Content uploaded by Parissa (Jahromi) Ballard
Author content
All content in this area was uploaded by Parissa (Jahromi) Ballard on Oct 19, 2015
Content may be subject to copyright.
Engaging youth in communities: a framework for
promoting adolescent and community health
Parissa J Ballard,
1
S Leonard Syme
2
1
University of California,
Berkeley and University of
California, San Francisco,
California, USA
2
University of California,
Berkeley, California, USA
Correspondence to
Dr Parissa J Ballard, University
of California, Berkeley and
University of California, >#50
University Hall, MC #7360,
San Francisco, CA 94720-
7360, USA; ballardpj@
berkeley.edu
Received 28 May 2015
Revised 17 September 2015
Accepted 20 September 2015
To cite: Ballard PJ,
Syme SL. J Epidemiol
Community Health Published
Online First: [please include
Day Month Year]
doi:10.1136/jech-2015-
206110
ABSTRACT
Health researchers and practitioners increasingly
recognise the important role communities play in
shaping individual health. Health researchers recognise
the role of community factors as causes or determinants
of health problems; use community-based methods for
understanding complex health issues; and design
community-level health solutions. In this commentary,
we propose a fourth way to think about the role of
communities in individual health by arguing that the
community engagement process itself has implications
for individual health and strong communities. This topic
is especially important during adolescence, a
developmental window of opportunity during which
individuals need meaningful opportunities to contribute
to the world around them.
The idea that communities play an important role
in individual health is now well accepted in the
fields of public health and social epidemiology.
Health researchers focus on three roles of commu-
nity for health: they recognise the role of commu-
nity factors as causes or determinants of health
problems; use community-based methods for
understanding complex health issues; and design
community-level health solutions. At the same
time, it should be noted that individuals and
groups contribute to building and maintaining
strong communities. Indeed, current thinking on
the topic extends beyond a unidimensional ‘context
matters for health’conceptualisation in favour of a
more dynamic and bidirectional understanding of
links between people and communities.
1
In this
commentary, we propose a fourth way to think
about the role of communities for health: By exam-
ining implications of the community engagement
process itself for individual and community health.
From the perspective of developmental psychology,
we argue that understanding the bidirectional links
between adolescents and communities (which we
consider to be groups defined by geographical and
social boundaries) holds special promise for pro-
moting individual health and strong communities.
COMMUNITIES IN HEALTH RESEARCH
The first area where health research is affording a
prominent role to communities is in understanding
the social causes or determinants of good and poor
health. A relatively recent movement in health
fields advocates for emphasising the multiple social
causes of health and health disparities rather
framing health exclusively in individual terms. In
social epidemiology, this can be seen through
increasing attention to the social determinants of
health. In this framework, there is specific interest
in the role of place in health
1
based on the under-
standing that communities ‘possess both physical
and social attributes which could plausibly affect
physical health.’
2
Accordingly, evidence is mount-
ing that features of the built environment (eg, walk-
ability, community greenspace, and access to
healthy food options)
3
and the social environment
(eg, social networks, trust, cohesion, bonds
4
) each
contribute to individual health trajectories.
Community-level factors might be especially
important to health and well-being during adoles-
cence; communities become increasingly salient
developmental settings as youth spend more time
outside their homes. Neighbourhood structural
factors, such as socioeconomic conditions, are
linked with a variety of adolescent academic and
behavioural outcomes
5
and recent prospective
research points to neighbourhood factors, such as
physical disorder, as a risk factor for physical
health (obesity) among early adolescent girls.
6
Importantly research shows that social environmen-
tal factors such as collective efficacy may play a
protective role for youth development
7
pointing to
community level social conditions as modifiable
social causes in adolescent health.
Second, there has been a simultaneous movement
in health research towards community-based
methods for understanding health.
Community-based methods are common in public
health
8
and are present, although less common, in
social epidemiology (referred to as popular or par-
ticipatory epidemiology).
9
Most frequently, propo-
nents suggest that health interventions will be most
effective and sustainable when local communities
are treated as partners, stakeholders and infor-
mants, as well as recipients, of health interven-
tions.
10
Community-based methods range from
working with community partners to locate rele-
vant health problems, to engaging communities in
the research process as an empowering health inter-
vention.
8
One subset of community-based methods
used with youth is especially relevant for the
present article. Youth participatory action research
is a community-based approach specifically
designed to empower youth in their developmental
settings, such as school and after-school pro-
grammes, to combat the ‘developmental mismatch’
between their increasing capacity and desire for
agency and their often constrained opportunities
for meaningful community contribution.
11 12
A third example of communities being afforded
prominence in health research is seen through
community-based solutions to health problems. If
health researchers are increasingly recognising the
role of community as causes of health problems
and are employing methods for understanding
Ballard PJ, Syme SL. J Epidemiol Community Health 2015;0:1–5. doi:10.1136/jech-2015-206110 1
Theory and methods
JECH Online First, published on October 6, 2015 as 10.1136/jech-2015-206110
Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence.
complex health issues, it follows that health solutions should be
community-based. A community solution focus is seen in
funding initiatives, for example, focused on promoting a
‘Culture of Health’,
13
in academic programmes with a specific
‘Community Health’focus, and in more specific initiatives for
multilevel and community-based interventions.
14
These pro-
grammes share the common goal of improving the health of
groups by recognising that health happens in communities
rather than in isolation. Multilevel health interventions may be
especially effective for youth as they capitalise on individual and
group processes, which are developmentally salient for adoles-
cents. In sum, then, many researchers and practitioners in the
health fields are shifting towards supporting health and decreas-
ing health disparities by understanding community causes of
health, using methods that partner with communities, and craft-
ing solutions that work for communities.
A FOURTH ROLE OF COMMUNITIES IN HEALTH
Attention to the benefits that individuals receive from being
embedded in cohesive and resourced communities is well docu-
mented in scholarly research. However, a long tradition of
research from psychology and public health reveals that there
may be something special about the flip side of being embedded
in communities: contributing. What people contribute to their
communities, through collaborating with others to address
social issues, may be just as—or even more—beneficial to health
than receiving support.
15–17
Community psychologists have
long argued that there are benefits of community participation
for individual and communities;
18 19
we add a developmental
argument for focusing on adolescents and suggest psychological
mechanisms that might link civic engagement with health. We
propose an initiative in health research to focus on youth civic
engagement (YCE) as a promising approach to synergise efforts
to promote adolescent and community health (figure 1).
Youth civic engagement
Adolescence
i
is a critical window of development characterised
by changes at multiple levels, from biology to social role transi-
tions,
20
during which opportunities for participation in mean-
ingful activities, feeling that one matters, and forming warm and
supportive relationships with adults are crucial to positive youth
development.
11 12 21 22
Furthermore, adolescence is a formative
window for life-long health
23
and civic trajectories.
24
Although
civic development and adolescent health are traditionally exam-
ined as separate processes, we believe that there is a compelling
reason for considering them together. A large body of work
documents health effects of certain forms of civic engagement,
such as volunteerism, among older adults.
25
However, adoles-
cents have a different set of developmental goals and needs that
make it a relevant stage to understand how community partici-
pation affects healthy development. For example, a major devel-
opmental task of adolescence is identity formation, which
includes defining one’s role in relation to society
26
and multiple
developmental frameworks, such as positive youth development
and sociopolitical development, suggest that youth engagement
within their communities is an important part of
development.
27 28
Civic engagement can be defined as ‘individual and collective
actions designed to identify and address issues of public
concern.’
29
Diverse youth have access to different types of civic
opportunities and may participate in a variety of such collective
actions aimed at community contribution: formal volunteerism,
political activities such as campaigning and voting ( for older
adolescents), and activism such as protesting.
30
We believe that
high-quality civic engagement, by offering youth meaningful
and empowering opportunities to engage with their communi-
ties, can provide positive experiences for adolescents at a crucial
developmental period while at the same time channelling the
considerable skills and energy of youth to improve
communities.
31 32
YCE can promote adolescent health
We propose that high quality YCE can promote adolescent health
by providing adolescents opportunities for care-giving and change-
making. YCE could affect three aspects of adolescent health:
health and risk behaviours, mental health, and indicators of
disease vulnerability or physiological stress markers (eg, inflamma-
tion). The most direct evidence that YCE can promote adolescent
health comes from research on care-giving through formal volun-
teering programmes. In a randomised control trial study, Schreier
et al
33
assigned high school students to volunteer weekly for
2 months in the Fall (intervention group) or Spring (control
group) in after-school programmes with elementary school chil-
dren. The authors found that intervention group participants had
lowered cardiovascular risk as measured through inflammatory
markers, cholesterol and body mass index
33
compared to the
control group, suggesting that volunteering can improve adoles-
cent health. Extensive research with adults points to a link
between volunteerism and better health
34
and one suggested
mechanism explaining the link between volunteerism and health is
the promotive function of caring for others and giving support.
Although caregiving for close others can increase health risk it
might be protective or promotive for health when not overly bur-
densome and when appraised as meaningful and fulfilling.
17 35
Indeed, psychological evidence suggests that providing care and
support to close others (family, friends, neighbours) can predict
positive affect,
15
reduce mortality and morbidity
15 36
and activate
neural reward systems.
37
While care-taking may provide health
benefits across ages, adolescents might specifically benefit from the
opportunity to contribute to their communities in meaningful
ways.
Volunteerism is one care-based category of civic activities;
YCE can also take explicitly political forms. Political forms of
civic engagement might affect health though a similar pathway
giving adolescents a chance to contribute, provide care, and find
meaning; or, it might operate through altogether different path-
ways, such as through psychological empowerment. Community
and developmental psychologists give special attention to the
positive role of empowerment in adolescent development, espe-
cially among marginalised young people.
38
High quality civic
programmes can help adolescents come to see themselves as
civic actors with real opportunities to engage with communities.
Such opportunities for civic empowerment among marginalised
youth are positively associated with academic success, political
engagement and general well-being.
39
Further, civic empower-
ment mediates the links between supportive family and school
contexts on well-being
40
and political participation.
41
Taken
together, correlational and experimental evidence suggest that
high quality YCE might have a positive developmental function
for many domains of youth development, though more direct
evidence is needed linking YCE and adolescent health. Given
that adolescents self-select into civic activities based on internal
motivations and structural opportunities and constraints
21 42
it
will be important to understand the interplay of selection effects
i
We consider adolescence to be roughly from age 12 to 21 and refer to
interchangeably with ‘youth’in this paper.
2 Ballard PJ, Syme SL. J Epidemiol Community Health 2015;0:1–5. doi:10.1136/jech-2015-206110
Theory and methods
and the civic experiences themselves on health outcomes.
34 43
Other critical questions to address are about mechanisms linking
various forms of YCE and health and understanding which
youth may especially benefit from such experiences (see box 1
for a suggested research questions and hypotheses). Importantly,
high quality YCE should operate at multiple levels to empower
individuals and communities.
19 39
YCE can improve structural aspects of communities
Ideally, high quality civic programmes offer youth a chance to
collectively engage with their communities to solve what they
see as pressing social problems. Although such change will be
slow and setbacks inevitable, from the perspective of positive
youth development, youth should be considered assets to com-
munities
31
with developing skills and ideas that can contribute
to community life with appropriate mentorship from adults.
22
As an example, youth from the San Francisco Youth
Commission engaged in a multiphase process to identify teen
transportation needs and to lobby for policy changes. After
3 years, the youth commission succeeded in convincing the
San Francisco Municipal Transportation Agency (MUNI) board
to approve a ‘Free MUNI for Youth’programme with an expan-
sion to include 18-year-olds from low to moderate income fam-
ilies in those eligible for free MUNI passes (SF Youth
Commission). In this example, engaged youth formed horizon-
tal partnerships with other youth across districts as well as verti-
cal partnerships with local political leaders. Together, they
successfully changed policy that directly improved the well-
being of San Francisco teen residents and families by providing
transportation access to some of the city’s most vulnerable
young people. Ultimately, incremental improvements in commu-
nities and policies affecting youth should feedback to support
adolescent health and the broader health of communities.
YCE can improve the social aspects of communities
YCE can help build community social capital, increase social trust
between community members, contribute to a sense of commu-
nity social cohesion, and promote collective empowerment.
19 39
From the perspective of social capital theory, individual civic
engagement is indeed part of what defines communities high in
social capital. A critical social aspect of communities is a sense of
collective efficacy, or the perceived ability that communities can
band together to solve social problems that arise. According to
extensive work of Sampson et al,
44
collective efficacy is a charac-
teristic that varies dramatically by neighbourhood and predicts
Figure 1 Schematic representation of
the role of communities in research on
adolescent health.
Box 1 Specific Proposals for a Research Agenda Linking
Youth Civic Engagement, Adolescent, and Community
Health
1. Community-engaged health intervention projects present an
opportunity for understanding whether the engagement
process has implications for health. Researchers engaging
community members in projects to improve the health of
their communities can add a dimension to studies by
measuring the civic experience of community members and
individual health during community engagement to gain
insight about how community-engagement processes covary
with individual health trajectories.
2. Large national studies of adolescent development can add
measures of civic experiences (eg, participation in different
types of civic activities, feelings of empowerment, and
feelings of contribution and meaning) to see how naturally
occurring civic development affects, and is affected by, other
domains of youth development.
3. To overcome methodological challenges in civic development
research, innovations in study methods for understanding
civic development are needed. For example, randomised
control trial studies will best enable researchers to establish
causal links between civic engagement and health. There are
challenges in designing random assignment studies in the
context of activities that are typically voluntary, but these
challenges can be overcome with creative methods such as
simulation studies. Qualitative studies will be needed to
contextualise particular civic experiences especially as they
vary for adolescents from demographic groups.
4. Researchers should examine complex links between civic
engagement and health, informed by theory. For example, it
is likely that links between civic engagement and health will:
A. Be non-linear over time ( perhaps with negative initial
health effects if civic engagement is stressful and positive
effects over the longer-term if it is empowering)
B. Be moderated by things like social status and quality of
civic experience
C. Be developmentally differentiated (with links stronger
during developmental transitions)
D. Vary by type of civic engagement (volunteerism vs
activism)
E. Vary by type of health outcome (health behaviours, mental
health, physical health
Ballard PJ, Syme SL. J Epidemiol Community Health 2015;0:1–5. doi:10.1136/jech-2015-206110 3
Theory and methods
neighbourhood safety and the health and development of resi-
dents. High quality YCE, should directly increase participants’
sense of collective efficacy, and, especially when visible to other
community members, could lead to broader a sense of commu-
nity collective efficacy.
45
Although this is a complex process with
nuance regarding the conditions under which civic engagement
indeed increases community capacity and health, ideally, engage-
ment should affect the perceived and actual capacity of communi-
ties to meet their needs.
19
CONCLUSION
Elaborating on Cummins et al’s
1
argument for a broader recogni-
tion of the ‘mutually reinforcing and reciprocal relationship
between people and place,’we argue that the process by which
people and place are reciprocally related also has implications for
individual and community health, especially during the develop-
mental window of opportunity known as adolescence. Ideally,
YCE operates at the individual level by offering youth a meaning-
ful chance to care for others and to become empowered to create
change, while also operating at the community level to increase
local capacity through social action processes. It is very important
to note that YCE also has the potential to undermine adolescent
health and well-being; for example, if such engagement is stress-
ful, burdensome or futile. The focus of the present paper is on
the positive potentials of YCE; the negative possibilities are
explored in depth elsewhere (eg, P J Ballard and E J Ozer. The
implications of youth activism for health and well-Being. In:
Conner J, Rosen S. Contemporary Youth Activism: advancing
Social Justice in the United States (under review)). The promise
of the approach outlined here is twofold: it offers a dual focus on
promoting adolescent and community health and it relies on a
transdisciplinary approach to health. Psychologists, epidemiolo-
gists and population health scientists each understand pieces of
the conceptual puzzle about how people become engaged with
places, how places support this process, and how this process can
promote individual and community health. By offering a frame-
work linking civic engagement, adolescent health, and healthy
communities, we challenge psychologists to focus on promoting
adolescent development in a way that also builds communities
and we challenge population health scientists to consider how
community engagement processes can affect adolescent health
and well-being. YCE can be a lens for simultaneously considering
individual and community health and the processes by which
community participation might improve the health and well-
being of our youth and our communities.
What is already known on this subject
Adolescent health is affected by the communities adolescents
live in. At the same time, adolescents affect their own
communities through civic engagement (ie, taking collective
action to address issues of public concern).
What this study adds
We believe that the community engagement process has
implications for adolescent health and strong communities. We
propose an initiative in health research to focus on youth civic
engagement as a promising approach to synergise efforts for
promoting adolescent and community health.
Acknowledgements The authors thank the Robert Wood Johnson Foundation
Health and Society Scholars program for its financial support. The authors thank
Keely Muscatell and Lindsay Till Hoyt for comments on an early draft and our many
colleagues at UCSF and UC Berkeley for ongoing discussion of these ideas. We also
thank Allen Lu from the San Francisco Youth Commission for feedback about the
youth MUNI program.
Contributors PJB conceptualised and wrote this article. SLS discussed
conceptualisation and helped with framing the idea and editing the article.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES
1 Cummins S, Curtis S, Diez-Roux AV, et al. Understanding and representing ‘place’in
health research: a relational approach. Soc Sci Med 2007;65:1825–38.
2 Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci
2010;1186:125–45.
3 Srinivasan S, O’Fallon LR, Dearry A. Creating healthy communities, healthy homes,
healthy people: initiating a research agenda on the built environment and public
health. Am J Public Health 2003;93:1446–50.
4 Kawachi I, Berkman LF. Social capital, social cohesion, and health. In: Berkman LF,
Kawachi I, Glymour MM, eds. Social epidemiology. 2 edn. New York: Oxford
University Press, 2014:290–319.
5 Leventhal T, Brooks-Gunn J. The neighborhoods they live in: the effects of
neighborhood residence on child and adolescent outcomes. Psychol Bull
2000;126:309–37.
6 Hoyt LT, Kushi LH, Leung CW, et al. Neighborhood influences on girls’obesity risk
across the transition to adolescence. Pediatrics 2014;134:942–9.
7 Odgers CL, Moffitt TE, Tach LM, et al. The protective effects of neighborhood
collective efficacy on British children growing up in deprivation: a developmental
analysis. Dev Psychol 2009;45:942.
8 Minkler M, Wallerstein N. Community-based participatory research for health: from
process to outcomes. 2 edn. San Francisco, CA: John Wiley & Sons, 2008.
9 Leung MW, Yen IH, Minkler M. Community based participatory research: a
promising approach for increasing epidemiology’s relevance in the 21st century. Int
J Epidemiol 2004;33:499–506.
10 Wallerstein NB, Yen IH, Syme SL. Integration of social epidemiology and
community-engaged interventions to improve health equity. Am J Public Health
2011;101:822–30.
11 Eccles JS, Midgley C, Wigfield A, et al. Development during adolescence: the impact
of stage-environment fit on young adolescents’experiences in schools and in
families. Am Psychol 1993;48:90–101.
12 Ozer EJ, Ritterman ML, Wanis MG. Participatory action research (PAR) in middle
school: opportunities, constraints, and key processes. Am J Community Psychol
2010;46:152–66.
13 Plough AL. Building a culture of health: a critical role for public health services and
systems research. Am J Public Health 2015;105(Suppl 2):S150–2.
14 Israel BA, Checkoway B, Schulz A, et al. Health education and community
empowerment: conceptualizing and measuring perceptions of individual,
organizational, and community control. Health Educ Behav 1994;21:149–70.
15 Brown SL, Nesse RM, Vinokur AD, et al. Providing social support may be more
beneficial than receiving it results from a prospective study of mortality. Psychol Sci
2003;14:320–7.
16 House JS, Landis KR, Umberson D. Social relationships and health. Science
1988;241:540–5.
17 Poulin MJ, Brown SL, Ubel PA, et al. Does a helping hand mean a heavy heart?
Helping behavior and well-being among spouse caregivers. Psychol Aging
2010;25:108–17.
18 Peterson NA, Zimmerman MA. Beyond the individual: toward a nomological
network of organizational empowerment. Am J Community Psychol
2004;34:129–45.
19 Wallerstein N. Empowerment and health: the theory and practice of community
change. Community Dev J 1993;28:218–27.
20 Dahl RE. Adolescent brain development: a period of vulnerabilities and
opportunities. Keynote address. Ann N Y Acad Sci 2004;1021:1–22.
21 Ballard PJ, Malin H, Porter TJ, et al. Motivations for civic participation
among diverse youth: more similarities than differences. Res Hum Dev
2015;12:63–83.
22 Damon W. The path to purpose: helping our children find their calling in life.
New York, NY: Simon and Schuster, 2008.
23 Viner RM, Ross D, Hardy R, et al. Life course epidemiology: recognising the
importance of adolescence. J Epidemiol Community Health 2015;69:719–20.
24 Hart D, Donnelly TM, Youniss J, et al. High school community service as a predictor
of adult voting and volunteering. Am Educ Res J 2007;44:197–219.
25 Anderson ND, Damianakis T, Kröger E, et al. The benefits associated with
volunteering among seniors: a critical review and recommendations for future
research. Psychol Bull 2014;140:1505–33.
4 Ballard PJ, Syme SL. J Epidemiol Community Health 2015;0:1–5. doi:10.1136/jech-2015-206110
Theory and methods
26 Erikson EH. Identity: youth and crisis. New York, NY: WW Norton & Company,
1968.
27 Hershberg RM,Johnson SK, DeSouza LM. Promoting contribution among youth:
Implications from positive youthdevelopment research for youth development programs.
In: Bowers E, Geldof JG, Johnson SK, et al, eds. Promoting positive youth development:
lessons from the 4-H study. New York: Springer, 2015:211–28.
28 Watts RJ, Diemer MA, Voight AM. Critical consciousness: current status and future
directions. New Dir Child Adolesc Dev 2011;2011:43–57.
29 Association AP. Civic engagement. 2012; http://www.apa.org/education/undergrad/
civic-engagement.aspx
30 Sherrod LR, Torney Purta J, Flanagan C. Introduction: research on the development
of citizenship: a field comes of age. In: Sherrod L, Torney-Purta J, Flanagan C, eds.
Handbook of research on civic engagement in youth. Hoboken, NJ, USA: John Wiley
& Sons, Inc., 2010:1–20.
31 Lerner RM. Promoting positive youth development: theoretical and empirical bases.
In: White paper prepared for the Workshop on the Science of Adolescent Health
and Development, National Research Council/Institute of Medicine. Washington DC:
National Academies of Science, 2005:1–91.
32 Lerner RM, Johnson SK, Wang J, et al. The study of the development of civic
engagement within contemporary developmental science: theory, method, and
application. Res Hum Dev 2015;12:149–56.
33 Schreier HMC, Schonert-Reichl KA, Chen E. Effect of volunteering on risk factors for
cardiovascular disease in adolescents: a randomized controlled trial. JAMA Pediatr
2013;167:327–32.
34 Piliavin JA, Siegl E. Health and well-being consequences of formal volunteering.
In: Schroeder DA, Graziano WG. The Oxford handbook of prosocial behavior.
Oxford, UK: The Oxford University Press, 2015:494–523; (in press).
35 Fuligni AJ, Telzer EH, Bower J, et al. Daily family assistance and inflammation
among adolescents from Latin American and European backgrounds. Brain Behav
Immun 2009;23:803–9.
36 Poulin MJ, Brown SL, Dillard AJ, et al. Giving to others and the association
between stress and mortality. Am J Public Health 2013:e1–7.
37 Inagaki TK, Eisenberger NI. Neural correlates of giving support to a loved one.
Psychosom Med 2012;74:3–7.
38 Zimmerman MA. Psychological empowerment: issues and illustrations. Am J
Community Psychol 1995;23:581–99.
39 Christens BD. Targeting empowerment in community development: a community
psychology approach to enhancing local power and well-being. Community Dev J
2012:bss031.
40 Christens BD, Peterson NA. The role of empowerment in youth development:
a study of sociopolitical control as mediator of ecological systems’
influence on developmental outcomes. J Youth Adolescence 2012;41:
623–35.
41 Diemer MA, Li C. Critical consciousness development and political participation
among marginalized youth. Child Dev 2011;82:1815–33.
42 Ballard PJ. What motivates youth civic involvement? J Adolescent Res
2014;29:439–63.
43 Konrath S, Fuhrel-Forbis A, Lou A, et al. Motives for volunteering are associated
with mortality risk in older adults. Health Psychol 2012;31:87–96.
44 Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime:
a multilevel study of collective efficacy. Science 1997;277:918–24.
45 Collins CR, Neal JW, Neal ZP. Transforming individual civic engagement into
community collective efficacy: the role of bonding social capital. Am J Community
Psychol 2014;54:328–36.
Ballard PJ, Syme SL. J Epidemiol Community Health 2015;0:1–5. doi:10.1136/jech-2015-206110 5
Theory and methods
