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.

The teamwork structure, process, and context of a paediatric cardiac surgery team in Mongolia: A mixed-methods approach.

INTRODUCTION: Effective teamwork in paediatric cardiac surgery is known to improve team performance and surgical outcomes. However, teamwork in low- and middle-income countries (LMICs), including Mongolia, is understudied. We examined multiple dimensions of teamwork to inform a team-based training programme to strengthen paediatric cardiac surgical care in Mongolia. METHODS: We used a mixed-methods approach, combining social network analysis and in-depth interviews with medical staff, to explore the structure, process, quality, and context of teamwork at a single medical centre. We conceptualised the team's structure based on communication frequency among the members (n = 24) and explored the process, quality, and context of teamwork via in-depth interviews with select medical staff (n = 9). RESULTS: The team structure was highly dense and decentralised, but the intensive care unit nurses showed high betweenness-centrality. In the quality and process domain of teamwork, we did not find a regular joint decision-making process, leading to the absence of common goals among the team members. Although role assignment among the medical staff was explicit, those strictly defined roles hindered active communication about patient information and responsibility-sharing. Most interviewees did not agree with the organisational policies that limited discussions among team members; therefore, medical staff continued to share training and work experiences with each other, leading to strong and trustworthy relationships. CONCLUSION: The findings of this study underscore the importance of well-structured and goal-oriented communication between medical staff, as well as the management of the quality of collaboration within a team to increase teamwork effectiveness in paediatric cardiac surgery teams in LMICs.

Gender Norms and Weight Control Behaviors in U.S. Adolescents: A Prospective Cohort Study (1994-2002).

PURPOSE: The aim of this article was to determine the relationship between gender norms and weight control behaviors in U.S. adolescents. METHODS: We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health (N = 9,861), at baseline in 1994-1995 (ages 11-18 years, Wave I), 1-year follow-up (ages 12-19 years, Wave II), and 7-year follow-up (ages 18-26 years, Wave III). The primary exposure variable was a measure of one's gender normativity based on the degree to which males and females behave in ways that are similar to the behaviors of their same-gender peers. The outcome variable was an individual's weight control attempts (trying to lose or gain weight) and behaviors (dieting, fasting/skipping meals, vomiting, or weight-loss pills/laxatives/diuretics to lose weight or ate different/more foods than usual or taking supplements to gain weight). RESULTS: In logistic regression analyses controlling for potential confounders, a higher baseline individual gender normativity score (higher femininity in females and higher masculinity in males) was associated with weight loss attempts (ß = .10; p = .01) and weight loss behaviors (ß = .18; p < .001) in girls but was associated with weight gain attempts (ß = .18; p < .001) and behaviors (ß = .16; p < .001) in boys at 1-year follow-up. Higher individual gender normativity score was protective of weight loss attempts (ß = -.15; p < .001) and weight loss behaviors (ß = -.17; p < .001) in males but not females at 7-year follow-up. Loess plots provided visualizations of significant relationships. CONCLUSIONS: Gender norms may reinforce a thinner body ideal for girls but a larger ideal for boys.

Adolescent gender norms and adult health outcomes in the USA: a prospective cohort study.

BACKGROUND: Previous research has documented differences in health behaviours between men and women, with differential risks and health outcomes between the sexes. Although some sex-specific differences in health outcomes are caused by biological factors, many others are socially driven through gender norms. We therefore aimed to assess whether gender expression as an adolescent, determined by the degree to which an individual's behvaiours were typical of their gender, were associated with health behaviours and outcomes in adulthood. METHODS: In this prospective cohort study, we used data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of US adolescents from whom data were collected during adolescence (ages 11-18 years) and adulthood (ages 24-32 years). We created a measure of gender expression that was based on the degree to which male and female adolescents and adults behave in stereotypically masculine (for men) or feminine (for women) ways relative to their same-gender peers. Adolescents were assessed for baseline sociodemographic characteristics and gender expression, and these participants were later assessed, during adulthood, for their gender expression and health behaviours and outcomes, which included depression, self-rated health, drug and alcohol use, cardiovascular risk factors, experience of sexual violence, diet, and obesity. These data were collected via surveys, except for body-mass index, cholesterol, and blood pressure, which were collected as biomarkers. FINDINGS: Between April and December, 1995, self-reported data were collected from 10 480 female and 10 263 male adolescents; similar data were subsequently collected in several waves in this cohort, with a final collection between January, 2008, and February, 2009, when participants were aged 24-32 years. We used data from this final wave and from baseline, and our study represents a secondary analysis of these data. Of these participants, complete follow-up data from 6721 (80%) adult women and 5885 (80%) adult men were available. Gender expression was stable for men and women from adolescence to adulthood. High masculinity (vs low masculinity) in adolescent and adult men was positively associated with smoking in the past month, use of marijuana and recreational drugs, prescription drug misuse (adult gender expression only), and consumption of fast food and soda (adolescent gender expression only) in the past week. However, higher masculine gender expression in adult men was negatively associated with diagnosed depression and high cholesterol in adulthood, and masculine gender expression in adolescent and adult men was negatively associated with high blood pressure in adults. High femininity (vs low femininity) in adolescent or adult women was positively associated with high cholesterol and blood pressure (both adult gender expression only), depression, migraines (adult gender expression only), and physical limitations (ie, health problems that limited their daily activities). However, higher femininity in adolescence was negatively associated with self-rated good health in adulthood. Although feminine gender expression in adolescents was predictive of adult recreational and prescription drug and marijuana use and experience of sexual violence, feminine gender expression in adulthood was negatively associated with adult substance use and experience of sexual violence, suggesting that expressions of femininity typical of adolescents impart risks that expression of femininity as an adult does not. Individuals who are highly masculine or feminine seem to be at greatest risk of adverse health outcomes and behaviours. INTERPRETATION: We found compelling evidence that adolescent gender expression is correlated with health in adulthood independently of gender expression as an adult. Although more research is needed to identify causal mechanisms, our results suggest that those designing health behaviour interventions should carefully consider integrating gender transformative components into interventions. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Gender Equality, Integrated Delivery, HIV, Nutrition, Family Planning, and Water Sanitation and Hygiene Program Strategy Teams (Bill and Melinda Gates Foundation).

Family environment, children's acculturation and mothers' dietary intake and behaviors among Latinas: An autoregressive cross-lagged study.

BACKGROUND: Many Latinos in the U.S. do not meet dietary recommendations for healthy eating. Family systems theory posits that the family environment affects family members' dietary behaviors. Moreover, research suggests that children's acculturation is associated with Latina mothers' dietary intake and behaviors. PURPOSE: This longitudinal study examined the effect of the family environment on Latina mothers' dietary intake and behaviors. Further, we examined whether these effects differed between mothers of assimilated versus bicultural children. METHODS: Secondary data were collected at three time points (baseline, and four and 10 months' post-baseline) from 162 culturally traditional and bicultural Latina mothers residing in Imperial County, California, U.S. Participants were enrolled in the delayed treatment group of a randomized controlled trial. Mothers' daily fruit, vegetable, and sugary beverages intake, percent of calories from fat, weekly away-from-home eating, and percent of weekly grocery dollars spent on fruits and vegetables were examined. The family environment was measured by family expressiveness and family interactions around food. Separate autoregressive cross-lagged models examined the effects of the family environment on dietary outcomes, adjusting for sociodemographic variables. Interactions between the family environment and children's acculturation were also tested. RESULTS: Less positive family interactions around food at baseline predicted more frequent away-from-home eating four months later among mothers of assimilated children. More family expressiveness at four months predicted more grocery dollars spent on fruits and vegetables at ten months among mothers of bicultural children. CONCLUSIONS: Findings suggest the importance of a positive family environment on socially-bound dietary behaviors (e.g., away-from-home eating) exhibited by the mother. Family interventions aimed at improving dietary intake and associated behaviors should promote a positive family environment around food and consider the moderating role of children's acculturation.

Self-comparisons as motivators for healthy behavior.

OBJECTIVE: We explored whether individuals' comparison of themselves to their social contacts, specifically feeling fitter or thinner than friends, is a significant predictor of three weight-loss behaviors (dieting, reducing alcohol, exercising). METHODS: We used a longitudinal survey of a national sample of Americans (N = 20,373) to measure respondents' personal social networks and their self-comparisons to their social contacts at two annual waves. RESULTS: Participants who felt thinner than friends in Wave 1 had 1.16 lower odds of dieting in Wave 2. Those who felt fitter than friends in Wave 1 had 1.10 times higher odds of reducing alcohol and 1.18 times higher odds of exercising in Wave 2. We found that 20% of the relationship between feeling thin at baseline and subsequent dieting may be because feeling heavier than friends makes one want to lose weight. This same dynamic accounts for 25% of the relationship between feeling fit and dieting and 12% of the relationship between feeling thin and reducing alcohol. CONCLUSIONS: These results suggest that normative self-comparison with important others is a potentially salient determinant of obesity-related health behavior and appears to work differently depending upon the behavior. Interventions may benefit from exploiting social comparisons in targeted ways.

Parental influence on substance use in adolescent social networks.

OBJECTIVE: To evaluate the relationship between the parenting style of an adolescent's peers' parents and an adolescent's substance use. DESIGN: Longitudinal survey. SETTING: Adolescents across the United States were interviewed at school and at home. PARTICIPANTS: Nationally representative sample of adolescents in the United States. MAIN EXPOSURE: Authoritative vs neglectful parenting style of adolescent's parents and adolescent's friends' parents and adolescent substance use. MAIN OUTCOME MEASURES: Adolescent alcohol abuse, smoking, marijuana use, and binge drinking. RESULTS: If an adolescent had a friend whose mother was authoritative, that adolescent was 40% (95% CI, 12%-58%) less likely to drink to the point of drunkenness, 38% (95% CI, 5%-59%) less likely to binge drink, 39% (95% CI, 12%-58%) less likely to smoke cigarettes, and 43% (95% CI, 1%-67%) less likely to use marijuana than an adolescent whose friend's mother was neglectful, controlling for the parenting style of the adolescent's own mother, school-level fixed effects, and demographics. These results were only partially mediated by peer substance use. CONCLUSIONS: Social network influences may extend beyond the homogeneous dimensions of own peer or own parent to include extradyadic influences of the wider network. The value of parenting interventions should be reassessed to take into account these spillover effects in the greater network.