Date of Award

5-13-2022

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Xiangming Fang

Second Advisor

Shannon Renee Self-Brown

Third Advisor

Ali Rahimi

Abstract

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the US, placing considerable economic and clinical burden on the nation. Hypertension (HTN) is the most common modifiable risk factor associated with CVD. Racial disparities in HTN incidence and prevalence make its burden all the heavier on minority populations.

Significant investments have failed to improve HTN incidence and prevalence. Studies have looked to non-medical factors, including social capital (SC) constructs, to explain this phenomenon. However, most studies are cross-sectional or over limited follow-up periods, unable to examine relationships between the timing or duration of SC and CVD-related outcomes. Three studies were conducted to address this gap.

The first study addresses the first research question: How has SC been defined, classified, and measured in the existing CVD literature? Across 74 studies included in the review, SC was largely defined as social networks and social support. The most common keywords were social support and risk factors and most studied CVD outcomes included mortality, myocardial infarction, and hypertension.

The second study uses a nationally representative longitudinal sample to answer the second research question: What is the association between life course social isolation and HTN in early middle adulthood? The findings suggested that social isolation in young or early middle adulthood significantly increases the odds of HTN, as does moving into social isolation in adulthood and the accumulation of social isolation across adolescence, young, and early middle adulthood.

The last study uses the same data source to answer the last research question: Do racial differences in the prevalence of HTN in early middle adulthood change when social connections are considered? The results showed that marriage/cohabitation in early middle adulthood mediated a significantly moderate portion of the non-Hispanic Black/White disparity in HTN prevalence. Similar mediation effects were found when considered across both adulthood life stages for marriage/cohabitation, close friendships, regular religious attendance, and volunteering.

The findings of this dissertation highlight opportunities to further examine the relationship between SC constructs and CVD-related measures and suggest that interventions to increase SC may reduce the overall incidence, and racial differences associated with, HTN in early middle adulthood.

DOI

https://doi.org/10.57709/28403490

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