Social network targeting to maximise population behaviour change: a cluster randomised controlled trial

BACKGROUND

Information and behaviour can spread through interpersonal ties. By targeting influential individuals, health interventions that harness the distributive properties of social networks could be made more effective and efficient than those that do not. Our aim was to assess which targeting methods produce the greatest cascades or spillover effects and hence maximise population-level behaviour change.

METHODS

In this cluster randomised trial, participants were recruited from villages of the Department of Lempira, Honduras. We blocked villages on the basis of network size, socioeconomic status, and baseline rates of water purification, for delivery of two public health interventions: chlorine for water purification and multivitamins for micronutrient deficiencies. We then randomised villages, separately for each intervention, to one of three targeting methods, introducing the interventions to 5% samples composed of either: randomly selected villagers (n=9 villages for each intervention); villagers with the most social ties (n=9); or nominated friends of random villagers (n=9; the last strategy exploiting the so-called friendship paradox of social networks). Participants and data collectors were not aware of the targeting methods. Primary endpoints were the proportions of available products redeemed by the entire population under each targeting method. This trial is registered with ClinicalTrials.gov, number NCT01672580.

FINDINGS

Between Aug 4, and Aug 14, 2012, 32 villages in rural Honduras (25-541 participants each; total study population of 5773) received public health interventions. For each intervention, nine villages (each with 1-20 initial target individuals) were randomised, using a blocked design, to each of the three targeting methods. In nomination-targeted villages, 951 (74·3%) of 1280 available multivitamin tickets were redeemed compared with 940 (66·2%) of 1420 in randomly targeted villages and 744 (61·0%) of 1220 in indegree-targeted villages. All pairwise differences in redemption rates were significant (p<0·01) after correction for multiple comparisons. Targeting nominated friends increased adoption of the nutritional intervention by 12·2% compared with random targeting (95% CI 6·9-17·9). Targeting the most highly connected individuals, by contrast, produced no greater adoption of either intervention, compared with random targeting.

INTERPRETATION

Introduction of a health intervention to the nominated friends of random individuals can enhance that intervention's diffusion by exploiting intrinsic properties of human social networks. This method has the additional advantage of scalability because it can be implemented without mapping the network. Deployment of certain types of health interventions via network targeting, without increasing the number of individuals targeted or the resources used, could enhance the adoption and efficiency of those interventions, thereby improving population health.

FUNDING

National Institutes of Health, The Bill & Melinda Gates Foundation, Star Family Foundation, and the Canadian Institutes of Health Research.

The role of self-interest in elite bargaining

One of the best-known and most replicated laboratory results in behavioral economics is that bargainers frequently reject low offers, even when it harms their material self-interest. This finding could have important implications for international negotiations on many problems facing humanity today, because models of international bargaining assume exactly the opposite: that policy makers are rational and self-interested. However, it is unknown whether elites who engage in diplomatic bargaining will similarly reject low offers because past research has been based almost exclusively on convenience samples of undergraduates, members of the general public, or small-scale societies rather than highly experienced elites who design and bargain over policy. Using a unique sample of 102 policy and business elites who have an average of 21 y of practical experience conducting international diplomacy or policy strategy, we show that, compared with undergraduates and the general public, elites are actually more likely to reject low offers when playing a standard "ultimatum game" that assesses how players bargain over a fixed resource. Elites with more experience tend to make even higher demands, suggesting that this tendency only increases as policy makers advance to leadership positions. This result contradicts assumptions of rational self-interested behavior that are standard in models of international bargaining, and it suggests that the adoption of global agreements on international trade, climate change, and other important problems will not depend solely on the interests of individual countries, but also on whether these accords are seen as equitable to all member states.

Click "like" to change your behavior: a mixed methods study of college students' exposure to and engagement with Facebook content designed for weight loss

Background

Overweight or obesity is prevalent among college students and many gain weight during this time. Traditional face-to-face weight loss interventions have not worked well in this population. Facebook is an attractive tool for delivering weight loss interventions for college students because of its popularity, potential to deliver strategies found in successful weight loss interventions, and ability to support ongoing adaptation of intervention content.

Objective

The objective of this study was to describe participant exposure to a Facebook page designed to deliver content to overweight/obese college students in a weight loss randomized controlled trial (N=404) and examine participant engagement with behavior change campaigns for weight loss delivered via Facebook.

Methods

The basis of the intervention campaign model were 5 self-regulatory techniques: intention formation, action planning, feedback, goal review, and self-monitoring. Participants were encouraged to engage their existing social network to meet their weight loss goals. A health coach moderated the page and modified content based on usage patterns and user feedback. Quantitative analyses were conducted at the Facebook post- and participant-level of analysis. Participant engagement was quantified by Facebook post type (eg, status update) and interaction (eg, like) and stratified by weight loss campaign (sequenced vs nonsequenced). A subset of participants were interviewed to evaluate the presence of passive online engagement or “lurking.”

Results

The health coach posted 1816 unique messages to the study’s Facebook page over 21 months, averaging 3.45 posts per day (SD 1.96, range 1-13). In all, 72.96% (1325/1816) of the posts were interacted with at least once (eg, liked). Of these, approximately 24.75% (328/1325) had 1-2 interactions, 23.39% (310/1325) had 3-5 interactions, 25.13% (333/1325) had 6-8 interactions, and 41 posts had 20 or more interactions (3.09%, 41/1325). There was significant variability among quantifiable (ie, visible) engagement. Of 199 participants in the final intervention sample, 32 (16.1%) were highly active users and 62 (31.2%) never visibly engaged with the intervention on Facebook. Polls were the most popular type of post followed by photos, with 97.5% (79/81) and 80.3% (386/481) interacted with at least once. Participants visibly engaged less with posts over time (partial r=–.33; P<.001). Approximately 40% of the participants interviewed (12/29, 41%) reported passively engaging with the Facebook posts by reading but not visibly interacting with them.

Conclusions

Facebook can be used to remotely deliver weight loss intervention content to college students with the help of a health coach who can iteratively tailor content and interact with participants. However, visible engagement with the study’s Facebook page was highly variable and declined over time. Whether the level of observed engagement is meaningful in terms of influencing changes in weight behaviors and outcomes will be evaluated at the completion of the overall study.

Relationships between depression, gender, and unhealthy weight loss practices among overweight or obese college students

INTRODUCTION

Unhealthy weight loss practices are common among female college students. It is unknown if these practices are also most common among women in the subset of overweight or obese college students or if these practices are related to depression. We examined the relationship between gender, depression, and unhealthy weight loss practices among overweight or obese college students.

METHODS

Students (body mass index between 25.0 and 34.9 kg/m(2)) from three Southern California universities (M(age) = 22 years, SD = 4; 70% women) were recruited from May 2011 to May 2012 for participation in a weight loss clinical trial (N = 404). Logistic regressions were performed with baseline data to assess the cross-sectional relationship between self-reported unhealthy weight loss practices and gender and depression as measured by the Center for Epidemiologic Studies Depression short form.

RESULTS

Twenty-nine percent of participants reported engaging in at least one unhealthy weight loss behavior (e.g., fasting, purging) over the last 30 days, with no differences by gender. Self-report of at least one unhealthy weight loss behavior was associated with report of symptoms of depression (e(B) = 1.14 [confidence interval, CI: 1.08-1.20]), adjusting for potential confounders. Interactions between gender and depression were not significant (e(B) = 1.04 [CI: 0.93-1.16]).

CONCLUSION

Among an overweight or obese sample of college students, unhealthy weight loss practices were equally common in both genders, and students with depressive symptomatology were at greatest risk. Obesity interventions targeting overweight or obese college students should educate both men and women about the dangers of unhealthy weight loss practices. In addition, screening for depression can help identify students who would benefit from additional supportive and coping strategies and resources.

Association between social network communities and health behavior: an observational sociocentric network study of latrine ownership in rural India

OBJECTIVES

We identified communities of interconnected people that might serve as normative reference groups for individual-level behavior related to latrine adoption.

METHODS

We applied an algorithmic social network method to determine the network community from respondent-reported social ties of 16 403 individuals in 75 villages in rural Karnataka, India; data were collected from 2006 to 2008. We used multilevel modeling to test the association between latrine ownership and community-level and village-level latrine ownership. We also investigated the degree to which network cohesion affected individual latrine ownership.

RESULTS

Three levels of social contacts (direct friends, social network community, and village) significantly predicted individual latrine ownership, but the strongest effect was found at the level of social network communities. In communities with high levels of network cohesion, the likelihood was decreased that any individual would own a latrine; this effect was significant only at lower levels of latrine ownership, suggesting a role for network cohesion in facilitating the nonownership norm.

CONCLUSIONS

Although many international health and development interventions target village units, these results raise the possibility that the optimal target for public health interventions may not be determined through geography but through social network interactions.

Detecting emotional contagion in massive social networks

Happiness and other emotions spread between people in direct contact, but it is unclear whether massive online social networks also contribute to this spread. Here, we elaborate a novel method for measuring the contagion of emotional expression. With data from millions of Facebook users, we show that rainfall directly influences the emotional content of their status messages, and it also affects the status messages of friends in other cities who are not experiencing rainfall. For every one person affected directly, rainfall alters the emotional expression of about one to two other people, suggesting that online social networks may magnify the intensity of global emotional synchrony.

Same-sex sexual attraction does not spread in adolescent social networks

Peers have a powerful effect on adolescents' beliefs, attitudes, and behaviors. Here, we examine the role of social networks in the spread of attitudes towards sexuality using data from the National Longitudinal Study of Adolescent Health (Add Health). Although we found evidence that both sexual activity (OR = 1.79) and desire to have a romantic relationship (OR = 2.69) may spread from person to person, attraction to same sex partners did not spread (OR = 0.96). Analyses of comparable power to those that suggest positive and significant peer-to-peer influence in sexual behavior fail to demonstrate a significant relationship on sexual attraction between friends or siblings. These results suggest that peer influence has little or no effect on the tendency toward heterosexual or homosexual attraction in teens, and that sexual orientation is not transmitted via social networks.

Corruption drives the emergence of civil society

Centralized sanctioning institutions have been shown to emerge naturally through social learning, displace all other forms of punishment and lead to stable cooperation. However, this result provokes a number of questions. If centralized sanctioning is so successful, then why do many highly authoritarian states suffer from low levels of cooperation? Why do states with high levels of public good provision tend to rely more on citizen-driven peer punishment? Here, we consider how corruption influences the evolution of cooperation and punishment. Our model shows that the effectiveness of centralized punishment in promoting cooperation breaks down when some actors in the model are allowed to bribe centralized authorities. Counterintuitively, a weaker centralized authority is actually more effective because it allows peer punishment to restore cooperation in the presence of corruption. Our results provide an evolutionary rationale for why public goods provision rarely flourishes in polities that rely only on strong centralized institutions. Instead, cooperation requires both decentralized and centralized enforcement. These results help to explain why citizen participation is a fundamental necessity for policing the commons.

Design and implementation of a randomized controlled social and mobile weight loss trial for young adults (project SMART)

PURPOSE

To describe the theoretical rationale, intervention design, and clinical trial of a two-year weight control intervention for young adults deployed via social and mobile media.

METHODS

A total of 404 overweight or obese college students from three Southern California universities (M(age) = 22( ± 4) years; M(BMI) = 29( ± 2.8); 70% female) were randomized to participate in the intervention or to receive an informational web-based weight loss program. The intervention is based on behavioral theory and integrates intervention elements across multiple touch points, including Facebook, text messaging, smartphone applications, blogs, and e-mail. Participants are encouraged to seek social support among their friends, self-monitor their weight weekly, post their health behaviors on Facebook, and e-mail their weight loss questions/concerns to a health coach. The intervention is adaptive because new theory-driven and iteratively tailored intervention elements are developed and released over the course of the two-year intervention in response to patterns of use and user feedback. Measures of body mass index, waist circumference, diet, physical activity, sedentary behavior, weight management practices, smoking, alcohol, sleep, body image, self-esteem, and depression occur at 6, 12, 18, and 24 months. Currently, all participants have been recruited, and all are in the final year of the trial.

CONCLUSION

Theory-driven, evidence-based strategies for physical activity, sedentary behavior, and dietary intake can be embedded in an intervention using social and mobile technologies to promote healthy weight-related behaviors in young adults.

Emotion regulation as the foundation of political attitudes: does reappraisal decrease support for conservative policies?

Cognitive scientists, behavior geneticists, and political scientists have identified several ways in which emotions influence political attitudes, and psychologists have shown that emotion regulation can have an important causal effect on physiology, cognition, and subjective experience. However, no work to date explores the possibility that emotion regulation may shape political ideology and attitudes toward policies. Here, we conduct four studies that investigate the role of a particular emotion regulation strategy – reappraisal in particular. Two observational studies show that individual differences in emotion regulation styles predict variation in political orientations and support for conservative policies. In the third study, we experimentally induce disgust as the target emotion to be regulated and show that use of reappraisal reduces the experience of disgust, thereby decreasing moral concerns associated with conservatism. In the final experimental study, we show that use of reappraisal successfully attenuates the relationship between trait-level disgust sensitivity and support for conservative policies. Our findings provide the first evidence of a critical link between emotion regulation and political attitudes.

Parental influence on substance use in adolescent social networks

OBJECTIVE

To evaluate the relationship between the parenting style of an adolescent's peers' parents and an adolescent's substance use.

DESIGN

Longitudinal survey.

SETTING

Adolescents across the United States were interviewed at school and at home.

PARTICIPANTS

Nationally representative sample of adolescents in the United States.

MAIN EXPOSURE

Authoritative vs neglectful parenting style of adolescent's parents and adolescent's friends' parents and adolescent substance use.

MAIN OUTCOME MEASURES

Adolescent alcohol abuse, smoking, marijuana use, and binge drinking.

RESULTS

If an adolescent had a friend whose mother was authoritative, that adolescent was 40% (95% CI, 12%-58%) less likely to drink to the point of drunkenness, 38% (95% CI, 5%-59%) less likely to binge drink, 39% (95% CI, 12%-58%) less likely to smoke cigarettes, and 43% (95% CI, 1%-67%) less likely to use marijuana than an adolescent whose friend's mother was neglectful, controlling for the parenting style of the adolescent's own mother, school-level fixed effects, and demographics. These results were only partially mediated by peer substance use.

CONCLUSIONS

Social network influences may extend beyond the homogeneous dimensions of own peer or own parent to include extradyadic influences of the wider network. The value of parenting interventions should be reassessed to take into account these spillover effects in the greater network.

Social contagion theory: examining dynamic social networks and human behavior

Here, we review the research we have conducted on social contagion. We describe the methods we have employed (and the assumptions they have entailed) to examine several datasets with complementary strengths and weaknesses, including the Framingham Heart Study, the National Longitudinal Study of Adolescent Health, and other observational and experimental datasets that we and others have collected. We describe the regularities that led us to propose that human social networks may exhibit a 'three degrees of influence' property, and we review statistical approaches we have used to characterize interpersonal influence with respect to phenomena as diverse as obesity, smoking, cooperation, and happiness. We do not claim that this work is the final word, but we do believe that it provides some novel, informative, and stimulating evidence regarding social contagion in longitudinally followed networks. Along with other scholars, we are working to develop new methods for identifying causal effects using social network data, and we believe that this area is ripe for statistical development as current methods have known and often unavoidable limitations.

Red brain, blue brain: evaluative processes differ in Democrats and Republicans

Liberals and conservatives exhibit different cognitive styles and converging lines of evidence suggest that biology influences differences in their political attitudes and beliefs. In particular, a recent study of young adults suggests that liberals and conservatives have significantly different brain structure, with liberals showing increased gray matter volume in the anterior cingulate cortex, and conservatives showing increased gray matter volume in the in the amygdala. Here, we explore differences in brain function in liberals and conservatives by matching publicly-available voter records to 82 subjects who performed a risk-taking task during functional imaging. Although the risk-taking behavior of Democrats (liberals) and Republicans (conservatives) did not differ, their brain activity did. Democrats showed significantly greater activity in the left insula, while Republicans showed significantly greater activity in the right amygdala. In fact, a two parameter model of partisanship based on amygdala and insula activations yields a better fitting model of partisanship than a well-established model based on parental socialization of party identification long thought to be one of the core findings of political science. These results suggest that liberals and conservatives engage different cognitive processes when they think about risk, and they support recent evidence that conservatives show greater sensitivity to threatening stimuli.

A 61-million-person experiment in social influence and political mobilization

Human behaviour is thought to spread through face-to-face social networks, but it is difficult to identify social influence effects in observational studies, and it is unknown whether online social networks operate in the same way. Here we report results from a randomized controlled trial of political mobilization messages delivered to 61 million Facebook users during the 2010 US congressional elections. The results show that the messages directly influenced political self-expression, information seeking and real-world voting behaviour of millions of people. Furthermore, the messages not only influenced the users who received them but also the users' friends, and friends of friends. The effect of social transmission on real-world voting was greater than the direct effect of the messages themselves, and nearly all the transmission occurred between 'close friends' who were more likely to have a face-to-face relationship. These results suggest that strong ties are instrumental for spreading both online and real-world behaviour in human social networks.

Genes, Economics, and Happiness

We explore the influence of genetic variation on subjective well-being by employing a twin design and genetic association study. In a nationally-representative twin sample, we first show that about 33% of the variation in life satisfaction is explained by genetic variation. Although previous studies have shown that baseline happiness is significantly heritable, little research has considered molecular genetic associations with subjective well-being. We study the relationship between a functional polymorphism on the serotonin transporter gene (5-HTTLPR) and life satisfaction. We initially find that individuals with the longer, transcriptionally more efficient variant of this genotype report greater life satisfaction (n=2,545, p=0.012). However, our replication attempts on independent samples produce mixed results indicating that more work needs to be done to better understand the relationship between this genotype and subjective well-being. This work has implications for how economists think about the determinants of utility, and the extent to which exogenous shocks might affect individual well-being.

Born to Lead? A Twin Design and Genetic Association Study of Leadership Role Occupancy

We address leadership emergence and the possibility that there is a partially innate predisposition to occupy a leadership role. Employing twin design methods on data from the National Longitudinal Study of Adolescent Health, we estimate the heritability of leadership role occupancy at 24%. Twin studies do not point to specific genes or neurological processes that might be involved. We therefore also conduct association analysis on the available genetic markers. The results show that leadership role occupancy is associated with rs4950, a single nucleotide polymorphism (SNP) residing on a neuronal acetylcholine receptor gene (CHRNB3). We replicate this family-based genetic association result on an independent sample in the Framingham Heart Study. This is the first study to identify a specific genotype associated with the tendency to occupy a leadership position. The results suggest that what determines whether an individual occupies a leadership position is the complex product of genetic and environmental influences; with a particular role for rs4950.

Egocentric social network structure, health, and pro-social behaviors in a national panel study of Americans

Using a population-based, panel survey, we study how egocentric social networks change over time, and the relationship between egocentric network properties and health and pro-social behaviors. We find that the number of prosocial activities is strongly positively associated with having more friends, or an increase in degree, with approximately 0.04 more prosocial behaviors expected for every friend added. Moreover, having more friends is associated with an improvement in health, while being healthy and prosocial is associated with closer relationships. Specifically, a unit increase in health is associated with an expected 0.45 percentage-point increase in average closeness, while adding a prosocial activity is associated with a 0.46 percentage-point increase in the closeness of one’s relationships. Furthermore, a tradeoff between degree and closeness of social contacts was observed. As the number of close social contacts increases by one, the estimated average closeness of each individual contact decreases by approximately three percentage-points. The increased awareness of the importance of spillover effects in health and health care makes the ascertainment of egocentric social networks a valuable complement to investigations of the relationship between socioeconomic factors and health.

The Southern California Twin Register at the University of Southern California: II

The Southern California Twin Register was initiated in 1984 at the University of Southern California, and continues to grow. This article provides an update of the register since it was described in the 2002 special issue of this journal. The register has expanded considerably in the past 4 years, primarily as a result of recent access to Los Angeles County birth records and voter registration databases. Currently, this register contains nearly 5000 twin pairs, the majority of whom are school age. The potential for further expansion in adult twins using voter registration records is also described. Using the Los Angeles County voter registration database, we can identify a large group of individuals with a high probability of having a twin who also resides in Los Angeles County. In addition to describing the expansion of register, this article provides an overview of an ongoing investigation of 605 twin pairs who are participating in a longitudinal study of behavioral problems during childhood and adolescence. Characteristics of the twins and their families are presented, indicating baseline rates of conduct problems, depression and anxiety disorders, and attention-deficit/hyperactivity disorder diagnoses which are comparable to nontwins in this age range.

Aspirin use and cardiovascular events in social networks

We tested whether friends' and family members' cardiovascular health events and also their own aspirin use are associated with the likelihood that an individual takes aspirin regularly. Analyses were based on longitudinal data on 2724 members of the Framingham Heart Study (based in Massachusetts, U.S.A.) who were linked to friends and family members who were also participants in the same study. Men were more likely to take aspirin if a male friend had recently been taking aspirin, and women were more likely to take aspirin if a brother had recently been taking aspirin. Men were also more likely to take aspirin if a brother recently had a cardiovascular event, and women were more likely to take aspirin if a female friend recently experienced a cardiovascular event. Aspirin use is correlated with the health and behavior of friends and family. These findings add to a growing body of evidence which suggests that behavioral changes that promote cardiovascular health may spread through social networks.

Social network determinants of depression

The etiology of depression has long been thought to include social environmental factors. To quantitatively explore the novel possibility of person-to-person spread and network-level determination of depressive symptoms, analyses were performed on a densely interconnected social network of 12,067 people assessed repeatedly over 32 years as part of the Framingham Heart Study. Longitudinal statistical models were used to examine whether depressive symptoms in one person were associated with similar scores in friends, co-workers, siblings, spouses and neighbors. Depressive symptoms were assessed using CES-D scores that were available for subjects in three waves measured between 1983 and 2001. Results showed both low and high CES-D scores (and classification as being depressed) in a given period were strongly correlated with such scores in one's friends and neighbors. This association extended up to three degrees of separation (to one's friends' friends' friends). Female friends appear to be especially influential in the spread of depression from one person to another. The results are robust to multiple network simulation and estimation methods, suggesting that network phenomena appear relevant to the epidemiology of depression and would benefit from further study.

Correlated genotypes in friendship networks

It is well known that humans tend to associate with other humans who have similar characteristics, but it is unclear whether this tendency has consequences for the distribution of genotypes in a population. Although geneticists have shown that populations tend to stratify genetically, this process results from geographic sorting or assortative mating, and it is unknown whether genotypes may be correlated as a consequence of nonreproductive associations or other processes. Here, we study six available genotypes from the National Longitudinal Study of Adolescent Health to test for genetic similarity between friends. Maps of the friendship networks show clustering of genotypes and, after we apply strict controls for population stratification, the results show that one genotype is positively correlated (homophily) and one genotype is negatively correlated (heterophily). A replication study in an independent sample from the Framingham Heart Study verifies that DRD2 exhibits significant homophily and that CYP2A6 exhibits significant heterophily. These unique results show that homophily and heterophily obtain on a genetic (indeed, an allelic) level, which has implications for the study of population genetics and social behavior. In particular, the results suggest that association tests should include friends' genes and that theories of evolution should take into account the fact that humans might, in some sense, be metagenomic with respect to the humans around them.