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OBJECTIVE: Comprehensive studies examining longitudinal predictors of dietary change during the coronavirus disease 2019 pandemic are lacking. Based on an ecological framework, this study used longitudinal data to test if individual, social and environmental factors predicted change in dietary intake during the peak of the coronavirus 2019 pandemic in Los Angeles County and examined interactions among the multilevel predictors. DESIGN: We analysed two survey waves (e.g. baseline and follow-up) of the Understanding America Study, administered online to the same participants 3 months apart. The surveys assessed dietary intake and individual, social, and neighbourhood factors potentially associated with diet. Lagged multilevel regression models were used to predict change from baseline to follow-up in daily servings of fruits, vegetables and sugar-sweetened beverages. SETTING: Data were collected in October 2020 and January 2021, during the peak of the coronavirus disease 2019 pandemic in Los Angeles County. PARTICIPANTS: 903 adults representative of Los Angeles County households. RESULTS: Individuals who had depression and less education or who identified as non-Hispanic Black or Hispanic reported unhealthy dietary changes over the study period. Individuals with smaller social networks, especially low-income individuals with smaller networks, also reported unhealthy dietary changes. After accounting for individual and social factors, neighbourhood factors were generally not associated with dietary change. CONCLUSIONS: Given poor diets are a leading cause of death in the USA, addressing ecological risk factors that put some segments of the community at risk for unhealthy dietary changes during a crisis should be a priority for health interventions and policy.
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COVID-19 , Dieta , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , Los Angeles/epidemiologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Dieta/estatística & dados numéricos , Fatores Socioeconômicos , Estudos Longitudinais , Verduras , Pandemias , Frutas , Características de Residência/estatística & dados numéricos , Idoso , Adulto Jovem , Comportamento Alimentar , Bebidas Adoçadas com Açúcar/estatística & dados numéricosRESUMO
BACKGROUND: Immigrants to the United States face structural barriers that contribute to rising cardiovascular risk factors and obesity after immigration. This manuscript describes the development of the Healthy Immigrant Community protocol and baseline measures for a stepped wedge cluster randomized trial to test the effectiveness of a social network intervention for cardiovascular risk reduction among two immigrant populations. METHODS: We developed a social network-informed, community-based, participatory research-derived health promotion intervention with Hispanic and Somali immigrant communities in Minnesota consisting of mentoring, educational and motivational sessions, group activities, and a community toolkit for healthy weight loss delivered by culturally concordant health promoters (HPs) to their social networks. Using a stepped wedge cluster randomized design, social network-based groups were randomly assigned to receive the intervention either immediately or after a delay of one year. Outcomes, measured at baseline, 6 months, 12 months, and 24 months, were derived from the American Heart Association's "Life's Simple 7": BMI and waist circumference, blood pressure, fasting blood glucose, total cholesterol, physical activity level, and dietary quality. RESULTS: A total of 51 HPs were enrolled and randomized (29 Hispanic; 22 Somali). There were 475 participants enrolled in the study, representing a mean social network group size of 8 (range, 5-12). The mean BMI of the sample (32.2) was in the "obese" range. CONCLUSION: Processes and products from this Healthy Immigrant Community protocol are relevant to other communities seeking to reduce cardiovascular risk factors and negative health behaviors among immigrant populations by leveraging the influence of their social networks.
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Doenças Cardiovasculares , Emigrantes e Imigrantes , Fatores de Risco de Doenças Cardíacas , Adulto , Humanos , Doenças Cardiovasculares/prevenção & controle , Hispânico ou Latino , Obesidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Rede Social , Estados UnidosRESUMO
Introduction: This mixed-methods study analyzed English-language U.S.-based Twitter posts related to E-cigarette use from February 2021. Methods: Posts were manually identified as health-related or not and, if health-related, whether they were posted by an E-cigarette user. A random selection of 1,000 health-related tweets from 986 unique E-cigarette users were qualitatively content analyzed for theory of planned behavior constructs as well as nature and tone of each tweet message. Using quantitative semantic network analysis, relationships among the identified topics and sentiment-specific conversation patterns were explored. Results: The most salient health-related conversation topics of E-cigarette users, health beliefs corresponding to each theory of planned behavior construct, and major motivational contexts of E-cigarette use were identified. Seven topics emerged in positive tweets: smoking cessation, social impact generation, controls over addiction, therapeutic effects on physical and mental health, social support, device attachment, and peer influence. Nine topics emerged in negative tweets: side effects on physical health, vaping addiction, lack of E-cigarette regulations, peer pressure, increased risk of COVID-19, side effects on mental health, no help in smoking cessation, social conflict, and polysubstance use. Most assertions for E-cigarette benefits were not substantiated. Jokes in tweets appeared to contribute to the view of vaping as an attractive, enjoyable, safe, and fun activity. Discussions about positive aspects of E-cigarette use were concentrated on a few related topics, whereas tweets discouraging E-cigarette use presented a diverse, less related set of topics. Conclusions: The results provide insights into the drivers of E-cigarette use behaviors. E-cigarette user perspectives gathered from social media may inform research to guide future prevention and cessation interventions.
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Interpersonal violence (IV) is a serious concern for adolescents in the United States that has devastating impacts for individuals and communities. Given the increased importance placed on friendships during adolescence, the purpose of the current study was to examine the extent to which IV experiences cluster within youths' friendship networks. Participants were students (N = 1303) in grades 7th to 10th who completed surveys at the beginning and end of an academic year. Results showed that friends' average perpetration (i.e., the percentage of the friends they nominated who perpetrated IV) was strongly associated with likelihood of individual perpetration at baseline but not at the follow-up. For victimization, friends' average report of victimization (i.e., the percentage of the friends they nominated who were victimized) was associated with higher likelihood reporting of victimization (at both baseline and follow-up). Although future research is needed to understand explanatory mechanisms underlying these findings, it is possible that the effectiveness of prevention initiatives may be enhanced by incorporating peer group information.
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Background: Determine if individual adolescent vaping is associated with the vaping behavior of their school-based friendships; whether that association stems from peer influence or peer selection; and whether it varies by age. Methods: Two wave longitudinal survey of 1,208 students in one Midwestern US school district. Students were asked if they ever vaped and to name their seven closest friends within the school district. A roster of all eligible students was pre-loaded into the survey to facilitate network data collection. Terms for network exposure, the proportion of vaping friends; and selection, the number of new friends who vape, were created. Logistic regression and Stochastic Actor Oriented Models were used to test both influence and selection effects. Results: A cross-sectional logistic regression model indicated that friend vaping was associated with individual vaping (AOR = 4.96, p < 0.01); and lagged logistic models indicated that increased friend vaping was associated with individual vaping initiation (AOR = 1.72, p < 0.05). Selecting new friends who vape was also associated with becoming a vaper (AOR = 1.25, p < 0.01). Both influence and selection were present for those less than 14 years old. Conclusions: This is the first study to use social network analysis to show that adolescents who vape or initiate vaping are more likely to do so if their friends vape, and/or they make new friends who vape. Prevention and cessation programs should address the role of friend influence and selection on e-cigarette use; particularly at younger ages.
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Sistemas Eletrônicos de Liberação de Nicotina , Vaping , Humanos , Adolescente , Estudos Transversais , Estudos Longitudinais , Rede SocialRESUMO
The purpose of the current study was to examine the diffusion effects of a youth-led sexual violence prevention program (i.e., Youth Voices in Prevention [Youth VIP]). Specifically, social network analysis was used to measure the extent to which Youth VIP changed behaviors for 1172 middle and high school youth who did not attend program events but were friends with Youth VIP participants and completed the first and final survey (approximately 2 years apart). Findings suggest that there was considerable interpersonal communication about Youth VIP among the students generated by program participation. Specifically, youth with friends who participated in Youth VIP were more likely to report hearing their friends talk about Youth VIP and reported talking to their friends about Youth VIP compared with those not connected to Youth VIP participants. However, there were no diffusion effects found for behavioral outcomes (i.e., bystander intervention behavior, violence victimization, and perpetration). Given the mixed findings, further research is needed to determine the extent to which youth-led sexual violence prevention initiatives lead to changes in broader community-wide changes in youths' behaviors.
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Vítimas de Crime , Delitos Sexuais , Humanos , Adolescente , Adulto , Delitos Sexuais/prevenção & controle , Violência/prevenção & controle , Comportamento Sexual , Instituições AcadêmicasRESUMO
PURPOSE: This study tested the relative efficacy of a culturally tailored dramatic narrative promoting COVID-19 vaccination in changing attitudes and behavioral intent among unvaccinated Latinas compared to a nonnarrative control containing similar information. DESIGN: A pretest-posttest experimental study with unvaccinated Latinas randomly assigned to watch either a dramatic narrative featuring Latina characters countering prevalent myths about COVID-19 vaccines or a nonnarrative film containing similar information (control condition). SETTING: The experiment was hosted online with the films embedded in the survey. PARTICIPANTS: Three-hundred-ninety adult Latinas living in the United States (mean age = 33.4 years; SD = 11.2) who had not been vaccinated against COVID-19 despite being eligible. At pretest, 57.7% were hesitant and 42.3% were resistant (refusing) to get vaccinated. MEASURES: Self-reported measures of engagement with the film, COVID-19 vaccine attitudes, and intent to get vaccinated within 30 days at pretest and posttest. RESULTS: Resistant women were significantly more engaged in the dramatic narrative than the nonnarrative control film (P = .03). Being engaged in a film predicted more positive post-viewing attitudes toward the vaccine (b = .28; P < .001) and higher intent to get vaccinated (b = 2.34, P < .001). CONCLUSION: Using culturally tailored stories to promote healthy behaviors such as vaccination can be an effective way of reaching resistant audiences.
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Vacinas contra COVID-19 , COVID-19 , Vacinação , Adulto , Feminino , Humanos , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Comportamentos Relacionados com a Saúde , Hispânico ou Latino , Vacinação/psicologia , Hesitação VacinalRESUMO
Objective: Using social network analysis, we assessed the mechanisms of social influence that promote e-cigarette use in adolescent networks. Methods: Data on health behaviours and friendship networks from a cohort of 10 high schools in Southern California (N=1599) were collected in grade 9 Spring 2021 (W1), grade 10 Fall 2021 (W2) and Spring 2022 (W3). Two mixed effects logistic regression models were estimated (full sample and subsample of non-vapers only) to evaluate the associations of W1 and W2 pro-vaping norms, peer e-cigarette use exposure and prior e-cigarette use (full sample) on past 6-month vaping at W3, adjusting for demographic covariates and school clustering. Results: Previous vaping was the strongest predictor of past 6-month vaping at W3 among the full sample. Greater exposure to friend e-cigarette use at W2 (adjusted OR (AOR)=12.2, 95% CI 4.04 to 36.5) and greater pro-vaping norms at W2 (AOR=2.63, 95% CI 1.24 to 5.55) were significantly and positively associated with increased odds of initiating e-cigarette use at W3 among students with no lifetime e-cigarette use. Conclusion: Peer network exposure and pro-vaping norms are significant predictors of vaping initiation even when network vaping prevalence is low.
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Background: Specialized cancer survivorship clinics are recommended for addressing treatment-related health concerns of long-term survivors, but their relative newness in medical oncology necessitates strategies to expand services and clinic referrals. This study used social network analysis to identify personal and/or network factors associated with referral of patients to a survivorship clinic. Methods: We conducted a cross-sectional social network survey of clinical personnel at a National Cancer Institute-designated comprehensive cancer center. Participants identified colleagues with whom they consult for advice (advice network) and/or discuss patient care (discussion network). Exponential random graph models and logistic regression were used to identify key opinion leaders in the network and factors associated with referral of patients to the center's survivorship clinic. Results: Here we show that of the respondents (n = 69), 78.0% report being aware of the survivorship clinic, yet only 30.4% had ever referred patients to it. Individuals tend to associate with others in the same occupational role (homophily). In the discussion network, holding an influential network position (betweenness centrality) is associated with patient referral to the survivorship clinic. In the advice network, several social workers are identified as opinion leaders. Conclusions: This study shows that there is strong homophily in both networks, potentially inhibiting information sharing between groups. In designing an inclusive network intervention, persons occupying influential network positions and opinion leaders (e.g., social workers in this case) are well-positioned to promote survivorship clinic referrals.
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BACKGROUND: Peer-led interventions for adolescents are effective at accelerating behavioral change. The Sources of Strength suicide preventive program trains student peer change agents (peer leaders) in secondary schools to deliver prevention messaging and conduct activities that increase mental health coping mechanisms. The program currently has school staff select peer leaders. This study examined potential for more efficient program diffusion if peer leaders had been chosen under network-informed selection methods. METHODS: Baseline assessments were collected from 5,746 students at 20 schools. Of these, 429 were selected by adults as peer leaders who delivered intervention content through the school year. We created theoretical alternate peer leader sets based on social network characteristics: opinion leadership, centrality metrics, and key players. Because these sets were theoretical, we examined the concordance of these sets with the actual adult-selected peer leaders sets and correlated this metric with diffusion of intervention modalities (i.e., presentation, media, communication, activity) after the first year. RESULTS: The sets of adult-selected peer leaders were 13.3%-22.7% similar to theoretical sets chosen by other sociometric methods. The use of friendship network metrics produced peer leader sets that were more white and younger than the general student population; the Key Players method produced more representative peer leader sets. Peer opinion leaders were older and more white than the general population. Schools whose selected peer leaders had higher overlap with theoretical ones had greater diffusion of intervention media and peer communication. CONCLUSIONS: The use of network information in school-based peer-led interventions can help create more systematized peer leader selection processes. To reach at-risk students, delivery of an indirect message, such as through a poster or video, may be required. A hybrid approach where a combination of visible, respected opinion leaders, along with strategically-placed key players within the network, may provide the greatest potential for intervention diffusion.
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Grupo Associado , Prevenção do Suicídio , Suicídio , Adolescente , Adulto , Atitude , Humanos , Instituições Acadêmicas , Estudantes/psicologia , Suicídio/psicologiaRESUMO
Community interventions that use social network analysis to identify and involve influential individuals are promising for behavior change. However, youth friendships are often unstable. The current study examined the stability of the youth selected as influential in a friendship social network, that is, the degree to which youth selected at one time point were also selected at subsequent time points. Influential youth, also called popular opinion leaders (POLs), were selected to be part of a community-wide sexual violence prevention initiative. POLs were selected based on high in-degree (number of times an individual was nominated as a best friend by another student). We found that POLs were unstable: only 29.81%-41.01% of POLs were stable across time. The percentage of POLs who were stable decreased across time. No factors (social identities, behavioral, attitudinal) consistently predicted POL stability. Although these findings are in need of replications, social network interventions for youth may need to repeatedly select new POLs to account for instability.
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Amigos , Análise de Rede Social , Adolescente , Humanos , Identificação Social , EstudantesRESUMO
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 (â¼50%). 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.
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Sobrepeso , Obesidade Infantil , Adolescente , Índice de Massa Corporal , Amigos , Humanos , Sobrepeso/epidemiologia , Obesidade Infantil/epidemiologia , Grupo AssociadoRESUMO
Acculturation is associated with substance use behaviors in Hispanic adolescents. However, there is limited research determining whether the individual's friends' acculturation patterns also influence substance use. Tenth-grade students (N = 970) participated in Project RED, a study of substance use and social networks among Hispanic youth in Southern California. Acculturation and substance use data from both the respondent and their nominated friends were regressed on lifetime cigarette use, marijuana use, and alcohol use controlling for sibling substance use, sex, depressive symptoms, and network measures. Respondent's Hispanic orientation was significantly associated with lower odds of both cigarette and marijuana use, whereas respondent's friends' US orientation was associated with higher odds of cigarette use. When controlling for network-level acculturation, individual-level U.S. orientation was not associated with substance use. Participants who nominated more friends had lower odds of cigarette use. Among this sample of Hispanic adolescents, affiliating with U.S.-oriented friends was associated with a higher risk for smoking. Substance use prevention efforts should consider encouraging Hispanic youth to maintain their cultural heritage and foster friendship groups that support abstinence and promote Hispanic and bicultural identity.
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Fumar Maconha , Transtornos Relacionados ao Uso de Substâncias , Aculturação , Adolescente , Hispânico ou Latino , Humanos , Rede SocialRESUMO
In the current article, we describe an innovative sexual violence (SV) prevention initiative that used social network analysis to identify youth and adult popular opinion leaders who were subsequently trained in best practices in SV prevention (e.g., bystander intervention) at a kickoff event (i.e., camp) of the initiative. We provide information on recruitment strategies, participation rates and how those rates varied by some demographic factors, reasons for nonattendance, the initial impact of the camp, and lessons learned. Despite challenges with youth and adult engagement, this innovative approach has the potential to transform the way we approach SV prevention among youth.
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Delitos Sexuais , Análise de Rede Social , Adolescente , Adulto , Humanos , Delitos Sexuais/prevenção & controle , Comportamento Sexual , Violência/prevenção & controleRESUMO
OBJECTIVES: Reducing potentially preventable hospitalizations (PPH) for chronic disease is a research and practice priority. Native Hawaiians and other Pacific Islanders (NHOPI) have disparities in PPH, and are understudied in both health literacy and social network research. Greater inclusion of social and familial networks can help address health disparities among people with chronic illness and enhance culturally relevant healthcare. METHODS: Adults hospitalized with a heart disease or diabetes-related PHH in Hawai'i (N = 22) were assessed for health literacy and social network membership ("alters"). RESULTS: Sixty-nine percent of respondents were NHOPI. Three respondents (14%) had no alters ("isolates"). Among non-isolates, 79% desired the participation of at least one alter in chronic disease management-related interventions. Fifty-nine percent of respondents had low health literacy. While the mean number of alters did not vary significantly by health literacy, those with lower health literacy had a trend (p = .055) towards less interest in social network engagement. DISCUSSION: In a sample primarily comprised of NHOPI with chronic disease, many patients wished to include social network members in interventions. Engagement varied by health literacy with implications for health disparities. Not all patients were interested in social network engagement, which must be considered in intervention planning.
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Diabetes Mellitus , Letramento em Saúde , Cardiopatias , Adulto , Havaí , Hospitalização , Humanos , Rede SocialRESUMO
Peer sexual violence is a significant social problem that affects adolescents and can lead to negative mental health and developmental consequences. Peers are a significant source of influence for adolescent behavior. For example, recent studies show training teens to be bystanders can be an effective prevention strategy to reduce peer violence and harassment. Peers can also promote risky behaviors including substance use and violence. The current study examined how sexual violence-specific risk and protective attitudes (e.g., denial of peer sexual violence and positive peer prevention norms) and behaviors (alcohol use and bystander actions to prevent peer sexual violence) clustered within peer networks cross-sectionally and over time. Participants were 1,499 7th-10th graders who took surveys during an academic year and who reported having opportunity to take action as bystanders to peer sexual violence. Participants took surveys 6 months apart online in schools. Questions included nomination of best friends to capture information about peer networks. Social network analyses indicated that there was weak but significant clustering of positive prevention attitudes such as bystander denial and marginal clustering on reactive bystander behaviors to address sexual assault. For comparison, alcohol use and academic grades were analyzed and found to also cluster in networks in these data. These findings suggest that for early adolescents, peer bystander training may be influential for some key bystander attitudes and reactive sexual violence prevention behaviors as individual behaviors are not independent of those of their friends.
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Comportamento do Adolescente , Delitos Sexuais , Adolescente , Comportamento do Adolescente/psicologia , Atitude , Humanos , Grupo Associado , Delitos Sexuais/prevenção & controle , Delitos Sexuais/psicologia , Violência/prevenção & controleRESUMO
OBJECTIVES: Management of cardiovascular disease (CVD) is an urgent challenge in low-income and middle-income countries, and interventions may require appraisal of patients' social networks to guide implementation. The purpose of this study is to determine whether egocentric social network characteristics (SNCs) of patients with chronic disease in western Kenya are associated with overall CVD risk and individual CVD risk factors. DESIGN: Cross-sectional analysis of enrollment data (2017-2018) from the Bridging Income Generation with GrouP Integrated Care trial. Non-overlapping trust-only, health advice-only and multiplex (trust and health advice) egocentric social networks were elicited for each participant, and SNCs representing social cohesion were calculated. SETTING: 24 communities across four counties in western Kenya. PARTICIPANTS: Participants (n=2890) were ≥35 years old with diabetes (fasting glucose ≥7 mmol/L) or hypertension. PRIMARY AND SECONDARY OUTCOMES: We hypothesised that SNCs would be associated with CVD risk status (QRISK3 score). Secondary outcomes were individual CVD risk factors. RESULTS: Among the 2890 participants, 2020 (70%) were women, and mean (SD) age was 60.7 (12.1) years. Forty-four per cent of participants had elevated QRISK3 score (≥10%). No relationship was observed between QRISK3 level and SNCs. In unadjusted comparisons, participants with any individuals in their trust network were more likely to report a good than a poor diet (41% vs 21%). SNCs for the trust and multiplex networks accounted for a substantial fraction of variation in measures of dietary quality and physical activity (statistically significant via likelihood ratio test, adjusted for false discovery rate). CONCLUSION: SNCs indicative of social cohesion appear to be associated with individual behavioural CVD risk factors, although not with overall CVD risk score. Understanding how SNCs of patients with chronic diseases relate to modifiable CVD risk factors could help inform network-based interventions. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02501746; https://clinicaltrials.gov/ct2/show/NCT02501746.
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Doenças Cardiovasculares , Diabetes Mellitus , Hipertensão , Adulto , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Hipertensão/epidemiologia , Quênia/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Rede SocialRESUMO
BACKGROUND: Incorporating social determinants of health into care delivery for chronic diseases is a priority. OBJECTIVES: The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. METHODS: The authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usual care plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primary outcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used to evaluate the outcomes. RESULTS: A total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF). Average baseline SBP was 157.5 mm Hg. Mean SBP declined -11.4, -14.8, -14.7, and -16.4 mm Hg in UC, MF, GMV, and GMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative to UC, SBP reduction was 3.9 mm Hg (-8.5 to 0.7), 3.3 mm Hg (-7.8 to 1.2), and 2.3 mm Hg (-7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefit poorer individuals. Active participation in GMV-MF was associated with greater benefit. CONCLUSIONS: A strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led to clinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was not met in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts ranging from substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery for chronic diseases has potential to improve outcomes. (Bridging Income Generation With Group Integrated Care [BIGPIC]; NCT02501746).
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Atenção à Saúde/economia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Prática de Grupo/economia , Hipertensão/economia , Hipertensão/epidemiologia , Idoso , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Análise por Conglomerados , Atenção à Saúde/métodos , Diabetes Mellitus/terapia , Feminino , Seguimentos , Humanos , Hipertensão/terapia , Quênia , Masculino , Pessoa de Meia-IdadeRESUMO
Amid the COVID-19 global pandemic, a highly troublesome influx of viral misinformation threatens to exacerbate the crisis through its deleterious effects on public health outcomes and health behavior decisions.This "misinfodemic" has ignited a surge of ongoing research aimed at characterizing its content, identifying its sources, and documenting its effects. Noticeably absent as of yet is a cogent strategy to disrupt misinformation.We start with the premise that the diffusion and persistence of COVID-19 misinformation are networked phenomena that require network interventions. To this end, we propose five classes of social network intervention to provide a roadmap of opportunities for disrupting misinformation dynamics during a global health crisis. Collectively, these strategies identify five distinct yet interdependent features of information environments that present viable opportunities for interventions.
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COVID-19/epidemiologia , Comunicação , Disseminação de Informação/métodos , Mídias Sociais/normas , Saúde Global , Comunicação em Saúde/normas , Humanos , SARS-CoV-2RESUMO
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.