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Purpose Mental health research has powerfully documented inequities related to characteristics, such as ethnicity and gender. Yet how and where disparities like unmet need occur have been more elusive. Drawing from a now modest body of research that deployed the Network Episode Model (NEM), we examine how individuals create patterns of response to mental health problems, influenced by the culture and resources embedded in their social networks. Methods The Person-to-Person Health Interview Study (P2P; N ~ 2,700, 2018–2021) provides representative, community-based, NEM-tailored data. Both descriptive, latent class and multinomial regression analyses mark mental health care-seeking patterns, including individuals consulted and activities used, as well as the influence of the structure and cultural content of social networks. Results Latent class analysis detected five pathways with good fit statistics. The Networked General Care Path (37.0%) and The Kin General Care Path (14.5%) differ only in whether friends are activated in using the general care sector. The Networked Multi-Sector Care Path (32.5%) and The Saturated Path (12.6%) involve family, friends, and both general and specialty care with only the latter expanding consultation to coworkers and clergy. The Null Path (3.3%), or no contacts, is not used as perceived problem severity increases. Network size and strength are associated with the more complex pathways that activate ties, respectively. Trust in doctors is associated with pathways that include specialty providers but not others at work or church. Race, age, and rural residence have specific pathway effects, while gender has no significant impact. Conclusions Social networks propel individuals with mental health problems into action. Tie strength and trust produce care responses that are fuller and more targeted. Considering the nature of homophily, results also suggest that majority status and college education are clearly implicated in networked pathways. Overall, findings support community-targeted rather than individually based efforts to increase service use.

Purpose The persistent gap between population indicators of poor mental health and the uptake of services raises questions about similarities and differences between social and medical/psychiatric constructions. Rarely do studies have assessments from different perspectives to examine whether and how lay individuals and professionals diverge. Methods Data from the Person-to-Person Health Interview Study (P2P), a representative U.S. state sample (N ~ 2700) are used to examine the overlap and correlates of three diverse perspectives—self-reported mental health, a self/other problem recognition, and the CAT-MH™ a validated, computer adaptive test for psychopathology screening. Descriptive and multinominal logit analyses compare the presence of mental health problems across stakeholders and their association with respondents’ sociodemographic characteristics. Results Analyses reveal a set of socially constructed patterns. Two convergent patterns indicate whether there is (6.9%, The “Sick”) or is not (64.6%, The “Well”) a problem. The “Unmet Needers” (8.7%) indicates that neither respondents nor those around them recognize a problem identified by the screener. Two patterns indicate clinical need where either respondents (The “Self Deniers”, 2.9%) or others (The “Network Deniers”, 6.0%) do not. Patterns where the diagnostic indicator does not suggest a problem include The “Worried Well” (4.9%) where only the respondent does, The “Network Coerced” (4.6%) where only others do, and The “Prodromal” (1.4%) where both self and others do. Education, gender, race, and age are associated with social constructions of mental health problems. Conclusions The implications of these results hold the potential to improve our understanding of unmet need, mental health literacy, stigma, and treatment resistance.

We examined the association of HIV prevention advocacy with social network members (alters) on alter condom use behavior, and factors that may mediate and moderate this relationship, among people living with HIV (PLWH) in Uganda. Ninety PLWH completed all assessments (baseline and 5- and 8-month follow-ups). Internalized HIV stigma, HIV disclosure self-efficacy, positive living behavior (i.e., condom use), and advocacy self-efficacy were examined as mediators (at 5-month follow-up) of the association between condom use advocacy and perceived alter condom use. Individual socio-demographic and social network characteristics at baseline were examined as moderators. Among alters who received condom use advocacy in the months prior to both baseline and 5-month follow-up, 69.9% (51/73) were perceived to mostly/always use condoms at either the 5- or 8-month follow-up, which was significantly higher than the 36.4% (235/645) of alters who received none or less advocacy. Participants’ internalized HIV stigma and consistent condom use mediated the association of advocacy and perceived consistent condom use among alters; the participant having any secondary education and the alter being male were associated with increased magnitude of the associations between advocacy and alter condom use. These findings highlight the importance of sustained advocacy to promote consistent condom use, and the value of anti-stigma and positive living interventions as mechanisms for enhancing effective advocacy.

HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels.

BACKGROUND: Social support reciprocity (the extent to which people exchange mutual support) is associated with long-term health. METHODS: We examined whether overall social support and reciprocity of support between people living with HIV and their treatment partners (informal caregivers selected from patients’ social networks to support adherence) is associated with HIV viral suppression. A total of 130 patients living with HIV and their treatment partners were recruited from a clinic in Gaborone, Botswana from May 2016 to April 2017. Participants completed surveys assessing socio-demographic and social network characteristics. Patients and treatment partners rated their emotional closeness to each other (not at all close=0, somewhat close=1, very close=2). RESULTS: Multivariable logistic regressions indicated a significantly higher likelihood of viral suppression among patients who reported greater average emotional closeness to social network members. The likelihood of viral suppression was lower in asymmetric relationships in which patients felt closer to treatment partners than treatment partners felt to them (compared to when treatment partners felt closer to patients); this negative effect was strongest in dyads with female treatment partners and male patients. Follow-up analyses additionally indicated that asymmetric relationships in which treatment partners felt closer to patients were as protective as symmetric relationships, in which patients and treatment partners felt equally close. CONCLUSIONS: Perceptions around reciprocity may matter as much as overall relationship closeness in patients’ health outcomes. Interventions to improve the support of informal caregivers could help to improve relationship quality and health outcomes among people with HIV.

Black and Latina women are disproportionately impacted by HIV/AIDS. Despite existing research linking social networks and HIV risk among men who have sex with men (MSM) and other high-risk populations, little research has examined how ethnic/racial minority women's social networks shape HIV prevention and intervention targets. Using interviews with a sample of 165 predominantly Black and Latina-identifying women from a small city in the Western U.S., this research examines the relationship between egocentric network characteristics and HIV knowledge, attitudes, and testing history. Results reveal that network characteristics play a significant role in shaping HIV-related knowledge, prejudice, and testing intention but not HIV testing history. Individual-level factors like homelessness and perceptions of testing barriers are more salient for explaining testing behaviors than network characteristics. Intervention efforts to improve knowledge and reduce prejudice among Black and Latina women may benefit from mobilizing network ties.

Objective Despite the efficacy of pre-exposure prophylaxis (PrEP) in reducing risk of HIV infection, uptake remains low among many who are most vulnerable to HIV, such as Black and Latinx women. Interventions that target social networks to encourage at-risk women to initiate PrEP are underutilized. Design This study employed an egocentric network design and sampled Black/African-American (BAA) and Latinx women at risk of HIV as well as people from their social networks (N=211) in a small, western city. Methods Multivariable Generalized Linear Mixed Effects Models (GLMM) regression models investigated individual-level and network-level characteristics associated with likely future PrEP use. Results PrEP awareness was low, but once informed, 36% considered themselves likely to take it in the future. Perceived risk of HIV, perceived barriers to HIV testing, and participation in a 12-step program increased odds of anticipated PrEP use. A higher proportion of friends in one's network decreased odds of future PrEP use, while a higher proportion of network members who tested regularly for HIV increased odds of future PrEP use. A marginally significant interaction was detected between proportion of friends in one's network and proportion of the network perceived to test for HIV regularly (i.e. testing norms). When HIV testing norms were low, a higher proportion of friends in the network decreased odds of likely PrEP use. However, this effect was reversed in contexts with strong testing norms. Conclusion Women who are interested in PrEP may be embedded within social and normative contexts that can foster or inhibit PrEP uptake.

This community-based study explored the lived experiences of being in and going through the rural HIV care continuum among 15 gay and bisexual men (GBM) with HIV who live in a rural area of a Midwe...

Pre-Exposure Prophylaxis (PrEP) health campaigns invite women to talk with their provider, partner, and peers about PrEP, though they do not offer specific guidance about who and how to engage. This study uses egocentric network methods in a sample of women at risk for HIV to understand what characteristics of women (egos), their networks, and network members (alters) were associated with anticipated PrEP advice-seeking and anticipated PrEP disclosure. Multivariable generalized linear mixed models revealed that women often consider close, supportive, and trusted network members as PrEP discussants while ego-level, network-level, and cross-level interactions depict the complexity of anticipated network activation. Findings highlight the importance of considering women at risk for HIV in a broader social context. Anticipated advice-seeking and disclosure related to PrEP were associated but distinct forms of network activation, which highlights the need to develop specific recommendations about who and how women should engage with their networks around PrEP.

Introduction Increased alcohol use coinciding with onset of the COVID-19 pandemic, particularly among women, has been documented among U.S. adults. This study examines trajectories of alcohol use and alcohol problems over a 9-month period during the pandemic, the extent to which these trajectories are predicted by social stress and drinking motives, and whether results differ for women and men. Methods Data come from three online surveys of a nationally representative sample of U.S. adults ages 30–80 conducted in May-July 2020, October-November 2020, and March 2021. The analytic sample consists of N = 1118 who initially reported any past year alcohol use. The early-COVID survey assessed demographics, social stressors, and drinking motives. All three surveys assessed average drinks per day in past month and drinking-related problems. Results Alcohol use declined for men, but remained stable for women. Alcohol problems increased for both sexes, especially for men. Level of alcohol use was associated with loneliness and social demands for men, and drinking motives for both sexes, with changes in use related to loneliness and social demands for men. Level of alcohol problems was associated with loneliness for women and drinking motives for both sexes, with changes in problems related to drinking motives for women. Interactions of social stress with drinking motives were not found. Conclusions Sex differences in alcohol use and alcohol problems during the pandemic—as well as their associations with indicators of social stress and drinking motives—highlight the importance of tailoring prevention and treatment efforts for men and women.

We evaluated the effects of a culturally adapted evidence-based HIV prevention intervention (Mpowerment), named “Tayf”, on condom use and HIV testing among young men who have sex with men (YMSM) in Beirut. A 2-year implementation of Tayf was carried out independently and in parallel with a research cohort of 226 YMSM who were surveyed at baseline and months 6, 12, 18 and 24 after Tayf initiation. Primary outcomes were (1) any condomless anal sex with HIV-positive or unknown status partners in the past 3 months, and (2) HIV testing in the past six months. Hierarchical logistic regression models examined the association of Tayf participation with the outcomes averaged across all assessments, and the moderating effect of Tayf participation on change in the outcomes over the follow-up period. A total of 331 YMSM attended at least one event, including 33% of the cohort. Tayf participation was associated with a higher rate of any condomless sex with HIV-positive or unknown status partners averaged across the five assessments, but there was no moderating effect of Tayf participation on change in this outcome over time. Tayf participation was associated with higher HIV testing when averaged across all assessments, but its interaction with time showed that the strength of this association diminished over time. In conclusion, Tayf proved feasible and acceptable in Beirut, but with limited effects. Further work is needed, including innovative publicity and marketing strategies, to bolster effects in high stigma settings where security and legal risks are prominent.

Background While considerable research on adult binge drinking has focused on social influences, the potential role of social capital has been largely overlooked. This study examines the role of social capital, assessed in terms of both neighborhood and social network characteristics, in understanding adult binge drinking. Methods Adults ages 30–80 were randomly drawn from the RAND American Life Panel and completed an online survey (analytic sample n = 1383). The main predictor variables were neighborhood cohesion, neighborhood order, and social network density. Associations of social capital with past month binge drinking (any, number of days) were examined, controlling for demographic characteristics. Results Zero-inflated negative binominal regression analysis indicated that any binge drinking was more likely among adults who lived in highly ordered neighborhoods and who had denser social networks but was negatively associated with neighborhood cohesion. However, binge drinking was more frequent among those who lived in neighborhoods lacking order and who had sparser social networks, but had no association with neighborhood cohesion. Age was not found to moderate associations of social capital with binge drinking. Conclusions Given that the associations of social capital with adult binge drinking behavior appear to differ by level of influence and type of drinking behavior, there is a need to gain a more nuanced understanding of these complex associations, including the mechanisms through which they operate.

OBJECTIVE. Trends show increased substance use among adults, yet little research on general population samples has examined differential patterns of licit and illicit substance use that can inform prevention and treatment efforts. This study identifies distinct patterns (classes) of substance use among 30-80 year olds, identifies demographic subgroups with the highest probability of class memberships, and compares classes on key indicators of functioning. METHOD. Participants (n=1,877) were from the RAND American Life Panel. Online survey measures included current alcohol, tobacco, cannabis, and nonmedical prescription drug use, as well as mental, physical and social functioning. RESULTS. Latent class analysis identified four classes: ‘Lighter Drinking’ (46.6%), ‘Abstaining’ (33.7%), ‘Heavy Drinking with Cigarette/Cannabis Use’ (17.1%), and ‘Cigarette Smoking with Prescription Drug/Cannabis Use (2.6%). Of these classes, ‘Cigarette Smoking with Prescription Drug/Cannabis Use’ reported the worst mental and physical functioning, and greater loneliness than the ‘Lighter Drinking’ class. ‘Heavy Drinking with Cigarette/Cannabis Use’ reported worse mental and physical functioning than the ‘Lighter Drinking’ class and less social support than the ‘Lighter Drinking’ and ‘Abstaining’ classes. The ‘Abstaining’ class reported consistently worse functioning than the ‘Lighter Drinking’ class. Both polysubstance use classes were associated with younger age, less education, and lower income, and heavy drinking polysubstance use was associated with being male and unmarried. CONCLUSIONS. Although lighter drinking was the most common pattern, 20% of adults were classified into two polysubstance use classes associated with poorer functioning. Targeted efforts may be needed to reach certain subgroups of adults who are particularly susceptible to polysubstance use.

This survey study examines individual-level changes in alcohol use in US adults and associated negative consequences, from before to during the coronavirus disease 2019 (COVID-19) pandemic.

We conducted a pilot randomized controlled trial of Game Changers, a 6-session group intervention that empowers people with HIV to be HIV prevention advocates in their social networks. Ninety-nine people with HIV (51 intervention, 48 wait-list control) and 58 of their social network members (alters) completed baseline and 5- and 8-month post-baseline assessments. Results indicated high acceptability, demonstrated by participants’ and facilitators’ positive attitudes qualitatively and favorable ratings of intervention sessions quantitatively, and high feasibility (76% attended all intervention sessions). Intention-to-treat analyses indicated significantly increased HIV prevention advocacy among HIV-positive participants and alters [b (SE) = 0.4 (0.2), p = .017; b (SE) = 0.4 (0.2), p = .035]; reduced internalized HIV stigma [b (SE) = − 0.3 (0.1), p = .012], increased HIV-serostatus disclosure [b (SE) = 0.1 (0.1), p = .051], and increased social network density among HIV-positive participants [b (SE) = 0.1 (0.03), p = .004]; and marginally reduced condomless sex among alters [OR (95% CI) = 0.3 (0.1–1.2), p = .08]. Positioning people with HIV as central to prevention has the potential to reduce stigma and improve prevention outcomes throughout social networks.

OBJECTIVE: To understand the process of practice transformation by identifying pathways for attaining patient‐centered medical home (PCMH) recognition. DATA SOURCES/STUDY SETTING: The CMS Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration was designed to help FQHCs achieve NCQA Level 3 PCMH recognition and improve patient outcomes. We used a stratified random sample of 20 (out of 503) participating sites for this analysis. STUDY DESIGN: We developed a conceptual model of structural, cultural, and implementation factors affecting PCMH transformation based on literature and initial qualitative interview themes. We then used conventional cross‐case analysis, followed by qualitative comparative analysis (QCA), a cross‐case method based on Boolean logic algorithms, to systematically identify pathways (i.e., combinations of factors) associated with attaining—or not attaining—Level 3 recognition. DATA COLLECTION METHODS: Site‐level indicators were derived from semistructured interviews with site leaders at two points in time (mid‐ and late‐implementation) and administrative data collected prior to and during the demonstration period. PRINCIPAL FINDINGS: The QCA results identified five distinct pathways to attaining PCMH recognition and four distinct pathways to not attaining recognition by the end of the demonstration. Across these pathways, one condition (change leader capacity) was common to all pathways for attaining recognition, and another (previous improvement or recognition experience) was absent in all pathways for not attaining recognition. In general, sites could compensate for deficiencies in one factor with capacity in others, but they needed a threshold of strengths in cultural and implementation factors to attain PCMH recognition. CONCLUSIONS: Future efforts at primary care transformation should take into account multiple pathways sites may pursue. Sites should be assessed on key cultural and implementation factors, in addition to structural components, in order to differentiate interventions and technical assistance.

RAND researchers assess the Appalachia Partnership Initiative (API)'s progress toward its vision and goals in improving science, technology, engineering, and mathematics education for grades K–12; energy and advanced manufacturing workforce development; and community building from 2014 through 2019. It is the final report in a multi-report series.

We assessed how egocentric (i.e., self-generated descriptions of a person's social contacts) network structure and composition corresponded with reported instances of condomless receptive and insertive anal intercourse with men who were reportedly HIV-infected or of unknown HIV serostatus in a sample of black men who have sex with men (MSM) in six U.S. cities. Ratings showing a higher percentage of network members who provided social participation and medical support were positively associated with reporting condomless sex. There were also significant positive associations between stimulant use and condomless insertive and receptive anal sex. Future research should examine the social processes that underlie these associations and explore ways that social support can affect HIV prevention efforts for black MSM.

Rationale African Americans living with HIV are less likely to adhere to antiretroviral treatment (ART) compared to other racial/ethnic groups. Medical mistrust is thought to be a factor in this disparity. Objective: We examined (1) whether exposure to HIV conspiracy beliefs, a specific type of HIV-related mistrust (about the origins and treatment of HIV) in social networks is associated with ART nonadherence among African Americans living with HIV; and (2) the characteristics of individuals who discuss HIV-related mistrust in the social networks of African Americans living with HIV. Methods: At baseline and 6- and 12-months post-baseline, 175 African Americans living with HIV on ART completed egocentric social network assessments, from which we assessed the structure and composition of their personal networks (the social context immediately surrounding them). HIV-related mistrust was operationalized with an indicator of whether any social network member had expressed HIV conspiracy beliefs to the participant. Daily medication adherence was monitored electronically. Results: At baseline, 63% of participants agreed with at least one conspiracy belief, and 55% reported hearing at least one social network member (“alter”) express conspiracy beliefs. In a multivariate linear repeated measures regression, expression of conspiracy beliefs by similar others in the network (in terms of age, gender, HIV status, sexual orientation, and race/ethnicity) was associated with ART nonadherence (i.e., percentage of prescribed doses taken). In a multivariate logistic regression, expression of conspiracy beliefs was more likely among social network members who were HIV-positive, who knew the participants’ serostatus, and with whom participants interacted frequently, and less likely among more well-connected social network members. Conclusion: HIV-related mistrust in the network may be most influential when expressed by similar others who may be HIV-positive themselves.

In 2012, our research with young men who have sex with men (YMSM) in Beirut showed high rates of recent condomless anal sex and low rates of recent HIV testing. In 2017, we collected data from YMSM to assess for temporal changes and sociodemographic correlates. Propensity score weighting was used to eliminate any sociodemographic differences between the 2012 (n = 164) and 2017 (n = 226) samples of YMSM (age 18–29) recruited with long-chain peer referral sampling. Regression analysis was used to examine sociodemographic correlates of recent condomless anal sex and HIV testing using the 2017 sample, and whether these behaviors differed between the samples. Compared to the 2012 sample, the 2017 sample was about half as likely to report any condomless anal sex in the past 3 months with partners whose HIV status was positive or unknown (14% vs. 23%; OR [95%CI] 0.56 [0.32, 0.98]), and nearly 2.5 times as likely to report HIV testing in the past 6 months (48% vs. 27%; OR [95%CI] 2.44 [1.46, 4.10]). In the 2017 sample, any recent condomless anal sex with partners whose HIV status was positive or unknown was associated with employment and Christian religious affiliation. Low income was the sole correlate of having recently tested for HIV. These findings suggest a temporal trend toward increased HIV protective behaviors among YMSM in Beirut over the past 5 years. Further inroads could be secured if HIV prevention programming targeted economic influences.

This study sought to examine whether: (1) the health composition of the social networks of children living in subsidized housing within market rate developments (among higher-income neighbors) differs from the social network composition of children living in public housing developments (among lower-income neighbors); and (2) children’s social network composition is associated with children’s own health. We found no significant differences in the health characteristics of the social networks of children living in these different types of public housing. However, social network composition was significantly associated with several aspects of children’s own health, suggesting the potential importance of social networks for the health of vulnerable populations.

Objectives. In a survey of families living in public housing, we investigated whether caretakers’ social networks are linked with children’s health status. Methods. In 2011, 209 children and their caretakers living in public housing in suburban Montgomery County, Maryland, were surveyed regarding their health and social networks. We used logistic regression models to examine the associations between the perceived health composition of caretaker social networks and corresponding child health characteristics (e.g., exercise, diet). Results. With each 10% increase in the proportion of the caretaker’s social network that exercised regularly, the child’s odds of exercising increased by 34% (adjusted odds ratio = 1.34; 95% confidence interval = 1.07, 1.69) after the caretaker’s own exercise behavior and the composition of the child’s peer network had been taken into account. Although children’s overweight or obese status was associated with caretakers’ social networks, the results were no longer significant after adjustment for caretakers’ own weight status. Conclusions. We found that caretaker social networks are independently associated with certain aspects of child health, suggesting the importance of the broader social environment for low-income children’s health.

Stigma may contribute to HIV-related disparities among HIV-positive Black Americans.We examined whether social network characteristics moderate stigma's effects.At baseline and 6 months post-baseline, 147 HIV-positive Black Americans on antiretroviral treatment completed egocentric social network assessments, from which we derived a structural social support capacity measure (i.e., ability to leverage support from the network, represented by the average interaction frequency between the participant and each alter). Stigma was operationalized with an indicator of whether any social network member had expressed stigmatizing attributions of blame or responsibility about HIV. Daily medication adherence was monitored electronically.In a multivariate regression, baseline stigma was significantly related to decreased adherence over time. The association between stigma and non-adherence was attenuated among participants who increased the frequency of their interactions with alters over time.Well-connected social networks have the potential to buffer the effects of stigma.

We examined how functional social support, HIV-related discrimination, internalized HIV stigma, and social network structure and composition were cross-sectionally associated with network members’ knowledge of respondents’ serostatus among 244 HIV-positive African Americans in Los Angeles. Results of a generalized hierarchical linear model indicated people in respondents’ networks who were highly trusted, well-known to others (high degree centrality), HIV-positive, or sex partners were more likely to know respondents’ HIV serostatus; African American network members were less likely to know respondents’ serostatus, as were drug-using partners. Greater internalized stigma among respondents living with HIV was associated with less knowledge of their seropositivity within their social network whereas greater respondent-level HIV discrimination was associated with more knowledge of seropositivity within the network. Additional research is needed to understand the causal mechanisms and mediating processes associated with serostatus disclosure as well as the long-term consequences of disclosure and network members’ knowledge of respondents’ serostatus.

Objective Many national HIV guidelines recommend that health care providers encourage patients to identify a treatment partner from their social network to support antiretroviral therapy adherence. This study examined associations of patient and treatment partner characteristics with patient viral suppression in Botswana. Design One hundred thirty-one patients [67 (51.1%) virally suppressed and 64 (48.9%) not suppressed] and their treatment partners were recruited for cross-sectional interviews from one HIV clinic. Methods Participants completed surveys assessing social network, sociodemographic, and psychosocial characteristics. Open-ended questions explored treatment partner relationship quality. Results Multivariate logistic regressions indicated a higher likelihood of viral suppression among patients who reported greater average emotional closeness to their network members [odds ratio (95% confidence interval) = 3.8 (1.3 to 11.5), P = 0.02] and whose treatment partners were spouses/partners [odds ratio (95% confidence interval) = 2.6 (1.0 to 6.7), P = 0.04]. Qualitative analyses indicated that treatment partners of suppressed patients provided both medical and nonmedical support, whereas treatment partners of unsuppressed patients focused mainly on adherence reminders and appointment accompaniment. Treatment partners, especially of unsuppressed patients, requested ongoing training and counseling skills. Conclusions Additional research is needed to further explore effective characteristics of treatment partners to inform HIV treatment guidelines. Standard training for treatment partners could include medical-related information and counseling education.

Marriages and other intimate partnerships are facilitated or constrained by the social networks within which they are embedded. To date, methods used to assess the social networks of couples have been limited to global ratings of social network characteristics or network data collected from each partner separately. In the current article, the authors offer new tools for expanding on the existing literature by describing methods of collecting and analyzing duocentric social networks, that is, the combined social networks of couples. They provide an overview of the key considerations for measuring duocentric networks, such as how and why to combine separate network interviews with partners into one shared duocentric network, the number of network members to assess, and the implications of different network operationalizations. They illustrate these considerations with analyses of social network data collected from 57 low-income married couples, presenting visualizations and quantitative measures of network composition and structure.

Bullying and homophobic teasing behaviors affect the lives of many school aged children, often co-occur, and tend to peak in middle school. While bullying and homophobic teasing behaviors are known to be peer group phenomena, studies typically examine the associations at the individual or school levels. An examination of these behaviors at the peer group level can aid in our understanding of the formation and maintenance of peer groups that engage in these forms of aggressive behavior (selection), and the extent to which friends and the peer group impact individual rates of these aggressive behaviors (influence). In this longitudinal study, we assess the co-evolution of friendship networks, bullying perpetration, and homophobic teasing among middle school students (n = 190) using a Stochastic Actor-Based Model (SABM) for longitudinal networks. Data were collected from 6–8th-grade students (Baseline age 12–15; 53% Female; 47% Male) across three waves of data. The sample was diverse with 58% African American, 31% White, and 11% Hispanic. Since bullying and homophobic teasing behaviors are related yet distinct forms of peer aggression, to capture the unique and combined effects of these behaviors we ran models separately and then together in a competing model. Results indicated that on average individuals with higher rates of bullying perpetration and homophobic teasing were associated with becoming increasingly popular as a friend. However, the effects were not linear, and individuals with the highest rates of bullying perpetration and homophobic teasing were less likely to receive friendship nominations. There was no evidence that bullying perpetration or homophobic teasing were associated with the number of friendship nominations made. Further, there was a preference for individuals to form or maintain friendships with peers who engaged in similar rates of homophobic name-calling; however, this effect was not found for bullying perpetration. Additionally, changes in individual rates of bullying perpetration were not found to be predicted by the bullying perpetration of their friends; however, changes in adolescent homophobic teasing were predicted by the homophobic teasing behaviors of their friends. In a competing model that combined bullying perpetration and homophobic teasing, we found no evidence that these behaviors were associated with popularity. These findings are likely due to the high association between bullying perpetration and homophobic teasing combined with the small sample size. However, friendship selection was based on homophobic name-calling, such that, there was a preference to befriend individuals with similar rates of homophobic teasing. We also examined several risk factors (dominance, traditional masculinity, impulsivity, femininity, positive attitudes of bullying, and neighborhood violence), although, impulsivity was the only covariate that was associated with higher levels of bullying perpetration and homophobic teasing. More specifically, youth with higher rates of impulsivity engaged in higher rates of bullying perpetration and homophobic teasing over time. The findings suggest bullying perpetration and homophobic teasing have important influences on friendship formation, and close friendships influence youth’s engagement in homophobic teasing. Implications for prevention and intervention efforts are discussed in terms of targeting peer groups and popular peers to help reduce rates of these aggressive behaviors.

Religious congregations can potentially reach disproportionately affected populations with HIV programming, however, factors that influence congregational involvement in HIV are not well-studied. Utilizing comparative case methods and in-depth qualitative data from a diverse sample of 14 urban congregations, we examine a range of attitudinal, organizational, resource, and demographic factors to systematically identify different case scenarios—i.e., combinations of characteristics—associated with the level and types of HIV activities in which the congregational cases tended to be involved. For example, White or mixed race congregations with active gay constituencies and an African-American congregation with a strong lay HIV champion were among the high HIV involvement case scenarios, compared to African-American congregations with a health emphasis but no lay HIV champion among the medium HIV involvement scenarios, and fundamentalist African-American and Latino congregations among the low HIV involvement scenarios. Two key factors that appeared influential across case scenarios included the existence of lay champions for HIV activities and the general theological orientation of the congregation.

Adolescents often befriend peers who are similar to themselves on a range of demographic, behavioral, and social characteristics, including substance use. Similarities in lifetime history of marijuana use have even been found to predict adolescent friendships, and we examine whether this finding is explained by youth’s selection of friends who are similar on a range of more proximate, observable characteristics that are risk factors for marijuana use. Using two waves of individual and social network data from two high schools that participated in Add Health (N = 1,612; 52.7% male), we apply longitudinal models for social networks to test whether or not several observable risky attributes (psychological, behavioral, and social) predict adolescent friendship choices, and if these preferences explain friend’s similarities on lifetime marijuana use. Findings show that similarities on several risk factors predict friendship choices, however controlling for this, the preference to befriend peers with a similar history of marijuana use largely persists. The results highlight the range of social selection processes that lead to similarities in marijuana use among friends and larger peer groups, and that also give rise to friendship groups whose members share similar risk factors for substance use. Friends with high “collective risk” are likely to be important targets for preventing the onset and social diffusion of substance use in adolescents.

Background With marijuana use increasing among American adolescents, better understanding of the factors associated with decreasing use and quitting can help inform cessation efforts. This study evaluates a range of neighborhood, family, peer network, and individual factors as predictors of marijuana use, change, and non-use over one year, and cessation over six years. Methods Data come from adolescents in Waves I and II of the National Longitudinal Study of Adolescent Health (N = 458, one-year sample), or Waves I and III (N = 358, six-year sample), and reported using marijuana at least four times in the past month at Wave I. Results Eighteen percent of adolescents stopped using marijuana after six years. Results suggest neighborhood context affects overall use level, whereas neighborhood context and friends were critical to cessation vs. continuation of use. Decrease in use were more likely among adolescents in disadvantaged or less cohesive neighborhoods, or who moved between waves. Non-use after one year was more likely among adolescents who did not move, had fewer marijuana-using friends, and did not exclusively have outside-of-school friends. Cessation at six years was more likely among adolescents in less disadvantaged and more cohesive neighborhoods, and for those with within-school friends. Conclusions Results highlight the importance of both objective and subjective neighborhood characteristics, as well as peer networks, on adolescent marijuana use. Factors associated with decreases in use appear distinct from those that predict quitting, suggesting that continuation vs. cessation is linked to peers as well as neighborhood context. Relocated and isolated individuals may face challenges with cessation.

This study capitalizes on a natural experiment in Montgomery County, Maryland, where low-income applicant families are randomly assigned to public housing that is either (a) clustered within seven public housing developments or (b) scattered into market-rate subdivisions via the county's inclusionary zoning policy. Through a survey of 453 public housing residents, we find that adults who lived in scattered public housing reported a lower proportion of low-socioeconomic status (SES) social ties generally and a lower proportion of low-SES neighbors specifically in their social networks. They also counted more high-SES individuals in their social networks, and this effect was related to the amount of time they lived in the neighborhood. Living in scattered public housing had no adverse effect on feelings of neighborhood belonging or satisfaction. The socioeconomic composition of respondents' social networks was associated with two health outcomes for respondents (smoking and depression) and modestly associat...

Objectives. We assessed whether 2 types of public housing—scattered among market-rate housing developments or clustered in small public housing projects—were associated with the perceived health and health behaviors of residents’ social networks. Methods. Leveraging a natural experiment in Montgomery County, Maryland, in which residents were randomly assigned to different types of public housing, we surveyed 453 heads of household in 2011. We asked residents about their own health as well as the perceived health of their network members, including their neighbors. Results. Residents in scattered-site public housing perceived that their neighbors were more likely to exercise than residents of clustered public housing (24.7% of network members vs 14.0%; P Conclusions. Different types of public housing have a modest impact on the health composition of one’s social network, suggesting the importance of housing policy for health.

In personal network studies, respondents (egos) are asked to report information about members of their personal network (alters); egos respond based on their perceptions. Previous studies of informant accuracy present a varied picture: Some find egos’ reporting on their relationships with alters to be accurate; others do not. In our study of people living with HIV/AIDS in Uganda, egos were asked to invite up to four alters named during their interview to answer questions about their relationship with ego. Using Gower’s general coefficient of similarity, we calculated a measure of accuracy both by variable and by alter. Our analysis by variable tends to confirm informant accuracy research, while our analysis by alter adds to the literature by identifying how accurate a particular ego is when discussing an alter and what characteristics might be associated with accuracy or inaccuracy.

AIMS: To identify characteristics of social network members with whom homeless youth engage in drinking and drug use. DESIGN: A multi-stage probability sample of homeless youth completed a social network survey. SETTING: Forty-one shelters, drop-in centers and known street hangouts in Los Angeles County. PARTICIPANTS: A total of 419 homeless youth, aged 13-24 years (mean age = 20.09, standard deviation = 2.80). MEASUREMENTS: Respondents described 20 individuals in their networks, including their substance use and demographics, and the characteristics of the relationships they shared, including with whom they drank and used drugs. Dyadic, multi-level regressions identified predictors of shared substance use. FINDINGS: Shared drinking was more likely to occur with recent sex partners [odds ratio (OR) = 2.64, confidence interval (CI): 1.67, 4.18], drug users (OR = 4.57, CI: 3.21, 6.49), sexual risk takers (OR = 1.71, CI: 1.25, 2.33), opinion leaders (OR = 1.69, CI: 1.42, 2.00), support providers (OR = 1.41, CI: 1.03, 1.93) and popular people (those with high degree scores in the network) (OR = 1.07, CI: 1.01, 1.14). Shared drug use was more likely to occur with recent sex partners (OR = 2.44, CI: 1.57, 3.80), drinkers (OR = 4.53, CI: 3.05, 6.74), sexual risk takers (OR = 1.51, CI: 1.06, 2.17), opinion leaders (OR = 1.24, CI: 1.03, 1.50), support providers (OR = 1.83, CI: 1.29, 2.60) and popular people (OR = 1.16, CI: 1.08, 1.24). CONCLUSIONS: Homeless youth in the United States are more likely to drink or use drugs with those who engage in multiple risk behaviors and who occupy influential social roles (popular, opinion leaders, support providers, sex partners). Understanding these social networks may be helpful in designing interventions to combat substance misuse. Language: en

This paper investigated how depressive symptoms moderate the role of peer cannabis use on developmental patterns of individual cannabis use from adolescence to young adulthood, controlling for a broad set of individual and family factors. Data from two sources were analyzed separately: two saturated schools in the National Longitudinal Study of Adolescent to Adult Health Waves I–III (N = 1550) covering 1994–2001; and three schools in the CARBIN study, covering 2012–2014. Discrete mixture models identified developmental trajectories of cannabis use in each data source, and logit models linked network and depressive symptom information to the trajectories. Five similar cannabis use trajectories were identified in both datasets: Nonuse, Low, Moderate, Increasing, and High. Peer cannabis use at baseline predicted higher individual cannabis use trajectories, controlling for a wide range of factors. However, the association between peer cannabis use and higher levels of use (Moderate and High) attenuated as the adolescent's level of depressive symptoms increased. Although these results may suggest that depression dampers adolescents' susceptibility to peer influence, these results are also consistent with the notion that depressed adolescents withdraw from their peer groups, distancing them from the initial source of peer influence over time. The resulting isolation may place adolescents at higher risk of adverse outcomes.

Background This study examines whether residential neighborhood characteristics influence the initiation of marijuana use and binge drinking, and if these neighborhood factors heighten or dampen peer influences on substance use. Methods Predictors of marijuana ( N = 6516) and binge drinking ( N = 6630) initiation over a 1-year period were identified using data from the National Longitudinal Study of Adolescent Health. Participants were of ages 12–19 years at baseline. The main predictor variables were neighborhood characteristics, using both objective (proportion of households below the poverty line and female-headed, unemployment rate, residential stability) and subjective (perceived cohesion and safety) measures. Binge drinking was defined as 5 or more drinks in a row. Results Initiation occurred for 12.9% of adolescents in the case of marijuana and 16.4% for binge drinking. Marijuana initiation was more likely among adolescents who lived in neighborhoods with a higher unemployment rate, and binge drinking initiation was more likely among those who perceived greater safety in their neighborhood, after adjusting for other neighborhood characteristics, demographics, friend characteristics, and behavioral and family risk factors. There was no evidence that neighborhood context moderates the associations of peer factors on initiation. Conclusions Select neighborhood characteristics appear relevant to the initiation of marijuana use and binge drinking, although the mechanisms appear to be distinct for each substance. If these results are found to be robust, future research should aim to better understand how neighborhood context influences the initiation of adolescent substance use in order to inform prevention efforts.