The relationships of social participation and community ratings to health and health behaviors in areas with high and low population density.

Previous studies have linked social participation and community levels of trust with improved health status. We examined the associations between levels of community participation, self-reported community ratings (trust), and health within a public health surveillance survey conducted in Kansas (N=4601). Independent variables were individual ratings of their communities (excellent, very good, good/ fair, poor), and their involvement in community groups or organizations in the last 5 years (yes/no). Dependent variables were self-rated health status, depressive symptoms, physical activity, smoking, obesity, and binge drinking. After controlling for age, gender, race/ethnicity, education, and having a medical doctor, self-rated health status (p<0.001) and physical activity (PA) (p<0.001) were positively, and smoking (p<0.001) and depressive symptoms (p<0.001) were negatively associated with community ratings. Only PA (p<0.001) remained associated with community involvement in a multivariate analyses. Multilevel analysis using county-level data showed no significant interactions between population density and dependent variables. Individuals from rural areas had the highest community involvement but relatively low levels of community ratings. Our findings suggest that individuals in rural areas, especially in densely settled rural areas, may face increased risks of poor health.