Effects of social integration on health: A prospective study of community engagement among African American women
Research highlights
► We examine the effect of community engagement on health in African American women. ► We consider early, late, persistent, and diverse and persistent engagement. ► Outcomes are physical functioning, self-rated health, anxiety, and depression. ► Late, persistent, and diverse and persistent engagement related to better health. ► Women with persistent versus early engagement had better mental health.
Introduction
Social integration refers to one’s attachment to society through informal ties to family and friends and formal links to community institutions. This attachment has long been recognized as a mechanism that reduces deviant behaviors and maintains social norms (Durkheim, 1951, Hirschi, 1969, Mirowsky and Ross, 1989, Seeman, 1959, Sieber, 1974). Over recent years, there has been increased interest in the role of social integration in protecting physical and mental health. Resulting studies have examined different aspects of social integration, such as social support, social networks, and community involvement (see reviews by Berkman and Glass, 2000, Cohen, 2004) along with social capital, often indicated by a community’s degree of social trust and civic and political engagement (e.g., Helliwell and Putnam, 2004, Kim et al., 2006). Regardless of the constructs used, many studies have found that social integration is protective for health.
This study focuses on the effects on health of community engagement (CE), or “formal” social integration, which we define as engagement in secular and religious organizations, as reported by adult African American women followed for over 20 years. These so-called “weak ties” to community groups and institutions are considered critical for obtaining information, resources, and links to opportunities, such as education and employment (Granovetter, 1973, Ensminger et al., 2009). Wilson (1987) contends that weak ties are particularly important for inner city populations who are typically isolated and have few contacts with individuals and institutions that represent mainstream society.
Although a number of studies have examined the importance of church involvement for African Americans’ health (e.g., Chatters et al., 2008, Krause, 2004), few have documented African Americans’ broader engagement in community organizations over time and how this relates to successful aging. This is an important area of study because African Americans are more likely than are Whites to experience physical and psychological problems as they age (George and Lynch, 2003, Kington and Smith, 1997). African American women in particular are at higher risk for many chronic diseases and psychological distress compared to Whites (Centers for Disease Control and Prevention, 2004, National Center for Health Statistics, 1999), and differential social integration may help mediate this disparity.
According to Durkheim (1951), ties to institutions provide social role norms and obligations, which reduce alienation from society. Those who do not have strong social ties are less likely to abide by prescribed norms and more likely to engage in deviant behavior (Mirowsky and Ross, 1989, Seeman, 1959, Sieber, 1974). The importance of institutional ties has been emphasized by social capital theorists. For example, Portes’ (1998) definition of social capital emphasized the significance of membership in broader social structures for increasing capacity to obtain scarce resources. Putnam’s (2000) seminal work highlighted the importance of being involved in community organizations and the implications of the recent decline of such involvement in the U.S. These theorists discuss how purposeful networks and organizations produce bridging social capital, ties across diverse groups that may increase one’s economic or political well being, resulting in improvements in one’s social environment, health behaviors, and other determinants of health (Kim et al., 2006). This concept is based on Granovetter’s (1973) influential work on “weak ties” which concluded that ties to community institutions beyond one’s inner circle provide exposure to important information and resources that one cannot get from usual contacts.
Involvement in community organizations also provides individuals with important social roles. Interactional role theory (Stryker & Statham, 1985) explains that social positions in society become behaviorally prescribed roles, providing role identities that form one’s self (Burke & Tulley, 1977). Having multiple roles (role enhancement) is considered beneficial (Sieber, 1974), with many studies finding a positive effect on physical and mental health (e.g., Lum and Lightfoot, 2005, Moen et al., 1992), while others find that too many roles become a strain (Goode, 1966), thereby negatively influencing health (Musick and Wilson, 2003, VanWilligen, 2000).
In general, involvement in community organizations is thought to benefit physical and mental health through its provision of social support, enhanced opportunities for interactions, expanded social networks, distractions from troubles, and positive perceptions of relationships (House et al., 1988, Musick and Wilson, 2003). It may also provide a sense of purpose and meaning in life (Thoits, 1983, Wethington et al., 2000) as well as power and prestige (Lum and Lightfoot, 2005, Moen et al., 1992). Volunteering in particular may improve health because it is intrinsically rewarding and provides a way to meet a civic obligation to give back to the community and to help others (Musick and Wilson, 2003, Thoits and Hewitt, 2001). Church involvement may uniquely protect health through its provision of a belief structure that enhances coping skills, provides meaning, improves coping, and emphasizes caring for community members (Ellison et al., 2001, Krause, 2006).
CE may have different meaning and impact depending on when it occurs. The Life Course Social Field Framework emphasizes the developmental nature of individual social roles within important social contexts across the life course (Kellam, Branch, Agrawal, & Ensminger, 1975). For example, in childhood, family and school are key social fields, and later, peers and intimate partners become more important. In adulthood, key social fields become work, family, and community (Ensminger et al., 2009). Participation in community organizations may be particularly important later in the life course, as this is a key social field in adulthood. According to Social Disengagement Theory, people as they age gradually lose key social roles (e.g., employee, spouse, parent), and as a result, become more isolated with fewer social bonds (Cumming and Henry, 1961, Pillemer and Glasgow, 2000). A key component of Rowe and Kahn’s (1998) “successful aging” is integration in the community through volunteering and other such acts of engagement. By involving oneself in a productive role, an older person reduces the likelihood of becoming isolated and takes on new purpose in life, leading to better physical and mental health (Su and Ferraro, 1997, Wethington et al., 2000). In addition, CE may directly convey health benefits for aging populations since it requires increased activity and mobility (Fried et al., 2004, Tan et al., 2009).
Studies of involvement in secular organizations have found positive associations with both physical and mental health, but their cross-sectional designs (e.g., Cornwell and Waite, 2009, Hyyppa and Maki, 2003), make unclear whether the association with health is explained primarily by social selection (good health increases involvement in the community) or social causation (involvement in the community enhances health). Controlling for early health, longitudinal examinations of volunteering have provided evidence for both social causation (e.g., Thoits and Hewitt, 2001, VanWilligen, 2000) and social selection (Li and Ferraro, 2005, Morrow-Howell et al., 2003, Thoits and Hewitt, 2001). Specifically, volunteering has been associated with later physical health, including self-rated health (e.g., Piliavin & Siegl, 2007); lower levels of functional dependence (e.g., Moen et al., 1992), and decreased mortality (Oman, Thoresen, & McMahon, 1999). It has also been related to various indicators of later mental health: well-being (e.g., Piliavin & Siegl, 2007), increased life satisfaction (VanWilligen, 2000), decreased depressive symptomatology (Morrow-Howell et al., 2003), and depression (e.g., Lum & Lightfoot, 2005). A few studies suggest these effects are stronger among older age groups (VanWilligen, 2000), with consistency of involvement over time (Musick & Wilson, 2003), and with involvement in diverse types of organizations (Piliavin & Siegl, 2007). Studies have also found simultaneous selection. For example, Thoits and Hewitt (2001) found that while volunteering increased later well-being, those with higher well-being volunteered more time. Similarly, Li and Ferraro (2005) found that although those who volunteered were less likely to report later depression, those with functional health problems were less likely to report later volunteering.
Little research has focused on involvement in secular organizations among African Americans specifically (e.g., Tan et al., 2009), and few studies have assessed the health impact of involvement in secular groups other than volunteer organizations (e.g., social and civic organizations) or used multiple measures of engagement at one time. One exception is the early two-wave panel study of women by Moen et al. (1992) which found that involvement in clubs and organizations related to functional ability and self-rated health 30 years later. No similar longitudinal study of organization involvement has been conducted with an African American population.
There are numerous studies of participation in religious organizations (measured in a variety of ways) and health in late adulthood, although most of these works are limited by use of a cross-sectional design. Overall, self-reported church (or “religious”) attendance relates to both physical and emotional health (Chatters, 2000). For African Americans in particular, church involvement strongly relates to health and well being. Krause, 2004, Krause, 2006 has attributed the church–health relationship to the history of African American churches and their central role in the African American community. Because of the long history of slavery and discrimination in the U.S., churches served as the social center of the African American community and were the source of social, economic, and spiritual support (Billingsley, 1999, DuBois, 2000, Krause, 2003). Development of broader community institutions (e.g., education, civic, health) serving African Americans was greatly aided by the churches (Taylor, Chatters, & Levin, 2004).
African American churches have a history of addressing and ameliorating adverse life conditions and improving the social, emotional, psychological, and spiritual well-being of their congregations (Taylor et al., 2004). The church likely affects health among African Americans through both psychosocial and behavioral mechanisms. For example, in addition to enhancing family cohesion and social networks, the church provides a sense of meaning, promotes health behaviors, and provides many types of social support, which can directly affect health or indirectly buffer the negative impact of adverse events and conditions, such as poverty and discrimination (Bierman, 2006, Ellison and Levin, 1998, Krause, 2002). However, not all African Americans are involved with a church. For example, there is some evidence that church involvement is associated with higher socioeconomic status among African Americans (Goode, 1966, Taylor et al., 2007).
Few prospective studies have examined the relationship between church and health among older African American adults. A couple of rare longitudinal studies have found that church attendance is related to fewer functional limitations (Benjamins, 2004, Idler and Kasl, 1997). Additional longitudinal research is needed to assess the effects of church attendance over time, taking into account early health.
In sum, studies of CE among African Americans have focused mainly on church involvement to the exclusion of other forms of CE. Furthermore, most of these studies are cross sectional, limiting the ability to control for selection effects. Research on involvement in secular organizations has used longitudinal data, but these studies have not focused on African Americans specifically. Therefore, much has yet to be learned about the importance of CE among African Americans.
The goal of this study is to build upon current literature by longitudinally assessing the effects of CE on both physical and mental health among an older population of African American women. Specifically, it examines the relationship between timing and persistence of involvement in religious and secular organizations and four health outcomes, taking into account age, early health, poverty, and education. We hypothesize that women involved with either religious or secular organizations at one time point will have better physical and mental health than those never tied to these institutions. We also hypothesize that women integrated with either church or other community-based organizations at two time points will have better health than those integrated at only one time or not at all. Finally, we expect that women involved with both religious and secular organizations over time will have more health benefits than those involved with only one type or none at all.
Section snippets
Study sample
Data for this study are derived from mothers of a cohort of first graders from Woodlawn, a largely African American community on the south side of Chicago and the fifth poorest of the city’s communities at the time the study began (de Vise, 1967). However, there was social and economic diversity among the study participants due in large part to racial segregation. All but 13 families in the cohort entering first grade in one of the community’s nine public or three parochial schools in 1966
Results
CE characteristics of the women at both assessments are shown in Table 1. In 1975, 40% reported going to church at least once a week, and more than 60% of the women participated in secular organizations. In 1997, 56% reported attending church at least once a week, and just under 40% participated in secular organizations. About 30% reported attending church once a week or more at both time points, and 30% reported involvement in secular organizations at both time points.
Looking at religious and
Discussion
Few studies have examined the role of formal social integration, defined here as engagement in community institutions (religious and secular), among African Americans. This study examined the impact of the timing and persistence of involvement in church and secular organizations on four different physical and mental health outcomes in a cohort of African American women followed at 1975 and 1997.
Acknowledgements
This research was supported by Grant 1RO1AGO27051-01 from the National Institute on Aging. We thank the Woodlawn study participants, the Woodlawn community, and the Woodlawn Advisory Board for their support and cooperation. We are grateful to the late Jeannette Branch and to Derian King of the Advisory Board for their help with the design of the overall project and to Sally Murphy and Ezella Pickett from National Opinion Research Center for their help with data collection. We give special
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