Best Practices for Modeling Egocentric Social Network Data and Health Outcomes

Using a Social Network Approach to Characterize Oral Health Behavior Social Support Among Mexican-Origin Young Adults

Using a social network approach, we characterize who Mexican-origin young adults perceive as social support sources for oral health behaviors and provide additional validity evidence for Oral Health Behavior Social Support Scales (OHBSS). From April to September 2022, we gathered social network data from 62 Mexican-origin adults (21-40 years old) through Zoom interviews about their perceived received social support for three oral health behaviors (toothbrushing, flossing, and obtaining dental care) from three potential sources of support (family, health providers, and others/friends). Overall, we found similar results across all three oral health behaviors. We also found evidence for convergent and discriminant validity of OHBSS scales using social network measures. Implications of findings are discussed.

Cross-sectional personal network analysis of adult smoking in rural areas

Research on smoking behaviour has primarily focused on adolescents, with less attention given to middle-aged and older adults in rural settings. This study examines the influence of personal networks and sociodemographic factors on smoking behaviour in a rural Romanian community. We analysed data from 76 participants, collected through face-to-face interviews, including smoking status (non-smokers, current and former smokers), social ties and demographic details. Multilevel regression models were used to predict smoking status. The results indicate that social networks are essential in shaping smoking habits. Current smokers were more likely to have smoking family members, reinforcing smoking within familial networks, while non-smokers were typically embedded in non-smoking environments. Gender and age patterns show that women were less likely to smoke, and older adults were more likely to have quit smoking. These findings suggest that targeted interventions should focus not only on individuals but also on their social networks. In rural areas, family-based approaches may be particularly effective due to the strong influence of familial ties. Additionally, encouraging connections with non-smokers and former smokers could help disrupt smoking clusters, supporting smoking cessation efforts.

Network Analysis of Women in Otolaryngology and Demographic Trends

OBJECTIVE

This study analyzes gender disparities between men and women otolaryngology faculty in the top 20 otolaryngology departments ranked by research output and discusses the implications of these disparities.

METHODS

This was a cross-sectional study of all articles published by faculty from January 2020 to December 2021 at the top 20 otolaryngology departments as ranked by Doximity's 2022 research output report. Integrated data from Web of Science, faculty directories, and NIH RePORT were used to collect data on faculty. Social network analysis was performed using ORA-LITE. Student's and Welch's t-tests and Pearson chi-squared tests were used to evaluate gender differences in academic metrics.

RESULTS

The findings revealed significant gender disparities, with men holding higher academic positions (men = 3.16, women = 2.69, p < 0.0001), higher H-indices (22.4, 13.8, p < 0.0001), more NIH grants (0.15, 0.07, p = 0.0032), and greater total degree centrality (3.98E-4, 2.4E-4, p < 0.0001) and betweenness centrality (4.47E-3, 3.00E-3, p = 0.0021). Men also had more publications (9.8, 6.8, p < 0.0001) with more distinct co-authors, both within (4, 3.1, p = 0.0074) and across (38.1, 25.8, p < 0.0001) institutions. Disparities persisted after accounting for career length. Notably, total degree centrality differences between men and women were statistically significant from 1991 to 2017 (p < 0.0001), but not from 2018 to 2022 (p = 0.83).

CONCLUSIONS

This study highlights gender inequities in otolaryngology, encouraging mentors to foster new collaborations with female peers. Importantly, it identifies a trend toward narrowing the gender gap within the specialty, particularly over the past 5 years, emphasizing the need to sustain these positive changes for enhanced gender equity.

LEVEL OF EVIDENCE

NA Laryngoscope, 2024.

Advancing the Measurement of Social Functioning in Schizophrenia: Applications of Egocentric Social Network Analysis

People with schizophrenia face challenges with forming and maintaining social relationships, often resulting in poor social functioning. Commonly used measures of social functioning provide broad information relating to social relationships, but they do not adequately capture information regarding network structure and characteristics of network members. One method that can assess these more detailed aspects of social networks and provide a more comprehensive understanding of social functioning deficits is egocentric social network analysis (SNA). SNA is a scientific discipline that uses principles of network science and graph theory to analyze social relations quantitatively. Even though some types of SNA have been applied in prior schizophrenia studies, its application as a framework to measure social functioning has been extremely limited. Therefore, this article aims to formally introduce SNA and select quantitative SNA metrics, including measures of network composition, structure, homophily, and centrality, to schizophrenia researchers as novel ways of measuring components of social functioning. To demonstrate the application of SNA, we provide illustrative examples of the SNA metrics and graphical diagrams of social networks for two individuals with schizophrenia.

Application of an egocentric social network approach to examine changes in social connections following treatment for anxiety and depression: A novel measurement tool for clinical trials research?

The epidemic of loneliness and social isolation has been recognized as a public health crisis warranting the same prioritization as other public health issues today, such as obesity, substance use disorders, and tobacco use. Social disconnection is particularly prevalent and disabling among individuals with anxiety and depression, yet it is inadequately evaluated and addressed in most clinical psychology treatment research. Studies generally employ global measures of perceived connectedness, loneliness, or relationship satisfaction, limiting understanding about elements of one's social network that may change with treatment. This study examined changes in the degree (number of people nominated) and quality of one's social network from pre-to post-treatment using an egocentric social network approach in 59 adults (mean age = 30.8 years, range = 18 to 54) with clinically elevated anxiety or depression who were randomized to a cognitive and behavioral positive valence treatment versus waitlist. Participants (egos) named people in their lives (alters) with whom they discussed important issues or spent free time. For each alter, participants rated how close they felt, how close they thought the alter felt to them, and how frequently they communicated. Linear regressions, which included treatment group as a predictor, revealed no group differences in changes in network degree, perceived alter feelings of closeness, or communication frequency, despite prior findings from this sample indicating larger increases in perceived global connectedness in the treatment group. Unexpectedly, the control group reported a greater increase in perceived closeness to alters. Post-hoc analyses revealed this was explained by the treatment group identifying more distal social ties (e.g., extended family, colleagues, roommates) as alters following treatment - an outcome positively associated with global improvements in connectedness. This proof-of-concept study suggests egocentric social network surveys may provide unique information on treatment-related changes in social functioning. Suggestions are provided for adaptations to facilitate application of social network surveys to mental health treatment research.

Use of social network analysis in health research: a scoping review protocol

INTRODUCTION

Social networks can affect health beliefs, behaviours and outcomes through various mechanisms, including social support, social influence and information diffusion. Social network analysis (SNA), an approach which emerged from the relational perspective in social theory, has been increasingly used in health research. This paper outlines the protocol for a scoping review of literature that uses social network analytical tools to examine the effects of social connections on individual non-communicable disease and health outcomes.

METHODS AND ANALYSIS

This scoping review will be guided by Arksey and O'Malley's framework for conducting scoping reviews. A search of the electronic databases, Ovid Medline, PsycINFO, EMBASE and CINAHL, will be conducted in April 2024 using terms related to SNA. Two reviewers will independently assess the titles and abstracts, then the full text, of identified studies to determine whether they meet inclusion criteria. Studies that use SNA as a tool to examine the effects of social networks on individual physical health, mental health, well-being, health behaviours, healthcare utilisation, or health-related engagement, knowledge, or trust will be included. Studies examining communicable disease prevention, transmission or outcomes will be excluded. Two reviewers will extract data from the included studies. Data will be presented in tables and figures, along with a narrative synthesis.

ETHICS AND DISSEMINATION

This scoping review will synthesise data from articles published in peer-reviewed journals. The results of this review will map the ways in which SNA has been used in non-communicable disease health research. It will identify areas of health research where SNA has been heavily used and where future systematic reviews may be needed, as well as areas of opportunity where SNA remains a lesser-used method in exploring the relationship between social connections and health outcomes.

Social networks and HIV treatment adherence among people with HIV initiating treatment in rural Uganda and peri-urban South Africa

Timely initiation of and adherence to antiretroviral therapy (ART) is critical for improving HIV outcomes and reducing HIV transmissibility. Social networks, or the social relationships individuals have with each other, have been linked with positive health outcomes, but less is known about the extent to which social network composition and structure are associated with improved ART adherence among people living with HIV (PLWH). We conducted an ego-centric network study among 828 previously ART-naïve PLWH presenting for ART initiation at 11 clinics in Mbarara, Uganda (rural population) and Gugulethu, South Africa (peri-urban population). We collected social network data using name generator and name interpreter questions. ART adherence was monitored over 12 months using wireless monitors (Wisepill). Our primary outcome of interest was ART adherence during the 12-month follow-up period. We used generalized linear models to estimate the associations between network measures and ART adherence. PLWH at the Uganda site (compared with the South Africa site) were less isolated, had larger social networks, and had more social ties providing sufficient social support; they were also more likely to bridge different social groups whereby not all social ties were connected to each other. In Uganda, social isolation was associated with a 5.5 percentage point reduction in ART adherence (95% confidence interval [CI] -9.95 to -1.13; p = 0.014), while having more same gender social ties was associated with higher ART adherence (b = 0.13, 95% CI 0.02-0.25, p = 0.025). In South Africa, there was no association between social isolation and ART adherence, and having more friendship ties (vs. family ties) was associated with lower ART adherence (b = -2.20, 95% CI -3.56 to -0.84; p = 0.002). Identifying and supporting PLWH who are isolated may facilitate optimal adherence, but understanding how networks differentially affect ART adherence by country context is important.

An egocentric network analysis of U.S. college students' recollection of mental health symptoms and social connections during the COVID-19 pandemic

Objective: This study analyzes pandemic-era diminished mental health and social connections among college students. Participants: Students of a large public university completed an online survey measuring self-reported mental health symptoms for themselves and that of their closest social connections. Methods: Three regression models were used to understand if pandemic-era diminished mental health was associated with mental health characteristics present among their social networks: (1) depressive symptoms, (2) loneliness, and (3) hopelessness. Results: Students experiencing depressive symptoms (R2 = 0.13, F = 3.685, p < 0.001) perceived depressive symptoms (β = 0.32, p = 0.01) among their social connections. Students experiencing loneliness (R2 = 0.13, F = 3.867, p < 0.001) perceived loneliness (β = 0.39, p = 0.02) among their social connections. Students experiencing hopelessness (R2 = 0.14, F = 4.223, p < 0.001) perceived depressive symptoms (β = 0.35, p = 0.01) among their social connections. Conclusion: Social connections may influence mental health symptoms and could be a social determinant of certain mental health outcomes.

Social network analysis to study health behaviours in adolescents: A systematic review of methods

PURPOSE

Our objectives were (i) to systematically review how SNA is used in studies investigating adolescent health behaviours (i.e., the purpose of using SNA, methods used for network data collection and analysis), and (ii) to develop methodological guidelines to help researchers use SNA in studies on adolescent health behaviours.

METHODS

Five databases were searched using keywords related to "social network analysis" and "adolescents". We extracted data from included articles pertaining to the choice of methods for network data collection and analysis. We used these data to develop a 5-step decision tree to help researchers make methodological decisions most appropriate to their research objectives.

RESULTS

A total of 201 articles were included. Most investigated tobacco (50%) or alcohol use (48%). SNA was used most often to examine processes related to peer selection or influence (37%) and/or to examine the effect of sociometric position on health behaviours (34%). 181 studies (90%) used a sociocentric approach for SNA, 16 studies (8%) used an egocentric approach, and 4 studies (2%) used both. We identified five decision-making steps in SNA including the choice of: (i) network boundary, (ii) SNA approach, (iii) methods for name generators, (iv) methods for name interpreters, and (iv) SNA indicators.

CONCLUSION

This study provides insights and guidance in a 5-step decision tree on practical and methodological considerations in using SNA to explore adolescent health behaviours.

The Relationship Between Intersectional Drug Use and HIV Stigma and HIV Care Engagement Among Women Living with HIV in Ukraine

This study used an intersectional approach to explore the association between enacted and internalized drug use and HIV stigma on HIV care outcomes among HIV-positive women who inject drugs in Ukraine. Surveys were conducted in Kyiv in 2019-2020. Among the 306 respondents, 55% were engaged in HIV care. More than half (52%) of participants not engaged in care reported internalized stigma related to both drug use and HIV status (i.e., intersectional stigma), compared to only 35% of those who were engaged in HIV care. Among those engaged in care, 36% reported intersectional enacted stigma compared to 44% of those not engaged in care; however, this difference was not statistically significant in the univariable analysis (p = 0.06). In the univariable analysis, participants who reported intersectional internalized stigma had 62% lower odds of being engaged in HIV care (OR 0.38, 95% CI 0.22, 0.65, p < 0.001). In the adjusted model, reported intersectional internalized stigma (aOR 0.52, 95% CI 0.30, 0.92, p = 0.026), reported intersectional enacted stigma (aOR 0.47, 95% CI 0.23, 0.95, p = 0.036), and knowing their HIV status for more than 5-years (aOR 2.29, 95% CI 1.35, 3.87, p = 0.002) were significant predictors of HIV care engagement. These findings indicate that interventions to improve HIV care engagement must address women's experiences of both HIV and drug use stigma and the different mechanisms through which stigma operates.

Adolescent-Adult Social Networks and Experiences of Violence Among Black Youth in Neighborhoods With High Levels of Community Violence

PURPOSE

Adult support is inversely linked to health-affecting risk behaviors. This study aimed to describe adolescent-adult support network structure and quality, and to analyze associations among network properties, strength of emotional and instrumental support, and violence involvement among predominantly Black youth residing in neighborhoods with high levels of community violence.

METHODS

One hundred six youth from urban neighborhoods with high levels of community violence in Pittsburgh, PA completed egocentric social network surveys describing adult supports, measures of support across contexts, and past 30-day violence perpetration, victimization, and witnessing. Forty youth-identified adults completed complementary social network surveys. Poisson regression examined associations among strength of social support, adults' violence experiences, and youths' violence experiences.

RESULTS

Mean youth participant age was 16.7 years, 56% self-identified as female, and 84% as Black or African-American. Youth and adult participants reported high levels of violence exposure and involvement. Youth identified a mean of 4.8 adult supports. Identifying at least one immediate family member in their network was inversely related to violence perpetration (adjusted incidence rate ratio [aIRR] 0.44, 95% confidence interval [CI] 0.22-0.89), victimization (aIRR 0.42, 95% CI 0.25-0.72), and witnessing (aIRR 0.48, 95% CI 0.35-0.64). The percent of adult supports involved in violence was directly associated with violence perpetration (aIRR 1.81, 95% CI 1.07-3.07), victimization (aIRR 1.95, 95% CI 1.09-3.45), and witnessing (aIRR 1.85, 95% CI 1.25-2.73). Few associations emerged between the structure of youth-reported adolescent-adult social networks and violence.

DISCUSSION

Network-based interventions combined with healing-centered services attuned to violence experiences among Black youth and their adult supports may offer opportunities to leverage youths' existing adult support network and reduce violence.

Understanding Caregiving and Caregivers: Supporting Children and Youth With Special Health Care Needs at Home

Caregiving encompasses the nurturing, tasks, resources, and services that meet the day-to-day needs of children and youth with special health care needs (CYSHCN) at home. Many gaps exist in the strategies currently offered by the health care system to meet the caregiving needs of CYSHCN. The work of family caregivers of CYSHCN is known to be extensive, but it is so poorly understood that it has been described as "invisible". This invisibility leads to poor communication and gaps in understanding between professional health care providers and family caregivers. To address these gaps, health care researchers must work with family caregivers to incorporate their expertise on caregiving and create meaningful and sustainable research partnerships. A growing body of research is attempting to remedy the problem of caregiving invisibility and lay better foundations for successful integration between health care settings, family caregiving, professional caregiving, and community supports for families of CYSHCN. We identify high-priority gaps in CYSHCN caregiving research and propose research questions that are designed to accelerate growth in evidence-based understanding of the work of family caregivers of CYSHCN and how best to support them.