Social Capital is Positively Associated with Self-rated Health Among Chinese Adolescents

doi:10.21203/rs.3.rs-3745430/v1

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Social Capital is Positively Associated with Self-rated Health Among Chinese Adolescents

https://doi.org/10.21203/rs.3.rs-3745430/v1

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Background

This study examines the relationship between self-rated health and social capital among Chinese adolescents and aims to understand the influence of family, neighborhood, and school connections on adolescents' perceived health.

Methods

This cross-sectional study involved 501 secondary school students (217 males, 284 females, 15–19 years old). Self-perceived health was rated on a five-point scale divided into 'good health' and 'bad health'. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the association between good self-rated health and social capital in family, neighborhood and school. Gender, self-perceived socioeconomic status, psychological distress and body mass index were considered in the analysis using multivariate logistic regression.

Results

The results indicate a robust correlation between good self-rated health and increased family social capital (OR 2.99; 95% CI: 1.78 to 5.00), increased neighborhood trust (OR 2.42; 95% CI: 1.56 to 3.76), and increased informal social control (OR 1.74; 95% CI: 1.07 to 2.83). Conversely, no statistically significant correlation was found between good self-rated health and school social capital.

Conclusions

These findings underscore the central role of family and neighborhood social capital in shaping the self-rated health of Chinese adolescents. The study highlights the need for a more comprehensive understanding of the specific influences of family and community connections on adolescents' well-being and thus contributes to the broader discourse on adolescent health in Chinese culture.

Social Capital

Self-rated Health

Adolescents

Family dynamicy

Chinese culture

Adolescence is a critical phase characterized by significant physical, psychological, and social changes (Joshi et al., 2023; Vinogradov et al., 2023; Yoon et al., 2023). During this developmental phase, individuals establish and maintain social relationships that can have a lasting impact on their health and well-being (Gómez-López et al., 2019; Manchanda et al., 2023; M. Yuen & Wu, 2023a). The complicated developmental processes of adolescence, including identity formation, peer influence, and the pursuit of autonomy, highlight the importance of understanding the role of social capital in shaping health perceptions (Alivernini et al., 2023; Gudi-Mindermann et al., 2023). As adolescents pass through this dynamic stage, the quality of their social relationships become a crucial factor influencing their attitudes toward health and the development of health-related behaviors (Casale et al., 2023; Levula et al., 2016; Paek & Hove, 2012). The link between social capital and adolescent health is based on the central role that social relationships play in mitigating stressors and promoting positive mental health outcomes (Duh-Leong et al., 2021). Adolescents who have strong social capital often benefit from a supportive network that promotes emotional well-being and provides a buffer against the challenges associated with this transitional phase (Jonsson et al., 2020; McLean et al., 2023; Popat & Tarrant, 2023). In addition, the sense of belonging and social cohesion that results from high social capital can help adolescents adopt healthier behaviors (Goodman et al., 2023), as they are more likely to make positive lifestyle choices when they are involved in a supportive social environment (de Freitas et al., 2023). Furthermore, the intricate interplay between these social dynamics and adolescents' self-rated health gains particular importance in the context of Chinese sociocultural dynamics(Alwah et al., 2023). Chinese adolescents likely experience a complex interplay of social factors that contribute to their self-rated health in the context of their unique sociocultural environment (Kim et al., 2023; Wang, Lu, et al., 2023; Xu et al., 2023). Research suggests that social capital and the nature and strength of social ties forged during adolescence may form the basis for long-term health outcomes (Edyburn et al., 2021; Gore, 2023; Taibi et al., 2023). The study of social capital in this population is particularly relevant given the collectivist nature of Chinese society and the potential influence of social networks on adolescents' perceptions of health (Wu et al., 2010; S. Yuen & Tang, 2023). In the context of adolescent health, social capital becomes a crucial determinant influencing various aspects of well-being, such as the development of health behaviors, psychological well-being, and overall health status (W. Hu et al., 2022; Hunduma et al., 2022; Rava et al., 2023; Wolff & Shen, n.d.; Zhang & Jung, 2022). Building on this foundation, this study aims to investigate the relationship between social capital and self-rated health among Chinese adolescents.

Extending the existing literature (Borges et al., 2010; Hibino et al., 2012; Li et al., 2022), this study hypothesizes that there is a positive relationship between social capital and self-rated health among Chinese adolescents. However, few studies have simultaneously examined the contribution of different sources of social capital to youth health. The presence of strong social ties, supportive relationships and a sense of community may contribute to a more positive perception of health. Conversely, a lack of social capital or strained social relationships may be associated with poorer self-rated health outcomes. Through an in-depth examination of social capital in the context of Chinese adolescents, this study aims to contribute valuable insights into understanding the complex relationship between social factors and health outcomes at this crucial developmental stage.

Participants

This study conducted a comprehensive empirical investigation of the demographic composition of secondary school students in Beijing, a major urban centre in the People's Republic of China with a population of over 20 million people. The participating secondary schools were randomly selected. The study targeted all students who were actively enrolled in the 2020/21 school year.

A cohort of 501 high school students between the ages of 15 and 19 took part in the study. This group included 217 male and 284 female students with an average age of 16.6 ± 1.0 years and an average body mass index of 22.7 ± 6.6 kg/m2. Ethical approval was obtained from the Institutional Review Board of the prestigious Beijing Sport University. In addition, the parents of the participating students gave prior consent by signing an informed consent form. Each individual student also confirmed their consent to participate by signing the appropriate consent form.

Self-rated health

Self-rated health was assessed with one question in a standardized questionnaire in which participants were asked to rate their perception of their health. The answers were classified on a 5-point Likert scale from 1 (very poor) to 5 (very good). To increase analytical accuracy, the scale was dichotomized, with a reassigned value of 1 indicating poor health. This category included responses categorized as "very poor"," "poor" and "neither poor nor good". A new value of 2, on the other hand, stands for a good state of health and includes the answers "good" and "very good". Self-rated health is a widely used variable in public health studies due to its ease of use. Extensive empirical data supports its utility as a reliable predictor of both mortality and health care utilization in the adult population (Mennig et al., 2023; Ren et al., 2023; Tang et al., 2023; Zheng et al., 2023). The application of self-rated health extends particularly to studies of adolescents (de Sales et al., 2023; Donnelly et al., 2023; Hetlevik et al., 2019; Padilla-Moledo et al., 2020).

Social capital indicators

This study focused on the nuanced facets of individual perceptions of social capital in the domains of family, neighborhood, and school (Grilo et al., 2023; Hoolihan & Thomas, 2020; Long & Renbarger, 2023). To assess family social capital, participants answered the specific item: "Do you feel that your family understands you and gives attention to you?" (Baycan & Öner, 2023; Cao et al., 2022; Puccia et al., 2021). The neighborhood social capital survey included two questions: "Do you feel that people in your neighborhood trust each other (neighborhood trust)?" and "Do you feel that your neighbors intervene to criticize someone's deviant behavior during high school (informal social control)?" (Lown, 2023; Novak et al., 2015a). The analysis of school social capital included responses to two questions: "Do you feel that teachers and students at your school trust each other (vertical trust at school)?" and "Do you feel that students at your school cooperate with each other (reciprocity at school)?" The categorical representations of the social capital variables, which were collected through responses on a Likert scale from 1 (strongly disagree) to 5 (strongly agree), were subjected to a binarization process. The reclassification resulted in a new value of 1, which includes the responses "strongly disagree"," "disagree" and "neither agree nor disagree" and indicates a low level of social capital. Conversely, the answers "agree" and "strongly agree" were assigned a new value of 2, indicating high social capital. This careful categorization increases the accuracy of this investigation on the different dimensions of social capital perceptions.

Covariates

The consideration of potential mediators in this study included body mass index (BMI), which was determined using self-reported height and weight measurements. A discriminatory scoring system was used, classifying responses in the ≥ 25 kg/m2 range as indicating a high BMI and thus distinguishing students with an elevated BMI from their peers with lower BMI values. To ensure methodological rigor, socioeconomic status (SES) was examined as a potential confounding variable (Foster et al., 2021). SES was operationalized based on both parents' occupations at the time of the study, and self-perceived SES was divided into three levels — high SES, medium SES, and low SES (16). Further refinement was made by binarizing into high/medium (responses in the 2–4 range) and low (responses in the 5–6 range) SES categories.

Psychological distress, which was identified as an additional potential confounding factor, was assessed using the 6-item Kessler scale (Clark et al., 2023). Each item on the scale was scored on a continuum from 0 (never) to 4 (always). The total score for the 6 items ranged from 0 to 24, with lower scores indicating less psychological distress. The scale had high internal reliability, as evidenced by a Cronbach's alpha value of .863. A dichotomous scoring ranging from 0–12 or 13 + was used, allowing for effective differentiation between students with and without significant psychological distress (Clark et al., 2023; Wang, Svalina, et al., 2023). The scale was then dichotomized using a new value of 1 for high psychological distress and a new value of 2 for low psychological distress within the 0–24 scale range.

Of note is the finding of a statistically significant gender difference in psychological distress observed through the interaction between psychological distress and gender (p < 0.001). This observation underscores the nuanced interplay between psychological well-being and gender dynamics within the population studied.

Data Analysis

Data analysis was performed using SPSS 24.0 software (SPSS Inc., Chicago, IL, USA). Descriptive statistics, including frequencies, were calculated to illustrate the distribution of the variables considered. A multivariate logistic regression analysis was performed to examine the relationships between the dependent variable, self-rated health status, and the independent variables, which included social capital, psychological distress, and sociodemographic factors. Odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were calculated to quantify the strength and precision of these relationships.

The regression model was systematically constructed by introducing each cluster of independent social capital variables separately, with sociodemographic and psychological distress variables serving as covariates. To comprehensively examine the relationships, all variables were included together in the regression model, which allowed for a holistic examination of the interplay between the dependent variable and all independent variables. Statistical significance was set at a p-value of less than 0.05 to ensure a strict criterion for interpreting the results.

The present paper was structured according to the guidelines of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement checklist to ensure transparency and completeness in the presentation of the research methodology and results. This systematic approach increases the credibility and reproducibility of study results within the scientific community.

A gender-specific analysis in Table 1 shows that the percentage of people reporting good self-rated health is higher for men (71.9%) than for women (61.3%). It is worth noting that around 35% of the total sample reported poor health. It is important to emphasise that the prevalence of mental disorders is relatively the same for boys and girls. In addition, a general observation shows that the average body mass index (BMI) is higher in men than in women (20.7 vs. 17.3).

Statistical analysis using the chi-square test revealed no significant evidence of gender differences in the proportion of people reporting good self-rated health, as shown in Table 1. This careful examination of demographic and health-related indicators contributes to a nuanced understanding of gender differences within the population studied.

Table 1 Descriptive statistics

	Total	Males N=217 (56.7%)	Females N=284 (43.3%)	p value

Self-rated health
Poor	171 (34.1)	61 (28.1)	110 (38.7)	.013
Good	330 (65.9)	156 (71.9)	174 (61.3)	.013
BMI
Not overweight	407 (81.2)	172 (79.3)	235 (82.7)	.322
Overweight	94 (18.8)	45 (20.7)	49 (17.3)	.322
Psychological distress
Low	291 (58.1)	89 (41.0)	121 (42.6)	.720
High	210 (41.9)	128 (59.0)	163 (57.4)	.720
Social capital
Family support
Low	75 (15.0)	31 (14.3)	44 (15.5)	.707
High	426 (85.0)	186 (85.7)	240 (84.5)	.707
Neighborhood trust
Low	125 (25)	46 (21.2)	79 (27.8)	.090
High	376 (75)	171 (78.8)	205 (72.2)	.090
Informal social control
Low	372 (74.3)	153 (70.5)	219 (77.1)	.094
High	129 (25.7)	64 (29.5)	65 (22.9)	.094
Vertical trust
Low	92 (18.4)	40 (18.4)	52 (18.3)	.972
High	409 (81.6)	177 (81.6)	232 (81.7)	.972
Reciprocity
Low	66 (13.2)	28 (12.9)	38 (13.4)	.876
High	435 (86.8)	189 (87.1)	246 (86.6)	.876

* Univariable, chi-squared test

Table 2 provides an in-depth examination of the complex relationship between self-rated health and various dimensions of social capital. The analysis shows a significant relationship between self-rated health and certain aspects of family and neighborhood social capital. In particular, good self-rated health shows a robust correlation with increased familial social capital (OR 2.99; 95% CI: 1.78 to 5.00), increased trust in the neighborhood (OR 2.42; 95% CI: 1.56 to 3.76) and increased informal social control (OR 1.74; 95% CI: 1.07 to 2.83). In contrast, no statistically significant correlation was found between good self-rated health and school social capital.

When all social capital domains were integrated into the model (Model 4), the positive association between good self-rated health and increased family social capital persisted (OR 1.91; 95% CI: 1.06 to 3.45), along with persistent correlations with increased trust in the neighborhood (OR 1.85; 95% CI: 1.13 to 3.04) and increased informal social control (OR 1.67; 95% CI: 1.03 to 2.72). These nuanced results contribute to a comprehensive understanding of the differentiated interplay between self-rated health and various dimensions of social capital and shed light on the different effects of family, neighborhood and school contexts on health perceptions in the population studied.

Table 2 Odds ratios for good self-rated health among Chinese adolescents

	Model 1	Model 2	Model 3	Model 4

Family support
Low
High	2.99 [1.78-5.00]***			1.91 [1.06-3.45]*
Neighborhood trust
Low
High		2.42 [1.56-3.76]***		1.85 [1.13-3.04]*
Informal social control
Low
High		1.74 [1.07-2.83]*		1.67 [1.03-2.72]*
Vertical trust
Low
High			1.29 [0.64-2.59]	1.13 [0.54-2.34]
Reciprocity
Low
High			1.79 [0.81-3.95]	1.12 [0.48-2.61]
Gender
Male
Female	0.60 [0.41-0.89]*	0.65 [0.43-0.96]*	0.60 [0.41-0.89]*	0.63 [0.42-0.94]*
Age	1.04 [0.86-1.26]	1.05 [0.86-1.27]	1.04 [0.86-1.25]	1.04 [0.85-1.26]
SES (father)	0.97 [0.81-1.15]	0.94 [0.79-1.13]	0.95 [0.80-1.13]	0.95 [0.80-1.14]
SES (mother)	1.18 [0.98-1.42]	1.18 [0.98-1.41]	1.18 [0.98-1.41]	1.19 [0.99-1.43]
BMI
Not overweight
Overweight	0.53 [0.33-0.86]**	0.49 [0.30-0.79]**	0.58 [0.36-0.92]*	0.48 [0.30-0.79]**
Psychological distress
High
Low	0.90 [0.31-1.33]	0.85 [0.57-1.27]	0.91 [0.62-1.35]	0.81 [0.54-1.21]

***p<0.001, **p<0.01, *p<0.05; OR – odds ratio; CI – 95% confidence interval. These four models were examined in a sequence of four logistic regression models.

Model 1: Examine association between family social capital and youth self-rated health adjusting for gender, body mass index, self-perceived socioeconomic status and psychological distress.

Model 2: Examine association between neighbourhood social capital and youth self-rated health adjusting for gender, body mass index, self-perceived socioeconomic status and psychological distress.

Model 3: Examine association between school social capital and youth self-rated health adjusting for gender, body mass index, self-perceived socioeconomic status and psychological distress.

Model 4: Examine association between all social capital variables and youth self-rated health adjusting for gender, body mass index, self-perceived socioeconomic status and psychological distress.

Understanding the intricate interconnection between social capital and self-rated health among Chinese adolescents is of paramount importance in the broader context of public health research (Gu & Zhu, 2020; X. Y. Hu & Hu, 2021; Novak et al., 2018; Pan & Wu, 2020; Zhu et al., 2019). Adolescence, characterized by dynamic psychosocial and physical development, is a crucial period in which social influences play a crucial role in shaping health perceptions. Examining the relationships between the various dimensions of social capital — particularly in the context of family, neighborhood and school — and self-rated health provides valuable insights into the nuanced factors that contribute to adolescents' well-being.

The family unit, considered the cornerstone of social structure during adolescence, has a significant impact on various aspects of adolescent development, including the formation of personal values, coping mechanisms, and social support networks. This study, which examines the nuanced interplay between family dynamics and self-rated health among Chinese adolescents, provides results that are consistent with expected outcomes. Specifically, a significant association was found between good self-rated health and increased family social capital (OR 2.99; 95% CI: 1.78 to 5.00). These findings align with the existing literature on this topic and support existing perspectives. In line with the work of Boele et al. (2023), Botelho Guedes et al. (2022) and Pechmann et al. (2020), this study confirms the recognized importance of family influence on adolescent well-being. The family, which serves as the primary context for the development of social bonds and emotional security, is of particular importance for health perceptions. Echoing the sentiments expressed by Lin & Yi (2019) and Seay et al. (2023), the results of this study highlight the enduring influence of family relationships on adolescents' psychosocial development. This emotional resilience and support contribute significantly to positive health outcomes as adolescents navigate the challenges and transitions characteristic of this stage of life. The role of the family as a crucial support system is particularly evident in Chinese culture, where strong family ties are deeply rooted. Furthermore, these results are consistent with cross-sectional studies such as that of Bamford et al. (2023), which emphasizes the universal importance of family relationships for adolescent health. Understanding the multifaceted impact of family on adolescents health therefore not only enriches the scientific discourse, but also emphasises the importance of targeted interventions that strengthen family connections for the overall well-being of Chinese adolescents."

Together with family influence, the immediate neighborhood environment proves to be a decisive social factor during adolescence that can either strengthen or hinder adolescents' health. In this study, the complex relationship between neighborhood social capital and self-rated health among Chinese adolescents is seamlessly consistent with the expected results. In particular, a significant correlation in which good self-rated health is associated with increased trust in the neighborhood was observed (OR 1.85; 95% CI: 1.13 to 3.04). The results were not surprising, as the sense of trust, support and cohesion within a neighborhood fosters a supportive environment and gives adolescents a sense of belonging and security. This positive social capital helps to reduce stress levels, improve mental health and increase the likelihood of engaging in health-promoting behaviors. In addition, the informal social control mechanisms within a well-connected community can positively influence health outcomes. The shared sense of responsibility and mutual support in the neighborhood can lead to a positive feedback loop that promotes the individual and collective well-being of Chinese adolescents. Consistent with studies such as that conducted by Novak et al. (2015b, 2016), the findings of this study highlight the universal importance of neighborhood relationships in shaping adolescent health. These studies not only increases the robustness of this study’s results, but also demonstrates that the influence of neighborhood dynamics on health perceptions transcends cultural boundaries. This study aligns with the perspectives presented by Aspillaga et al. (2022) and Marquez et al. (2023), who emphasize the role of social capital in community health. The observed positive association between good self-rated health and increased trust in the neighborhood is consistent with the theoretical framework proposed by these authors. In addition, the findings obtained from this study are consistent with the findings of (Marquez, Qualter, et al., 2023; Shareck et al., 2023), who further emphasize the positive association between neighborhood social capital and individual health outcomes. The association between good self-rated health and increased trust in the neighborhood uncovered in this study’s results points to a potential avenue for positive health interventions. This highlights the potential effectiveness of strategies aimed at strengthening community cohesion and trust.

This study takes a different turn when it looks at the area of school social capital. Surprisingly, a statistically significant correlation in these results was not found, which deviates from expectations and prompts further reflection. This result is in contrast to the expected role of school social capital, which is often considered crucial for adolescents' health perceptions. To understand this result, it is important to examine the reasons for the lack of a statistically significant relationship. In contrast to this study, the results seem to contradict the findings of other authors. For example, the research presented by Buerger et al. (2023), Cilar et al. (2020), Pechmann et al. (2020b), Rudolf & Lee, (2023) and M. Yuen & Wu (2023b) indicates a strong positive correlation between school social capital and self-rated health in adolescents. However, the results of this study paint a different picture, as no statistically significant correlation was found. This deviation from expectations underlines the complexity of social capital at school level and the fact that different factors can manifest themselves differently in different environments. Possible reasons for the lack of correlation in this study could be differences in the socioeconomic background of the study participants, different perceptions of social capital among students, or unique contextual factors influencing the school environment. In addition, the complexity of building and maintaining social capital in the school environment as well as the role of individual personalities and social dynamics could contribute to the observed deviation from the expected correlations. To fully decipher the complex relationships, future research should consider a qualitative approach to examine students' life experiences and the qualitative aspects of social interactions in the school context.

Nevertheless, this study is subject to certain limitations. Firstly, the regional differences in socio-economic, cultural and educational development in China may affect the generalizability of the results. Beijing, as the capital, has a relatively high level of socio-economic and cultural development, which contributes to the overall higher socio-economic status of families. However, there are differences between the 16 districts and the different high schools in Beijing. To increase the representativeness of the sample size, future studies should consider greater geographical diversity and conduct more comprehensive analyses. Second, the self-reported family socioeconomic status and health assessments of high school students are susceptible to individual perception bias. The ongoing effects of the Covid-19 pandemic further complicate the matter, as a noticeable decline in community and school-organised activities affects students' self-assessment of their health. In further research projects, a broader and more diverse group of participants combined with a differentiated investigation of contextual influences would be essential for a more thorough understanding of the complex relationships.

The positive correlation found in this study between increased social capital, in both the family and neighborhood context, and improved adolescent health offers valuable starting points for future scientific research. The plausible association with the strong family ties prevalent in China suggests that future research should examine the complicated dynamics of family relationships and their impact on health outcomes in more detail. The recognition of the family as a key support system in difficult situations, where its members provide crucial assistance, prompts the inclusion of family-related variables in further studies. This observed relationship between social capital, particularly in the family and neighborhood, and improved health underscores the need for a more nuanced examination of cultural influences. Future scientific research should focus on the multifaceted role of family and neighborhood ties in promoting adolescent well-being in China's unique cultural context and contribute to a more comprehensive understanding of health dynamics in this population.

Ethics approval and consent to participate

Ethics approval to conduct this study was obtained from the Institutional Review Board (IRB) of Beijing Sport University, a leading institution in this field (Approval No. BSU-IRB-2023/08). Prior to the start of the study, informed consent was obtained from the parents of all participating students by completing comprehensive consent forms. This was a prerequisite to ensure compliance with ethical standards. In addition, each participating student gave individual consent by signing a customised consent document. In this document, the aims and methods of the study were explained in detail to ensure informed and voluntary participation of the participants in accordance with the ethical research guidelines.

Consent to publication

Not applicable, all authors are in agreement with the final manuscript.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request aand with the permission of National Social Science Fund of China.

Competing interests

The authors declare that they have no competing interests.

Funding

This research is funded by National Social Science Fund of China (Study on the Status, Value, and Implementation Path of Sports in Fostering Virtue in the New Era). Project No. 21VSZ062.

Authors' contributions

XW, ZQ and DN designed the research and recruited participants. BM conducted the data analysis. ZQ interpreted the results. TP and DN drafted the manuscript. All authors read and approved the final version of the manuscript.

Acknowledgements

The authors would like to thank the National Social Science Fund of China for the financial support that made this research project possible.

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Social Capital is Positively Associated with Self-rated Health Among Chinese Adolescents

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