The Collective Dynamics of Smoking in a Large Social Network

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
New England Journal of Medicine (Impact Factor: 55.87). 06/2008; 358(21):2249-58. DOI: 10.1056/NEJMsa0706154
Source: PubMed


The prevalence of smoking has decreased substantially in the United States over the past 30 years. We examined the extent of the person-to-person spread of smoking behavior and the extent to which groups of widely connected people quit together.
We studied a densely interconnected social network of 12,067 people assessed repeatedly from 1971 to 2003 as part of the Framingham Heart Study. We used network analytic methods and longitudinal statistical models.
Discernible clusters of smokers and nonsmokers were present in the network, and the clusters extended to three degrees of separation. Despite the decrease in smoking in the overall population, the size of the clusters of smokers remained the same across time, suggesting that whole groups of people were quitting in concert. Smokers were also progressively found in the periphery of the social network. Smoking cessation by a spouse decreased a person's chances of smoking by 67% (95% confidence interval [CI], 59 to 73). Smoking cessation by a sibling decreased the chances by 25% (95% CI, 14 to 35). Smoking cessation by a friend decreased the chances by 36% (95% CI, 12 to 55 ). Among persons working in small firms, smoking cessation by a coworker decreased the chances by 34% (95% CI, 5 to 56). Friends with more education influenced one another more than those with less education. These effects were not seen among neighbors in the immediate geographic area.
Network phenomena appear to be relevant to smoking cessation. Smoking behavior spreads through close and distant social ties, groups of interconnected people stop smoking in concert, and smokers are increasingly marginalized socially. These findings have implications for clinical and public health interventions to reduce and prevent smoking.

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    • "Alternatively, social network members may act as health regulators and pressure their loved one to seek help and professional treatment (Pescosolido, Gardner, & Lubell 1998; Pescosolido et al. 1998; Vogel et al. 2007). More recent research suggests that not only behaviors but emotional states, positive and negative, get transferred from one person to another through social networks like infectious diseases over periods of time, which is referred to as the contagion effect (Fowler and Christakis 2008; Hill et al. 2010). "
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    • "Changing the behavior of a wellconnected heavy drinker is likely to also impact his or her associates. For example, in a seminal study, Christakis and Fowler (2008) showed that the likelihood of quitting smoking was increased by 36% when a friend quit smoking. Findings from the present study may inform future investigations that target specific heavy drinkers in an effort to reduce drinking for that individual and his or her close associates. "
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    ABSTRACT: Introduction: Individuals rate opposite sex faces as more attractive after consuming or being primed with alcohol. However, other traits such as intelligence and likeability have not been examined and might vary as a function of information about one's drinking habits. We expected social drinkers to be rated more positively than heavy drinkers, abstainers, or recovering alcoholics. We further hypothesized that faces with similar drinking habits to participants would be rated as more appealing. Methods: Five hundred ninety-four undergraduates viewed 25 opposite sex faces randomly paired with drinking information, and rated each face on perceived appeal. Results: Hierarchical linear models revealed that social drinkers were rated as most appealing, as expected. Unexpectedly, recovering alcoholics were rated as the next most appealing, followed by abstainers, then heavy drinkers. The interaction between drinker type and participants' own drinking predicting ratings indicated that the heavier the participant drinks, the more favorably they rated heavy drinkers compared to other types of drinkers. Thus, as expected, ratings varied as a function of participants' own drinking; however, ratings did not vary as a function of participants' alcohol-related problems. Conclusions: Findings support hypotheses in that social drinkers were generally perceived as appealing compared to other drinker types, and ratings tended to be influenced by participants' own drinking. Individuals' prototypes and norms regarding drinking may influence how they perceive others when others' drinking habits are known. This might be especially important to consider with heavy drinkers who may seek out others who drink similarly, which could reinforce problematic drinking.
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    • "In addition, peer services have increasingly assumed an important role in mental health services for persons with serious mental illness (Chinman et al., 2014; Davidson, Chinman, Sells, & Rowe, 2006; Green, Janoff, Yarborough, & Paulson, 2013; Resnick, Armstrong, Sperrazza, Harkness, & Rosenheck, 2004; Salzer, Schwenk, & Brusilovskiy, 2010). Peer support may be particularly useful in smoking cessation because of the strong connection that has been demonstrated in the general population between quitting smoking and interpersonal associations with nonsmokers (Christakis & Fowler, 2008). Persons with mental illnesses are often in environments where many of their peers smoke (Ziedonis et al., 2008). "
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    ABSTRACT: Objective: We evaluated a well-specified peer mentor program that enhanced a professionally led smoking cessation group for persons with serious mental illnesses. Method: Participants were 8 peer mentors, persons with serious mental illnesses who had successfully quit smoking, and 30 program participants, persons with serious mental illnesses enrolled in a 6-month intervention. Peer mentors were trained and then helped to deliver a smoking cessation group and met with program participants individually. We assessed the mentors' skills after training, their fidelity to the model, and the program's feasibility and acceptability. We also measured the smoking outcomes of the program participants including change in exhaled carbon monoxide, a measure of recent smoking, and aspects of the peer mentor-program participant relationship. Results: Peer mentors attained a mean score of 13.6/14 on role play assessments after training and delivered the intervention with fidelity as assessed by adherence and competence ratings (mean scores of 97% and 93%, respectively). The feasibility and acceptability of the intervention was demonstrated in that 28/30 participants met with their peer mentors regularly and only 1 participant and no peer mentor discontinued in the study. Both parties rated the interpersonal alliance highly, mean of 5.9/7. The program participants had a decline in carbon monoxide levels and number of cigarettes smoked per day (repeated measures ANOVA F = 6.04, p = .008; F = 15.87, p < .001, respectively). A total of 22/30 (73%) made a quit attempt but only 3 (10%) achieved sustained abstinence. Conclusions and implications for practice: Our study adds to the growing literature about peer-delivered interventions. (PsycINFO Database Record
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