Are family, neighbourhood and school social capital associated with higher selfrated health among Croatian high school students? A population-based study

Objectives: We investigated the associations between self-rated health and social capital among Croatian high school students. Design: A cross-sectional survey among high school students was carried out in the 2013-2014 school year. Setting: High schools in Croatia. Participants: Subjects were 3427 high school students (1688 males and 1739 females), aged 17-18 years. Main outcome measure: Self-rated health was assessed by the single item: "How do you perceive your health?". Possible responses were arranged along a fiveitem Likert-type scale: 1 very poor, 2 poor, 3 fair, 4 good, 5 excellent. The outcome was binarised as 'good health' (excellent, good or fair) versus 'poor health' (poor or very poor). Methods: We calculated ORs and 95% CIs for good self-rated health associated with family, neighbourhood and school social capital, while adjusting for gender, selfperceived socioeconomic status, psychological distress, physical activity and body mass index. We used generalised estimating equations using an exchangeable correlation matrix with robust SEs. Results: Good self-rated health was significantly associated with higher family social capital (OR 2.43; 95% CI 1.55 to 3.80), higher neighbourhood trust (OR 2.02; 95% CI 1.48 to 2.76) and higher norms of reciprocity at school (OR 1.79; 95% CI 1.13 to 2.84). When all of the social capital variables were entered simultaneously, good self-rated health remained significantly associated with higher family social capital (OR 1.98; 95% CI 1.19 to 3.30), neighbourhood trust (OR 1.77; 95% CI 1.25 to 2.51) and reciprocity at school (OR 1.71; 95% CI 1.08 to 2.73). Conclusions: Higher levels of social capital were independently associated with higher self-rated health among youth. Intervention and policies that leverage community social capital might serve as an avenue for health promotion in youth.