Cancer has consequences not only for the sick person but also for those who have a close relationship with that person. Greater knowledge about how family members manage the situation in the period immediately following the diagnosis means greater opportunity to provide the best possible support for the family. The purpose of this study was to explore management strategies that family members use when the patient is in the early stage of treatment for advanced cancer.
Twenty family members of cancer patients were included in the study shortly after the diagnosis. The patients had been diagnosed 8-14 weeks earlier with advanced lung cancer or gastrointestinal cancer. The data were collected in interviews with family members and subjected to qualitative latent content analysis. Through the identification of similarities and dissimilarities in the units of meaning, abstraction into codes and sub-themes became possible. The sub-themes were then brought together in one overarching theme.
The overall function of management strategies is expressed in the theme Striving to be prepared for the painful. The family members prepare themselves mentally for the anticipated tragedy. Family relationships become increasingly important, and family members want to spend all their time together. They try to banish thoughts of the impending death and want to live as normal a life as possible. It becomes important to family members to live in the present and save their energy for the time when they will need it the most. How participants handle their worries, anxiety and sadness can be categorized into seven sub-themes or management strategies: Making things easier in everyday life, Banishing thoughts about the approaching loss, Living in the present, Adjusting to the sick person's situation, Distracting oneself by being with others, Shielding the family from grief, and Attempting to maintain hope.
The findings revealed that the family members have their own resources for handling the early stage of the cancer trajectory in an acceptable way. There is a need for longitudinal studies to generate knowledge for designing evidence-based intervention programmes that can prevent future ill-health in these vulnerable family members.
Social phobia is a common mental disorder associated with significant impairment. Current research and treatment models of social phobia rely on categorical diagnostic conceptualizations lacking empirical support. This study aims to further research exploring whether social phobia is best conceptualized as a dimension or a discrete categorical disorder.
This study used three distinct taxometric techniques (mean above minus below a cut, maximum Eigen value and latent mode) to explore the latent structure of social phobia in two large epidemiological samples, using indicators derived from diagnostic criteria and associated avoidant personality traits.
Overall, outcomes from multiple taxometric analyses supported dimensional structure. This is consistent with conceptualizations of social phobia as lying on a continuum with avoidant personality traits.
Support for the dimensionality of social phobia has important implications for future research, assessment, treatment, and public policy.
dimensional; latent structure; social phobia; taxometric
Receiving a cancer diagnosis affects family members as well as the person diagnosed. Family members often provide support for the sick person in daily life out of duty and love, and may not always think of their own vulnerability to illness. To individualise support for them, family members who are most at risk for becoming ill must be identified.
The aim of this study was to investigate health-related quality of life (HRQOL) in family members of patients with advanced lung or gastrointestinal cancer 3 to 15 months after diagnosis.
Data on mental and physical dimensions of HRQOL were collected from family members of these patients in this prospective quantitative study. Five assessments using the Short Form 36 Health Survey (SF-36) and EuroQol (EQ-5D) were conducted during a 1-year period starting 3 months after diagnosis. Thirty-six family members completed the study, i.e. participated in all five data collections.
No statistically significant changes in physical or mental HRQOL within the study group appeared over the 1-year follow-up. Compared with norm-based scores, family members had significantly poorer mental HRQOL scores throughout the year as measured by the SF-36. Family members also scored statistically significantly worse on the EQ-5D VAS in all five assessments compared to the norm-based score. Findings showed that older family members and partners were at higher risk for decreased physical HRQOL throughout the 1-year period, and younger family members were at higher risk for poorer mental HRQOL.
It is well known that ill health is associated with poor HRQOL. By identifying family members with poor HRQOL, those at risk of ill health can be identified and supported. Future large-scale research that verifies our findings is needed before making recommendations for individualised support and creating interventions best tailored to family members at risk for illness.
Family member; Advanced cancer; Health-related quality of life; Mental health dimension; Physical health dimension
Social support is defined as a network of family/friends who provide practical and emotional help. A sizable literature describes a direct relationship between social support and improved cancer clinical outcomes. This study explored the extent of social support and its potential association with survival and adverse events in geriatric lung cancer patients.
One hundred thirteen patients, who were aged 65 years or older, had incurable cancer, and were enrolled in one of two chemotherapy trials, completed the Lubben Social Network Scale, a validated instrument that measures social support. All were followed for survival and chemotherapy-related adverse events.
The median age (range) of the cohort was 74 years (65–91), and performance scores of 0, 1, or 2 were observed in 29%, 55%, and 16%, respectively. Forty-two percent were women. This cohort had a high level of social support: 81% reported they “always” had someone to take them to medical appointments. However, there were no gender-based differences in social support and no associations between social support and either survival or adverse events.
In this cohort of geriatric lung cancer patients – all of whom were treated during a clinical trial – there was a high level of social support. However, there were no gender-based differences in extent of social support, and the latter did not predict clinical outcomes.
social support; lung cancer; elderly; adverse events; survival
When patients share personal health information with family and friends, their social networks become better equipped to help them through serious health situations. Thus, patients need tools that enable granular control over what personal health information is shared and with whom within social networks. Yet, we know little about how well such tools support patients’ complex sharing needs. We report on a lab study in which we examined the transparency of sharing interfaces that display an overview and details of information sharing with network connections in an internet-based personal health information management tool called HealthWeaver. Although participants found the interfaces easy to use and were highly confident in their interpretation of the sharing controls, several participants made errors in determining what information was shared with whom. Our findings point to the critical importance of future work that examines design of usable interfaces that offer transparent granularity in support of patients’ complex information sharing practices.
The purpose of this study was to examine HRQOL depending on whether the participants have family members with disabilities or not. In addition, we examined the relationship between HRQOL and social networks among family caregivers in Japan.
The study has a cross-sectional design. Survey forms were distributed to 9205 people aged 30 and older who visited a dispensing pharmacy within fifteen areas of Japan. We collected data on gender, age, job status, and care giving status for persons with disabilities. Moreover, we assessed support size, social support, and HRQOL. Out of the 2029 questionnaires returned, 1763 (male: 663, female: 1100, mean age = 63.06 ± 13.34) were valid for statistical analyses (the available response rate was 19.15%).
A significant difference in HRQOL was identified between family caregivers and non-family caregivers. Further, in males (N = 101), the results confirmed that only social support predicted the PCS and MCS scores, while other variables did not predict either score. On the other hand, in females (N = 144), it was found from the second step of hierarchical multiple regression analysis that only age explained the PCS score, while job status and support size explained the MCS score.
It is reasonable to conclude that the HRQOL of family caregivers was lower than that of non-family caregivers, and that the HRQOL of family caregivers was estimated by their social networks.
While previous evidence has shown increased likelihood for survival in cancer patients who have social support, little is known about changes in social support during illness and their impact on survival. This study examines the relationship between social support and survival among women diagnosed with breast carcinoma, specifically assessing the effect of network size and changes in social contact post-diagnosis.
A population-based sample of 584 women was followed for up to 12.5 years (median follow-up =10.3 years). The mean age at diagnosis was 44 years, 81% were married, and 29% were racial/ethnic minorities. Cox regression analysis was used to estimate survival as a function of social support (changes in social contact and the size of social support), disease severity, treatment, health status, and socio-demographic factors.
Fifty-four-percent of the women had local and 44% had regional stage disease. About 53% underwent mastectomy, 68% received chemotherapy, and 55% had radiation. Regression results showed that disease stage, estrogen receptor status, and mastectomy were associated with greater risk of dying. Although network size was not related to survival, increased contact with friends/family post-diagnosis was associated with lower risk of death, with a hazard ratio of 0.31 (95% CI, 0.17-0.57).
Findings from this study have identified an important aspect of a woman’s social network that impacts survival. An increase in the amount of social contact, representing greater social support, may increase the likelihood of the women’s survival by enhancing their coping skills, providing emotional support, and expanding opportunities for information-sharing.
Breast cancer; oncology; social support; social network; survivorship
This study aimed to clarify the difference in the perception of family functioning and social support by the schizophrenic patients and their principal caretakers, and whether the social support is related to healthy family functioning.
Setting and Design:
The study was set in the psychiatric outpatient department of a tertiary care hospital and data was collected by means of a semi-structured interview.
Materials and Methods:
Fifty unremitting schizophrenics diagnosed by diagnostic and statistical manual (DSM)-IV criteria and their family members were interviewed. Family functioning was assessed by the family assessment device (FAD) and the social support was assessed by the multidimensional scale of perceived social support (MSPSS).
Group differences were analyzed using unpaired ‘t’ test for comparison of FAD and MSPSS means and subscale scores. Pearson’s correlation coefficient was used to find the direction and magnitude of association between the various dimensions (subscales) of FAD and the social support from family.
Schizophrenic patients had more difficulty on problem solving as compared to their relatives, while no significant differences were noted on the other dimensions of FAD in the two groups. Also, schizophrenics perceived more social support from friends than from their families. All the dimensions of the family functioning correlated to the social support perceived from the family in the schizophrenic patients.
Our study highlights the need to study the issues of perception of family functioning and social support so as to improve the prognosis in a disabling disorder like schizophrenia. Providing better social support and understanding the family functioning will result in strengthening the family as a unit, so as to provide better care to the patient.
Family functioning; schizophrenia; social support
This study had two goals. The first goal was to see if church-based social relationships are associated with change in self-esteem. Emotional support from fellow church members and having a close personal relationship with God served as measures of church-based social ties. The second goal was to see whether emotional support from fellow church members is more strongly associated with self-esteem than emotional support from secular social network members. The data came from an ongoing nationwide survey of older adults. The findings revealed that having a close personal relationship with God is associated with a stronger sense of self-esteem at the baseline and follow-up interviews. In contrast, emotional support from fellow church members was not associated with self-esteem at either point in time. However, emotional support from secular social network members was related to self-esteem at the baseline but not the follow-up interview.
Translational research networks are a deliberate strategy to bridge the gulf between biomedical research and clinical practice through interdisciplinary collaboration, supportive funding and infrastructure. The social network approach examines how the structure of the network and players who hold important positions within it constrain or enable function. This information can be used to guide network management and optimise its operations. The aim of this study was to describe the structure of a translational cancer research network (TCRN) in Australia over its first year, identify the key players within the network and explore these players' opportunities and constraints in maximising important network collaborations.
Methods and analysis
This study deploys a mixed-method longitudinal design using social network analysis augmented by interviews and review of TCRN documents. The study will use network documents and interviews with governing body members to explore the broader context into which the network is embedded as well as the perceptions and expectations of members. Of particular interest are the attitudes and perceptions of clinicians compared with those of researchers. A co-authorship network will be constructed of TCRN members using journal and citation databases to assess the success of past pre-network collaborations. Two whole network social network surveys will be administered 12 months apart and parameters such as density, clustering, centrality and betweenness centrality computed and compared using UCINET and Netdraw. Key players will be identified and interviewed to understand the specific activities, barriers and enablers they face in that role.
Ethics and dissemination
Ethics approvals were obtained from the University of New South Wales, South Eastern Sydney Northern Sector Local Health Network and Calvary Health Care Sydney. Results will be discussed with members of the TCRN, submitted to relevant journals and presented as oral presentations to clinicians, researchers and policymakers.
Translational research networks are a deliberate strategy to transform biomedical research ‘at the bench’ into clinical practice ‘at the bedside’ through interdisciplinary collaboration, supportive infrastructure, staff and funding.
What features of network structure hinder or promote successful translational research endeavours?
What is the role of key players in a collaborative, interdisciplinary network?
A protocol for a mixed method, longitudinal study of a new translational research network using a social network approach.
A social network approach can inform management of the network and suggest ways in which to optimise its function.
Strengths and limitations of this study
Mixed methods give quantitative data enriched with qualitative data.
Data was collected from the whole network, rather than from a sample of members.
Longitudinal design gives comparative data rather than a snapshot.
The aim of this study was to examine the net balance of transfers between persons aged 50 and older and their family, taking into account both the exchange of money and the exchange of practical assistance (time). Toward this end, a unique net balance outcome measure was computed by costing the value of time transfers into wage equivalents. The study made use of data from the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), and focused upon intergenerational exchange in two specific countries: Germany and Israel. The descriptive findings show that—up to an age of about 80 years—the elderly are net providers of help. The outcome variable was next regressed on a set of relevant predictors identified in the literature on intergenerational transfers and support—among them, sociodemographic background, health, social policy, social network and motivation variables. Holding these variables constant, the balance pattern by age remains valid: respondents aged 50–79 in both settings contributed to their family more than they received. These trends in net transfer exchanges were largely similar across both countries and across regions or population groups within both countries. Women were more likely to have a positive net exchange balance and poorer health was associated with net receiving. However, differences also emerged: social capital was more clearly associated with a positive exchange balance in Israel, transfer motivations shaped transfer behaviors in Germany but not in Israel, and socioeconomic variables seemed to work in opposite directions in the two countries. In sum, the results underscore the generally positive contribution of older people to intergenerational exchange in the family. This outcome holds for both Germany and Israel despite their very different conditions of context.
Intergenerational exchange; Time transfers; Financial transfers; 50+; Germany; Israel; SHARE
The purpose of this study is to develop and test a latent variable model that explores the ways in which social structural factors influence the amount of social support that older adults provide to their social network members. Neighborhood conditions play a key role in this conceptual scheme. The findings provide support for the following conceptual linkages: (1) low parental education is associated with low respondent education; (2) older people with less education encounter more economic difficulty; (3) greater financial problems are associated with living in a rundown neighborhood; (4) older individuals who live in dilapidated neighborhoods are more hostile; and (5) older adults who are hostile are less likely to provide social support to their social network members. Research indicates that helping others is a key to successful aging. Ways must be found to help economically disadvantaged elders provide support to their social network members.
Neighborhood; hostility; social support; latent variable models
An integrative theoretical framework, developed for cross-disciplinary implementation and other behaviour change research, has been applied across a wide range of clinical situations. This study tests the validity of this framework.
Validity was investigated by behavioural experts sorting 112 unique theoretical constructs using closed and open sort tasks. The extent of replication was tested by Discriminant Content Validation and Fuzzy Cluster Analysis.
There was good support for a refinement of the framework comprising 14 domains of theoretical constructs (average silhouette value 0.29): ‘Knowledge’, ‘Skills’, ‘Social/Professional Role and Identity’, ‘Beliefs about Capabilities’, ‘Optimism’, ‘Beliefs about Consequences’, ‘Reinforcement’, ‘Intentions’, ‘Goals’, ‘Memory, Attention and Decision Processes’, ‘Environmental Context and Resources’, ‘Social Influences’, ‘Emotions’, and ‘Behavioural Regulation’.
The refined Theoretical Domains Framework has a strengthened empirical base and provides a method for theoretically assessing implementation problems, as well as professional and other health-related behaviours as a basis for intervention development.
Theoretical domains framework; Behaviour; Change; Implementation; Validation; Theory
Social support has a strong impact on individuals, not least on older individuals with health problems. A lack of support network and poor family or social relations may be crucial in later life, and represent risk factors for elder abuse. This study focused on the associations between social support, demographics/socio-economics, health variables and elder mistreatment.
The cross-sectional data was collected by means of interviews or interviews/self-response during January-July 2009, among a sample of 4,467 not demented individuals aged 60–84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden).
Multivariate analyses showed that women and persons living in large households and with a spouse/partner or other persons were more likely to experience high levels of social support. Moreover, frequent use of health care services and low scores on depression or discomfort due to physical complaints were indicators of high social support. Low levels of social support were related to older age and abuse, particularly psychological abuse.
High levels of social support may represent a protective factor in reducing both the vulnerability of older people and risk of elder mistreatment. On the basis of these results, policy makers, clinicians and researchers could act by developing intervention programmes that facilitate friendships and social activities in old age.
Purpose: The study considers the social networks of older Americans, a population for whom there have been few studies of social network type. It also examines associations between network types and well-being indicators: loneliness, anxiety, and happiness. Design and Methods: A subsample of persons aged 65 years and older from the first wave of the National Social Life, Health, and Aging Project was employed (N = 1,462). We applied K-means cluster analysis to derive social network types using 7 criterion variables. In the multivariate stage, the well-being outcomes were regressed on the network type construct and on background and health characteristics by means of logistic regression. Results: Five social network types were derived: “diverse,” “friend,” “congregant,” “family,” and “restricted.” Social network type was found to be associated with each of the well-being indicators after adjusting for demographic and health confounders. Respondents embedded in network types characterized by greater social capital tended to exhibit better well-being in terms of less loneliness, less anxiety, and greater happiness. Implications: Knowledge about differing network types should make gerontological practitioners more aware of the varying interpersonal milieus in which older people function. Adopting network type assessment as an integral part of intake procedures and tracing network shifts over time can serve as a basis for risk assessment as well as a means for determining the efficacy of interventions.
Social relations; NSHAP; Loneliness; Anxiety; Happiness; Social work
There is a lack of consensus in the addiction treatment literature regarding the definition of substance abuse "recovery".
This study utilized a review of the literature together with a participatory research design to construct a conceptual model of recovery from the perspectives of addiction treatment professionals, those recovering from addictions, and researchers.
A multidimensional, comprehensive hypothetical model consisting of seven conceptual domains (physical, biomarker, psychological, psychiatric, chemical dependency, family/social, and spiritual) is presented. Each domain is operationally defined by identifying reliable and valid instruments that may be used to measure the domain. It is proposed that the conceptual model be tested using confirmatory factor analysis.
If empirically supported, this conceptual model would validate the hypothesized multidimensional nature of recovery and provide a potential means for assessing recovery in future treatment outcome studies.
Scientists designing network-based interventions intending to improve the adoption or maintenance of healthy behaviors are well-advised to classify potential adopters into network roles, such as opinion leaders, brokers, members, and isolates, and to work closely with existing opinion leaders. In past studies focusing on HIV, opinion-leader interventions have had mixed results. This may be addressed, in part, by empirically validating these network roles. To this end, we used latent class analysis to test whether people’s social connections fall into mutually exclusive and exhaustive subgroups of social capital that represent theorized network roles well with a dataset collected in Nyangana, Namibia (n = 400). A 4-class model best fit the dataset, but the categories identified do not clearly represent the theorized roles. Rather, this study revealed the following four network classes: single-group members (59%), connectors (24%), single-group loyalists (15%), and selective connectors (2%). The implications of their findings for opinion-leader interventions focused on HIV are discussed.
The focus of this paper is the family factors associated with primary headache in children between 8 and 14 years. We studied the differences in the family ecology between 32 children with headaches and 32 healthy controls. The families were comparable for socio-economic status and children's age. We examined various aspects of the family connectedness, daily workload, social network and support, ecological fit and resilience using an Italian version of the Ecocultural Family Interview. Families of juvenile headache patients have less resilience in using their subsistence base, less social support and are less closely knitted than the control families. No difference was found for the amount of domestic workload. These findings suggest that psychosocial environment and family ecology are relevant to children's headaches, and that clinical support can be planned to sustain parents of children affected by primary headache.
Key words Juvenile primary headache; Ecocultural family interview
The vital role played by family caregivers in supporting dying cancer patients is well recognized, but the burden and economic impact on caregivers is poorly understood. We prospectively examined the psychosocial, occupational and economic impact of caring for a person with a terminal illness.
We studied 89 caregivers of women with advanced breast cancer receiving care at either the Ottawa or Hamilton regional cancer centres in Ontario. Patients were followed until their death or study completion at 3 years. Patients identified a principal caregiver to participate in the study. The Karnofsky Performance Status (KPS) index, the Medical Outcomes Study 36-item Short Form (SF-36), the Hospital Anxiety and Depression Scale, the Zarit Burden Inventory, FAMCARE and the Medical Outcomes Study Social Support Survey were administered during follow-up. Economic data were collected by means of a questionnaire administered by an interviewer. Assessments were conducted every 3 months during the palliative period (KPS score > 50) and every 2 weeks during the terminal period (KPS score ≤ 50).
Over half of the caregivers were male (55%) and the patient's spouse or partner (52%), with a mean age of 53 years. At the start of the palliative period, the caregivers' mean physical functioning score was better than the patients' (51.3 v. 35.1, 95% confidence interval [CI] 13.3–20.0); there were similar mean mental functioning scores (46.6 and 47.1 respectively); similar proportions were depressed (11% and 12%); and significantly more caregivers than patients were anxious (35% v. 19%, p = 0.009). More caregivers were depressed (30% v. 9%, p = 0.02) and had a higher level of perceived burden (26.2 v. 19.4, p = 0.02) at the start of the terminal period than at the start of the palliative period. Burden was the most important predictor of both anxiety and depression. Of employed caregivers, 69% reported some form of adverse impact on work. In the terminal period 77% reported missing work because of caregiving responsibilities. Prescription drugs were the most important component of financial burden.
Caregivers' depression and perceived burden increase as patients' functional status declines. Strategies are needed to help reduce the psychosocial, occupational and economic burden associated with caregiving.
While previous research has established a link between socioeconomic status (SES) and cancer outcomes, there is still little understanding of the processes that contribute to these outcome disparities.
This study aims to describe the ways a family's socioeconomic status (SES) influences their health care behavior after a child is diagnosed with cancer.
The sample included five case study families and in-depth interviews with 21 parents. Case study families were interviewed and observed once a month for six months.
Parents' finances influenced their ability to maintain household expenses, and to pay for health care expenses and household help. Wealth and help from friends and family are important aspects of families' financial statuses. Parents' educational attainment affected their ability to understand diagnosis and treatment options, their confidence and communication with health care professionals, and the utility of their social networks. Parents' occupation influenced their work schedule flexibility, fringe benefits, and their access to and quality of employer-sponsored health insurance.
Findings suggest that three overarching domains of SES (e.g. financial, education and occupation) have important implications for parents' health care navigation. This study underscores the need to use a nuanced set of SES measures (beyond income and education) in future research to enhance our understanding of how SES affects health care navigation, and refine intervention initiatives designed to help reduce health disparities.
Implications for Practice:
Cancer education initiatives should focus on enhancing patient-provider interactions, health communication, accessing health information, and resolving work and financial barriers to cancer care.
This study tested the logistical feasibility of obtaining data on social support systems from cancer patients enrolled on clinical trials and compared the social support of older adults (age ≥65) and younger adults (<50 years of age) with cancer.
Patients had to be eligible for a phase II or phase III oncology clinical trial and enter the study prior to treatment. Patients filled out the Lubben Social Network Scale (LSNS) at baseline. The Symptom Distress Scale (SDS) and single-item overall quality of life (QOL) Uniscale were assessed at baseline and weekly for 4 weeks.
There was no significant difference in overall mean Lubben social support levels by age. Older patients had more relatives they felt close to (85% versus 53% with 5 or more relatives, P = 0.02), heard from more friends monthly (84% versus 53% with 3 or more friends, P = 0.02), less overall symptom distress (P = 0.03), less insomnia (P = 0.003), better concentration (P = 0.005), better outlook (P = 0.01), and less depression (P = 0.005) than younger patients.
Younger subjects reported worse symptoms, a smaller social support network, and fewer close friends and relatives than older subjects. Having someone to discuss decisions and seeing friends or relatives often was associated with longer survival.
social support; Lubben scale; QOL; elderly
This article describes the development of an innovative community-based program, One Hundred Intentional Acts of Kindness toward a Pregnant Woman© (100 Acts), which seeks to increase reproductive social capital for pregnant women in south and central Los Angeles communities. Reproductive social capital includes features such as networks, norms, and social trust that facilitate optimal reproductive health within a community. 100 Acts was designed and developed by the Healthy African American Families project, using community participatory methods, to increase local community and social network support for pregnant women. Dialog groups with pregnant women identified specific actions that families, friends, and strangers might do to support pregnancies. Participants primarily wanted emotional and instrumental support from family and friends. From strangers, they wanted respect for personal space and common courtesy. Based on these results, the 100 Acts was created for use in the Los Angeles community. 100 Acts encourages and engages active participation from community members in promoting healthy pregnancies. By seeking to increase community-level reproductive social capital, 100 Acts shifts the provision of social support during pregnancy from a high-risk approach to a population approach. 100 Acts also establishes new social norms about how pregnant women are valued, treated and respected.
Specialized 12-step based groups have emerged to address the needs of persons recovering from both substance abuse and psychiatric illness.
This study investigates the role of social support in mediating the association between mutual aid participation and subsequent substance use for dually-diagnosed persons.
A cohort of Double Trouble in Recovery (DTR) members in New York City were studied prospectively over a two-year period.
Longer DTR participation during the first year of the study was associated with lower substance use in the second year; that effect was partially explained by the maintenance of high level of social support.
These findings speak to the enduring influence of 12-step attendance on reducing substance use, and underline the importance of both 12-step attendance and supportive networks for dually-diagnosed persons.
12-step; social support; recovery; dual-diagnosis; substance use
Networks of person-to-person contacts form the substrate along which infectious diseases spread. Most network-based studies of this spread focus on the impact of variations in degree (the number of contacts an individual has). However, other effects such as clustering, variations in infectiousness or susceptibility, or variations in closeness of contacts may play a significant role. We develop analytic techniques to predict how these effects alter the growth rate, probability and size of epidemics, and validate the predictions with a realistic social network. We find that (for a given degree distribution and average transmissibility) clustering is the dominant factor controlling the growth rate, heterogeneity in infectiousness is the dominant factor controlling the probability of an epidemic and heterogeneity in susceptibility is the dominant factor controlling the size of an epidemic. Edge weights (measuring closeness or duration of contacts) have impact only if correlations exist between different edges. Combined, these effects can play a minor role in reinforcing one another, with the impact of clustering the largest when the population is maximally heterogeneous or if the closer contacts are also strongly clustered. Our most significant contribution is a systematic way to address clustering in infectious disease models, and our results have a number of implications for the design of interventions.
epidemic; clustering; reproductive ratio; epidemic probability; attack rate
Breast cancer among Filipinas in the United States is a major but largely neglected cancer disparity. In 2004, a community– university partnership resulted in the first Filipina breast cancer support group in the San Francisco Bay Area. Building on this partnership, we explored the social and cultural contexts of Filipinas’ experiences with breast cancer to inform development of culturally appropriate and sustainable support services and outreach. We utilized multiple qualitative methods (participant observation, individual and small group in-depth qualitative interviews) to identify meanings of survivorship and support. Interviews and observations revealed the influences of social context and immigration experiences on women’s understandings of cancer, what “surviving” cancer means, and what it means to take care of someone with breast cancer (or be taken care of). Our findings highlight the importance of a transnational perspective for the study of immigrant women’s experiences of cancer and survivorship.
cancer; breast; immigrants/migrants; social support; survivorship