Applications of social network analysis to obesity: a systematic review

Understanding the selection of support partners in a behavioral weight loss program

OBJECTIVE

Engaging a support partner during behavioral weight loss (BWL) programs can improve outcomes. However, little information is available about those selected as support partners. The study aimed to (1) characterize support partners and qualities of the relationship, (2) assess differences in relationship dynamics across relationship types, and (3) assess differences in supportive relationships by participant gender.

METHODS AND MEASURES

Upon entering a 24-month BWL program, participants (N = 323) nominated a support person from their existing social networks. Participants completed self-report measures at baseline, including the Working Alliance Inventory and study-specific measures assessing characteristics of the support person and comfort in communicating with them.

RESULTS

Spouse/partners were chosen by 43.3% of all participants. Among married participants, 80.9% of men and 53.8% of women chose their spouse/partner. Working alliance was lower when the support partner was a spouse/partner versus a friend (p < 0.05, r = -0.19). Comfort talking about exercise with a support partner was higher than talking about eating or weight (p < 0.001, η2p= 0.05).

CONCLUSION

A variety of friends and family can be selected as support partners during BWL. Programs should attend to the unique needs of men versus women when identifying sources of support.

Social network risk factors and COVID-19 vaccination: A cross-sectional survey study

BACKGROUND

Social networks have an important impact on our health behaviours, including vaccination. People's vaccination beliefs tend to mirror those of their social network. As social networks are homogenous in many ways, we sought to determine in the context of COVID-19 which factors were most predictive of belonging to a mostly vaccinated or unvaccinated social group.

METHODS

We conducted a cross-sectional survey among Canadian residents in November and December 2021. Participants were asked about the vaccination status of their social networks their beliefs relating to COVID-19, and various sociodemographic factors. Respondents were split into three groups based on social network vaccination: low-, medium-, and high-risk. Chi-squared tests tested associations between factors and risk groups, and an ordinal logistic model was created to determine their direction and strength.

RESULTS

Most respondents (81.1 %) were classified as low risk (i.e., a mostly vaccinated social network) and few respondents (3.7 %) were classified as high-risk (i.e., an unvaccinated social group). Both the chi-square test (29.2 % difference between the low- and high- risk groups [1.8 % vs. 31.0 %], p < 0.001) and the ordinal logistic model (odds ratio between the low- and high-risk groups: 14.45, p < 0.01) found that respondents' perceptions of COVID-19 as a "not at all serious" risk to Canadians was the most powerful predictor of belonging to a predominantly unvaccinated social circle. The model also found that those in mostly unvaccinated social circles also more often reported severe COVID-19 symptoms (odds ratio between the low- and high-risk groups: 2.26, p < 0.05).

CONCLUSION

Perception of COVID-19 as a threat to others may signal communities with lower vaccination coverage and higher risk of severe outcomes. This may have implications for strategies to improve public outreach, messaging, and planning for downstream consequences of low intervention uptake.

Fixed orthodontic appliances and adolescents' peer relations in school : A social network analysis using cross-sectional survey data

PURPOSE

Studies from the 1970s and 1980s, but also recent investigations on social media suggest that wearing a fixed orthodontic appliance can be a cause of bullying and social exclusion. With the greater uptake of orthodontic treatment in recent decades, it can be assumed that fixed braces are increasingly perceived as normal or even socially desirable. This study investigated how wearing visible fixed braces affects adolescents' social position in their peer networks using cross-sectional survey data.

METHODS

A total of 3002 students in the seventh grade (ages 12/13) at 39 secondary schools were asked about their social relationships in school. These directed network data were used to compare different indegrees (friendship, popularity and victimisation) of students with and without fixed braces. Statistical analyses were performed using ordinary least squares multiple regression models with school cohort fixed effects.

RESULTS

In all, 19% of the surveyed students indicated that they wear visible fixed braces. Girls with fixed braces were slightly more likely to be nominated for friendship and popularity and slightly less likely to be nominated for victimisation than girls without fixed braces (p < 0.05). These associations also remained stable when controlling for socioeconomic differences. Among boys, all observed associations were statistically insignificant.

CONCLUSION

We found no evidence that wearing fixed braces in adolescence is socially sanctioned by peers. Rather, female students with fixed braces even tend to hold a slightly more favourable position in their peer networks than girls without braces do. These analyses exemplify how network-analytic approaches can be successfully applied in interdisciplinary research at the intersection of sociology, epidemiology and medicine.

Paths towards a healthier BMI among short and adequate sleepers: A pathway network analysis considering movement behaviors in low-income preschoolers

INTRODUCTION

Short sleep duration has been seen as a predictor of higher body mass index (BMI) in youth. Sleep duration varies substantially along early childhood, and the paths towards a healthier BMI, considering the other movement behaviors (physical activity-PA and screen time) are unexplored in preschoolers.

AIM

To construct a sleep-BMI model to capture the direct and indirect paths to intervening towards a healthier BMI, according to low-income preschoolers' compliance with the other movement behaviors.

METHODS

Two hundred and seventy two preschoolers (4.5 ± 0.0; 138 boys) participated in the study. Sleep and screen time (ST) were assessed in a face-to-face interview with primary caregivers. PA was assessed using accelerometer (wGT3X-BT). Preschoolers were categorized as compliant or not with sleep, screen time, total and moderate to vigorous PA recommendations. BMIz-score was calculated according to preschoolers' sex and age. All the assessed variables, besides sex and age were included in a Network Pathway Analysis (NPA) according to age as nodes.

RESULTS

At 3 years old, a direct and negative path between sleep-BMIz score was observed. At four and 5 years old, this relationship became positive. Further, girls were more compliant with sleep, ST and total PA recommendations. Total PA (TPA) showed the highest expected influence value in the general, 3 and 4 years old NPA.

CONCLUSION

The NPA analysis showed different directions for the relationship between sleep and BMIz score, according to age. Intervention strategies to a healthier BMI among preschoolers compliant or not with sleep recommendations should focus in increasing TPA.

Adolescent relational behaviour and the obesity pandemic: A descriptive study applying social network analysis and machine learning techniques

AIM

To study the existence of subgroups by exploring the similarities between the attributes of the nodes of the groups, in relation to diet and gender and, to analyse the connectivity between groups based on aspects of similarities between them through SNA and artificial intelligence techniques.

METHODS

235 students from 5 different educational centres participate in this study between March and December 2015. Data analysis carried out is divided into two blocks: social network analysis and unsupervised machine learning techniques. As for the social network analysis, the Girvan-Newman technique was applied to find the best number of cohesive groups within each of the friendship networks of the different classes analysed.

RESULTS

After applying Girvan-Newman in the three classes, the best division into clusters was respectively 2 for classroom A, 7 for classroom B and 6 for classroom C. There are significant differences between the groups and the gender and diet variables. After applying K-means using population diet as an input variable, a K-means clustering of 2 clusters for class A, 3 clusters for class B and 3 clusters for class C is obtained.

CONCLUSION

Adolescents form subgroups within their classrooms. Subgroup cohesion is defined by the fact that nodes share similarities in aspects that influence obesity, they share attributes related to food quality and gender. The concept of homophily, related to SNA, justifies our results. Artificial intelligence techniques together with the application of the Girvan-Newman provide robustness to the structural analysis of similarities and cohesion between subgroups.

Social Network, Food Patterns, Physical Activity and Associations with Overweight and Obesity in Adolescents from a School in Rural Brazil

The objective of this study was to evaluate the social network, food patterns, physical activity, and their associations with overweight/obesity in adolescents from a school in rural Brazil. Students from a rural school in Northeast Brazil (n = 90) completed questionnaires on sociodemographic characteristics, food consumption, physical activity, and a name generator. Social networks were constructed using students' social proximity ties. Principal component analysis was performed to determine food patterns, and logistic models were used to investigate variables associated with overweight/obesity. Most participants were girls (62.9%), and the proportion of overweight/obesity was 30% among adolescents. Students cited 2070 people from their networks (family, friends at school, friends outside of school, and others). Among them, the family had the highest degree of influence (61%) in the network and had the most shared meals with adolescents (47%). Adolescents' perception of their family members' body size as obese, compared to normal or underweight, was prevalent (51%). Adolescents with unhealthy food patterns were 72% more likely to be categorized as overweight/obese, and eigenvector centrality was also associated with overweight/obesity (OR = 5.88, 95% CI = 1.08-32.03). Adolescents presented a social network with strong family influence, in which a high percentage of overweight/obesity was observed. Adolescents with high eigenvector centrality were more likely to be in the overweight/obesity category. Additionally, overweight/obesity was associated with unhealthy food patterns in the family network.

Social Environmental Predictors of Lapse in Dietary Behavior: An Ecological Momentary Assessment Study Amongst Dutch Adults Trying to Lose Weight

BACKGROUND

When losing weight, most individuals find it difficult to maintain a healthy diet. Social environmental conditions are of pivotal importance in determining dietary behavior. To prevent individuals from lapsing, insight in social environmental predictors of lapse in dietary behavior is needed.

PURPOSE

Identify social environmental predictors of lapse in dietary behavior, using ecological momentary assessment (EMA) amongst Dutch adults trying to lose weight.

METHODS

Adults (N = 81) participated in two 7-day EMA weeks. Six times a day semi-random prompts were sent. At each prompt, participants indicated whether a lapse had occurred and responded to questions assessing social support, descriptive norm, injunctive norm, social pressure, presence of others, and current location. Generalized estimating equations were used to examine associations with lapse.

RESULTS

Injunctive norm (OR = 1.07, 95% CI = 1.03-1.11), descriptive norm (OR = 1.04, 95% CI = 1.02-1.07), and social pressure (OR = 1.09, 95% CI = 1.05-1.14), all toward diverting from diet plans, predicted lapses. Social support toward sticking to diet plans and presence of others did not predict lapses. When controlling for a prior lapse, all other associations became nonsignificant. Lapses occurred most often at home and gradually occurred more often during the day.

CONCLUSIONS

Traditional public health perspectives have mainly focused on individual choice and responsibility for overweight related unhealthy lifestyles. This study shows that there may be opportunities to enhance intervention programs by also focusing on social norms and social pressure. The involvement of partners or housemates may create more awareness of the impact of (unintentional) social pressure on risk of lapsing, and reduce the level of exerted social pressure.

Body mass index and obesity-related behaviors in African American church-based networks: A social network analysis

A growing body of research suggests that obesity can be understood as a complex and biobehavioral condition influenced by social relationships ─social networks. Social network analysis allows us to examine how an individual's network characteristics (e.g., popularity) are associated with obesity and obesity-related behaviors. The objectives of the study were to (a) examine whether network members in African American churches are similar in body mass index (BMI) and obesity-related behaviors (physical activity, eating, alcohol consumption) and (b) examine whether an individual's network characteristics, such as popularity (i.e., receiving nominations from peers) and expansiveness (i.e., sending nominations to peers) are associated with BMI and obesity-related behaviors. We used a cross-sectional study design and conducted social network analysis using Exponential random graph models with three African American church-based social networks (network A, B, and C, n = 281). There were no significant network members' similarities on BMI in the three church-based networks. One out of three networks showed similarities in fruit and vegetable consumption (network B), fast food consumption (network C), physical activity, sedentary behaviors, and alcohol consumption (network A). African Americans with a high BMI were more popular, as were individuals with greater fat intake and alcohol consumption. Our findings support the perspective that we need to improve obesity-related behaviors by targeting influential individuals and existing ties and to develop obesity interventions using social networks. The degree to which our findings varied across churches also suggests that the relationship among an individual's obesity-related behaviors and network characteristics should be understood in the unique social context.

Association between friendship quality and subjective wellbeing among adolescents: a systematic review

BACKGROUND

Social integration with friends has an important role in shaping adolescents' behavior and determining their wellbeing. Friendship features such as companionship, trust, closeness, intimacy, and conflicts all form the concept of friendship quality. The quality of friendships can either enhance or impede mental development during adolescence. Therefore, this systematic review was conducted to understand the association between friendship quality and adolescents' mental wellbeing.

METHODS

In November 2020 and later in August 2022, the search for evidence was conducted on five databases (Medline, Embase, ProQuest, Scopus, and PsycINFO). Only peer-reviewed quantitative studies published from January 2000 to August 2022 that investigated friendship quality as their exposure variable in relation to six constructs of subjective wellbeing (mood, loneliness, life satisfaction, happiness, self-esteem, and subjective wellbeing) were included. After screening for eligibility, two reviewers independently extracted the data based on population characteristics, study design, exposure and outcome variables, outcome measures used, and results. Risk of bias assessment was performed utilizing the NIH Quality Assessment Tool. Narrative evidence synthesis was performed based on the constructs of subjective wellbeing.

RESULTS

Forty-three articles out of 21,585 records were included in the review. The relationship between friendship quality and depression has been investigated extensively in the literature and negative (beneficial) associations were found in eighteen studies out of twenty-three. Poor peer relationship was associated with loneliness in nine studies out of ten. All seven studies on life satisfaction and quality of peer connection found a positive association. In five studies, better peer relationship was found to be associated with happiness. A positive association between friendship quality and self-esteem was observed in five out of six applicable studies. Friendship quality was found to be positively associated with subjective well-being in all of five included studies.

CONCLUSIONS

Although majority of the included studies were cross-sectional in nature, this review demonstrates the paramount value of promoting healthy friendship to adolescents' subjective wellbeing constructs. Interventions that aim to promote subjective wellbeing among adolescents should consider the development and maintenance of healthy friendships.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020219312.

Dynamic weight status changes and peer lifestyles in early adolescence: A social network analysis on a longitudinal cohort of Taiwanese youth

BACKGROUND

Friendship networks are relevant to adolescent weight status and lifestyle, but little is known about their relationship in an East Asian setting. Using a longitudinal cohort of Taiwanese adolescents, we studied how weight status and lifestyles might influence friendship. Simultaneously considering the influence of friendship networks, we further examined the effects of peers' lifestyles on the body weight status of adolescents.

METHODS

Data were retrieved from the first three waves of the Taiwan Youth Project (N = 2409; 51 % boys). Participants were asked to nominate their friends at school and to report their lifestyle factors (e.g. sleep habits, internet use, and athletic performance). Weight status was proxied by body mass index calculated from self-reported weight and height. Stochastic actor-based modeling was used for the friendship network analyses.

RESULTS

Considering network structure, adolescents selected friends based on similarities in weight status (β = 0.147 [standard error = 0.044], p < 0.001) and lifestyle factors, such as athletic performance (β = 0.181 [0.034], p < 0.001), internet use (β = 0.156 [0.039], p < 0.001), and social jetlag (β = 0.055 [ ± 0.022], p < 0.05). In the behavior dynamics model, we did not observe any peer influence on changes in adolescents' weight status.

CONCLUSION

These findings suggest a pervasive homophilic friendship selection explained by weight and lifestyle-based similarities, despite no evidence of peer influence on weight status. Stakeholders and care providers of adolescent health should be aware of the social network processes that underlie weight problems.

Targeted maximum likelihood estimation of causal effects with interference: A simulation study

Interference, the dependency of an individual's potential outcome on the exposure of other individuals, is a common occurrence in medicine and public health. Recently, targeted maximum likelihood estimation (TMLE) has been extended to settings of interference, including in the context of estimation of the mean of an outcome under a specified distribution of exposure, referred to as a policy. This paper summarizes how TMLE for independent data is extended to general interference (network-TMLE). An extensive simulation study is presented of network-TMLE, consisting of four data generating mechanisms (unit-treatment effect only, spillover effects only, unit-treatment and spillover effects, infection transmission) in networks of varying structures. Simulations show that network-TMLE performs well across scenarios with interference, but issues manifest when policies are not well-supported by the observed data, potentially leading to poor confidence interval coverage. Guidance for practical application, freely available software, and areas of future work are provided.

Social network sites as learning environments and their implications for mental health

Social network sites (SNSs) have become ubiquitous around the globe and interwoven with all aspects of life. In this article, I will argue that the communicative infrastructure of SNSs, i.e., all SNS-elements that allow users to communicate, is a key element for understanding their impact as it creates environments in which users, their behaviors, and social interactions are embedded. These digital environments facilitate and encourage fundamental mechanisms of implicit learning from feedback as well as observation in an unprecedented way. I will discuss how these technology-based learning environments impact the mental health of their users, e.g., by linking negative online feedback to depression and following influencers to disturbed eating. The article ends with a conclusion that emphasizes the advantages of understanding SNSs as environments in order to reflect the complexity, relevance, and ubiquitousness of the phenomenon.

Adolescent Body Mass Index and Exposure to Peers with Overweight and Obesity: A Structural Equation Model Approach to Longitudinal Network Data

Purpose: Considerable evidence has shown that social networks influence a wide variety of health behaviors. This study investigates whether having friends with overweight/obesity in one's social network (network exposure) can predict changes in body mass index (BMI) throughout high school in a diverse urban population of students. Methods: Racially and ethnically diverse students from five high schools in Los Angeles County were surveyed at four time points throughout high school from 2010 to 2013 (N = 2091). Surveys included questions on students' social networks, demographics, and health-related information. BMI and weight categories were calculated for all students who provided height and weight information (∼50%). A latent growth curve model was used to assess the growth trajectory of BMI and the time-varying effect of network exposure to friends with overweight/obesity while controlling for demographic covariates. Results: Hispanic students had a significantly higher initial BMI compared with non-Hispanic students (p < 0.01). There was a significant positive slope for time on BMI growth (p < 0.01). Greater personal network exposure to friends with overweight/obesity was associated with a significant 0.65-point average increase in BMI (p < 0.05) at the first follow-up time point (T2) and a significant 0.62-point average increase in BMI (p < 0.01) at the last follow-up (T4) while controlling for covariates. Conclusions: Using structural equation modeling to understand the relationship between BMI and social networks, we found that increased network exposure to peers with overweight/obesity is associated with higher individual BMI, demonstrating that friendships may influence adolescents' weight status over time.

Network analysis based on big data in social media of Korean adolescents’ diet behaviors

Adolescents are increasingly interested in weight control; hence, proper health education is important for helping them control their weight properly. This study was designed to pick out social media words that express adolescents’ diet behaviors, and identify the associations and types between such words and the behaviors. It used text-mining techniques and semantic network analysis for related big data collected from the Internet on adolescents’ diet behaviors. Text mining was used to extract meaningful information from unstructured text data, whereas semantic network analysis was used to understand the relationships between keywords. The top five keywords were “obesity,” “health,” “exercise,” “eat,” and “increase” in online news, and “exercise,” “eat,” “weight loss,” “obesity,” and “health” in blogs. The betweenness centrality of “appearance” was particularly higher than that of other centralities in online news. As a result of the CONCOR analysis, eight clusters each were identified in online news and blogs. This study’s results will serve as a basis for weight management-related intervention strategies, reflecting the perspectives of adolescents. It also has significance as basic data to provide correct information, and establish desirable weight control in the future.

The influence of social relationships and activities on the health of adults with obesity: A qualitative study

BACKGROUND

Obesity in adults is a leading health challenge that causes millions of deaths worldwide and represents a risk factor for developing long-term conditions. Social relationships are one of the multiple drivers shaping obesity and obesity-related practices. However, there is still little evidence as to the processes by which relationships influence the adoption of positive and negative obesity health-related practices-eating, physical activity and alcohol intake. This study aims first to identify the types of relationships relevant to the adoption of practices in adults with obesity and, second, to explore the type of activities these relationships engage with or promote to produce those practices and their potential health consequences.

METHODS

Nineteen adults who have or had a history of obesity living in the United Kingdom were interviewed between May 2020 and March 2021. Experiences were explored through semi-structured interviews and network mapping via videoconferencing. Data were analysed using a hermeneutic phenomenology informed thematic analysis.

RESULTS

Three main themes were identified: (1) everyday familial routines matter, (2) chasing healthier lifestyles: comparing, modelling and connecting emotionally with friends and (3) healthcare professionals as negative influencers.

DISCUSSION AND CONCLUSIONS

Findings show how different types of relationships might shape the risk of developing and losing weight. They uncover the power of informal networks (family and friends) and highlight the potentially negative impact of formal ones (healthcare professionals). Our exploration could add to arguments about the need for stakeholders confronting obesity to be aware of the relevance of everyday social relationships in health and well-being strategies for tackling the issue, in creating collective and individual person-centred long-term sustainable actions.

PATIENT AND PUBLIC CONTRIBUTION

Feedback on the tone/content of the interview questions was provided by the two first participants. The results were checked and received feedback from one of the interviewees.

A Sedentary and Unhealthy Lifestyle Fuels Chronic Disease Progression by Changing Interstitial Cell Behaviour: A Network Analysis

Managing chronic diseases, such as heart disease, stroke, diabetes, chronic lung disease and Alzheimer’s disease, account for a large proportion of health care spending, yet they remain in the top causes of premature mortality and are preventable. It is currently accepted that an unhealthy lifestyle fosters a state of chronic low-grade inflammation that is linked to chronic disease progression. Although this is known to be related to inflammatory cytokines, how an unhealthy lifestyle causes cytokine release and how that in turn leads to chronic disease progression are not well known. This article presents a theory that an unhealthy lifestyle fosters chronic disease by changing interstitial cell behavior and is supported by a six-level hierarchical network analysis. The top three networks include the macroenvironment, social and cultural factors, and lifestyle itself. The fourth network includes the immune, autonomic and neuroendocrine systems and how they interact with lifestyle factors and with each other. The fifth network identifies the effects these systems have on the microenvironment and two types of interstitial cells: macrophages and fibroblasts. Depending on their behaviour, these cells can either help maintain and restore normal function or foster chronic disease progression. When macrophages and fibroblasts dysregulate, it leads to chronic low-grade inflammation, fibrosis, and eventually damage to parenchymal (organ-specific) cells. The sixth network considers how macrophages change phenotype. Thus, a pathway is identified through this hierarchical network to reveal how external factors and lifestyle affect interstitial cell behaviour. This theory can be tested and it needs to be tested because, if correct, it has profound implications. Not only does this theory explain how chronic low-grade inflammation causes chronic disease progression, it also provides insight into salutogenesis, or the process by which health is maintained and restored. Understanding low-grade inflammation as a stalled healing process offers a new strategy for chronic disease management. Rather than treating each chronic disease separately by a focus on parenchymal pathology, a salutogenic strategy of optimizing interstitial health could prevent and mitigate multiple chronic diseases simultaneously.

Children's experiences of meals after obesity treatment: a qualitative follow-up four years after a randomized controlled trial

Background

The practice of eating together, commensality, is rarely explored in the context of childhood obesity treatment. This is noteworthy given long-standing debates about the physical, psychosocial, and societal benefits of meals, especially family meals. Moreover, as children with obesity experience weight bias and stigma both within and outside the home, it is important to examine meals as a locus of social exchange around food and the body. Our study is based on the premises that eating together (i) matters and (ii) occurs in different environments with diverse social organization, where food-related interactions create varying arrangements of individuals, groups, their statuses, and their actions.

Method

The study explores children’s experiences of meals in different social contexts. Thirty-two children (age 8–10 years) living in Sweden were interviewed, 4 years after they entered an obesity intervention trial. Thematic analysis was applied to the data.

Results

We thematized three meal types, with each meal type having two subthemes: (i) “The family meal”, with “Shared routines, rituals, and rules” and “Individual solutions and choices”; (ii) “The school meal”, with “Rules and norms of the school” and “Strategies of the child”; and (iii) “The friend meal”, with “Handling food that was disliked” and “Enjoyment of food”. These three different meal types carried different experiences of and knowledge about how they were socially organized.

Conclusions

While the children spoke about the family and school meals as meaningful, the friend meal stood out as particularly positive. Contrary to our expectations, the children did not express experiences of weight bias or obesity stigma around meals, nor did they speak negatively about parental control of their food intake. Our findings, especially regarding the friend meal, have implications for further research into commensality and social influences on eating among children with obesity, from early childhood into adolescence.

Does Exposure to Health-related Information and Peer Effects Affect the Nutritional Status of Adolescents in Urban and Rural Areas?

BACKGROUND: The influence of health information exposure particularly from peer influences on the health and nutrition of adolescents and its effect on the nutritional status of female adolescents. AIM: The purpose of this research is to acknowledge the health information exposure and peer influences on female adolescents in urban and rural areas. METHODS: This study used a cross-sectional study design. The sample was 96 female adolescents with 44 from State Junior High School 1 Purwokerto representative of the urban area and 52 female adolescents from State Junior High School 1 Patikraja as representative from rural area. Exposure data and health information sources were collected using a questionnaire, peer influences measurement using Peer Influence Scale (PIS) questionnaire, and nutrition status measurement using Body Mass Index per age. The Statistics Test used in this study was Chi-square and Fisher Exact with 5% accuracy. RESULTS: No significant association was found between health information exposure and peer influences with nutrition status in female adolescents (p = 0.29; 0.77 > 0.05) and there was also no significant difference in acceptance source and health nutrition information topic of female adolescents in urban and rural areas. However, there was a significant difference between peer influences in female adolescents in urban and rural areas (p = 0.00 < 0.05). CONCLUSION: In both groups of female adolescents from urban and rural, there was comparable acceptance in their sources of information regarding health and nutrition. There was a significant difference in the effect of peer influences between female adolescents in urban and rural areas. However, peer influences does not have any effect on their nutrition status.

A Need for a Paradigm Shift in Healthy Nutrition Research

Research in the field of sustainable and healthy nutrition is calling for the application of the latest advances in seemingly unrelated domains such as complex systems and network sciences on the one hand and big data and artificial intelligence on the other. This is because the confluence of these fields, whose methodologies have experienced explosive growth in the last few years, promises to solve some of the more challenging problems in sustainable and healthy nutrition, i.e., integrating food and behavioral-based dietary guidelines. Focusing here primarily on nutrition and health, we discuss what kind of methodological shift is needed to open current disciplinary borders to the methods, languages, and knowledge of the digital era and a system thinking approach. Specifically, we advocate for the adoption of interdisciplinary, complex-systems-based research to tackle the huge challenge of dealing with an evolving interdependent system in which there are multiple scales-from the metabolome to the population level-, heterogeneous and-more often than not- incomplete data, and population changes subject to many behavioral and environmental pressures. To illustrate the importance of this methodological innovation we focus on the consumption aspects of nutrition rather than production, but we recognize the importance of system-wide studies that involve both these components of nutrition. We round off the paper by outlining some specific research directions that would make it possible to find new correlations and, possibly, causal relationships across scales and to answer pressing questions in the area of sustainable and healthy nutrition.

Review of social networks of professionals in healthcare settings-where are we and what else is needed?

Background

Social Network Analysis (SNA) demonstrates great potential in exploring health professional relationships and improving care delivery, but there is no comprehensive overview of its utilization in healthcare settings. This review aims to provide an overview of the current state of knowledge regarding the use of SNA in understanding health professional relationships in different countries.

Methods

We conducted an umbrella review by searching eight academic databases and grey literature up to April 30, 2021, enhanced by citation searches. We completed study selection, data extraction and quality assessment using predetermined criteria. The information abstracted from the reviews was synthesized quantitatively, qualitatively and narratively.

Results

Thirteen reviews were included in this review, yielding 330 empirical studies. The degree of overlaps of empirical studies across included reviews was low (4.3 %), indicating a high diversity of included reviews and the necessity of this umbrella review. Evidence from low- and middle-income countries (LMIC), particularly Asian countries, was limited. The earliest review was published in 2010 and the latest in 2019. Six reviews focused on the construction or description of professional networks and seven reviews reported factors or influences of professional networks. We synthesized existing literature on social networks of health care professionals in the light of (i) theoretical frameworks, (ii) study design and data collection, (iii) network nodes, measures and analysis, and (iv) factors of professional networks and related outcomes. From the perspective of methodology, evidence lies mainly in cross-sectional study design and electronic data, especially administrative data showing “patient-sharing” relationships, which has become the dominant data collection method. The results about the impact of health professional networks on health-related consequences were often contradicting and not truly comparable.

Conclusions

Methodological limitations, inconsistent findings, and lack of evidence from LMIC imply an urgent need for further investigations. The potential for broader utilization of SNA among providers remains largely untapped and the findings of this review may contain important value for building optimal healthcare delivery networks.

PROSPERO registration number

The protocol was published and registered with PROSPERO, the International Prospective Register of Systematic Reviews (CRD42020205996).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-021-00772-7.

High school students’ friendship network, physical activity and residential locations – a stochastic actor based model

Evidence shows that adolescents do not do enough physical activity (PA), which could contribute to childhood overweight and obesity. Studies have shown that both the built environment and social networks could influence adolescents’ PA, but more studies are needed to investigate their combined influence using longitudinal data. We used a stochastic actor-based model analyzing two waves of Add Health data to test if (1) home location has a significant influence on high school student’s friendships, and (2) the neighborhood built environment has a significant influence on high school student’s PA while controlling for friendship networks. The results indicate that students’ PA level emulated peers’ PA levels and students who lived closer together, increased the likelihood of forming friendships. However, the built environment variables that described adolescents’ residential neighborhoods did not show a significant influence on students’ PA dynamics. This study contributes to our understanding of the joint impacts of social networks and home location on adolescents’ friend networks and PA dynamics in urban settings.

Personal Social Networks and Adiposity in Adolescents: A Feasibility Study

Background and Objective: Weight-related behaviors are determined by multiple individual and contextual factors, with recent evidence implicating personal social networks (PSNs). Greater understanding of these relationships could help inform healthy weight promoting interventions. We conducted a feasibility study among youth at risk of obesity to document process outcomes, to discern relationships between PSN features and weight-related behaviors, and to generate hypotheses with respect to perceived social support (SS) and sex. Methods: Participants (egos) nominated up to 10 people (alters) with whom they discussed important matters. Egos reported their own and each alter's age, sex, body shape, lifestyle behaviors, relation, frequency of exercising with each alter, and of being encouraged by each alter to exercise. We examined relationships between PSN features and weight-related outcomes and explored the role of SS, using both correlational and linear regression analyses. Results: There were 45 participants (mean age 16.4 years) and body mass index z-score (zBMI) ranged from -1.2 to 3.9. There were few missing responses to PSN items; broad variation across most items, including SS scores, was reported. Correlations pointed to plausible relationships implicating PSN features and lifestyle behaviors. In exploratory analyses, network-based SS was positively associated with adiposity in girls and negatively associated in boys, while lifestyle role modelling was not associated with adiposity. Conclusions: Our findings support the feasibility of measuring the PSN in youth and the potential for using social network analysis to investigate social and behavioral mechanisms associated with obesity.

A case study of university student networks and the COVID-19 pandemic using a social network analysis approach in halls of residence

The COVID-19 pandemic has meant that young university students have had to adapt their learning and have a reduced relational context. Adversity contexts build models of human behaviour based on relationships. However, there is a lack of studies that analyse the behaviour of university students based on their social structure in the context of a pandemic. This information could be useful in making decisions on how to plan collective responses to adversities. The Social Network Analysis (SNA) method has been chosen to address this structural perspective. The aim of our research is to describe the structural behaviour of students in university residences during the COVID-19 pandemic with a more in-depth analysis of student leaders. A descriptive cross-sectional study was carried out at one Spanish Public University, León, from 23th October 2020 to 20th November 2020. The participation was of 93 students, from four halls of residence. The data were collected from a database created specifically at the university to "track" contacts in the COVID-19 pandemic, SiVeUle. We applied the SNA for the analysis of the data. The leadership on the university residence was measured using centrality measures. The top leaders were analyzed using the Egonetwork and an assessment of the key players. Students with higher social reputations experience higher levels of pandemic contagion in relation to COVID-19 infection. The results were statistically significant between the centrality in the network and the results of the COVID-19 infection. The most leading students showed a high degree of Betweenness, and three students had the key player structure in the network. Networking behaviour of university students in halls of residence could be related to contagion in the COVID-19 pandemic. This could be described on the basis of aspects of similarities between students, and even leaders connecting the cohabitation sub-networks. In this context, Social Network Analysis could be considered as a methodological approach for future network studies in health emergency contexts.

Leveraging Emergent Social Networks to Reduce Sedentary Behavior in Low-Income Parents With Preschool-Aged Children

This study tested the hypothesis that parents participating in a pediatric obesity intervention who formed social network ties with a parent in the intervention arm would engage in more daily physical activity and less sedentary behavior (after controlling for participant covariates). Data were collected at baseline, 12 months, and 36 months from 610 low-income parent-child pairs participating in an obesity prevention intervention for 3- to 5-year-old children. A network survey was used to identify social network ties among parents and accelerometers were used to measure parental physical activity and sedentary time. Longitudinal regression analyses tested effects of social network ties on parents' physical activity and sedentary behavior. Compared with parents without a social network tie, having a tie with an intervention group participant was associated with a clinically meaningful 11.04 min/day decrease in parental sedentary behavior that approached statistical significance (95% confidence interval [Cl] = [-22.71, 0.63], p = .06). Social network ties among parents in a pediatric obesity prevention intervention were not clearly associated with reduced sedentary behavior among those parents at the traditional level of p = .05. The large effect size (over 77min per week improvement) suggests there might be potential importance of promoting new social networks in community-based health promotion interventions to elicit and support behavior change, but further examination is needed.

Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy in Terms of Efficacy and Safety: a Comparative Study During 11-Year Experience

PURPOSE

This cohort study was designed to compare the efficacy and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) for the management of morbid obesity during the 11-year experience.

MATERIALS AND METHODS

This study was conducted between July 2006 and August 2019. Annually we recorded data about the weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage of weight loss (%WL), weight regain, and postoperative complications into a prospectively collected database.

RESULTS

A total of 1146 patients (LRYGB=396 and LSG=750) aged >18 years old were included in the study. Over the first 7 years after surgery, the weight loss rate was significantly higher in the LRYGB-treated group than the LSG-treated group, and weight regain was significantly lower in the LRYGB-treated group in comparison with the LSG-treated group. Our results revealed that statistically, but not clinically, the efficacy of LRYGB and LSG is equivalent in terms of %WL, %EWL, and weight regain within 8 years and more. Besides, there were no significant differences in surgery-related mortality and severe complications between the two procedures.

CONCLUSION

Our study's results indicated that the clinical efficacy of LRYGB in the management of obesity is better than LSG during the 11-year experience. But the differences in weight loss and weight regain were not statistically relevant at 8 years and more after the surgery. Also, a comparison of severe complications did not indicate significant differences between the two groups.

Interplay of Support, Comparison, and Surveillance in Social Media Weight Management Interventions: Qualitative Study

BACKGROUND

There has been a significant increase in the trend of using social media as a platform to deliver weight management interventions. This illustrates a need to develop a holistic understanding of doctor-patient communication and peer-to-peer communication in social media interventions and to determine their influences on weight management for people with overweight or obesity. Such studies will highlight how social media can be more effectively integrated into weight management programs to enhance individuals' short-term and long-term weight management behaviors.

OBJECTIVE

The aim of this study was to examine patients' experiences with doctor-patient communication and peer interactions in a social media-based (WeChat) weight management program, and to describe the interplay of three social influence factors-social support, social comparison, and surveillance-in their weight control practices. The program, designed and implemented by the research team located in a tertiary referral hospital in a southeastern province in China, included both diet and physical activity components that targeted people with overweight or obesity.

METHODS

We conducted in-depth interviews with 32 program participants of different ages (mean 35.6, SD 7.7 years), gender (18 women), duration of program membership (mean 1.4 years), and weight loss outcomes (54% weight loss to 9% weight gain). All interview data were audio-recorded, transcribed, and translated using the translation-backtranslation technique. Nvivo software was used to facilitate the coding process.

RESULTS

Results of thematic analysis indicated the distinct functions of professionally led support and peer support. Professional support was presented in the form of knowledge infusion, efficacy enhancement, and provision of timely feedback. Peer support fostered empathy and sense of belonging, and had a mutually reinforcing relationship with peer comparison and peer-based surveillance. Peer comparison enhanced motivation and positive competition. However, it also reinforced negative group norms, and resulted in downturns in reference standards and collective inactivity. Social media surveillance prompted participants' reactions to the gaze from medical professionals and peers that could be encouraging or inhibiting. Surveillance enhanced vigilance with weight control norms; however, its influence weakened when participants chose to fake weight data and turn off notifications. Findings from this study illustrated the interrelated and fluctuating influences of support, comparison, and surveillance.

CONCLUSIONS

The interactive traits of social media eased the practices of social support and social comparison, and created new forms of surveillance. This study contributes to an in-depth understanding of social media influences on individuals' weight control behaviors. Practical implications of the study concern improved strategies for maintaining the positive dynamics of social media interactions and preventing negative resistance to surveillance technology.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900025861; http://www.chictr.org.cn/showprojen.aspx?proj=42497.

Relational body image: Preliminary evidence that body image varies within a person from one specific relationship to another

Although social factors influence body image, it remains unknown whether a given individual's body image varies from one specific relationship to another. The present study examined this novel concept of relational body image by investigating the extent to which individuals' body image differs across their relationships with specific others. These differences were expected to arise in part due to differences in how an individual perceives others' personal body preoccupation, others' acceptance of her body, and others' body size relative to her own. Eighty-seven female undergraduates reported on their typical levels of body appreciation, appearance orientation, and intuitive eating with 10 people in their lives, and reported on the characteristics of these others. Intraclass correlations revealed that participants' body image and eating varied across their different relationships. Furthermore, participants perceived differences in others' acceptance of the participant's body, body preoccupation, and body size. Multilevel modelling showed that participants reported more adaptive body image and eating patterns in relationships with others whom they perceived to be relatively more accepting of their body, less body preoccupied, and more similar in size to them. Findings provide initial support for the concept of relational body image.

A survey on exponential random graph models: an application perspective

The uncertainty underlying real-world phenomena has attracted attention toward statistical analysis approaches. In this regard, many problems can be modeled as networks. Thus, the statistical analysis of networked problems has received special attention from many researchers in recent years. Exponential Random Graph Models, known as ERGMs, are one of the popular statistical methods for analyzing the graphs of networked data. ERGM is a generative statistical network model whose ultimate goal is to present a subset of networks with particular characteristics as a statistical distribution. In the context of ERGMs, these graph's characteristics are called statistics or configurations. Most of the time they are the number of repeated subgraphs across the graphs. Some examples include the number of triangles or the number of cycle of an arbitrary length. Also, any other census of the graph, as with the edge density, can be considered as one of the graph's statistics. In this review paper, after explaining the building blocks and classic methods of ERGMs, we have reviewed their newly presented approaches and research papers. Further, we have conducted a comprehensive study on the applications of ERGMs in many research areas which to the best of our knowledge has not been done before. This review paper can be used as an introduction for scientists from various disciplines whose aim is to use ERGMs in some networked data in their field of expertise.

Association of social network factors with weight status and weight loss intentions among hispanic adults

Hispanic adults have the highest obesity prevalence in the United States, but little is known about weight-related social network influences. A community-based sample of 610 Hispanic participants completed height/weight and a survey. The proportion of overweight or obese (OW/OB) network members was higher for OW/OB respondents compared to normal weight respondents. Participants with high weight loss intentions reported more positive social norms for weight control, social support, and social cohesion. If most or all of OW/OB participant's social contacts were trying to lose weight, the odds that they were likely to try to lose weight was four times higher than other participants. The relationship between weight loss intentions and number of social contacts trying to lose weight was strongly mediated by social norms for weight control and social support. These results suggest that social contacts and functional network characteristics may impact weight status and weight control intentions among Hispanic adults.

Low Self-Esteem for Physical Appearance Mediates the Effect of Body Mass Index on Smoking Initiation Among Adolescents

Objective

Adolescence is a period during which youth may begin experimenting with substances. Youth with overweight or obesity may be at increased risk for substance use, including cigarette smoking. Understanding the associations between smoking and excess weight and the pathways associated with increased likelihood for smoking initiation is of particular importance given the increased risk for negative health outcomes associated with each.

Methods

Using longitudinal panel data from 1,023 middle school youth (baseline age M = 12.5, 52% female), we tested whether smoking initiation was concurrently and prospectively predicted by self-reported body mass index (BMI) and whether self-esteem for physical appearance (SEPA) mediated the effect of BMI on risk of early initiation.

Results

BMI predicted smoking initiation concurrently and prospectively in unadjusted models. In adjusted models, SEPA mediated the effects of BMI on smoking initiation. Bootstrapped mediation results indicated that the positive relationship between BMI and subsequent smoking initiation was significantly mediated by lower SEPA (B =.10, 95% confidence interval [0.01, 0.22]).

Conclusions

Adolescents who have overweight or obesity are more likely to feel negatively about their appearance and bodies, and this negative perception may result in experimentation with cigarettes. Cigarettes may be used by youth with overweight or obesity in an effort to manage weight, to cope with low self-esteem or for other reasons. Future research should explore the motives and psychosocial context of smoking initiation among adolescents with overweight/obesity further (e.g., with whom they first try smoking, perceived benefits of smoking).

Social Influences on Obesity: Current Knowledge, Emerging Methods, and Directions for Future Research and Practice

PURPOSE OF REVIEW

Individuals tend to be socially connected with those of similar weight and obesity status. To inform future research and intervention development, we reviewed recent literature examining social influences on weight with a focus on mechanisms of social influence, populations studied, and emerging analytical methods.

RECENT FINDINGS

Social networks appear to influence weight gain and weight loss. It remains unclear what underlying mechanisms (e.g., social norms, social comparison, behavioral modeling) drive this relationship. Stochastic actor-oriented modeling is an important method in the field, but other work has leveraged natural experiment or randomized designs to study social influence. Future networks and obesity research should examine social influence mechanisms, focus on diverse populations across the life course, and carefully consider how to adequately control for competing factors of social selection and physical environments.

Social networks and obesity among Somali immigrants and refugees

BACKGROUND

Somali immigrants and refugees to the United States are at high risk for obesity and related cardiovascular risk. Social network factors influence health behaviors and are important contributors to the obesity epidemic. The objective of this study was to describe social networks and obesity-related characteristics among adult Somali immigrants in a Minnesota city in order to inform a community-based, participatory, research-derived, social network intervention to decrease obesity rates.

METHODS

Survey data (demographics, general health measures, and sociobehavioral and network measures) and height and weight measures (for calculating body mass index) were collected from adult Somali immigrants by bilingual study team members at community locations. Descriptive statistics were used to report the survey and biometric data. Logistic regression models were used to describe the basic associations of participants and network factors. Network data were analyzed to identify nodes and ties, to visualize the network, and to identify potential interventionists for a future social network intervention.

RESULTS

Of the 646 participants, 50% were overweight or affected by obesity. The network had 1703 nodes with 3583 ties between nodes, and modularity was high (0.75). Compared with respondents of normal weight, participants who were overweight or affected by obesity had more network members who were also overweight or obese (odds ratio [OR], 2.90; 95% CI, 1.11-7.56; P = .03); this was most notable for men (OR, 4.58; 95% CI, 1.22-17.22; P = .02) and suggestive for those 50 years or older (OR, 24.23; 95% CI, 1.55-377.83; P = .03). Weight loss intention among participants who were overweight or affected by obesity was associated with number of family members and friends trying to lose weight, enabling functional network factors (social norms for weight loss, social support for healthy eating, and social cohesion), and less favorable obesogenic social norms.

CONCLUSIONS

In this community sample of Somali immigrants, distinct social networks are clustered by weight status, and social contacts and functional network characteristics are related to individuals' weight loss intentions. These factors should be considered in weight loss interventions and programs. A social network intervention targeting weight loss, within a community-based participatory research framework, is feasible in this vulnerable population.

Peer social network processes and adolescent health behaviors: A systematic review

Research has highlighted the importance of peers for determining health behaviors in adolescents, yet these behaviors have typically been investigated in isolation. We need to understand common network processes operating across health behaviors collectively, in order to discern how social network processes impact health behaviors. Thus, this systematic review of studies investigated adolescent peer social networks and health behaviors. A search of six databases (CINAHL, Education Resources Information Centre, Embase, International Bibliography of the Social Sciences, Medline and PsycINFO) identified 55 eligible studies. The mean age of the participants was 15.1 years (range 13-18; 51.1% female). Study samples ranged from 143 to 20,745 participants. Studies investigated drinking (31%), smoking (22%), both drinking and smoking (13%) substance use (18%), physical activity (9%) and diet or weight management (7%). Study design was largely longitudinal (n = 41, 73%) and cross-sectional (n = 14, 25%). All studies were set in school and all but one study focused on school-based friendship networks. The Newcastle-Ottawa Scale was used to assess risk of bias: studies were assessed as good (51%), fair (16%) or poor (33%). The synthesis of results revolved around two network behavior patterns: 1) health behavior similarity within a social network, driven by homophilic social selection and/or social influence, and 2) popularity: health behavior engagement in relation to changes in social status; or network popularity predicting health behaviors. Adolescents in denser networks had statistically significant lower levels of harmful behavior (n = 2/2, 100%). Findings suggest that social network processes are important factors in adolescent health behaviors.

Do Birds of a Feather Flock Together Within a Team-Based Physical Activity Intervention? A Social Network Analysis

BACKGROUND

Homophily is the tendency to associate with friends similar to ourselves. This study explored the effects of homophily on team formation in a physical activity challenge in which "captains" signed up their Facebook friends to form teams.

METHODS

This study assessed whether participants (n = 430) were more similar to their teammates than to nonteammates with regard to age, sex, education level, body mass index, self-reported and objectively measured physical activity, and negative emotional states; and whether captains were more similar to their own teammates than to nonteammates. Variability indices were calculated for each team, and a hypothetical variability index, representing that which would result from randomly assembled teams, was also calculated.

RESULTS

Within-team variability was less than that for random teams for all outcomes except education level and depression, with differences (SDs) ranging from +0.15 (self-reported physical activity) to +0.47 (age) (P < .001 to P = .001). Captains were similar to their teammates except in regard to age, with captains being 2.6 years younger (P = .003).

CONCLUSIONS

Results support hypotheses that self-selected teams are likely to contain individuals with similar characteristics, highlighting potential to leverage team-based health interventions to target specific populations by instructing individuals with risk characteristics to form teams to help change behavior.

Social network influences and the adoption of obesity-related behaviours in adults: a critical interpretative synthesis review

BACKGROUND

Obesity is a key risk factor for developing a long-term condition and a leading cause of mortality globally. The limited evidence associated with interventions that currently target obesity-related behaviours demand new approaches to tackle this problem. Given the evidence that social ties are implicated in the gaining and reduction of weight, the use of social networks in interventions is potentially a novel and useful means of tackling this health issue. There is a specific gap in the literature regarding what and how social network properties and processes together with environmental and individual factors influence the adoption of positive and negative obesity-related behaviours in adults.

METHODS

To address this gap in developing an integrated and holistic conceptual approach, a critical interpretative synthesis was undertaken following a line of argument synthesis as an analytical strategy.

RESULTS

Twenty-four studies were included. The data-driven themes meso-micro network processes, contextual and individual factors, and types of ties and properties were identified individually as components and causes of different health scenarios. Nevertheless, these drivers do not act on their own. As a consequence, developing multi-agent coalitions considering cross-level influences between the data-driven themes are two mechanisms that are created to understand more in-depth how social networks and the environment influence the adoption of obesity-related behaviours. These two new constructs point to a dynamic multilevel set of influences between multiple constructs, developing scenarios where positive and negative health results are identified.

CONCLUSIONS

This critical interpretative synthesis offers a new means of exploring the application of social network properties and mechanisms in the 'obesity' field. The synthesizing argument created during the analysis process might be considered by health policy-makers, who might need to contemplate the wider open system of socially connected individuals and harness these forces to design new interventions where social networks and other contextual and individual factors operate together in a complex multilevel environment influencing obesity-related behaviours and practices.

Evaluating Potential Behavioral Mediators for Increasing Similarity in Friends' Body Size among College Students

College students and their friends become more similar in weight status over time. However, it is unclear which mediators explain this relationship. Using validated survey measures of diet, physical activity, alcohol intake, sleep behaviors, mental health, and food security status, we take a comprehensive look at possible factors associated with excess weight gain that may explain friends’ convergence on body mass index (BMI), waist circumference, waist to hip ratio, and waist to height ratio over time. We use linear mixed models applied to a longitudinal dataset of first-year college students to examine whether these variables satisfy two criteria for potential candidate mediators of friends’ influence on anthropometrics—cross-sectional similarity among friends (n = 509) and longitudinal associations with increasing anthropometrics (n = 428). While friends were similar on some survey measures (such as dining hall use, home cooked meal consumption, fruit intake, alcohol intake, hours of sleep, and stress). Only dining hall use and stress emerged as potential explanations for why friends’ BMI and anthropometric change may be similar. Given that only a few variables satisfied the two criteria as potential mediators, future research may need to consider alternative measurement approaches, including real-time assessments, objective measurements, and alternative factors causing the convergence of friends’ and college students’ body size over time.

The role of maternal social networks on the outcomes of a home-based childhood obesity prevention pilot intervention

BACKGROUND

Despite evidence that obesity and related behaviors are influenced by social networks and social systems, few childhood obesity initiatives have focused on social network factors as moderators of intervention outcomes, or targets for intervention strategies.

OBJECTIVES

This pilot study examines associations between maternal social network characteristics hypothesized to influence health behaviors, and the target outcomes of a family-centered childhood obesity prevention initiative. The pilot intervention entailed the provision of healthy eating and activity components as part of an existing home visiting program (HVP) delivered to mothers and infants, to test the feasibility of this approach for improving mother diet, physical activity, and weight status; and infant diet and weight trajectory.

METHODS

Mothers and their infants (N=50 dyads) receiving services from our HVP partner were recruited and randomized to receive the HVP core curriculum with or without a nutrition and physical activity enhancement module for six months. Assessments of mothers' social network characteristics, mother/infant food intake and mother physical activity, and mothers' postpartum weight retention and children's growth velocity were conducted at baseline and post-intervention.

RESULTS

Several features of mothers' social networks, including the receipt of health-related social support, were significantly associated with the focal intervention outcomes (p < .05) at follow-up, controlling for study condition.

CONCLUSIONS

Integrating childhood obesity prevention into HVPs appears promising. Future family-based interventions to prevent childhood obesity may be enhanced by including social network intervention strategies. For example, by addressing family network characteristics that impede healthy behavior change, or enhancing networks by fostering social support for healthy behavior and weight change.

Using social network analysis to plan, promote and monitor intersectoral collaboration for health in rural India

BACKGROUND

As population health and well-being are influenced by multiple factors that cut across sectoral boundaries, an intersectoral approach that acknowledges and leverages the multiple determinants, actors and sectors at play is increasingly seen as critical for achieving meaningful and lasting improvements. In this study, we utilize social network analysis (SNA) to characterize the intersectoral collaboration between the organizations working on maternal & child health (MCH) and water & sanitation (WASH) before and immediately after the implementation of HCL Foundation (HCLF)-funded HCL Samuday Project (2015-2017) in a rural block of Uttar Pradesh state, India. While SNA has been used to examine public health issues, few have used it monitor stakeholder relationships, intervene, improve and facilitate project implementation involving intersectoral partnerships, particularly in the context of a low-and middle-income countries.

METHOD

An organization-level SNA was conducted with 31 key informants from 24 organizations working on MCH and/or WASH in Kachhauna, Uttar Pradesh, India. Data were collected using face-to-face, semi-structured interviews between June and September 2017. Density, centrality and homophily were calculated to describe the network and a qualitative analysis was also conducted to identify the strengths and weaknesses of collaboration between organizations working on MCH and WASH.

RESULTS

Overall, our findings showed that the network of organizations working on MCH and WASH in Kachhauna grew in number since the implementation of Samuday. HCLF rapidly achieved centrality, thus positioning the organization to serve as a gatekeeper of information and enabling it to play a coordinator role within the network. Direct collaboration between other organizations working on MCH and WASH was low at both time points. Interviews with key informants indicated widespread interest in increasing interorganizational interactions and engagement throughout the network.

CONCLUSION

This study demonstrates the feasibility and practical application of SNA for projects like Samuday that involve intersectoral collaboration. It also provides lessons about the use of SNA with organizations as the unit of analysis and in the context of rural India, including challenges, practical considerations, and limitations.

Social Network Analysis of Dementia Wards in Psychiatric Hospitals to Explore the Advancement of Personhood in Patients with Alzheimer's Disease

Background:

Little is known on investigating how healthcare teams in dementia wards act for promoting personhood in persons with Alzheimer’s disease (PWA).

Objective:

The current research aimed to identify the social networks of dementia health carers promoting the personhood of PWA in acute or long-term dementia wards in public and private psychiatric hospitals.

Methods:

We used a mixed-method research approach. Ethnographic observations and two-mode Social Network Analysis (SNA) captured the role and social networks of healthcare professionals promoting PWA personhood, using SocNetv version 2.4. The social network graphs illustrated how professionals participated in PWA care by computing the degree of centrality (%DC) for each professional; higher values indicated more statistical significance of a professional role compared to others in the provision of personhood care. The categories of personhood were biological, individual, and sociologic. Nurses, doctors, ward managers, hospital managers, clinical psychologists, occupational therapists, care coordinators, physiotherapists, healthcare assistants, and family members were observed if they were promoting PWA personhood.

Results:

The highest %DC in SNA in biological personhood was held by the ward nurses (36%), followed by the ward doctors (20%) and ward managers (20%). All professional roles were involved in 16% of cases in the promotion of individual personhood, while the hospital managers had the highest %DC (33%) followed by the ward managers and nurses (27%) in the sociologic personhood.

Conclusion:

All professional roles were deemed to promote PWA personhood in dementia wards, although some limitation exists according to the context of the assessment.

Emotional feeding as interpersonal emotion regulation: A developmental risk factor for binge-eating behaviors

Emotional feeding is an interpersonal emotion regulation strategy wherein people provide food to others as a means of influencing the recipient's emotional response. Parental emotional feeding has been linked to higher levels of emotional eating in children and adolescents using cross-sectional, retrospective, and prospective designs; however, there is little research on emotional feeding as a developmental risk factor for emotional eating and binge-eating behaviors in adolescence and adulthood. This Idea Worth Researching article explores the rationale for studying emotional feeding as a lifespan construct and its potential implications for understanding eating disorder pathology. Specifically, it offers suggestions for examining emotional feeding as a predictor of emotional eating and binge-eating behavior across the lifespan, assessing potential intergenerational transmission pathways, and researching similarities in feeding styles and emotional eating across a variety of relationships beyond the parent-child dyad.

Social Network Structures in African American Churches: Implications for Health Promotion Programs

The prevalence of obesity among African Americans is higher than among other racial/ethnic groups. African American churches hold a central role in promoting health in the community; yet, church-based interventions have had limited impact on obesity. While recent studies have described the influence of social networks on health behaviors, obesity interventions informed by social network analysis have been limited. We conducted a cross-sectional study with 281 African American men and women from three churches in northeast urban cities in the USA. Data were collected on sociodemographic and clinical factors and anthropometrics. Using a social network survey applying a name generator, we computed network level metrics. Exponential random graph models (ERGM) were performed to examine whether each structural property found in the empirical (observed) networks occurred more frequently than expected by chance by comparing the empirical networks to the randomly simulated networks. Overall, church friendship networks were sparse (low density). We also found that while friendship ties were more reciprocated between dyads in church networks, and there were more tendencies for clustering of friendships (significant positive transitive closure) than in random networks, other characteristics such as expansiveness (number of actors with a great number of friends) did not differ from what would be expected by chance in random networks. These data suggest that interventions with African American churches should not assume a unitary network through which a single intervention should be used.

How the study of networks informs knowledge translation and implementation: a scoping review

Background

To date, implementation science has focused largely on identifying the individual and organizational barriers, processes, and outcomes of knowledge translation (KT) (including implementation efforts). Social network analysis (SNA) has the potential to augment our understanding of KT success by applying a network lens that examines the influence of relationships and social structures on research use and intervention acceptability by health professionals. The purpose of this review was to comprehensively map the ways in which SNA methodologies have been applied to the study of KT with respect to health professional networks.

Methods

Systematic scoping review methodology involved searching five academic databases for primary research on KT that employed quantitative SNA methods, and inclusion screening using predetermined criteria. Data extraction included information on study aim, population, variables, network properties, theory use, and data collection methods. Descriptive statistics and chronology charting preceded theoretical analysis of findings.

Results

Twenty-seven retained articles describing 19 cross-sectional and 2 longitudinal studies reported on 28 structural properties, with degree centrality, tie characteristics (e.g., homophily, reciprocity), and whole network density being most frequent. Eleven studies examined physician-only networks, 9 focused on interprofessional networks, and 1 reported on a nurse practitioner network. Diffusion of innovation, social contagion, and social influence theories were most commonly applied.

Conclusions

Emerging interest in SNA for KT- and implementation-related research is evident. The included articles focused on individual level evidence-based decision-making: we recommend also applying SNA to meso- or macro-level KT activities. SNA research that expands the range of professions under study, examines network dynamics over time, extends the depth of analysis of the role of network structure on KT processes and outcomes, and employs mixed methods to triangulate findings, is needed to advance the field. SNA is a valuable approach for evaluating key network characteristics, structures and positions of relevance to KT, implementation, and evidence informed practice. Examining how network structure influences connections and the implications of those holding prominent network positions can provide insights to improve network-based KT processes.

Weight and social comparison: Does the weight of a stranger affect a person's perception of their own weight?

Research suggests that social context affects individuals’ perception of their own weight. Using face-to-face interviews as the social context, we analyze the effect of interviewers’ (N = 90) body mass index on respondents’ (N = 3068) self-perceived weight level. Respondents reported a higher weight level when the interviewer had a higher body mass index (absolute social comparison). Female respondents reported a lower weight level if interviewers had a higher body mass index than they did (relative social comparison). Results suggest that weight perception reflects both absolute and relative social comparison, especially among women. Future research should consider causation and self-selection when studying social context and body image.

Changes in non-fasting concentrations of blood lipids after a daily Chinese breakfast in overweight subjects without fasting hypertriglyceridemia

BACKGROUND

Overweight is always accompanied by hypertriglyceridemia (HTG), but the change in non-fasting triglyceride (TG) concentration in overweight subjects without postprandial hypertriglyceridemia was unknown.

METHODS

Concentrations of serum lipids were measured at 2 and 4 h in matched overweight (OW group, n = 54) and control subjects (CON group, n = 55) after a daily meal. Concentrations of remnant cholesterol and non-HDL cholesterol were calculated according to the formulas. The diagnostic criteria for non-fasting HTG were based on 2 different consensus statement. ROC curve was used to determine the pointcut of postprandial HTG.

RESULTS

OW group had higher fasting concentrations of RC and non-HDL-C than CON group. Non-fasting concentrations of triglyceride and RC significantly increased in 2 groups while were higher in OW group (p < .05). The proportion of non-fasting HTG increased after a daily meal in OW group was significantly higher than the percentage of fasting HTG (p < .05). There was a significant correlation between the postprandial concentrations of TG and RC.

CONCLUSIONS

Overweight subjects were more likely to develop non-fasting hypertriglyceridemia and higher concentrations of RC and non-HDL-C. Additionally, 2.0 mmol/l at 4 h after breakfast could be a pointcut value to detect changes in lipid profile of Chinese overweight people.

Friendship as a social mechanism influencing body mass index (BMI) among emerging adults

Background

Social relationships have been proposed as a significant factor shaping obesity risk. The first year of college, a period of major social, behavioral, and weight changes, provides a context well-suited to tracking longitudinally the impact of shifting friendships on weight outcomes. This study sought to identify social mechanisms impacting BMI change among emerging adults.

Methods

An analytic sample of 276 college students (71.0% female, 52.2% non-White) provided repeated reports of relationships and BMI was measured up to four times during 2015–2016. Stochastic actor-oriented models were used to examine change in BMI through social influence and change in friendships over time, controlling for sex and race/ethnicity.

Results

At baseline, mean BMI was 24.2±4.5 kg/m². Overall, mean BMI increased over time; individual decreases in BMI were uncommon. There was a selection effect of BMI: participants with BMIs between 22 and 26 kg/m² were most likely to be nominated as a friend. While participants did not select friends based on BMI similarity, participants who were reported as friends were more likely to experience convergence in BMI over time relative to the BMIs of non-friends (p = 0.015). An increase in BMI (versus stability or a decrease) was more likely for those whose friends had a higher BMI on average compared to participants whose friends had the same or lower BMI (OR = 2.85, 95% CI = 1.22, 6.71).

Conclusion

Analyses indicated BMI affected friend selection, not through students selecting friends with similar BMI, but rather, by students avoiding friends with more extreme BMI levels.

Personal Network Analysis in the Study of Social Support: The Case of Chronic Pain

In the context of chronic illness, the individual's social and relational environment plays a critical role as it can provide the informal support and care over time, beyond healthcare and social welfare institutions. Social Network Analysis represents an appropriate theoretical and methodological approach to study and understand social support since it provides measures of personal network structure, composition and functional content. The aim of this mixed method study is to present the usefulness of Personal Network Analysis to explore social support in the context of chronic pain. Personal and support network data of 30 people with chronic pain (20 alters for each ego, 600 relationships in total) were collected, obtaining measures of personal network structure and composition as well as information about social support characteristics. Also, semi-structured interviews with participants were conducted to identify the context of their experience of pain, their limitations as regards leading an autonomous life, their social support needs and other aspects concerning the effect of pain on their social and relational lives. This approach shows the importance of non-kin social support providers and the significant role of non-providers in the personal networks of people suffering chronic pain.