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SOCIAL SUPPORT HEALTH NETWORKS
The classical theorists of industrialization and
modernization (Tönnies, Durkheim, Simmel) viewed
urban residents as suffering from debilitating
losses of community and intimacy compared to
rural villagers.
Emile Durkheims Suicide (1897) hypothesized that
either high or low levels of integration (ties to
social groups) and regulation (normative
constraints) could lead to four types of
self-murder fatalistic, egoistic, anomic,
altruistic. (Pescosolido Levy 20028)
In The Metropolis and Mental Life (1903), Georg
Simmel argued that the modern citys intense
nervous stimulation produces a self that is
rational, unemotional, blasé, alienated
autonomous. (Stadtluft macht frei und krank
City air makes you free .. and sick). Lacking
traditional societys constraints, urban dwellers
form calculative indifferent social relations,
with their individualism reaping negative
outcomes, such as loneliness and mental illness.
These ideas persist in studies of how social
networks affect physical and mental
health/illness and coping strategies.
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Mens Sana in Corpore Sano?
Ill-structured interpersonal networks can
influence development of physical disease, mental
illness, substance abuse. In a vicious cycle,
illnesses that disrupt egos support network can
then lead to a downward spiral of job loss,
isolation, homelessness, ...

• Epidemiological studies reveal that many
  contagious diseases are not transmitted randomly,
  but by close contacts
• Alcohol drug addictions are sustained by peer
  enablers
• Relapse rehospitalization risk rises for severe
  mentally ill patients with unsupportive networks
  of families and friends (hostile, critical,
  emotionally overinvolved)

Conversely, strong-tie support networks may help
to inoculate people against negative outcomes,
even catching the common cold! What public
health policy implications of these researches?
3
Modeling Epidemics
SIR model is a baseline epidemiological
explanation of infectious disease transmission (
Susceptibility, Infection, Resistant /Recovered/
Removed i.e., dead). Three phases of an
infectious epidemic slow growth, explosion,
burnout. Infamous examples Bubonic Plague, 1918
Influenza, English foot-and-mouth, AIDS, Ebola,
SARS, Swine Flu,
Using a random interaction assumption, classic
SIR models parameters to explain epidemic
patterns are pathogen (virus or bacteria)
reproduction rate (R0) relative sizes of
infected susceptible populations. But, modern
transportation social ties allow viruses to
leap into new geographic and social territories
On a small-world network, the key to explosive
growth of a disease is the shortcuts (Watts
2003180).
Because most contacts are very locally clustered,
the infectives mainly interact with others who
are already infected, preventing quick breakout
into an epidemic. Only when shortcuts lead to
fresh fields can random mixing processes generate
explosive growth. Policy implication find and
block ties that connect diseased clusters to
uninfected populations.
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The Paradox of STDs
Until recently, epidemiologists ignored how
networks linked by sexual contact enable sexually
transmitted diseases (STDs) to survive and
spread. Infection rates usually too low to
become epidemic, but higher rates in small core
networks allow disease to remain endemic. Small
behavioral changes may trigger rapid outbreak
into the larger population.

• The sexual networks in two small cities infected
  with chlamydia had similar sizes structures
• Colorado Springs 401 networks size 2-12 with
  468 cases and 700 sexual contacts the chlamydia
  infection rate increased by 46 from 1996 to 1999
• Winnipeg 442 networks size 2-20 with 571
  cases and 663 sexual contacts

Most nets were dyads or triads, but a handful had
more than 10 partners. These smaller, sparsely
linked networks, peripheral to the core, may form
the mechanism by which chlamydia can remain
endemic, in contrast with larger, more densely
connected networks, closer to the core, which are
associated with steep rises in incidence. (Jolly
et al. 2001)
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Socially Cohesive STDs
Colorado Springs chlamydia networks had little
potential for epidemic propagation, in contrast
to its gonorrhea network structure
Four largest chlamydia components
Largest gonorrhea component (gang)
Overall network structure is fragmented and
dendritic, notably lacking the cyclic (closed
loops) structures associated with network
cohesion and thus with efficient STD
transmission. Comparison of network structure
with that of an intense STD outbreak
(characterised by numerous cyclic structures)
suggests low level or declining endemic rather
than epidemic chlamydia transmission during the
study interval. Finally, the gang associated
STD outbreak clearly demonstrates the relation
between dense network connectivity and
epidemicity. Network cohesion seems strongly
predictive of STD transmission intensity.
(Potterat et al. 2002152 157)
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All Stressed Out
The stress-buffering hypothesis asserts that
social supports positively influences health and
well-being by protecting people from the
pathogenic effects of stressors (Cohen Willis
1985 Wheaton 1985). An alternative
main-effects hypothesis claims that social
supports positively influence health regardless
of whether stressors occur.

• Stressors moderators factors may be personal or
  environmental
• Stressors include daily hassles (arguments, bad
  weather, unexpected change of plans) major life
  events (death of friend or relative, serious
  illness or injury, divorce)
• Moderators include support from family, friends,
  coworkers, classmates who offer advice, provide
  material aid, help overcome emotional distress,
  and share responsibilities

Perceptions of support beliefs cognitions
about the presence and quality of interpersonal
ties may be more crucial than the actual
support received for reducing physical illnesses,
psychological symptoms, and various maladaptive
stress-behaviors, such as colds, ulcers, anger,
anxiety, rage, depression, alcohol drug
sexual abuse, delinquency, fighting, suicide,
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Do Your Friends Make You Fat?
Nicholas Christakis studied whether the weight
gains of an ego are associated with weight gains
by egos friends, siblings, spouse, or neighbors.
Obesity clusters extended to three degrees of
separation!
Among 12,067 egos in the Framingham Heart Study
(1971-2003), 5,124 had friend ties to another.
Largest friendship component was N2,200 (see
Pajek figure on next slide). Obesity was defined
as a body-mass index (BMI) 30. Used time-lagged
dependent variable to eliminate serial
correlation of errors, control for genetic
predispositions.
A person's chances of becoming obese increased
by 57 if he or she had a friend who became obese
in a given interval. Among pairs of adult
siblings, if one sibling became obese, the chance
that the other would become obese increased by
40. If one spouse became obese, the likelihood
that the other spouse would become obese
increased by 37. These effects were not seen
among neighbors in the immediate geographic
location. Persons of the same sex had relatively
greater influence on each other than those of the
opposite sex. The spread of smoking cessation did
not account for the spread of obesity in the
network. (Christakis Fowler 2007)
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Figure 1. Largest Connected Subcomponent of the
Social Network in the Framingham Heart Study in
the Year 2000
Social Network Image Animator (SoNIA) generated
network videos (requires Macromedia Flash program
to view) http//content.nejm.org/cgi/content/ful
l/357/4/370/DC2
9
Who Brings You Chicken Soup?
Social network diversity seems to reduce chances
of catching a common cold or influenza, probably
by preventing stress-released hormones that
weaken immune processes, such as destroying the
lymphocytes (white cells) that fight disease.
Sheldon Cohen et al. (1998) gave 276 healthy
volunteers nasal drops with common cold viruses,
but only 40 got clinically ill. People with lt
four types of social ties caught colds 4 times
more than those with six types. Not only were
they less susceptible to developing colds, they
produced less mucus, were more effective in
mucocilliary clearance of the nasal passage, and
shed less virus.
The longer a stressful events duration, the
greater the health risk. An argument with a
spouse resolved in a few days has little effect.
Marital discord lasting a month or more
substantially increases the risk. The type of
stress also plays an important role in disease
susceptibility. Job loss and divorce produced the
most serious threat to the individual, whereas
other less significant life challenges may not
have the same impact.
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Formalizing Support Networks
Can intentionally designed support networks
whether nonprofit or governmental provide
benefits to people with deficient ego-nets?

• Disease-based support networks (e.g., CJD Support
  Network) try to help patients families cope
  with stress, comply with difficult medical
  regimes
• 12-step self-help programs (e.g., Alcoholic
  Anonymous) deploy buddy systems to prevent
  relapses into self-destructive, anti-social
  behaviors

Caregivers themselves, especially women raising
kids and caring for aged parents, may seek to
alleviate their burdens stresses by
participating in emotional-support
groups Parents without Partners Elder Care
Resources Alzheimers Support Group
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References
Christakis, Nicholas A. and James H. Fowler.
2007. The Spread of Obesity in a Large Social
Network over 32 Years. New England Journal of
Medicine 357370-79. lthttp//content.nejm.org/cgi/
content/full/357/4/370gt Cohen, Sheldon and Thomas
A. Willis. 1985. Stress, Social Support, and the
Buffering Hypothesis. Psychological Bulletin
98310-357. Cohen, S., E. Frank, W.J. Doyle, D.P.
Skoner, B.S. Rabin, and J.M. Gwaltney, Jr. 1998.
Types of Stressors that Increase Susceptibility
to the Common Cold in Adults. Health Psychology
17214-223. Dukheim, Emile. 1897. Le Suicide.
Paris Alcan. Jolly A.M., S.Q. Muth, J.L. Wylie
and J.J. Potterat JJ. 2001. Sexual Networks and
Sexually Transmitted Infections A Tale of Two
Cities. Journal of Urban Health
78(3)433-445. Potterat J.J., S.Q. Muth, R.B.
Rothenberg, H. Zimmerman-Rogers, D.L. Green, J.E.
Taylor , M.S. Bonney, and H.A. White. 2002.
Sexual Network Structure as an Indicator of
Epidemic Phase. Sexually Transmitted Infections
78 Suppl 1152-158. Simmel, Georg. 1903. The
Metropolis and Mental Life. Pp. 409-424 in The
Sociology of Georg Simmel, translated by Kurt
Wolff. New York Free Press. Watts, Duncan. 2003.
Six Degrees The Science of a Connected Age. New
York Norton. Wheaton, Blair. 1985. Models for
the Stress-Buffering Functions of Coping
Resources. Journal of Health and Social Behavior
26352-365.