1. THE ASSOCIATIONS AMONG SOCIAL CAPITAL, HEALTH BEHAVIOURS, AND COGNITIVE MECHANISMS IN CARDIAC OUTPATIENTS Valerie Haboucha 1,2, Darren A Mercer 1,2,3, Blaine Ditto 2, Kim L Lavoie 1,3,4,5, Simon L Bacon 1,3,4,6 BACKGROUND As the leading cause of death in the world 1, 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 adherence 2. 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 behaviours 3, 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 benefit 4. As a social determinant of health, social capital has been shown to be positively associated with CVD- related health behaviours in the general population 5. OBJECTIVE To 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. METHODS A 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 CONCLUSIONS Positive 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 group 6 —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 2000 6, 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 factors VariableFpβ (SE) BMI0.300.58-0.06 (0.11) MET-hrs/wk1.210.270.28 (0.26) Pack years4.60**0.031.11 (0.52) Avg # drinks/wk0.390.54-0.23 (0.38) PCS score4.01**0.050.12 (0.06) Table 1: Sample characteristics Variable M ± SD or % (n) Age (years)64.2 ± 9.3 Sex (% women)31% (152) Years of education13.5 ± 4.4 Any CVD diagnosis54% (267) Social trust score7.5 ± 2.0 Social participation score9.9 ± 6.4 Served as an officer or on a committee19% (90) BMI27.4 ± 4.5 Leisure-time physical activity (MET-hours/week)6.2 ± 10.5 Current smoker9% (40) Never smoked36% (164) Lifetime smoking (pack years)13.7 ± 19.6 Average # drinks/week15.4 ± 16.3 Perceived competence scale (PCS) score27.0 ± 2.8 VariableFpβ (SE) BMI0.660.420.03 (0.04) MET-hrs/wk0.630.43-0.07 (0.08) Pack years2.68*0.100.27 (0.17) Avg # drinks/wk0.020.88-0.02 (0.12) PCS score1.860.17-0.03 (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 REFERENCES 1 World Health Organization. The Top Ten Causes of Death, Fact Sheet No. 310. Geneva: World Health Organization; 2011. 2 Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. The Lancet. 2004; 364(9438):937-52. 3 Williams GC, McGregor HA, Sharp D, Levesque C, Kouides RW, Ryan RM, et al. Testing a self- determination theory intervention for motivating tobacco cessation: Supporting autonomy and competence in a clinical trial. Health Psychology. 2006; 25(1):91-101. 4 Putnam RD. Making Democracy Work: Civic Traditions in Modern Italy. Princeton, NJ: Princeton University Press; 1993. 5 Poortinga W. Do health behaviors mediate the association between social capital and health? Preventive Medicine. 2006; 43(6):488-93. 6 Health Canada. Canadian Tobacco Use Monitoring Survey (CTUMS) 2011. 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