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Letter to the Editor

Now It's Time to Implement Social Capital and Sexually Transmitted Infection/HIV Interventions in the United States

Ransome, Yusuf DrPH; Ritchwood, Tiarney D. PhD

Author Information
Sexually Transmitted Diseases: July 2020 - Volume 47 - Issue 7 - p e16-e17
doi: 10.1097/OLQ.0000000000001188
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To the Editor:

Substantial evidence from international research1,2 showed that social capital-specific or informed interventions could reduce population-level transmission of sexually transmitted infections (STIs) in low- and middle-income settings, and that changes from those interventions seem to be sustainable. However, in the United States, public health interventions based on social capital frameworks to lower STIs are rare.3 Although ecological research examining the associations between social capital and STIs4–6 may support the priorities of public health agencies to advance practice-driven research,7 studies frequently miss opportunities to suggest actionable steps or example scenarios and are often exploratory in nature, making it difficult to translate findings into theoretically informed interventions. A recent study,8 for example, found that higher county-level social capital was strongly associated with lower rates of 3 commonly reported bacterial STIs in the United States. The study was strengthened by an extensive covariate adjustment and spatial econometric methods. However, the analyses were not conducted in a way that facilitated a discussion of potential concrete actionable social capital interventions.

How do we elevate social capital research to inform practice and priorities for STI prevention intervention funding?9 First, studies need to address challenges with conceptualizing and measuring social capital to explain subsequent findings. Owusu-Edusei et al.8 note that social capital includes 2 domains (cognitive and structural) and that definitions and indices depend on the developer and the researcher's field. Although true, the authors were unclear about their rationale for comparing the 2 selected social capital indices, which could have been addressed by explicitly identifying a theory based on the study aims and outline specific constructs that enable testing modifiable pathways to the STI outcomes.10,11 The authors concluded that it may be important to understand communities' associational life, and that findings reinforce the potential to incorporate social capital concepts to control STIs. Such an assertation would have required that they test each social capital subindex, which was not done. Regarding conceptualizing and measuring social capital,12,13 composite indices are sometimes limited by unhelpful value judgments.14 Selected items within an index may ignore differences in the creation and distribution of social capital across individual race/ethnicity or racial composition of a geographic unit.15,16 For example, the family unity subindex included the proportion of births to unmarried women and the proportion of single parent households. How are those 2 items related to cognitive or structural social capital and to STIs? Positively or negatively? Next, how do we advise health officials to deploy social capital resources when an index fails to distinguish religious (e.g., places of worship) and secular (e.g., civic and social clubs) entities, given that social capital is formed and operates differently across those 2 entities?17,18 Although we understand that some study designs limit causal inference, to truly promote the integration of social capital within STI prevention interventions, the scientific community should conclude articles with actionable steps; otherwise, we will persist with the ongoing stalemate in prevention funding and practice.

Yusuf Ransome, DrPH
Department of Social and
Behavioral Sciences
Yale School of Public Health
New Haven, CT
[email protected]
Tiarney D. Ritchwood, PhD
Department of Family Medicine and
Community Health
Duke University
Durham, NC

REFERENCES

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