Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. e1124-e1131 (doi:10.1542/peds.2005-1913)
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Social Capital, Family Violence, and Neglect

Adam J. Zolotor, MD, MPHa and Desmond K. Runyan, MD, DrPHb

a Departments of Family Medicine
b Social Medicine and Pediatrics, University of North Carolina, Chapel Hill, North Carolina


   ABSTRACT
TOP
 ABSTRACT
METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
BACKGROUND. Social capital includes collective efficacy, psychological sense of community, neighborhood cohesion, and parental investment in the child. It has been shown to be associated with a variety of health and welfare outcomes and may be useful in understanding and preventing parenting behaviors on the continuum of child abuse and neglect.

OBJECTIVE. The purpose of this research was to evaluate low social capital as a risk factor for harsh physical punishment, neglectful parenting, psychologically harsh parenting, and domestic violence.

METHODS. This study is an analysis of cross-sectional telephone survey data of mothers in North and South Carolina (n = 1435). We constructed a 4-point social capital index reflecting survey responses to items ascertaining neighborhood characteristics, willingness to take personal action, the presence of 2 adults in the household, and regular religious service participation. We assessed the relationship of social capital to inventories of self-reported parenting behaviors and in-home violence.

RESULTS. In adjusted analysis, we found that each 1 point increase in a 4-point social capital index was associated with a 30% reduction in the odds of neglectful parenting, psychologically harsh parenting, and domestic violence. There was no relationship between social capital and harsh physical punishment.

CONCLUSIONS. This study demonstrates that increasing social capital decreases the odds of neglectful parenting, psychologically harsh parenting, and domestic violence but not harsh physical punishment. This supports further investigation into developing social capital as a resource for families.

Key Words: child maltreatment • child abuse • social capital • social-environmental risk • parenting

Abbreviations: PCCTS—Parent Child-Conflict Tactics Scale • OR—odds ratio • CI—confidence interval

The World Bank defines social capital as "institutions, relationships, and norms that shape the quality and quantity of a society's social interactions."1 Social capital includes collective efficacy, psychological sense of community, neighborhood cohesion, and parental investment in the child. Collective efficacy means that members of a group believe in the ability of the group to act effectively. Psychological sense of community includes sense of membership, bidirectional influence, integration, and emotional connection. Neighborhood cohesion refers to affective and instrumental support.2 Social networks are a part of social capital. Social networks are the connections a person has in a community but do not describe features of social capital, such as trust, shared reciprocity, and community norms. Social capital is theorized to be a resource available to a family, like financial and human capital, that can help families overcome adversity or prosper economically.3 Low social capital is a risk for school dropout, violent crimes, childhood injuries, poor cognitive and behavioral outcomes, and overall mortality.4–9 The concept has received increasing interest among health researchers and social scientists.10 Public health agencies and governments have begun to look at ways in which we can grow social capital to improve well-being.1,11,12

The negative parenting behaviors examined in this study are part of the spectrum of child maltreatment including harsh physical punishment, neglectful parenting, and psychologically harsh parenting. Exposure to domestic violence is emotionally harmful to children and is often considered a type of child maltreatment.13 The causes of child maltreatment have been evaluated along multiple domains, including individual, family, community, national factors, and societal norms. The parent-child dyad are at the center of a complicated set of systems, which may influence the individual-level characteristics leading to maltreatment.14

A previous study showed that, in poor neighborhoods, low neighborhood cohesion (a part of social capital) measured at the neighborhood level is associated with an increase in neighborhood rates of substantiated child abuse of all types.15 However, maltreating parents may not have the same level of access to neighborhood cohesion as nonmaltreating parents. Also, this previous study did not distinguish between types of maltreatment. In the current study, we measure social capital at the level of the family, as well as self-reported parenting behaviors and in-home violence. We examine the relationship of low social capital to the probability of self-reported harsh physical punishment, neglectful parenting, psychologically harsh parenting, and domestic violence.


   METHODS
TOP
 ABSTRACT
 METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Study Design and Sampling
An anonymous telephone survey on child rearing was administered to a probability sample of North and South Carolina mothers. This survey has been described previously in this journal in a report on the epidemiology of harsh physical punishment.16 Nearly half of our sample (47%) came from telephone random-digit dialing. The remaining households were enrolled from a random selection of telephone numbers representing a targeted sample of households with children <18 years of age. The targeted sample was added because of difficulty generating the desired sample size. Sampling frames were purchased from GENESYS Sampling Systems (Fort Washington, PA). A total of 8262 numbers were used. There were 4611 ineligible numbers (ie, numbers not in service, business), and 1335 were of unknown eligibility (maximum call attempts resulted in no answer). There were 881 eligible numbers that did not complete an interview (eg, refused, unavailable). A combined response rate of 52% * was achieved following the computational guidelines of the American Association for Public Opinion Research for response rate 3. 17

Data Collection
The survey was conducted from August to December of 2002 using Blaise, a computer-assisted telephone interview software package by Statistics Netherlands (Voorburg, Netherlands). A minimum of 12 callback attempts was placed. Eligible households were located in North and South Carolina, with a child under 18 years of age in the household, and a mother or female guardian present. At the start of the interview, after eligibility was determined, telephone numbers were purged from the interviewer's computer to provide anonymity to the respondent. Where >1 child resided in the home, a referent child was selected by a computerized algorithm. If the parent or guardian spoke only Spanish, the interview was administered in that language. In preparation for Spanish-speaking families, the survey was translated into Spanish and independently back-translated. All of the respondents were given telephone numbers for parenting resources as part of a routine "debriefing." This study was approved by the University of North Carolina School of Medicine Institutional Review Board.

Measures
In the absence of standard measures for social capital, we assembled an extensive list of questions used in previous studies to capture the concepts of collective efficacy, neighborhood cohesion, and psychological sense of community.2,6,7 These surveys were reviewed with several senior sociologists and psychologists familiar with social capital theory. After piloting, questions were eliminated that were ambiguous, difficult to answer, or redundant. The final survey included 22 questions to assess social capital.

In addition to measuring social capital, the survey was designed to assess parenting behaviors, disciplinary practices, and family and community characteristics. The parenting behaviors were assessed using questions from the Parent-Child Conflict Tactics Scale (PCCTS)18 with additional questions suggested by international focus groups. The PCCTS has been widely used to assess parenting practices.16,19 The final instrument was shortened to be completed in 20 to 25 minutes. The use of anonymous surveys to assess potentially abusive caregiver behaviors uses the work of Straus et al,20 which shows that caregivers are willing to report harsh and socially disapproved forms of discipline.

Statistical Analysis
Analyses were performed using Stata 8.2 (Stata Corp, College Station, TX). Descriptive and analytic statistics were based on weighted estimates using socioeconomic status and race/ethnicity to represent North and South Carolina. Descriptive statistics were performed for demographic variables, social capital measures, and inventories of parenting behaviors and in-home violence.

The social capital questions were subjected to factor analysis to reduce the number of variables. Two factors emerged representing different concepts. See Appendix 1 for questions, response options, factor loading, and Cronbach's {alpha} values. Factor analysis details are available from the authors. Factor 1 represents neighborhood attributes, including neighborhood cohesion and psychological sense of community. Factor 2 represents 6 questions of respondents' willingness to take personal action if an undesirable activity was taking place in their neighborhood (such as a fight, physical abuse, or graffiti). This is a component of collective efficacy in that personal ability to act effectively to benefit the group is essential for the group to act effectively. A new variable was created for each factor by generating a mean response. The mean responses were dichotomized at 1.75 (<1.75 = high social capital, ≥1.75 = low social capital). This grouped those with social capital responses for a factor averaging <1.75 as having high social capital on that domain.


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  		APPENDIX 1 Social Capital Factor Loadings

 
We then created a 4-point social capital index. In addition to the 2 factors described above, regular religious service attendance (≥3 times last month) and having a partner in the home were included because of importance of each to Coleman's social capital theory.8 The latter variable is a proxy for parental resources available to members of a family, which has been used in previous work.6,9 For high social capital in each domain, respondents were assigned a value of 1, and the domains were summed in the index. This allowed us to assess cumulative benefit of increasing levels of social capital similar to previous work on cumulative risk and its relationship to development and behavior and on cumulative protection of social capital on development and intelligence.6,21,22

We grouped parent reports of child discipline into summary rates for the use of harsh physical punishment, neglectful parenting, psychologically harsh punishment, and domestic violence. See Appendix 2 for grouping of items, parenting/violence summary rates, and weighted percentages. Questions were asked of the mother's behavior toward the index child and toward her partner. Questions were also asked about the mother's partner and his behavior toward the index child and toward the mother. For each inventory, respondents were dichotomized to those who endorsed ≥1 of the behaviors listed and those who endorsed none. The summaries of parenting behavior are cumulative; therefore, the total exceeds the total responding affirmatively to each question.


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  		APPENDIX 2 Creation of Parenting Inventories

 
We performed logistic regression to assess the simple relationships between known risk factors for child maltreatment and the outcome inventories of parenting and in-home violence. We then performed multivariate logistic regression using the inventories of parenting and in-home violence as the outcome variables and the social capital index as the main exposure of interest while controlling for demographic variables and risk factors selected from previous research (child age, maternal education, receipt of public assistance as a proxy for poverty, and race).14 Also, we controlled for very high church attendance defined as going to church >8 times in the last month. In early analyses, we found that church attendance has a nonlinear relationship with some of our outcome variables. Fourteen percent of parents reported very high rates of church attendance. Failing to control for this statistically important nonlinearity violated the linearity assumption of logistic regression in models before development of a cumulative scale.


   RESULTS
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 ABSTRACT
 METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
Sample characteristics are shown in Table 1 for demographic characteristics used in the analysis. In crude percentages, the index children were 51% male and 79% white, with a mean child age of 8.9 years, mean maternal education of 14.3 years, and 33% with household incomes less than $40000.


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  		TABLE 1 Participant Characteristics (n = 1435)

 
The inventories of parenting behavior and in-home violence yielded the following results: 12% of mothers responded affirmatively to ≥1 of the harsh physical punishment questions, 13% admitted to ≥1 of the neglectful parenting questions, 13% responded affirmatively to ≥1 of the psychologically harsh parenting questions, and 20% reported a positive response to ≥1 of the domestic violence questions (Table 2). We generated a correlation matrix to assess the relationship of the inventories. The domestic violence inventory was moderately correlated with the inventory of harsh psychological parenting (R2 = 0.19). The other inventories were not very correlated (results not shown). Table 2 also shows the weighted percentage of affirmative respondents for each component of the social capital index.


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  		TABLE 2 Measures of Social Capital and Parenting Behaviors (n = 1435)

 
Table 3 shows unadjusted analyses of risk factors and social capital variables with parental behavior. Parents who report the use of harsh physical punishment more commonly have younger children, are minority race, and receive public assistance. They report less willingness to take personal action to intervene for a neighbor (factor 2). Parents who acknowledge neglectful parenting are more likely to receive public assistance, less likely to have a partner, and report lower neighborhood characteristics (factor 1) and less willingness to take personal action (factor 2). Also, each 1-point increase in social capital is associated with a lower odds of neglectful parenting (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.57–0.91).


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  		TABLE 3 Relationships Between Risk Factors, Social Capital Variables, and Measures of Harsh Parenting and Domestic Violence (Unadjusted ORs)

 
Mothers who report psychologically harsh punishment more commonly report a higher mean age of the index child, lower average grade completed, less likelihood of having a partner, and less willingness to take personal action (factor 2). Each 1-point increase in social capital is associated with a lower odds of psychologically harsh punishment (OR: 0.66; 95% CI: 0.53–0.83).

Parents who report domestic violence are less likely to report regular church attendance. Also, each 1-point increase in social capital is associated with a lower odds of domestic violence (OR: 0.69; 95% CI: 0.53–0.90). Figure 1 demonstrates in an unadjusted graphic that increasing social capital as measured by the index is generally associated with a decline in the percentage of parents responding affirmatively to the parenting and in-home violence inventories.


Figure 1
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  		FIGURE 1 Proportion of children exposed to each parenting/violence inventory according to social capital index score (weighted, unadjusted).

 
As part of our rationale for the development of the 4-point cumulative index, it should be noted that all of the social capital index components are associated with a similar decrease in the odds of neglectful parenting, psychologically harsh punishment, and domestic violence (ORs range from 0.45 to 0.82). This approach models the accumulation of risk model described by Sameroff21 and an earlier cross-sectional article on social capital and child development.6

To assess the independent relationship between social capital and the inventories of parenting and in-home violence, we controlled for potential confounders from Table 3. Adjusted ORs are shown in Table 4. The most important finding from Table 4 is that each 1-point increase in social capital is associated with a ~30% decrease in the odds of reporting neglectful parenting (OR: 0.71; 95% CI: 0.53–0.95), psychologically harsh punishment (OR: 0.69; 95% CI: 0.53–0.90), and domestic violence (OR: 0.70; 95% CI: 0.53–0.93), adjusted for receipt of public assistance, minority status, child age, maternal education, and very frequent church attendance. This analysis also showed that minority status and younger child age are associated with a significant increase in the odds of harsh physical punishment. Very frequent church attendance is associated with an increase in the odds of reporting neglectful acts. Increasing child age is associated with an increase in the use of psychologically harsh punishment.


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  		TABLE 4 Multivariate Logistic-Regression Analyses of Social Capital and the Measures of Harsh Parenting or In-Home Violence

 

   DISCUSSION
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
Our most important finding is that each 1-point increase in the index of social capital is associated with a 30% decrease in the odds of neglectful parenting, psychologically harsh parenting, and domestic violence. This is consistent with Vinson and Baldry's15 previous work evaluating the relationship of neighborhood cohesion to child maltreatment in a single Australian suburb. They found that neighborhood cohesion, when measured in the neighborhood aggregate, was associated with neighborhood rates of confirmed child maltreatment. The current study, however, shows that social capital measured at the household level is associated with specific types of parenting behavior and in-home violence.

Social capital remains an abstract concept despite 2 decades of research. There is no universal definition of social capital and no universal method for measurement.10 Some social capital researchers use the family as the unit of measurement.6,23 Others use the block, neighborhood, or census tract as the unit of measurement.15 Questionnaires and other assessment methods vary widely. Because social capital is a resource available to members of a community much like financial and human capital, it is appealing to measure it at the level of a community.2 However, previous research on child maltreatment has shown that higher levels of social support and networks are associated with lower rates of maltreatment.24 Maltreating parents have been shown to have smaller peer networks,24 more social isolation,25,26 and have lived in their neighborhoods for less time.27 Even if maltreating parents live in neighborhoods with strong social networks, they have less access to those networks.28 Similarly, maltreating parents may live in communities with high social capital but be unable to access these resources. The current study supports our hypothesis that increasing levels of social capital are associated with a decrease in the odds of parents reporting certain types of destructive behaviors along the continuum of child maltreatment.

The finding that social capital is unrelated to harsh physical punishment is unexpected. We repeated a multivariate analysis using an inventory of more severe types of harsh physical punishment (eg, kicking, beating, and burning). There was no association between social capital and this more clearly abusive inventory. Given the relationships between neglect, harsh psychological parenting, domestic violence, and social capital, why is harsh physical punishment not related to social capital? This study includes 2 measures of family violence (domestic violence and harsh physical punishment). One might expect these forms of physical violence to behave alike in relation to social capital. However, under US law, children may be legally hit.14 In 2002 in North and South Carolina, 42% of children were spanked, and 23% were hit on the buttocks with an object.16 In contrast, 5.2% of women reported that they were slapped, kicked, or hit by their partner or that they had done so to their partner. Domestic violence is illegal, and, because of mounting advocacy, political, and legal efforts, is increasingly unacceptable in the United States. Justice department statistics suggest a dramatic 50% decline in domestic violence in the United States between 1993 and 2001.29 Social capital may be protective against domestic violence, because it is less common, less accepted, and illegal in contrast to many forms of harsh physical punishment. Regular church attendance increased the odds of harsh physical punishment in our bivariate analysis. To better understand this differential effect on physical punishment, we created a social capital index without the term for regular church attendance. We then repeated the multivariate analysis, and our results were no different; social capital, in a cumulative index (minus churchgoing) is not significantly associated with the use of harsh physical punishment.

The relationship between very high church attendance and neglectful parenting was also unexpected. Although the relationship was statistically significant in bivariate analysis, the magnitude of this relationship increased markedly when controlling for potential confounders. Specifically, when controlling for public assistance (a proxy for poverty), the magnitude of this relationship changed markedly (unadjusted OR: 1.80; adjusted OR: 3.09). We have no data on the type of churches very frequent churchgoers attend. Because regular churchgoing is an important locus for developing social capital and is often discussed and studied in relationship to social capital, this finding merits replication before conclusions can be drawn. We further examined the role of very high church attendance to see if we could explain the relationship to neglect. We developed logistic models testing the interaction of all of the control variables with high church attendance for each outcome. The only significant interaction was between receipt of public assistance and very high churchgoing in the model for neglectful parenting. Very high church attendance increases the odds of neglectful parenting only among those who receive public assistance (model not shown).

We recognize several limitations of this study. The survey used for this analysis was designed to assess the rates of child maltreatment,16 social capital, and family characteristics. Because of time demands, not all potential questions could be asked regarding social capital or child discipline. As a cross-sectional survey, we can report associations but only infer causality. One item in our social capital index was the presence of 2 parents in the home. In Coleman's30 social capital theory, it is more the quality of the relationships than the presence of 2 parents in the home that determines how much each parent gives to each child. We acknowledge that this part of our measurement of social capital is limited. Overall levels of social capital, as measured with our questions, were high. This good news complicated our analysis, because it allowed less discrimination between respondents. Only 1.5% of mothers reported 0 points on the social capital index, whereas 57% of mothers reported 3 or 4 points in the social capital index. Most previous work on social capital has examined measures of social capital in high-risk cohorts6,23 or impoverished communities7,15 with lower levels of social capital. This pattern of high social capital limits the precision of our analyses but confirms our understanding of the role of social capital among a population-based sample. Because so few respondents had 0 points on our social capital index, we reran all of the models collapsing respondents with 0 and 1 point on the index. The results were nearly identical.

The summary scores for disciplinary behaviors and in-home violence were generated to improve the precision of our analysis. Rare outcomes (such as beating or kicking a child) would be hard to model, particularly in adjusted analyses. Previous work using the PCCTS has shown poor scalability.18 Items in this instrument serve more as an inventory than a scale. Items from this and similar instruments have been used to approximate child abuse and neglect.16,18,31 Threshold responses similar to social service or legal definitions are unclear. We chose cutoffs based on our experience with families and previous work with the instrument.16

Despite these limitations, we believe that our cumulative index of social capital provides an important construct with which to better understand the importance of social capital in the development of communities. Furthermore, our index of social capital can help policy makers to construct programs and laws that help communities grow social capital in the different domains represented by our index. Social capital remains an important but complex construct that offers us ways to assess the impact of the social environment on child well-being. Its impact may be mediated through particular parenting behaviors. Social capital provides us with a model for how we might improve the lives of children and families. Policy makers have suggested that social capital could be augmented by promoting safe and clean neighborhoods, social and religious programs, and policies that encourage 2-parent families and rich relationships between parents and children.1,11,12 Future work in social capital should seek to understand the potential for policy and programming changes to augment social capital and improve health and well-being.32,33


   ACKNOWLEDGMENTS
 
Dr Zolotor is supported by grant T32 HP 14001–17 from the National Research Service Award funded by the Health Resources and Services Administration. The CarolinaSAFE survey was supported by the Duke Endowment.

William Kalsbeck, PhD, provided statistical and sampling consultation; Antionette Laskey, MD, MPH, assisted with survey development; Robert DeVellis, PhD, assisted with factor analysis; and Robert Agans, PhD, assisted with survey management.


   FOOTNOTES
 
Accepted Dec 22, 2005.

Address correspondence to Adam J. Zolotor, MD, MPH, University of North Carolina, CB# 7595, Chapel Hill, NC 27599-7595. E-mail: ajzolo{at}med.unc.edu

Preliminary results of this study were presented at the annual meeting of the National Research Service Award Fellows and the annual meeting of the Academy Health Annual Research; June 25–26, 2005; Boston, MA.

The authors have indicated they have no financial relationships relevant to this article to disclose.

* This response rate is calculated by subtracting the ineligible and unknown eligibility numbers from the total numbers (8262 – 4611 – 1335 = 2316). Of the numbers with unknown eligibility, we assume that the proportion of eligible numbers is the same as the proportion among those of known eligibility status (0.33 x 1335 = 441). The total adjusted response rate is the number of respondents divided by the total number of estimated and known eligible numbers [1435/(1435 + 881 + 441) = 52%]. AAPOR response rate 6 provides a higher estimate of the response rate if we assume that all unknown eligibility numbers are ineligible. Using this method, our adjusted response rate is 62%. Back


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