“My health affects other people’s health” — social-health beliefs and modifiable cardiovascular risk burden in a German prevention survey

Background Modifiable cardiovascular risk factors contribute substantially to chronic disease burden, yet prevention remains difficult to implement at scale. Beyond knowledge and resources, prevention behaviors may be shaped by social beliefs and perceived responsibility for others. Whether endorsement of the belief “my health affects other people’s health” is linked to overall modifiable risk burden is unclear. [1, 2] Purpose To examine the association between this social-health belief and modifiable cardiovascular risk burden in a German prevention survey. Methods In a 58-item questionnaire study, participants rated the statement “My health affects other people’s health”. Responses were grouped as Always, Sometimes, and Rarely/Never. “Don’t know” (DK) responses were treated as a distinct response category in descriptive analyses and explored separately in regression-based sensitivity analyses. Modifiable risk burden was operationalized as a 0–6 score summing six domains (obesity, smoking, alcohol, low physical activity, impaired sleep, high stress), requiring ≥5/6 domains available. Associations with risk burden were assessed using linear regression with robust standard errors, adjusted for age, sex, education, household income, and cardiovascular disease (CVD) status. Adjusted means were visualized using predictive margins. Results The adjusted analysis sample comprised 1,012 participants with complete covariates. Among substantive responders (n=916; Always 190, Sometimes 553, Rarely/Never 173), adjusted mean risk burden decreased from Always 1.21 (1.05–1.37) to Sometimes 1.02 (0.94–1.11) and Rarely/Never 0.99 (0.83–1.14), with a borderline global difference (overall p=0.074; Figure). In Table, education and household income differed across belief groups (education p=0.017; income p=0.005), and perceived risk was higher in those endorsing “Always” (p=0.037). DK responses were frequent (236/1,152; 20.5%). In a planned contrast model (Always vs Not always [Sometimes/Rarely/Never]) including a DK indicator (n=1,012), Not always was associated with a lower adjusted risk burden (β = −0.20, 95% CI −0.38 to −0.02; p=0.030), whereas DK showed no clear difference from the reference (β = +0.13, p=0.139). Conclusion In this prevention survey, endorsement of the belief “my health affects other people’s health” was associated with modifiable cardiovascular risk burden, with the highest burden among those answering “Always” and the lowest among “Rarely/Never.” DK responses appeared to represent a distinct subgroup with intermediate burden. These findings suggest that social-health beliefs—and uncertainty about them—may help identify target groups for tailored prevention messaging and behavioral support.