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PurposeThe purpose of this paper is to explore the relationship between social capital and collective action at the county level in the US while incorporating the moderating effects of community racial diversity and urbanity and to find the changing effects of social capital on philanthropic collective action for community education.Design/methodology/approachThis paper employs a quantitative research design. The dependent variable measures philanthropic collective action for community education while the independent variable for social capital is measured as a community level index. Moderating variables include a community racial diversity index and urbanity. This analysis tests and interprets interaction effects using moderated multiple regression (MMR), with the baselines of MMR being grounded to multivariate ordinary least squares (OLS) regression. Analyses are carried out in the context of the USA during 2006 and 2010, with US counties employed as the unit of analysis.FindingsThe effects of social capital on philanthropic contributions decline in counties with low- and mid-levels of racial diversity. On the contrary, the effects of social capital increase in highly racially diverse counties. The three-way interaction model result suggests that racial diversity positively moderates social capital on philanthropic collective action for community education where the effect of social capital is strong and positive in highly racially diverse urban communities.Originality/valueThis research complicates the notion that social capital and racial diversity are negatively associated when exploring collective action and community education, and suggests effects of social capital varies with moderating effects on philanthropic collective action for community education.

Introduction/Purpose
Efforts to improve chronic disease outcomes among US adults highlight families, particularly support from families, as a key aspect of disease prevention and management. To date, however, an overwhelming focus on individual-level outcomes and unidirectional support (eg, from a family caregiver to an identified care recipient) belies the existence of co-occurring health concerns and interdependent care. There are increasing calls for more sophisticated and intensive family health interventions that better integrate family-level factors, processes, and outcomes to provide comprehensive family support services in health care and community-based settings.


Methods
This commentary provides key considerations for advancing this work while centering family health equity and families themselves in health initiatives.


Results
Several critical barriers are identified and discussed. For example, a narrow focus on family and inadequate measures of family-level disease burden make it challenging to understand how the disproportionate burden of chronic disease observed among individuals of lower socioeconomic status and certain racial and ethnic groups compounds and complicates family health experiences. In addition, limited attention to the interaction between individuals, families, and broader sociocultural factors that influence family resources and constraints, such as racism, hamper program design, implementation, and evaluation.


Conclusion
To center families in efforts to reduce chronic disease disparities, it is necessary to move beyond superficial attention to the complexity of disease prevention and management within the family context. This commentary serves to enhance understanding of important drivers of family-level chronic disease outcomes, while providing important considerations for advancing research and practice.

Purpose: African Americans (AAs) in rural south and southeast regions of the United States have among the highest prevalence of cardiovascular disease (CVD) in the country. The purpose of this qualitative, exploratory study is to understand family influences on CVD-related knowledge and health-related behaviors among rural AA adults. Design: Qualitative descriptive study design using a community-based participatory research approach. Setting: Two rural North Carolina counties. Participants: Eligible participants were AA adults (at least 21 years of age), who self-reported either CVD diagnosis or selected CVD risk factor(s) for themselves or for an adult family member (N = 37). Method: Directed content analysis of semistructured interviews by community and academic partners. Results: Family health history and familial norms and preferences influenced participants' CVD-related knowledge, beliefs, and health-related behaviors. Participants reported their families were helpful for increasing motivation for and overcoming barriers to healthy behaviors, including hard-to-access community resources and physical challenges. Conversely, and to a lesser extent, participants also reported that family members hindered or had little influence (positive or negative) on their engagement in healthy behaviors. Conclusion: Family played an important role in helping individuals overcome personal and community-related challenges. Efforts to reduce CVD burden among rural AAs should seek to understand the family-related facilitators, barriers, and processes associated with CVD knowledge and risk-reduction behaviors.

Purpose:Parents and caregivers play an important role in sexual socialization of youth, often serving as the primary source of information about sex. For African American rural youth who experience disparate rates of HIV/sexually transmitted infection, improving caregiver–youth communication about sexual topics may help to reduce risky behaviors. This study assessed the impact of an intervention to improve sexual topic communication.Design:A Preintervention–postintervention, quasi-experimental, controlled, and community-based trial.Setting:Intervention was in 2 rural North Carolina counties with comparison group in 3 adjacent counties.Subjects:Participants (n = 249) were parents, caregivers, or parental figures for African American youth aged 10 to 14.Intervention:Twelve-session curriculum for participating dyads.Measures:Audio computer-assisted self-interview to assess changes at 9 months from baseline in communication about general and sensitive sex topics and overall communication about sex.Analysis:Multivariable models were used to examine the differences between the changes in mean of scores for intervention and comparison groups.Results:Statistically significant differences in changes in mean scores for communication about general sex topics ( P < .0001), communication about sensitive sex topics ( P < .0001), and overall communication about sex ( P < .0001) existed. Differences in change in mean scores remained significant after adjusting baseline scores and other variables in the multivariate models.Conclusions:In Teach One Reach One intervention, adult participants reported improved communication about sex, an important element to support risk reduction among youth in high-prevalence areas.