1. Social Networks and Environmental Context in Health-Related Behaviors Gina S. Lovasi, PhD, MPH Columbia University

2. 2 Copyright restrictions may apply. Yates, L. B. et al. Arch Intern Med 2008;168:284-290. Probability of an additional 20-year survival for a 70-year-old man, according to the presence of modifiable adverse factors at baseline Behavior patterns predict longevity

3. 3 Individual-focused interventions are limited Many effective individual focused interventions are expensive Maintenance of behavior change is difficult to achieve Social networks and environments may present barriers to behavior change and maintenance of new behaviors Network-based or multi-level interventions may reach a broader audience and be effective over a longer time

4. 4 The Built Environment

5. 5 24 26 28 30 Body mass index 0200004000060000 Population density (residents per square km) high school $30,000/year Black raceHispanic ethnicity College educated, higher income, non-Hispanic whites

6. 6 24 26 28 30 Body mass index 0200004000060000 Population density (residents per square km) high school $30,000/year Black raceHispanic ethnicity College educated, higher income, non-Hispanic whites high school $30,000/year Black raceHispanic ethnicity College educated, higher income, non-Hispanic whites Hypothetical stronger association for disadvantaged groups ???????

7. 7 24 26 28 30 Body mass index 0200004000060000 Population density (residents per square km) high school $30,000/year Black raceHispanic ethnicity College educated, higher income, non-Hispanic whites p < 0.001

8. Static environment (e.g., current park access) Behavior (e.g., physical activity) Health outcome (e.g., blood pressure) a. Simplifying assumption that causal relationships are automatic and uniform has facilitated interpretation of cross-sectional studies Complexity and social context are recognized, requiring awareness of the role of human agency Blacksher, E., Lovasi, G.S., 2011. Place-focused physical activity research, human agency, and social justice in public health: Taking agency seriously in studies of the built environment. Health & Place.

9. Static environment (e.g., current park access) Dynamic environment to meet local needs Selection of activity spaces and behavior patterns Residents health and wellbeing Behavior (e.g., physical activity) Health outcome (e.g., blood pressure) Social connections and local capacity a. b. Simplifying assumption that causal relationships are automatic and uniform has facilitated interpretation of cross-sectional studies Engagement can activate local social networks Depending on process, environmental change can enhance local capacity Perceptions, barriers, and goals determine resource utilization Consequences of behavior extend beyond `health The environment to fit local needs will depend on behavior of residents Prior health status and achievement of other goals will affect behavior Complexity and social context are recognized, requiring awareness of the role of human agency Blacksher, E., Lovasi, G.S., 2011. Place-focused physical activity research, human agency, and social justice in public health: Taking agency seriously in studies of the built environment. Health & Place.

10. 10 Social Networks

11. 11 Social network studies are increasing Lovasi, G.S., adams, j., Bearman, P., In Handbook of Medical Sociology, Sixth Edition, Edited by Chloe E. Bird, et. al.Vanderbilt University Press, New York. 2010.

12. 12 a. Isolation vs connection b. Group identity, norms, or common constraints may characterize the network c. Transmission through a network of a pathogen or idea Connections can enable or transmit

13. 13 1975 Christakis NA, Fowler JH. Connected: The Surprising Power of Social Networks and How They Shape Our Lives.

14. 14 Christakis NA, Fowler JH. Connected: The Surprising Power of Social Networks and How They Shape Our Lives. 1990

15. 15 Juxtaposition of social and spatial distance Christakis, N.A., Fowler, J.H., 2008. The collective dynamics of smoking in a large social network. N Engl J Med 358, 2249-2258.

16. 16 Homophily and influence are challenging to disentangle People tend to be connected to similar people (homophily) Over time connected people may become similar (influence)

17. 17 Using social networks to support healthy behaviors Target dyads, families, groups, workplaces, neighborhoods

18. 18 Using social networks to support healthy behaviors Target dyads, families, groups, workplaces, neighborhoods Develop strategic partners within network

19. 19 Valente, T. W., & Davis, R. L. (1999). Accelerating the diffusion of innovations using opinion leaders. The Annals of the American Academy of the Political and Social Sciences, 566, 55-67. Sociogram based on tiesOptimal leader/learner matching 1(a) 1(b) Using Social Network Structure to Deploy an Intervention

20. 20 Using social networks to support healthy behaviors Target dyads, families, groups, workplaces, neighborhoods Develop strategic partners within network

21. 21 Using social networks to support healthy behaviors Target dyads, families, groups, workplaces, neighborhoods Develop strategic partners within network Foster local social connections and physical activity through built environment design

22. 22 Intersection Between Social and Built Environment

23. 23 Bringing together Social Networks and Built Environments Complementary types of resource supporting healthy behaviors Social Networks special issue on the intersection of social networks and spatial analysis Identification of influence vs homophily or selection adults with high BMI are move to sprawl, and also to where they have connections As an outcome that matters to a broader sense of wellbeing Social network protection/cultivation may compete with or complement health promotion

24. 24 Acknowledgements Funding from the National Institutes of Health (NIEHS, NIDDK, NHLBI), Environmental Protection Agency US Forest Service Robert Wood Johnson Foundation Active Living Research program Robert Wood Johnson Foundation Health & Society Scholars program Key collaborators in this work: Andrew Rundle, Kathryn Neckerman, Chris Weiss, Michael Bader, Julien Teitler, James Quinn, Malo Hutson, John Beard, Erika Blacksher, jimi adams and Peter Bearman

25. Thanks for your attention glovasi@columbia.edu Built Environment & Health Project www.beh.columbia.edu