Lack of consistency in measurement methods and semantics used for network measures in adolescent health behaviour studies using social network analysis: a systematic review

BACKGROUND

Social network analysis (SNA) is often used to examine how social relationships influence adolescent health behaviours, but no study has documented the range of network measures used to do so. We aimed to identify network measures used in studies on adolescent health behaviours.

METHODS

We conducted a systematic review to identify network measures in studies investigating adolescent health behaviours with SNA. Measures were grouped into eight categories based on network concepts commonly described in the literature: popularity, position within the network, network density, similarity, nature of relationships, peer behaviours, social norms, and selection and influence mechanisms. Different subcategories were further identified. We detailed all distinct measures and the labels used to name them in included articles.

RESULTS

Out of 6686 articles screened, 201 were included. The categories most frequently investigated were peer behaviours (n=201, 100%), position within the network (n=144, 71.6%) and popularity (n=110, 54.7%). The number of measurement methods varied from 1 for 'similarity on popularity' (within the 'similarity' category) to 28 for the 'characterisation of the relationship between the respondent and nominated peers' (within the 'nature of the relationships' category). Using the examples of 'social isolation', 'group membership', 'individuals in a central position' (within the 'position within the network' category) and 'nominations of influential peers' (sub within the 'popularity' category), we illustrated the inconsistent reporting and heterogeneity in measurement methods and semantics.

CONCLUSION

Robust methodological recommendations are needed to harmonise network measures in order to facilitate comparison across studies and optimise public health intervention based on SNA.

Systems science methods in public health: what can they contribute to our understanding of and response to the cost-of-living crisis?

BACKGROUND

Many complex public health evidence gaps cannot be fully resolved using only conventional public health methods. We aim to familiarise public health researchers with selected systems science methods that may contribute to a better understanding of complex phenomena and lead to more impactful interventions. As a case study, we choose the current cost-of-living crisis, which affects disposable income as a key structural determinant of health.

METHODS

We first outline the potential role of systems science methods for public health research more generally, then provide an overview of the complexity of the cost-of-living crisis as a specific case study. We propose how four systems science methods (soft systems, microsimulation, agent-based and system dynamics models) could be applied to provide more in-depth understanding. For each method, we illustrate its unique knowledge contributions, and set out one or more options for studies that could help inform policy and practice responses.

RESULTS

Due to its fundamental impact on the determinants of health, while limiting resources for population-level interventions, the cost-of-living crisis presents a complex public health challenge. When confronted with complexity, non-linearity, feedback loops and adaptation processes, systems methods allow a deeper understanding and forecasting of the interactions and spill-over effects common with real-world interventions and policies.

CONCLUSIONS

Systems science methods provide a rich methodological toolbox that complements our traditional public health methods. This toolbox may be particularly useful in early stages of the current cost-of-living crisis: for understanding the situation, developing solutions and sandboxing potential responses to improve population health.

Lethal use of force surveillance: practical considerations for open-source database linkage

Currently, there remains no reliable and timely government tracking in the USA of deaths caused by law enforcement. Federal efforts to track these events are insufficient, generally missing as many as half of community deaths that occur annually because of law enforcement's lethal use of force. The dearth of accurate data on these events limits the ability to accurately quantify their burden and effectively identify opportunities for intervention and policy change. The most reliable data sources on law enforcement related deaths among community members in the USA are publicly run (such as those run by the Washington Post and The Guardian newspapers) or crowdsourced systems, such as Fatal Encounters and Mapping Police Violence, which draw on both traditional and non-traditional sources of reporting and provide open-source access to users. We used successive deterministic and probabilistic linkage to merge these four databases. After exclusions, we found a total of 6333 deaths identified from 2013 to 2017. While most cases were identified by multiple databases, each database also found unique cases during their years of operation. The methodology described here emphasises the importance of these non-traditional data sources and can serve as a helpful resource to improve data accessibility and timeliness for public health agencies and others seeking to expand their study, understanding and response to this growing public health crisis.

Impact evaluation of the TAMANI project to improve maternal and child health in Tanzania

BACKGROUND

The Tabora Maternal and Newborn Health Initiative project was a multicomponent intervention to improve maternal and newborn health in the Tabora region of Tanzania. Components included training healthcare providers and community health workers, infrastructure upgrades, and improvements to health management. This study aimed to examine the impact of trainings on four key outcomes: skilled birth attendance, antenatal care, respectful maternity care and patient-provider communication.

METHODS

Trainings were delivered sequentially at four time points between 2018 and 2019 in eight districts (two districts at a time). Cross-sectional surveys were administered to a random sample of households in all districts at baseline and after each training wave. Due to practical necessities, the original stepped wedge cluster randomised design of the evaluation was altered mid-programme. Therefore, a difference-in-differences for multiple groups in multiple periods was adopted to compare outcomes in treated districts to not yet treated districts. Risk differences were estimated for the overall average treatment effect on the treated and group/time dynamic effects.

RESULTS

Respondents reported 3895 deliveries over the course of the study. The intervention was associated with a 12.9 percentage point increase in skilled birth attendance (95% CI 0.4 to 25.4), which began to increase 4 months after the end of training in each district. There was little evidence of impact on antenatal care visits, respectful treatment during delivery and patient-provider communication.

CONCLUSION

Interventions to train local healthcare workers in basic and comprehensive emergency obstetric and newborn care increased skilled birth attendance but had limited impact on other pregnancy-related outcomes.

Testing and refining middle-range theory in evaluations of public-health interventions: evidence from recent systematic reviews and trials

Evaluations of public-health interventions might potentially be used to test and refine middle-range theory (ie, theory about the mechanisms, which generate outcomes that is analytically generalisable enough to span a range of contexts, interventions or outcomes, but specific enough to be salient in a given application). This approach has been suggested as one means of developing more informed assessments of how different interventions work and whether mechanisms might transfer across contexts. However, we have noticed that studies included in some of our recent systematic reviews are not oriented towards helping test middle-range theory because interventions draw on multiple middle-range theories (so that it is difficult to draw any conclusions about each middle-range theory based on their results) and these middle-range theories are insufficiently clear (with vague constructs) or parsimonious (with too many constructs) to be readily testable. Some studies might in future better contribute to testing and refining middle-range theory via focusing on interventions informed by one middle-range theory and focused on one mechanism at a time. Such 'proof-of-principle' studies should draw on middle-range theory that is sufficiently clear and parsimonious to allow such testing. These evaluations might facilitate more rigorous testing of middle-range theory and hence refinement of scientific knowledge. They might inform broader assessments of how mechanisms transfer across contexts aiding the development of future public-health interventions. Such studies would be a complement not an alternative to pragmatic studies of scalable complex interventions, often informed by more than one middle-range theory.

Gender-inclusive writing for epidemiological research on pregnancy

People who have a uterus but are not cisgender women may carry pregnancies. Unfortunately, to date, academic language surrounding pregnancy remains largely (cis) woman-centric. The exclusion of gender-diverse people in the language of pregnancy research in English is pervasive. In reviewing a random sample of 500 recent articles on pregnancy or pregnant populations across health research fields, we found that only 1.2% of articles used gender-inclusive language (none of them in epidemiology), while the remaining 98.8% used (cis) woman-centric language. First and foremost, recent recommendations highlight the need to include trans, non-binary and gender-diverse people in study design. Meanwhile, there remains a lack of awareness that all research on pregnancy can contribute to inclusiveness, including in dissemination and retroactive description. We explain how the ubiquitous use of (cis) woman-centric language in pregnancy-related research contributes to (1) the erasure of gender diversity; (2) inaccurate scientific communication and (3) negative societal impacts, such as perpetuating the use of exclusionary language by students, practitioners, clinicians, policy-makers and the media. We follow with recommendations for gender-inclusive language in every section (ie, introductions, methods, results, discussions) of epidemiological articles on pregnant populations. The erasure of gender-diverse people in the rhetoric of research about pregnant people can be addressed immediately, including in the dissemination of results from ongoing studies that did not take gender diversity into consideration. This makes gender-inclusive language a crucial first step towards the inclusion of gender-diverse people in epidemiological research on pregnant people and other health research more globally.

Measuring older people's socioeconomic position: a scoping review of studies of self-rated health, health service and social care use

Background

The challenges of measuring socioeconomic position in older populations were first set out two decades ago. However, the question of how best to measure older people’s socioeconomic position remains pertinent as populations age and health inequalities widen.

Methods

A scoping review aimed to identify and appraise measures of socioeconomic position used in studies of health inequalities in older populations in high-income countries. Medline, Scopus, EMBASE, HMIC and references lists of systematic reviews were searched for observational studies of socioeconomic health inequalities in adults aged 60 years and over, published between 2000 and 2020. A narrative synthesis was conducted.

Findings

One-hundred and thirty-eight studies were included; 20 approaches to measuring socioeconomic position were identified. Few studies considered which pathways the chosen measures of socioeconomic position intended to capture. The validity of subjective socioeconomic position measures, and measures that assume shared income and educational capital, should be verified in older populations. Incomplete financial data risk under-representation of some older groups when missing data are socially patterned. Older study samples were largely homogeneous on measures of housing tenure, and to a lesser extent, measures of educational attainment. Measures that use only two response categories risk missing subtle differences in older people’s socioeconomic circumstances.

Conclusion

Poor choice of measures of socioeconomic position risk underestimating the size of health inequalities in older populations. Choice of measures should be shaped by considerations of theory, context and response categories that detect subtle, yet important, inequalities. Further evidence is required to ascertain the validity of some measures identified in this review.

Socioeconomic status and subjective social status measurement in KiGGS Wave 2

This article describes the method applied to measure socioeconomic status (SES) and subjective social status (SSS) in the current wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), which was conducted over three years between 2014 and 2017. The composite multidimensional SES index was calculated as a sum of point scores for the parents' education level, occupational status and equivalised disposable income. SSS was assessed in the 11 to 17 year age group using a German version of the MacArthur Scale for children and adolescents. To demonstrate the use of both instruments, we present examples that highlight the association between SES and SSS with the general health of children and adolescents in the 3 to 17 and/or 11 to 17 age groups. Over 95% of parents rated the general health of their children as 'very good' or 'good'. However, the analyses clearly reveal that children and adolescents from families with low SES and SSS have poorer general health than their better-off peers. Even when mutually adjusted, both low SES and SSS are independently associated with poorer general health. In addition to the SES index, studies on the health of children and adolescents should therefore also consider SSS. In this way, additional aspects of the socioeconomic conditions of families can be taken into account.