THE ASSOCIATIONS AMONG SOCIAL CAPITAL, HEALTH BEHAVIOURS, AND COGNITIVE MECHANISMS IN CARDIAC OUTPATIENTS

Valerie Haboucha1,2, Darren A Mercer1,2,3, Blaine Ditto2, Kim L Lavoie1,3,4,5, Simon L Bacon1,3,4,6

BACKGROUNDAs the leading cause of death in the world1, cardiovascular disease (CVD) is a primary public health concern. Many CVD risk factors are highly modifiable health behaviours, such as diet, physical inactivity, obesity, excessive alcohol consumption, smoking, and medication adherence2.

In addition to behavioural risk factors for CVD, there are cognitive mechanisms that predict maintained behaviour change, effective performance, and the internalization of values. One such cognitive mechanism, perceived competence—an innate psychological need—has been associated with positive health behaviours3, and as such, low perceived competence is a risk factor for CVD.

Social capital encompasses the social and organizational structures of a community, and the affiliated resources, which facilitate cooperation for mutual benefit4. As a social determinant of health, social capital has been shown to be positively associated with CVD-related health behaviours in the general population5.

OBJECTIVETo examine the associations among social capital, operationalized as social trust and social participation, and behavioural and cognitive risk factors for CVD, including obesity, physical activity, smoking history, alcohol use, and perceived competence for medication use.

METHODSA sample of 494 outpatients who had been referred to the Nuclear Medicine Department of the Montreal Heart Institute was recruited.

Participants were sent a questionnaire package by mail. Demographic, social capital, health behaviour, and perceived competence data were collected, as displayed in Table 1.

Social capital was measured by the Social Capital Community Benchmark Survey short form. Specifically, a social trust measure, a continuous social participation measure, and a dichotomous social participation measure (leader or committee member, yes/no) were used.

General linear model regressions were used to determine the effects of social trust, continuous social participation, and dichotomous social participation on health behaviours and perceived competence

RESULTS

1 Montreal Behavioural Medicine Centre, Montreal, Canada, 2 Department of Psychology, McGill University, Montreal, Canada, 3 Research Centre, Montreal Heart Institute – a University of Montréal affiliated hospital, Montreal, Canada, 4 Research Centre, Sacré-Coeur Hospital of Montreal – a University of Montréal affiliated hospital, Montreal, Canada, 5 Department of Psychology, University of Quebec at Montreal, Montreal, Canada , 6 Department of Exercise Science, Concordia University, Montreal, Canada

CONCLUSIONSPositive associations between smoking history, measured in pack years consumed, and both higher social trust score and being a leader or committee member of an organization were observed. There was also a positive relationship trending toward significance between pack years smoked and higher continuous social participation score. This indicates that higher social capital was associated with an increased number of pack years smoked.

These findings revealed a correlation in the opposite direction than expected, which may be due to past social attitudes toward smoking in the province of Quebec. The fact that 55% of this sample were previous smokers—well above the national rate of 37% for the same age group6—is likely to have influenced the direction of the relationship between social capital and pack years consumed. Past attitudes toward smoking as a social activity, which contributed to Quebec having the highest smoking prevalence in Canada until the year 20006, likely contributed to the association between higher social capital and smoking history.

Social trust score was positively associated with perceived competence for medication use. To our knowledge, this is the first study to investigate a relationship between social capital and a cognitive risk factor for CVD. The public health implications of this finding should be further explored with additional research to determine whether this result is generalizable to perceived competence for other health behaviours, and whether perceived competence acts as a mechanism that underlies the relationship between social trust and positive health behaviours.

Table 2: Linear regression analyses between social trust score and CVD risk factorsVariable F p β (SE)

BMI 0.30 0.58 -0.06 (0.11)MET-hrs/wk 1.21 0.27 0.28 (0.26)Pack years 4.60** 0.03 1.11 (0.52)Avg # drinks/wk 0.39 0.54 -0.23 (0.38)PCS score 4.01** 0.05 0.12 (0.06)

Smoking (Pack Years)0

5

10

15

20

Figure 1: Association between be-ing a leader or committee mem-

ber and pack years smoked (F = 4.33, p = 0.04)

No Yes

Table 1: Sample characteristicsVariable M ± SD or % (n)Age (years) 64.2 ± 9.3Sex (% women) 31% (152)Years of education 13.5 ± 4.4Any CVD diagnosis 54% (267)Social trust score 7.5 ± 2.0Social participation score 9.9 ± 6.4Served as an officer or on a committee 19% (90)BMI 27.4 ± 4.5Leisure-time physical activity (MET-hours/week) 6.2 ± 10.5Current smoker 9% (40)Never smoked 36% (164)Lifetime smoking (pack years) 13.7 ± 19.6Average # drinks/week 15.4 ± 16.3Perceived competence scale (PCS) score 27.0 ± 2.8

Variable F p β (SE)BMI 0.66 0.42 0.03 (0.04)MET-hrs/wk 0.63 0.43 -0.07 (0.08)Pack years 2.68* 0.10 0.27 (0.17)Avg # drinks/wk 0.02 0.88 -0.02 (0.12)PCS score 1.86 0.17 -0.03 (0.02)

Table 3: Linear regression analyses between continuous social participation score and CVD risk factors

* denotes a trend at p = 0.10 level ** denotes significance at p = 0.05 level

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