Hegde Sonia T, Trostle James A, Mukherjee Bhramar, Eisenberg Joseph N S
Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
Department of Anthropology, Trinity College, Hartford, CT, USA.
SSM Popul Health. 2022 Jun 29;19:101159. doi: 10.1016/j.ssmph.2022.101159. eCollection 2022 Sep.
Social networks are often measured as conduits of infection. Our prior cross-sectional analyses found that denser social ties among individuals reduces transmission of acute gastrointestinal illness (AGI) in coastal Ecuador; social networks can describe both risk and protection. We extend findings to examine how social connectedness influences AGI longitudinally in Ecuador from 2007 to 2013, a time of rapid development, using a two-stage Bayesian hierarchical model to estimate multiple network effects. A larger community network of people to discuss important matters with was consistently protective against AGI over time, and a network defined by people passing time together became a stronger measure of risk, due to increasing population density and travel. These networks were interdependent: the joint effect of having a small passing time network and large important matters network reduced the odds of AGI over time (2007: OR 1.16 (95% CI: 0.94, 1.44), 2013: OR 0.56 (95% CI: 0.45, 0.71)); and synergistic: the people an individual passed time with became the people they discussed important matters with. Focus groups emphasized that with greater remoteness came greater community cohesion resulting in safer WASH practices. Social networks can enhance and reduce health differently as social infrastructure evolves, highlighting the importance of community-level factors in a period of rapid development.
社交网络通常被视为感染的传播渠道。我们之前的横断面分析发现，厄瓜多尔沿海地区个人之间更紧密的社会联系会减少急性胃肠道疾病（AGI）的传播；社交网络既能描述风险，也能提供保护。我们扩展了研究结果，以考察2007年至2013年厄瓜多尔快速发展时期社交联系如何对AGI产生纵向影响，使用两阶段贝叶斯分层模型来估计多种网络效应。随着时间推移，一个更大的用于讨论重要事务的社区网络一直对AGI具有保护作用，而一个由共度时光的人所定义的网络由于人口密度增加和出行，成为了更强的风险衡量指标。这些网络相互依存：拥有一个共度时光的小网络和一个讨论重要事务的大网络的联合效应随着时间推移降低了患AGI的几率（2007年：比值比1.16（95%置信区间：0.94，1.44），2013年：比值比0.56（95%置信区间：0.45，0.71））；并且具有协同作用：一个人与共度时光的人成为了他们讨论重要事务的对象。焦点小组强调，随着偏远程度增加，社区凝聚力增强，从而带来更安全的水、环境卫生和个人卫生实践。随着社会基础设施的演变，社交网络对健康的增强和降低作用会有所不同，这凸显了在快速发展时期社区层面因素的重要性。
