Peer effects on health-related behaviours of adolescents in Scotland using social network analysis: a cross-sectional study.

BACKGROUND: Previous research suggests that adolescent norms and behaviours may be influenced by peers. The aim of this study was to investigate social clustering of health outcomes among school friendship groups. METHODS: Cross-sectional surveys were collected from Oct 26, 2022, to March 30, 2023, in four secondary schools in Scotland's central belt, and all Secondary 2 (12-13 years) and Secondary 4 (14-15 years) students were invited to take part. Schools self-selected into the study, between 6% and 27% had a free school meal registration (Scotland average 25%). The survey asked about health and about friendships in school. The outcomes of interest were binary indicators of: mental health and self-esteem using validated scales, smoking, drinking without parents knowing (DWPK), and trying drugs. Ethics approval for the study was given by the University of Glasgow (200190035) and all participants gave consent via an online form. We used Auto-Logistic Actor Attribute Models (ALAAMs) to model the association between features of individuals' social networks and their health outcomes. We specified a model for each health outcome separately including parameters: indegree, outdegree, and simple contagion, and combined using meta-analysis. FINDINGS: Response rate was 74% (n=1097; 50% boys, 46% girls, 4% other). Based on self-report measures, 40% participants had poor mental health, 15% had low self-esteem, 6% smoked regularly, 4% tried drugs, and 18% were drinking without parents knowing. Preliminary unadjusted analysis found evidence of social contagion for mental health. Odds of poor mental health for each additional friend with poor mental health was 1·15 (95% CI 1·05-1·26). There was no evidence of contagion for self-esteem (1·13, 0·95-1·34), smoking (1·14, 0·46-2·82), DWPK (0·88, 0·71-1·10), and having tried drugs (0·91, 0·38-2·19). Some networks had low or zero prevalence of the outcomes, increasing the uncertainty in the pooled estimate for the contagion parameter. INTERPRETATION: A cross-sectional study cannot differentiate between social contagion and selecting similar friends, and low prevalence and social desirability bias might have masked associations. However, the unique combination of social network data with advanced statistical modelling gives initial findings on the potential communicable nature of mental health and health behaviours in adolescence. Preliminary results indicate preventive approaches in schools could benefit from social network methods. FUNDING: Medical Research Council (MRC) and Chief Scientist Office (CSO).

Outdoor nature-based play in early learning and childcare centres: Identifying the determinants of implementation using causal loop diagrams and social network analysis.

Nature-based play benefits children's health and development. However, the delivery of this in early learning and childcare centres (ELC) is extremely diverse, and implementation is not well understood. We applied a systems science perspective to understand the factors crucial to implementing nature-based outdoor play in ELC settings. Through Group Model Building workshops with 20 participants in managerial and practitioner roles, crucial factors were appraised using Causal Loops Diagrams. Twelve thematic causal loops emerged. Network analysis was employed to analyse the diagram. Exponential Random graph models explained the diagram construction process. Centrality measures alongside conditional uniform tests identified six leverage factors: use of outdoor space, culture of being outdoors, ELC culture of outdoor play, perceived child safety and enjoyment, educator confidence and educator agency. This research brings novel and practically relevant evidence about the important factors, and interdependencies, involved in the implementation of outdoor play practice within ELC settings.

School Climate, Peer Relationships, and Adolescent Mental Health: A Social Ecological Perspective.

The current study investigated peer relationship and school climate factors associated with adolescent mental health. Cross-sectional data from 2,571 fifteen-year old students in 22 Scottish secondary schools was used. Multilevel models tested for school differences in mental health, and nested linear regression models estimated peer and school effects. Results demonstrated no significant between-school variation in mental health. Peer victimization was the only peer effect associated with mental health. School-belonging, student-teacher relationships, and a perceived inclusive school climate were associated with better mental health, whereas a perceived school climate of exam pressure was associated with worse mental health. The findings highlight multiple aspects of school climate that could be targeted in school-based interventions for adolescent mental health.

Appraising the Implementation of Complexity Approaches Within the Public Health Sector in Scotland. An Assessment Framework for Pre-Implementation Policy Evaluation.

Complexity approaches have gained international attention as potentially effective strategies to address population health challenges. In light of this, the Scottish government (Scot. Gov.) set the implementation of these approaches as the recommended practice for its public health sector organizations. This study evaluates the opportunity and feasibility of implementing complexity approaches in public health Scotland employees' everyday routine by employing a qualitative study that involves 20 stakeholders, representative of different organizations and roles. We made use of an assessment framework based on Soft Systems Methodology (SSm) and Normalization Process Theory (NPT) comprised of five phases: Phase One defines the boundaries, aims, and goals of the issue under study; Phase Two consists of data collection, drawing on the e-Health Implementation Toolkit (e-HIT); Phase Three involves short presentations and breakout group activities to provide information on the new policy; Phase Four employs system thinking tasks to structure debate and builds shared understanding among participants; Phase Five applies NPT to appraise the organizational position around complexity based on information from the preceding steps. We found two main obstacles to implementing complexity approaches: (1) a lack of a shared understanding of the key concepts in complexity and their practical implications; (2) stakeholders' fear of significant disruption to work routines and power relationships. We recommend addressing these issues with appropriate training and customization of goals and tools that may enable complexity approaches to succeed within the Scottish public health context. Our assessment framework allows the recognition of key mechanisms to support how Scotland's Public Health body can enhance the implementation of complexity approaches. The appraisal framework could be used to study early-stage policy implementation in other contexts.