Self-administered Postal Questionnaire Research Articles

Rationale, Procedures, and Response Rates for a Pilot Study to Sample Cancer Survivors for NCI’s Health Information National Trends Survey: HINTS-SEER 2021

The National Cancer Institute’s (NCI) Health Information National Trends Survey (HINTS) is a nationally representative survey of U.S. adults in which 12–17% of respondents report a cancer history. To increase representation from adult cancer survivors, in 2021, NCI sampled survivors from three Surveillance, Epidemiology, and End Results (SEER) program cancer registries: Iowa, New Mexico, and the Greater Bay Area. Sampling frames were stratified by time since diagnosis and race/ethnicity, with nonmalignant tumors and non-melanoma skin cancers excluded. Participants completed a self-administered postal questionnaire. The overall response rate for HINTS-SEER (N = 1,234) was 12.6%; a non-response bias analysis indicated few demographic differences between respondents and the pool of sampled patients in each registry. Most of the sample was 10+ years since diagnosis (n = 722; 60.2%); 392 respondents were 5 to < 10 years since diagnosis (29.6%); and 120 were < 5 years since diagnosis (10.2%). Common cancers included male reproductive (n = 304; 24.6%), female breast (n = 284; 23.0%), melanoma (n = 119; 9.6%), and gastrointestinal (n = 106; 8.6%). Tumors were mostly localized (67.8%; n = 833), with 22.4% (n = 282) regional, 6.2% (n = 72) distant, and 3.7% (n = 47) unknown. HINTS-SEER data are available by request and may be used for secondary analyses to examine a range of social, behavioral, and healthcare outcomes among cancer survivors.

Acceptance of Teledermatology: Results of a Survey of General Practitioners and Dermatologists in Saxony (Germany)

The aim of this study was to investigate acceptance and intention to use teledermatological application by means of a survey of general practitioners and dermatologists in Saxony (Germany). Considering the demographic development in Saxony and the low regional density of medical specialists, this federal state is particularly well suited for conducting a survey dealing with telemedicine. Based on a stratified random selection, 108 physicians were interviewed via self-administered postal or online questionnaire (60 general practitioners and 48 dermatologists, response rate: 23.5%). The theory of acceptance and use of technology (UTAUT) was applied to teledermatology. Four central hypotheses were deduced and tested with logistic regressions. The tested hypotheses postulating relationships between performance expectancy, effort expectancy, social influence and facilitating conditions and the intention to use teledermatology were partly confirmed. In addition, teledermatology was shown to have potential among Saxon general practitioners, as 9.5% of their patients came to the medical office for treatment of skin diseases; 78% of general practitioners offered skin cancer screenings. The population structure and the low density of medical specialists in Saxony would be favourable prerequisites for the implementation of teledermatology. Survey results failed to show any reservations of general practitioners and dermatologists towards teledermatology.

The structure and efforts of the health sectors in municipalities from the first infected case to the second wave of COVID-19

Objective To describe the structure and efforts of the health sectors in municipalities to address the COVID-19 pandemic from the first infected case to the second wave.Method We conducted self-administered postal questionnaires with the department head or an equivalent position of the 1,741 municipal health departments (108 cities or districts with public health centers (PHC) and 1,633 general municipalities) in Japan as of November 1, 2020. The survey period was from November 11, 2020 to January 8, 2021. The respondents were asked to provide the type of local government they were affiliated with, the number of COVID-19 cases in their municipality between January 16 to November 1, 2020, the operational structure of the health sectors after the pandemic began, and efforts made to address it. The analysis tested for the differences in response rates by cities with PHC and general municipalities, and by population size of the general municipalities.Results A total of 1,270 valid questionnaires (valid response rate 72.9%) were returned from 83 cities with PHC and 1,187 general municipalities. Concerning the operational structure, over 90% of the cities with PHC transferred personnel from other departments to the department of infection control. Over 80% of all municipalities found a way to hold meetings remotely. More than half of the cities with PHC centers had employees working from home. Fewer than 50% of the general municipalities had a business continuity plan (BCP) prepared and in place for an outbreak, such as a novel influenza. Concerning the efforts within the local government, high rates of "secured supplementary budgets" and "monitored and secured infection control equipment" were reported. Concerning the efforts directed toward related organizations, over 70% of the cities with PHC "supported contact tracing at the PHC" and "monitored the stock of infection control equipment and procured equipment to address the shortages at medical institutions, welfare facilities, etc." Meanwhile, approximately 80.5% of general municipalities "corresponded and coordinated with medical institutions concerning the health examinations and services, etc." Concerning the efforts directed toward the public, over 90% of the respondents, regardless of local government type, "wrote articles and disseminated information regarding the infections in public relations (PR) reports or online" and "responded to inquiries from the public." In general municipalities, the larger the population size, the higher the percentage of implementation.Conclusion Although the municipalities responded to the transmission of the COVID-19, there were some issues. Further preparation for the pandemic is required.

Issues in Radiation Nursing Education in Japan Before and After the Fukushima Daiichi Nuclear Power Plant Accident.

The response of nurses in Japan to the Fukushima Daiichi Nuclear Power Plant accident was deemed inadequate. This study examined the issues in Japanese radiation nursing education. Anonymous, self-administered postal questionnaires were sent to managers and teachers of 1053 basic nursing educational institutions in Japan. Among the 342 institutions that completed the questionnaire, 218 (63.7%) had incorporated Radiological Nursing Education into their curriculum while 124 (36.3%) had not. Based on the time of their incorporation, they were divided into the pre-accident incorporation group and the post-accident incorporation groups. For 89 of 111 institutions (85.6%) in the former group, the main reason for the incorporation was radiotherapy care. For 11 of 26 institutions (42.3%) in the latter group, the incorporation was their response to the nuclear disaster. Nursing education in Japan has been inadequate, and as such, nurses find it hard to respond to nuclear disasters. Examining the current nursing education system and building a new model based on the nuclear disaster experience are urgent issues.

Workforce and Contents of Home Dental Care in Japanese Insurance System

Background In Japan's super-aging society, it is required to establish a home dental service provision system. It is necessary to analyze the current state of visiting dentistry. Methods A cross-sectional survey was conducted using a self-administered postal mail questionnaire distributed to all members of the Iwate Dental Association. We analyzed the implementation status of dental care at home/nursing facilities, the number of dental clinic staff, and the contents of dental home care. Correspondence analysis, item response theory, and zero-inflated model were used for the analysis. Results Of the 354 dental clinics, 187 (52.8%) performed visiting dental care and 195 (55.1%) implemented dental care in a nursing home. Visit dentistry was mainly performed by part-time workers. Denture treatment and oral care were common treatments for dental home care. Conclusion More than half of the dental clinics did not offer visiting dentistry. In order to fully provide dental visiting services, infrastructure development is necessary. Specifically, human resources are most important, even if they are part-time workers.

PD06-03 LONG-TERM OUTCOMES OF FEMALE STRESS INCONTINENCE SURGERY: A REAL-WORLD STUDY

INTRODUCTION AND OBJECTIVES:The need for long-term follow up data in female patients undergoing surgery for stress urinary incontinence (SUI) has been repeatedly highlighted by Cochrane reviews and the FDA. This is especially relevant in the current climate of controversy over the safety of mesh-related products. We aimed to assess the subjective long-term outcomes of patients who had undergone SUI surgery at our institution in this real-world study.METHODS:All female patients who underwent SUI surgery at one institution from January 2011 to December 2016 were identified and sent a 5-item self-administered postal questionnaire. Results were analysed using GraphPad Prism 6.0.RESULTS:Questionnaires were returned by 364 of 570 patients identified (64% response rate), with a median age of 51 (range 17–84) and mean follow up of 54 months. The majority of respondents underwent TOT insertion (79%), followed by TVT (17%), autologous sling (2%) and Burch colposuspension (2%). 94% of procedures were primary (6% rev...

Willingness to Work and the Working Environment of Japanese Dental Hygienists.

Japanese dental hygienists' employment rate is low. The environment factors and daily job contents that contribute to willingness to work of Japanese dental hygienists and their structures were investigated. A cross-sectional survey was conducted using a self-administered postal questionnaire distributed for one thousand and twenty-three members of Japan Dental Hygienist Association registered in Iwate prefecture affiliation. Three items concerning willingness to work, satisfaction for the 9 items about working environment, anxiety for work, and 106 daily job contents were used for analysis. Structural equation modeling, decision analysis, and correspondence analysis were carried out. The present study found that working environment such as interpersonal relationship was more important than social environment such as salary for the regular employee of Japanese dental hygienist working at private dental office. However, salary was only the determinant for the dental hygienist who strongly disliked their work. And daily job contents affected the willingness to work. Especially, jobs concerned with prosthodontic treatments were of major concern. Improving the working environment and avoiding assignment of tasks that require lower level of skill may improve dental hygienists' willingness to work and may assist to improve the employment rate of dental hygienist in Japan.

The Northern Ireland Baby Hearts Study: A Case-Control study using a hybrid data linkage method

BackgroundThe Northern Ireland (NI) Baby Hearts study aimed to investigate risk factors for congenital heart defects (CHD), and to investigate the health behaviours of a representative sample of NI pregnant women.&#x0D; MethodsWe performed a case-control study with hybrid data collection methods, including self-administered iPad questionnaire or postal questionnaire, information held in maternity records and linkage to prescription records. Cases (n=286) were recruited following diagnosis prenatally or postnatally, controls (n=966) were recruited during recruitment months in each maternity unit at 18-20 weeks gestation.&#x0D; FindingsRefusal rates for questionnaire completion were low (7-8%). Among those recruited, consent for access and linkage to medical records was high (98%). Recruitment of both cases and controls was closely representative of the NI population in terms of age, area of residence and deprivation. There was considerable discordance between self-report questionnaires, maternity records and prescription records regarding medications taken in the first trimester, and between self-report questionnaires and maternity records regarding behaviours such as preconceptional folic acid, pregnancy planning, and smoking. However, there were no differences between cases and controls that would indicate recall bias.&#x0D; ConclusionsOur results suggest that hybrid data collection approaches are a useful way forward for aetiological studies.

Confidence in communicating with patients with cancer mediates the relationship between rehabilitation therapists' autistic-like traits and perceived difficulty in communication.

Recently, rehabilitation therapists have become involved in cancer rehabilitation; however, no communication skills training that increases the ability to provide emotional support for cancer patients has been developed for rehabilitation therapists. In addition, no study has examined associations between rehabilitation therapists' communication skills and their level of autistic-like traits (ALT), which are in-born characteristics including specific communication styles and difficulty communicating with patients. In this study, we aimed to investigate whether confidence in communicating with patients mitigates communication difficulties experienced by rehabilitation therapists who have high levels of ALT. Rehabilitation therapists who treat patients with cancer completed self-administered postal questionnaires anonymously. Scores were obtained on the Autism-Spectrum Quotient short form, confidence in communication, and communication difficulties. We used covariance structure analyses to test hypothetical models, and confirmed that confidence in communication mediates the relationship between ALT and perceived communication difficulties. Participants included 1,343 respondents (49.6%). Autism-Spectrum Quotient scores were positively correlated with communication difficulties (r = 0.16, p < 0.001). The correlation was mitigated by confidence in communication in the fit model. However, higher confidence in creating a supportive atmosphere was associated with more difficulty in communication (r = 0.16, p < 0.001). Communication difficulty was linked to rehabilitation therapists' ALTs. By increasing confidence in areas of communication other than creation of a supportive atmosphere, ALT-related difficulties in communication may be ameliorated. Confidence to create supportive environments correlated positively with difficulty. Communication skills training to increase confidence in communication for rehabilitation therapists should be developed with vigilance regarding ALT levels.

Multidimensional factors associated with the loss of independence: A population-based longitudinal study.

To clarify the factors associated with loss of independence multidimensionally over a 3-year period among community-dwelling older adults. The survey was exclusively carried out by the local government for people aged >65 years who were independent at baseline living in H-City, a mid-sized urban city in Japan. The participants completed a self-administered postal questionnaire, and we obtained data regarding their loss of independence from administrative records 3 years later. A total of 22 328 participants completed the follow up (baseline mean age 71.6 years). At follow up, 998 (4.3%) participants were categorized as dependent, with 606 requiring partial support in toileting, bathing and so on (mild loss of independence), and 392 requiring complete support (severe loss). Factors independently associated with mild loss of independence after 3 years for both men and women were advanced age, low physical function, low nutritional status, low cognitive function and high depression risk. In contrast, factors independently associated with severe loss of independence were advanced age, low physical function and high depression risk in men, and advanced age, and low physical and cognitive function in women. We clarified the variety of factors associated with loss of independence according to its severity, and the strength of those independent associations was different in the whole city longitudinal study. The present study's findings have important clinical implications for the development of better preventive medicine to establish a society of healthy longevity. Geriatr Gerontol Int 2018; 18: 448-455.

Access to public mobility services and health in old age: A cross-sectional study in three Swedish cities

Little evidence is available on how public transport features can impact on older people's health. The overarching aim of this paper is to evaluate socio-demographic, health and mobility-related factors correlated with health-related quality of life among people aged between 75 to 90 years old in three Swedish Municipalities. Within the SEBEM study, a cross-sectional survey using a self-administered postal questionnaire was conducted among 2398 older people aged between 75 and 90 years. Primary outcome of the study was health-related quality of life measured using the SF12 which distinguishes two dimensions of health, i.e. the Physical Composite Score (PCS) and the Mental Component Score (MCS). Descriptive statistics were used to analyze the variability study outcomes. Multilevel regression models were used to investigate factors independently correlated with health, controlling for the influence of potential confounders. Higher physical and mental self-reported health is associated with walking more than 500 m on a daily basis, use of a private car and frequent engagement in social activities. Access to the car is only associated with physical health. Mental health scores are significantly lower among those living far from the closest bus stop and never using public transport. We provide evidence of epidemiological associations between access to public mobility services and good health in older age. Given the cross-sectional design of our analyses, and the related limitations, the associations found should be investigated more thoroughly by future studies using longitudinal and/or experimental designs.

Short communication: Weak associations between mastitis control measures and bulk milk somatic cell counts in Swedish dairy herds.

Despite the fact that control programs have been available for several decades, mastitis remains an important problem in dairy herds around the world. Possible reasons for this include poor uptake and application of recommended mastitis control measures; poor or variable compliance; or variability in the effects of these measures. The objective of this study was to evaluate the associations between implemented mastitis control measures and bulk milk somatic cell count (BMSCC) in Swedish dairy herds. Data for this study were collected primarily from an extensive self-administered postal questionnaire about the herds, the people responsible for udder health, and details of udder health and mastitis management. A total of 898 questionnaires were distributed, and 428 questionnaires were returned (overall response rate of 48%), but we used the information from only 395 herds in this study. For all herds, we collected data on herd size and geometric average calculated BMSCC from the Swedish Official Milk Recording Scheme. We used logistic regression to assess the association between mastitis control measures and BMSCC, dichotomized as low (<200,000 cells/mL) or high (>200,000 cells/mL). We investigated 21 measures that have been suggested for mastitis control, but found only 2 to be associated with udder health as measured by BMSCC. Not providing dry cows with a specialized mineral feed was significantly associated with increased risk of high BMSCC, and not using post-milking teat disinfectant tended to be associated with increased risk. The lack of association for all other measures was not likely due to low power (because most of these measures had variable implementation rates) but could be due to the relatively narrow range of BMSCC in our study (range 61,000-524,000 cells/mL). However, our results agreed well with those of other recent studies, supporting the call for a thorough review of the current knowledge of mastitis control and for wider application of intervention studies to verify the actual effects of suggested control measures.

Are differences in population prevalence of alcohol's harm to others related to survey administration mode?

This study assessed the comparability of estimates of alcohol's harm to others across different administration modes in Swedish general population surveys. Harm was categorised as harm from strangers' drinking and harm from heavy drinkers known to the respondent. Three surveys were conducted in 2011/2012 (n=6841), including identical questions. One was based on self-administered postal or Web questionnaires, and two were based on computer-assisted telephone interviews of which one included a more ambitious procedure in terms of for example monetary incentives to the respondents. Pearson χ2 -tests were used to compare differences in the prevalence of harm. To estimate potential effects of survey mode, the samples were pooled, and multivariate Poisson regression models with mode as explanatory variable were used, adjusting for socio-demographic and behavioural factors. Respondents in the two computer-assisted telephone interviews were more likely to report harm from strangers' drinking compared with respondents in the self-administered postal or Web questionnaires. However, no significant differences were found between survey modes concerning reports of harm from known people's drinking. A survey mode based on interviews seems to facilitate reports of harm from strangers' drinking. This does not apply to reports of harm from known people's drinking. Therefore, the comparability of estimates of alcohol's harm to others between survey modes depends on the type of harm being studied. [Sundin E, Landberg J, Galanti MR, Room R, Ramstedt M. Are differences in population prevalence of alcohol's harmto others related to survey administration mode?

Organizational Justice and Collaboration Among Nurses as Correlates of Violent Assaults by Patients in Psychiatric Care.

This study tested the hypothesis that poor organizational justice and collaboration among nurses are associated with increased stress among nurses, which, in turn, increases the likelihood of violent assaults by patients. A cross-sectional survey was conducted of nurses in 90 psychiatric inpatient wards in five hospital districts and one regional hospital in Finland. A total of 758 nurses (registered nurses or enrolled/mental health nurses) responded to the survey. Self-administered postal questionnaires were used to assess organizational justice, collaboration, nurses' stress, and violent assaults by patients. Structural equation modeling (SEM) was used in model testing. SEM did not support a role for stress in mediating between organizational justice, collaboration between nurses, and violent assaults by patients, given that stress levels were not dependent to a significant degree on organizational justice, nor were patients' assaults dependent on stress levels. However, low organizational justice and poor collaboration between nurses were associated with increased reports of violent assaults by patients in psychiatric inpatient settings (p<.05 for both). The model explained 5.7% of violent assaults at nearly significant levels (p=.052). These findings suggest that organizational justice, collaboration between staff members, and violent assaults by patients are linked in psychiatric inpatient settings. Evaluating a variety of factors, including issues related to organizational justice and collaboration among nurses, may be useful to minimize assaults by patients in psychiatric settings.

Employment Status, Anxiety and Depression in a Municipal Context

Objectives: This study aimed to investigate the prevalence of anxiety and depression by employment status among a sample of the working age population residing in Gävle Municipality in Sweden.&#x0D; Methods: A total of 241 persons completed a self-administered postal questionnaire in the baseline survey of the Gävle Household, Labour Market and Health Outcomes (GHOLDH) survey, which collected information on the employment status and psychological health (anxiety and depression) among persons aged 18-65 years. Descriptive and multivariate analyses were performed.&#x0D; Results: The prevalence and risk of anxiety and depression were high among people who were out of work. In the multiple regression analysis, compared to employed people, those who were not employed had a risk of anxiety of 7.76 (5.97-9.75) and 4.67 (3.60-5.74) for depression.&#x0D; Conclusion: The prevalence of anxiety and depression was higher among those who were out of labour market as compared to those employed. Furthermore, people who were out of work had a higher risk of anxiety and depression. The odds were slightly higher for anxiety than for depression.

The battle over employers’ demand for “more flexibility”

PurposeThe purpose of this paper is to place empirical research on New Zealand employers’ attitudes to collective bargaining and legislative change within the context of the long running debate of flexibility.Design/methodology/approachA cross-sectional survey design using a self-administered postal questionnaire, covering private sector employers with ten or more staff and including employers within all 17 standard industry classification. To explore particular issues, an additional in-depth interviews were conducted of 25 employers participating in the survey.FindingsIt is found that employers support overwhelmingly recent legislative changes though there are variations across industries and firm sizes. There is also considerable variation in terms of which legislative changes are applied in the workplace. Despite fewer constraints on employer-determined flexibility, there was a rather puzzling finding that most employers still think that employment legislation is even balanced or favouring employees.Originality/valueCross-sectional survey findings of New Zealand employer attitudes to legislative changes are few and provide valuable data for policy makers, unions, employers and employment relations researchers. The paper also contributes to a more comprehensive understanding of pressures to increase employer-determined flexibility in many western countries.

The multidimensional burden of informal caregivers in primary malignant brain tumor

Informal caregivers (ICs) provide care and improve the quality of life of patients with malignant brain tumor. We analyze the impact of their involvement on themselves from a triple perspective. Home-dwelling patients with primary malignant brain tumor underwent a medical examination. ICs burden was evaluated by a self-administered postal questionnaire. Objective burden (Informal Care Time, ICT), subjective burden (Zarit Burden Inventory, ZBI), and financial burden (valuation of lost earnings using the Replacement and Opportunity Cost Methods, RCM, OCM) were evaluated. ICs (N=84) were principally women (87%) and spouses (64%), of mean age 55years, who assisted patients of mean age 53years and with a mean KPS score of 61 (range=30-90, med=60). Subjective burden was moderate (mean ZBI=30). Objective burden was high (mean ICT=11.7h/day), mostly consisting of supervision time. Higher subjective and objective burden were associated with poorer functional status (KPS) but not with a higher level of cognitive disorders in multivariate analyses. Other independent associated factors were bladder dysfunction and co-residency for objective burden and working and a poor social network for subjective burden. The 56 working ICs made work arrangements (75%) that impacted their wages (36%) and careers (30%). Financial burden due to uncompensated caregiving hours for Activities of Daily Living had a mean monetary value from Є677(RCM) to Є1683(OCM) per month (i.e., ranging from Є8124 to Є20196 per year). IC burden is multidimensional. Greater provision of formal care, more IC support programs, and economic interventions targeting IC employment and finances are needed.

Factors associated with risk for assisted living among community-dwelling older Japanese

ObjectivesTo clarify the factors associated with risk for assisted living among community-dwelling older people, we conducted a large-scale survey in an urban city in Japan. DesignPopulation-based cross-sectional study. SettingA mid-sized urban city in western Japan with a population of approximately 410,000. ParticipantsNondisabled and nondemented community-dwelling older people (≥65 years). MeasurementsA self-administered postal questionnaire, including a health checklist for the screening of older people at high risk for assisted living, as well as demographic/sociodemographic questions on sex, age, present illness, living alone, duration of residence within the current city, community participation, and employment status, was distributed. ResultsThere were 41,796 returned questionnaires (response rate: 73.8%, average age: 72.0). Participants who were at high risk for assisted living accounted for 25.2%. The independent factors associated with risk for men and women were higher age, present illness, lack of community participation, unemployment, and<20years of residence. Living alone was a significant factor for men, whereas it was insignificant among women. The types of illnesses among people at risk were different between men and women. ConclusionHigher age, present illness, and several social factors were independently associated with high-risk status for assisted living in the large-scale whole community survey, and there was a sex difference. Our results may provide basic information for the further application of effective preventive intervention in the community.

Nursing activities in family medicine groups for patients with chronic pain

Thousands of people treated in primary care are currently experiencing chronic pain (CP), for which management is often inadequate. In Quebec, nurses in family medicine groups (FMGs) play a key role in the management of chronic health problems. The present study aimed to describe the activities performed by FMG nurses in relation to CP management and to describe barriers to those activities. A descriptive correlational cross-sectional postal survey was used. The accessible population includes FMG nurses on the Ordre des infirmières et infirmiers du Québec list. All nurses on the list who provided consent to be contacted at home for research purposes were contacted. A self-administered postal questionnaire (Pain Management Activities Questionnaire) was completed by 53 FMG nurses. Three activities most often performed by nurses were to establish a therapeutic relationship with the client; discuss the effectiveness of therapeutic measures with the physician; and conduct personalized teaching for the patient. The average number of individuals seen by interviewed nurses that they believe suffer from CP was 2.68 per week. The lack of knowledge of possible interventions in pain management (71.7%) and the nonavailability of information on pain management (52.8%) are the main barriers perceived by FMG nurses. FMG nurses are currently performing few activities in CP management. The nonrecognition of CP may explain this situation.

Social capital and health: implication for health promotion by lay citizens in Japan.

A non-profit organization was formed in 2009 by lay citizens of Nagahama, Japan in response to a community-based genome-epidemiologic study, the ‘Nagahama Zero(0)-ji Prevention Cohort Project (N0PCP)’. This organization aims to promote health by taking advantage of citizens’ social networks. The Ottawa Charter for Health Promotion affirms the importance of creating supportive environments and coordinating social relationships. Supportive environments (infrastructure) and social relationships (resources) work together as aspects of social capital. This study sought to examine the association between self-rated health and social capital, at both individual and neighborhood levels, and to discuss suitable health promotion strategies for local circumstances.A cross-sectional survey was conducted in 2011, using a self-administered postal questionnaire. Social capital indicators included aspects of support in the environment (social support, neighborhood connectedness, informal social controls, neighborhood trust, general trust, and attachment to place) and social relationships (number of activities; participation in neighborhood activities; participation in recreational activities; and social leverage regarding physical health, mental health, and acquisition of health information). Neighborhood-level social capital was calculated as the percentage of individuals in a neighborhood in the ‘high social capital’ category. At the individual level, participation in recreational activities, high general trust, and discussion regarding mental health problems with family members were associated with self-rated health positively, whereas discussion of mental health problems with acquaintances had a negative correlation. At the neighborhood level, a highly supportive environment did not contribute to good health, whereas aggregated attachment to place had a positive correlation. There were no significant inter-regional health differences.The results of this study suggest that health promotion activities should aim at promoting the formation of empathetic friendships through individual networks, based on bringing individuals who need support to compatible places. Attachment to place should be incorporated into activities as an important and effective tool.