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Health Disparities

HD: Food Security (2011)


Martin KS, Rogers BL, Cook JT, Joseph HM. Social capital is associated with decreased risk of hunger. Soc Sci Med. 2004 Jun; 58 (12): 2,645-2,654.PMID: 15081212

PubMed ID: 15081212
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:

The purpose of this study is to examine whether food security is associated with both household-level and community-level social capital.

Inclusion Criteria:

All households in Hartford, Connecticut with incomes below 185 percent of the federal poverty line were included. Of these households, 1,050 were randomly selected to receive surveys.

Exclusion Criteria:

Households were excluded if incomes were above 185 percent of the federal poverty line, if there was no response after three separate attempts to contact, or if they refused to participate in the study.

Description of Study Protocol:


Households participating were randomly selected from a list of all households with incomes below 185 percent of the poverty line in Hartford, Connecticut.


Surveys were completed door-to-door by trained interviewers and respondents were paid $5 for participating. The survey measured food security, social capital and household demographics. The US Household Food Security Model was used to measure food insecurity and hunger. A seven-item Likert scale with four response categories was used to measure social cohesion and trust. Participants were also asked about: How long they've lived in their house or apartment; how long they've lived in Hartford; and if anyone in the household is a member of any social or civic organization, such as the PTA or a religious organization. Demographic information was also collected on: Highest level of education completed by any adult in the household; household income; race and ethnicity of respondent; family structure; whether household owns a car and can borrow a car; and employment status of adult members.

Blinding used 

Not applicable


Not applicable

Statistical Analysis

Logistic regression models, multivariate regression models and chi-squared tests were used.

Data Collection Summary:

Timing of Measurements

Surveys were conducted once per household. Three separate attempts were made by interviewers to contact households.

Dependent Variables

  • Food security
  • Decreased risk of hunger.

Independent Variables

Social capital

Control Variables

  • Household-level socioeconomic factors such as:
    • Household income
    • Education level of adult household members
    • Employment status of adult household members.
Description of Actual Data Sample:
  • Initial N: 1,050 households were randomly selected to participate
  • Attrition (final N): Surveys were completed in 330 households
  • Age:
    • 215 households had a child <18 years
    • 115 households did not have a child <18 years
    • 53 households have a senior
    • 277 households did not have a senior
  • Ethnicity:
    • 155 households identified themselves as Hispanic
    • 145 households identified themselves as Black
    • 20 households identified themselves as White
  • Other relevant demographics:
    • 132 households identified themselves as being headed by a single mother
    • 198 households identified themselves as not being headed by a single mother
    • 104 households identified themselves as being a member of an organization
    • 226 households identified themselves as not being a member of an organization
    • 162 households identified themselves as having income above 100 percent of the poverty line
    • 168 households identified themselves as having income below 100 percent of the poverty line
    • 148 households identified themselves as owning a car
    • 182 households identified themselves as not owning a car
    • 138 households identified themselves as adults having full-time employment
    • 192 households identified themselves as adults not having full-time employment
    • 190 households identified themselves as adults having a high school degree
    • 140 households identified themselves as adults not having a high school degree
  • Anthropometrics: Not applicable
  • Location: Hartford, Connecticut.
Summary of Results:

Key Findings

  • Household social capital is associated with significantly decreased odds of being hungry (adjusted odds ratio=0.87 [95% CI 0.76, 0.99], P<0.03)
  • Higher community-level social capital significantly decreases the odds of hunger (adjusted odds ratio=0.50 [95% CI 0.29, 0.87] P<0.01)
  • Households in a neighborhood with high social capital are less than half as likely to experience hunger as households living in a neighborhood with low social capital (adjusted odds ratio=0.48 [95% CI 0.28, 0.81], P<0.01)
  • Households with an elderly member are significantly less likely to experience hunger as households without an elderly member (P<0.01)
  • Households with an elderly member are over two and a half times more likely to have high social capital (adjusted odds ratio=2.68 [95% CI 1.22, 5.87], P<0.01)
  • Households in which someone is a member of a social or civic organization are almost twice as likely to have high social capital as households not involved in local organizations (adjusted odds ratio=1.97 [95% CI 1.17, 3.33], P<0.01)
  • High household social capital is not associated with owning a car, but is positively associated with the ability to borrow a car (P<0.02)
  • Being Hispanic is significantly associated with having low social capital (P<0.04). 
Variables Adjusted Odds Ratio
(95% Confidence Interval)
Statistical Significance of
Group Difference
Experiencing hunger and household-level social capital 0.87 (0.76-0.99)  P<0.05

Experiencing hunger and community-level social capital

0.47 (0.28-0.81)  P<0.05 

Experiencing hunger and elderly member of household

0.32 (0.11-0.92)  P<0.05 
High social capital scores and member of organization 1.97 (1.17-3.33)  P<0.05 
High social capital scores and elderly member of household 2.68 (1.22-5.87)  P<0.05 

Other Findings

Elderly households are more likely than non-elderly households to have higher levels of social capital, to be involved in social or civic organizations, and to have lived in their home for a longer length of time, after controlling for income.

Author Conclusion:

Social capital at both the household and community level is associated with lower odds of hunger, regardless of household income, education, or employment status of adult members. Findings suggest that households may derive protective benefits both from their own social networks and from the greater extent of shared networks throughout the community. This research suggests that it is important to consider aspects of social capital when working to build food security and prevent hunger and aspects of social capital, particularly reciprocity, can translate into greater access to tangible resources.

Funding Source:
Hartford Foundation for Public Giving & Daphne Sebolt Culpepper Foundation
Reviewer Comments:

The authors discuss many limitations to this study. Because this was a cross-sectional study causality cannot be inferred, and other uncontrolled variables could have confounded the results. Other limitations are the study size. Data were limited to one medium-size city may not be generalizable to other cities or rural areas, and the $5 incentive for completing the survey may have led to selection bias. Also, households that could not be reached and households that refused to participate may have different or lower levels of social capital than those households that did participate. 

Note: Social capital is defined by the authors as a measure of trust, reciprocity and social networks.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? Yes
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? Yes
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) Yes
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? Yes
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) No
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? No
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? N/A
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? Yes
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes