Introduction to the Special Section: Networks and Health Care Outcomes

Social scientists have long recognized the value of social networks, i.e., ties between individuals, organizations, or groups, for influencing a variety of outcomes, including health [1]. In the late 1960s, Coleman, Katz, and Menzel’s book, Medical Innovation, brought attention to interpersonal connections as potential pathways for information spread between healthcare professionals with a landmark study of physician adoption of a prescription drug. That book not only underscored the possibility of interpersonal influence at the time but also has yielded decades of subsequent consideration by scholars, as evidenced by numerous efforts to reanalyze the original study data, e.g., Burt [2], Strang and Tuma [3], Valente [4], van den Bulte and Lilien [5], and Ratna et al. [6]. Seminal work by Berkman and Syme [7–9] and Seeman [10] demonstrated that social isolation—or the lack of social network ties—poses a significant risk for mortality, independent of socioeconomic status and health behaviors (smoking, alcohol use, obesity, and level of physical activity). Mark Granovetter’s classic article, “The Strength of Weak Ties” (1973) which proposed the value of weaker ties between individuals for diffusing information since weaker ties allow for the transmission of information to individuals who may not otherwise be connected. In other words, more people can be reached through weaker, than stronger, ties. More recently, work by Christakis and Fowler [11] in 2007, which examined the spread of obesity through a social network, sparked a renewed interest among health researchers and behavioral scientists in network effects

Provider response and follow-up to parental declination of HPV vaccination

Objective: Parents often decline HPV vaccination, but little is known about how healthcare providers should promote vaccination at a later visit for secondary acceptance. We examined the associations of two factors, providers’ response to declination during the visit and follow-up after the visit, with secondary acceptance. Methods: We conducted a cross-sectional survey of US parents whose 9- to 17-year-old child had not yet completed the HPV vaccination series. Parents who declined HPV vaccination during an initial discussion with a provider (n = 447) reported whether their provider engaged in any active response during the visit (e.g., giving information, trying to change their mind) or any follow-up after the visit (e.g., scheduling another visit). We conducted multivariable logistic regression to determine whether an active response or follow-up was associated with secondary acceptance of HPV vaccination. Results: Only about one-third of parents reported an active response during the visit (35%) or follow-up after the visit (39%) following HPV vaccination declination. Parents had higher odds of secondary acceptance of HPV vaccine if they received any provider follow-up after the visit (43% vs. 20%, aOR:3.19; 95% CI:2.00:5.07). Receipt of an active provider response was not associated with secondary acceptance. More parents thought a provider should actively respond and follow-up (61% and 68% respectively), compared with those who received such a response (both p <.01). Conclusions: Providers’ follow-up after the visit may be important for promoting secondary acceptance of HPV vaccination. Parents who decline HPV vaccination often prefer to receive an active response or follow-up from a provider

Interpersonal communication as an indirect pathway for the effect of antismoking media content on smoking cessation

In the context of health campaigns, interpersonal communication can serve at least 2 functions: (a) to stimulate change through social interaction and (b) in a secondary diffusion process, to further disseminate message content. In a 3-wave prospective study of 1,079 smokers, the authors demonstrate that mass media messages (antismoking campaigns and news coverage relevant to smoking cessation) have an indirect effect on smoking cessation intention and behavior via interpersonal communication. Exposure to campaigns and news coverage prompts discussion about the campaigns, and, in turn, about smoking cessation. Interpersonal communication regarding smoking cessation then influences intention to quit smoking and attempts to quit smoking. The study finds evidence not only for the social interaction function of interpersonal communication, but also for the secondary diffusion function. A substantial number of smokers who are not directly exposed to the antismoking campaigns are nevertheless indirectly exposed via communication with people who have seen these campaigns. These results imply that encouragement of interpersonal communication can be an important campaign objective