Social Capital, Social Support and Long-Term Quality of Life

Institution: University of California, Berkeley
Investigator(s): Dana Petersen, M.A., M.P.H. -
Award Cycle: 2006 (Cycle 12) Grant #: 12GB-0005 Award: $67,540
Award Type: Dissertation Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side



Initial Award Abstract (2006)
The proposed study will explore why some long-term breast cancer survivors experience high levels of quality of life and functional ability while others report physical and mental concerns long after treatment. It is important to discover the reasons why some breast cancer survivors recover more fully and remain healthy while others do not so that public health researchers and practitioners can promote the well-being of all survivors.

The goal of this study is to identify characteristics of the San Francisco Bay Area neighborhoods in which survivors live that positively affect the quality of their lives and functional health status. Specifically, the project examines whether differences in survivors’ quality of life are predicated by the amount of social capital available in a survivor’s neighborhood and/or the amount of social support a survivor receives. Social capital is defined as the degree of social cohesion, interaction, trust, reciprocity, and sense of mutual obligation experienced among members of a neighborhood. Social support is defined as the number of confidants and social connections a survivor has. Four main questions drive the study. First, is there something about the neighborhoods in which survivors live that affects their quality of life and functional status? Second, does social capital positively influence breast cancer survivors’ long-term well-being? Third, does social capital magnify the benefits of a survivor’s personal social support during long-term recovery from breast cancer? Fourth, do women from different backgrounds (e.g. race/ethnicity, education, income) react differently to social support and the level of social capital available in their neighborhoods?

Telephone interviews will be conducted with approximately 400 ten-year breast cancer survivors to collect information regarding their backgrounds, available social support, perceptions of neighborhood social capital, quality of life and functional health status. Additional information about the neighborhoods including the availability of voluntary and social organizations, crime incidence and voter participation will also be collected. Statistical analyses will be conducted to determine whether and how much a survivor’s personal background, available social support, and neighborhood characteristics (e.g. social capital) affect her quality of life/functional ability. Breast cancer survivors and advocates will be meaningfully involved in the proposed research, conducing telephone interviews and participating in focus groups to discuss study results and interpret findings.

The study is innovative in that it is among the first to examine characteristics of neighborhoods that may positively influence breast cancer survivors’ heath outcomes. Findings could provide the basis to promote the development of new public health interventions, public health policy and neighborhood vitalization activities that increase the social capital of neighborhoods. Findings could also be used to support the production of social capital through community-building activities and other infrastructure investments. The development of neighborhood organizations (e.g. neighborhood watch groups, community newsletters, block parties) and increased opportunities for social interaction (e.g. community centers, safe parks, walking groups, support groups, book clubs) may offer support for long-term breast cancer survivors, enhance their quality of life, and diminish some of their functional difficulties.


Final Report (2008)

More effective breast cancer detection and treatment regimes have resulted in a new public health challenge – helping an unprecedented number of survivors live longer, higher-quality lives than ever before. Studies show that although survivors are living longer they continue to experience a range of quality of life (QOL) concerns, some which worsen over time. Research focusing on medical, treatment, and personal variables has explained some, but not all of the variation in long-term survivors’ QOL. This dissertation study added to existing research by exploring whether neighborhood factors (i.e., social capital) helped explain some of this residual variation.

Using cross-sectional survey data from telephone interviews completed with 387 long-term (10+years) survivors, I explored relationships among neighborhood structural social capital (e.g., the density of voluntary, social, and civic organizations per zip code), perceived neighborhood cognitive social capital (e.g., perceptions of trust, cooperation, reciprocity and mutual aid per zip code), emotional support, social network ties, demographic and medical/treatment variables, and QOL outcomes. Nested linear regression models were estimated using a generalized estimating equation approach adjusting for residual correlation due to neighborhood clustering.

Results suggest that some social resources– namely personal emotional support and neighborhood cognitive social capital– are positively associated with some aspects of QOL. The social environment in which long-term breast cancer survivors live, including both the quality of the social relationships they maintain (i.e. emotional support) and the general sense of trust and cohesion in their neighborhood (i.e. cognitive social capital), is related to their QOL – most significantly, their mental health and vitality. Findings were less favorable regarding the role of structural social capital and social network size on QOL outcomes. Results also provide further evidence of the association of particular demographic and medical/treatment factors with better QOL – namely older age, fewer chronic illnesses, higher income, identification with a non-white ethnic/racial group, and having received radiation but not chemotherapy treatment.

Preliminary evidence of an interaction effect between social capital and social support variables was observed in unadjusted models, in that cognitive social capital and emotional support may act as substitutes for each other in conferring some mental health and vitality QOL benefits. That is, survivors with low emotional support benefit more from increases in neighborhood cognitive social capital than do survivors with high emotional support with regard to mental health and vitality outcomes. Also, results imply that structural social capital benefits survivors who perceive their neighborhoods to be low in cognitive social capital more than other survivors with regard to mental component QOL.

Overall, dissertation findings suggest that the social environment of long-term breast cancer survivors (including both the quality of the social relationships they maintain and the general sense of trust and cohesion in their neighborhood) is associated with some aspects of QOL. Considering this evidence, it will be important to continue developing ways to promote emotional support and develop cognitive social capital in neighborhoods to provide ongoing aid to long-term breast cancer survivors. The QOL of survivors rests not only on the contributions of those individuals who provide them with direct emotional support, but also upon those additional individuals in their neighborhoods who collectively create a sense of cohesion and trust.




Symposium Abstract (2007)
Which matters more: Who you know or where you live? This study seeks to clarify this question, and explores why some long-term breast cancer survivors experience high levels of quality of life while others report physical and mental concerns long after treatment. It is important to discover the reasons why some breast cancer survivors recover more fully and remain healthy while others do not so that public health researchers and practitioners can promote the well-being of all survivors.

The goal of this study is to identify social characteristics of the San Francisco Bay Area neighborhoods in which survivors live that positively affect the quality of their lives. Specifically, the project examines whether differences in survivors’ quality of life are predicated by the amount of social capital available in a survivor’s neighborhood and/or the amount of social support a survivor receives. Social capital is defined as the degree of social cohesion, interaction, trust, reciprocity, and sense of mutual obligation experienced among members of a neighborhood. Social support is defined as the number of confidants and social connections a survivor has.

Information regarding socio-demographic backgrounds, available social support, perceptions of neighborhood social capital, and quality of life was collected through telephone interviews with approximately 400 ten-year breast cancer survivors. Information about the availability of voluntary and social organizations in women’s neighborhoods was also collected. Descriptive statistics are complete.

Findings from this study could provide the basis to promote the development of new public health interventions, public health policy and neighborhood vitalization activities that increase the social capital of neighborhoods. Findings could also be used to support the production of social capital through community-building activities and other infrastructure investments. Community-based activities, programs, interventions and policies may offer support for long-term breast cancer survivors, enhance their quality of life, and diminish some of their functional difficulties.

Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors.
Periodical:Psycho-oncology
Index Medicus:
Authors: Bloom JR, Petersen DM, Kang SH
Yr: 2007 Vol: 16 Nbr: 8 Abs: Pg:691-706