likely to believe that health insurance is necessary even after controlling for health status (Holahan & Keeney, 2008). These data strengthen the stereotype pointed out by Collins and colleagues that young adults consider themselves to be "invincible" (2012). Data from focus groups conducted by the Minnesota Department of Health (Krueger & Associates, 2002) support the sentiment that health insurance lacks value. The young adults participating in the focus groups felt health insurance was not worth what it costs and that they would pay more for insurance than they currently spend on health care. Additionally, it is difficult for young adults to access government-sponsored health programs, such as Medicaid. A majority of the young adults between the ages of 19-34 do not qualify for government health programs due to strict limitations on eligibility (Schwartz & Schwartz, 2008). According to Holahan and Kenny (2008), only 13% of uninsured young adults could be enrolled in Medicaid or other public coverage, which leaves them at the highest risk of not receiving needed medical attention (2008). In addition to eligibility, other barriers to using government-sponsored insurance include a lack of knowledge about eligibility, how, and where to apply; concerns about welfare eligibility; and barriers related to income documentation and the application process (Stuber & Bradley, 2005). Clearly government safety-net programs have a long way to go in addressing access issues facing the young adult population. Without insurance, young adults choose to skip recommended treatments, tests and follow up visits; avoid seeking necessary medical attention; forgo purchasing prescribed medications, or are paying off medical debt (Callahan & Cooper, 2005; Collins et al., 2012). Young adults are also more likely to lack a usual source of care, which can have long-term consequences for their health. …

This article aimed to examine changes in the HIV prevention capacity of HIV prevention program managers who completed the Institute for HIV Prevention Leadership (“Institute”) between 2002 and 2004, and who worked in community-based organizations that primarily served African Americans. Participants completed a survey at three points in time, in which they rated the frequency with which they conducted activities related to HIV prevention practice. Participants also rated their confidence in performing activities. Repeated measures ANOVA was conducted to detect differences at three time points (baseline, immediate posttest, and 6 months posttest). A significant overall positive trend was found in the frequency and confidence of participants to perform specific HIV prevention practices and an overall positive trend in the frequency of processes that support HIV prevention practice. Investment in long-term, intensive, capacity-building programs like the Institute is critical to address the increasing incidence of HIV in many African American communities.

The purpose of this article is to describe evaluation measures for a capacity-building program for HIV prevention program managers and discuss how the Institute for HIV Prevention Leadership (Institute) curriculum may have increased community-based organization (CBO) capacity. HIV is an important problem that is disproportionately affecting minority communities, It is estimated that between 1,039,000 and 1,185,000 persons were living with HIV in the United States by the end of 2003.1 The AIDS epidemic is not evenly distributed across the population. From 1999 to 2003, AIDS cases increased among blacks, Hispanics, women, and young adults. Blacks accounted for 50 percent of all HIV/AIDS eases diagnosed in 2003,2 In addition, although Latinos account for 13 percent of the population, they comprise 19 percent of new AIDS cases.3 As well, the number of persons exposed to HIV/AIDS through heterosexual contact increased between 1999 and 2003.2 Understanding the social, cultural, and economic context of HIV infection is critical to developing effective prevention programs, and programs developed at the local level should more appropriately capture the linguistic, cultural, and social norms of a targeted community. For this reason, CBOs—one of the principle frontline providers of HIV/AIDS services and prevention programs since the emergence of the epidemic in 1981—continue to hold special promise for reaching communities at risk for HIV, especially minority communities.4 More than 1,450 CBOs have received funding from the Centers for Disease Control and Prevention (CDC) and have provided more than 3,000 HIV prevention programs in the United States and its territories.5 Community involvement in defining and solving health problems is vital to the success of HIV/AIDS CBOs, especially those that serve racial, ethnic, and /or sexual minority populations.6–8 Thus, building community capacity or enhancing CBOs’ capacity to address HIV/AIDS within communities hardest hit by the epidemic has become a central focus of current HIV prevention activities.9–10 HIV prevention capacity building is defined by the CDC as “a process by which individuals, organizations, and communities develop abilities to enhance and sustain HIV prevention efforts” with the goal of “fostering self-sufficiency and the self-sustaining ability” of CBOs “to improve HIV prevention programs, processes, and outcomes.” CDC capacity-building efforts are currently focused in four areas: strengthening organizational infrastructure; enhancing HIV prevention interventions; mobilizing communities for HIV prevention; and strengthening HIV prevention community planning.9 One project that the CDC currently supports to build capacity of local HIV prevention program managers who work in CBOs is the Institute. In 1998, the CDC funded a needs assessment of the training needs and preferences of HIV prevention program managers working in CBOs, Those data revealed domains of instruction and supported a capacity-building format, whereby trainees would be sent to one national training site several times and be engaged for a 9-month period.11 The Institute was formed on this model and offered its first capacity-building programs to a national cohort of professionals from January 2000 to September 2000. For more on the curriculum development processes and curriculum itself see Richter et al11,12

Using a case-study approach, representatives of the Insure Duluth coalition were interviewed in order to evaluate processes, strengths, challenges and outcomes associated with using a coalition approach to community outreach and enrollment in health insurance via the new state marketplace, which is part of the implementation of the Affordable Care Act. Overall, interview participants cited numerous strengths to the coalition approach as well as technical challenges with enrolling persons in health insurance. They also felt such challenges had the unintended effect of strengthening the relationships between coalition organizations. Community level outcomes were identified as being associated with the coalition’s work. Participants also discussed key contextual factors supporting the coalition. The coalition approach appears to be a promising tactic to increase health insurance access. States can provide funding for and foster policies to assist coalitions expand health insurance access. Keywords: Coalitions, Health Insurance, Health Care Access, Affordable Care Act, Interviews, Case-Study Community coalitions have become a widespread and accepted means for addressing

Background The potential for social capital to influence health outcomes has received significant attention, yet few studies have assessed the temporal ordering between the two. Even less attention has been paid to more vulnerable populations, such as low-income women with children. Our objective was to explore how different dimensions of social capital impact future health status among this population. Methods This study uses data from the Fragile Families and Child Well-Being (FFCWB) Study, which has followed a cohort of children and their families born in large U.S. cities between 1998 and 2000 to mostly minority, unmarried parents who tend to be at greater risk for falling into poverty. Four separate measures of social capital were constructed, which include measures of social support and trust, social participation, perceptions of neighborhood social cohesion, and perceptions of neighborhood social control. The temporal effect of social capital on self-reported health (SRH) is investigated using logistic regression and we hypothesize that higher levels of social capital are associated with higher levels of self-rated health. Results After controlling for socioeconomic and demographic factors related to social capital and self-rated health, social support and trust, perceptions of neighborhood social cohesion and control at an earlier point in time were positively associated with higher levels of health four-years later. Social participation was not related to increased health. The empirical results appear robust. Conclusion Higher levels of social capital are predictive of improved health over a four-year time frame. These results suggest that policy initiatives supporting increasing the social capital available and accessible by low-income, urban, minority women are viable for improving health. Such policies may have the potential to reduce socioeconomic health disparities.