The power of (Mis)perception: Rethinking suicide contagion in youth friendship networks

Highlights

• Youth tend to overestimate friends' attempted suicide.
• Misperception of friends' attempted suicide occurs primarily among at-risk youth.
• Overestimating friends' attempted suicide amplifies the risk of attempted suicide.

Suicide is a leading cause of death among youth. In the wake of peer suicide, youth are vulnerable to suicide contagion. But, questions remain about the mechanisms through which suicide spreads and the accuracy of youths' estimates of friends' suicidal behaviors. 

This study addresses these questions within school-aged youths' friendship networks. Social network data were drawn from two schools in the National Longitudinal Study of Adolescent to Adult Health, from which 2180 youth in grades 7-12 nominated up to ten friends. A measure of "perceived" friends' attempted suicide was constructed based on respondents' reports of their friends' attempted suicide. This measure was broader than a "true" measure of friends' attempted suicide, constructed from self-reports of nominated friends who attended respondents' schools. Sociograms graphically represented the accuracy with which suicide attempters estimated friends' suicide attempts. 

Results from cross-tabulation with Chi-square analysis indicated that approximately 4% of youth (88/2180) attempted suicide, and these youth disproportionately misperceived (predominantly overestimated) friends' suicidal behaviors, compared to non-suicide-attempters. Penalized logistic regression models indicated that friends' self-reported attempted suicide was unrelated to respondent attempted suicide. But, the odds of respondent attempted suicide were 2.54 times higher (95% CI, 1.06-6.10) among youth who accurately perceived friends' attempted suicide, and 5.40 times higher (95% CI, 3.34-8.77) among youth who overestimated friends' attempted suicide. 

The results suggest that at-risk youth overestimate their friends' suicidal behaviors, which exacerbates their own risk of suicidal behavior. Methodologically, this suggests that a continued collaboration among network scientists, suicide researchers, and medical providers is necessary to further examine the mechanisms surrounding this phenomenon. 

Practically, it is important to screen at-risk youth for exposure to peer suicide and to use the social environment created by adolescent friendship networks to empower and support youth who are susceptible to suicidal thoughts and behaviors.

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By:  Zimmerman GM1, Rees C2, Posick C3, Zimmerman LA4.

• Electronic address: g.zimmerman@neu.edu.
• 2Brigham Young University, Department of Sociology, 2019 Joseph F. Smith Building, Provo, UT 84602, USA. Electronic address: carter_rees@byu.edu.
• 3Georgia Southern University, Department of Criminal Justice & Criminology, PO BOX 8105, 1332 Southern Drive, Statesboro, GA 30458, USA. Electronic address: cposick@geogiasouthern.edu.
• 4Department of Gastroenterology/Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: lori.zimmerman@childrens.harvard.edu.
• Soc Sci Med. 2016 Apr 1;157:31-38. doi: 10.1016/j.socscimed.2016.03.046.  

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Personal Networks of Women in Residential & Outpatient Substance Abuse Treatment

This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. 

The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. 

Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t-tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. 

These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse...

Upon treatment entry, women report child related concerns, psychosocial difficulties, physical/sexual abuse, health issues and mental health problems to a far greater degree than their male counterparts (Wechsberg et al., 1998). These complex problems present difficulties for women in accessing social support and developing supportive personal network relationships (Tracy & Martin, 2007), thereby compromising their recovery (Warren, Stein, & Grella, 2007; Wenzel, Tucker, Golinelli, Green, & Zhou, 2010). Although different clinical profiles have been identified between women in residential and outpatient substance abuse treatment, no previous studies have examined or identified differences in personal network characteristics between these two groups of women. The purpose of this study was to identify differences in personal network characteristics between women entering residential substance abuse treatment and those entering intensive outpatient treatment. A deeper understanding of these differences may add an important dimension to substance abuse treatment planning, and may be utilized to inform treatment interventions for women in residential and outpatient treatment settings.

Clinical characteristics by treatment modality (N = 377).

	n (%)
	Residential (n = 119)	Outpatient (n = 258)	χ2 or t	p
Substance use disorder (SUD)
Marijuana	44 (37.9)	105 (41.0)	0.32	0.574
Amphetamine	3 (2.6)	1 (0.4)	3.62	0.092†
Sedatives	5 (4.3)	14 (5.5)	0.22	0.638
Cocaine	78 (67.2)	135 (52.7)	6.87	0.009
Opiates	35 (30.2)	51 (19.9)	4.72	0.030
Hallucinogens	0 (0.0)	9 (3.5)	4.18	0.062†
Inhalants	0 (0.0)	1 (0.4)	0.45	>0.999†
Phencyclidine	3 (2.6)	9 (3.5)	0.22	0.761†
Alcohol	63 (54.3)	112 (43.8)	3.57	0.059
Multiple SUD (yes)	74 (63.8)	132 (51.8)	4.67	0.031
Mental health disorder
Generalized anxiety	21 (17.6)	68 (26.5)	3.50	0.062
Posttraumatic	39 (32.8)	108 (42.0)	2.92	0.087
Major depressive episode	68 (57.1)	149 (58.0)	0.02	0.879
Dysthymia	5 (4.2)	7 (2.7)	0.57	0.531†
Manic episode	27 (22.7)	91 (35.4)	6.11	0.013
Hypomanic episode	9 (7.6)	31 (12.1)	1.73	0.188
Dual diagnosis	89 (74.8)	186 (72.7)	0.19	0.664
Previous treatment	90 (75.6)	185 (72.3)	0.47	0.493
HIV test result (positive)	1 (0.9)	5 (2.0)	0.66	0.669†
Multiple chronic health condition (2 or more)	26 (22.0)	65 (25.2)	0.44	0.507
Trauma symptom checklist, M(SD)	49.40 (20.94)	42.51 (21.29)	2.93	0.004

†Fisher’s Exact Test.

Full article at:   http://goo.gl/lxtcy6

By:  HyunSoo Kim,1 Elizabeth Tracy,2 Suzanne Brown,3 MinKyoung Jun,4 Hyunyong Park,2 Meeyoung Min,2 and Chris McCarty5

¹Department of Social Welfare, Dongguk University, Gyeongju-si, Republic of Korea

²The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA

³School of Social Work, Wayne State University, Detroit, MI, USA

⁴Gyeonggido Family & Women’s Research Institute, Gyeonggido, Suwon, Republic of Korea

⁵Survey Research Center, University of Florida, Gainsville, FL, USA

Correspondence: Dr Elizabeth Tracy, The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland 44106, OH

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A Pilot Test of a Mobile App for Drug Court Participants

The U.S. criminal justice system refers more people to substance abuse treatment than any other system. Low treatment completion rates and high relapse rates among addicted offenders highlight the need for better substance use disorder treatment and recovery tools. 

Mobile health applications (apps) may fill that need by providing continuous support. In this pilot test, 30 participants in a Massachusetts drug court program used A-CHESS, a mobile app for recovery support and relapse prevention, over a four-month period. Over the course of the study period, participants opened A-CHESS on average of 62% of the days that they had the app. Social networking tools were the most utilized services. 

The study results suggest that drug court participants will make regular use of a recovery support app. This pilot study sought to find out if addicted offenders in a drug court program would use a mobile application to support and manage their recovery.

Below:  A-CHESS mobile app user interface

Below:  Percentage of days in which participants used A-CHESS

Below:  Average number of times participants who used each service used it over the total study period

Below:  Social network map of all participants including staff

Below:  Social network map of drug court participants

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By:  Johnson K1, Richards S2, Chih MY3, Moon TJ4, Curtis H5, Gustafson DH1.

• 1Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA.
• 2Communications Coordinator, Population Health Institute, University of Wisconsin-Madison, Madison, WI, USA.
• 3Research Assistant, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA.; Assistant Professor, University of Kentucky, Lexington, KY, USA.
• 4Honorary Fellow, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA.
• 5Advocates, Inc., Ayer Concord Drug Court, Ayer, MA, USA. 
• Subst Abuse. 2016 Feb 14;10:1-7. doi: 10.4137/SART.S33390. eCollection 2016.

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The Transmission of Gun and Other Weapon-Involved Violence Within Social Networks

Fatal and nonfatal injuries resulting from gun violence remain a persistent problem in the United States. The available research suggests that gun violence diffuses among people and across places through social relationships. Understanding the relationship between gun violence within social networks and individual gun violence risk is critical in preventing the spread of gun violence within populations. 

This systematic review examines the existing scientific evidence on the transmission of gun and other weapon-related violence in household, intimate partner, peer, and co-offending networks. Our review identified 16 studies published between 1996 and 2015 that suggest that exposure to a victim or perpetrator of violence in one's interpersonal relationships and social networks increases the risk of individual victimization and perpetration. 

Formal network analyses find high concentrations of gun violence in small networks and that exposure to gun violence in one's networks is highly correlated with one's own probability of being a gunshot victim. Physical violence by parents and weapon use by intimate partners also increase risk for victimization and perpetration. 

Additional work is needed to better characterize the mechanisms through which network exposures increase individual risk for violence and to evaluate interventions aimed at disrupting the spread of gun and other weapon violence in high-risk social networks.

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By:  Tracy M, Braga AA, Papachristos AV.
Correspondence to Dr. Melissa Tracy, Department of Epidemiology and Biostatistics, School of Public Health, University at Albany (http://www.albany.edu/sph/), State University of New York, One University Place, GEC 133, Rensselaer, NY 12144 (e-mail: mtracy@albany.edu).

Epidemiol Rev. 2016 Jan 5. pii: mxv009. 

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Association of Internalized and Social Network Level HIV Stigma with High-Risk Condomless Sex among HIV-Positive African American Men

We examined whether internalized HIV stigma and perceived HIV stigma from social network members (alters), including the most popular and most similar alter, predicted condomless intercourse with negative or unknown HIV status partners among 125 African American HIV-positive men. 

In a prospective, observational study, participants were administered surveys at baseline and months 6 and 12, with measures including sexual behavior, internalized HIV stigma, and an egocentric social network assessment that included several measures of perceived HIV stigma among alters. 

In longitudinal multivariable models comparing the relative predictive value of internalized stigma versus various measures of alter stigma, significant predictors of having had condomless intercourse included greater internalized HIV stigma (in all models), the perception that a popular (well-connected) alter or alter most like the participant agrees with an HIV stigma belief, and the interaction of network density with having any alter that agrees with a stigma belief. 

The interaction indicated that the protective effect of greater density (connectedness between alters) in terms of reduced risk behavior dissipated in the presence of perceived alter stigma. 

These findings call for interventions that help people living with HIV to cope with their diagnosis and reduce stigma, and inform the targets of social network-based and peer-driven HIV prevention interventions.

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By:   Wagner GJ¹, Bogart LM^2,3,4, Klein DJ^2,3, Green HD Jr², Mutchler MG^5,6, McDavitt B^5,6,7, Hilliard C⁸.

¹Health Unit, RAND Corporation (http://www.rand.org/health.html), 1776 Main St., Santa Monica, CA, 90407, USA. gwagner@rand.org.

²Health Unit, RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.

³Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.

⁴Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

⁵Department of Sociology, California State University, Dominguez Hills, Carson, CA, USA.

⁶Community-Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA.

⁷Clinical Psychology, Pacifica Graduate Institute, Carpinteria, CA, USA.

⁸Department of Psychiatry & Human Behavior, Charles Drew University of Medicine and Science, Los Angeles, CA, USA.

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Exploring Associations between Exposure to Sexy Online Self-Presentations & Adolescents' Sexual Attitudes & Behavior

Previous research suggests that adolescents' social network site use is related to their sexual development. However, the associations between adolescents' exposure to sexy self-presentations of others on social network sites and their sexual attitudes and experience have not yet been empirically supported. 

This study investigated reciprocal longitudinal relationships between adolescents' exposure to others' sexy self-presentations on social network sites and their sexual attitudes (i.e., sexual objectification of girls and instrumental attitudes towards sex) and sexual experience. 

We further tested whether these associations depended on adolescents' age and gender. Results from a representative two-wave panel study among 1,636 Dutch adolescents (aged 13-17, 51.5 % female) showed that exposure to sexy online self-presentations of others predicted changes in adolescents' experience with oral sex and intercourse 6 months later, but did not influence their sexual attitudes. Adolescents' instrumental attitudes towards sex, in turn, did predict their exposure to others' sexy online self-presentations. Sexual objectification increased such exposure for younger adolescents, but decreased exposure for older adolescents. In addition, adolescents' experience with genital touching as well as oral sex (only for adolescents aged 13-15) predicted their exposure to sexy self-presentations of others. 

These findings tentatively suggest that the influence on adolescents' sexual attitudes previously found for sexual media content may not hold for sexy self-presentations on social network sites. However, exposure to sexy self-presentations on social network sites is motivated by adolescents' sexual attitudes and behavior, especially among young adolescents.

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By:   van Oosten JM1, Peter J, Boot I.

• 1Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Postbus 15791, 1001 NG, Amsterdam, The Netherlands, j.m.f.vanoosten@uva.nl. 
• J Youth Adolesc. 2015 May;44(5):1078-91. doi: 10.1007/s10964-014-0194-8. Epub 2014 Oct 7.

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Finding and Keeping a Job: The Value and Meaning of Employment for Parolees

Finding stable employment has been identified as one of the best predictors of post-release success among prisoners. However, offenders face a number of challenges in securing employment when released from prison. 

This article examines processes that shape the abilities and motivations of parolees to secure gainful employment by examining interview data collected from parolees in Queensland, Australia (n = 50). We explore the role of social networks and commercial employment providers in helping parolees find work, the perceived value of institutional work and training, and the meanings, challenges, and impact of managing the disclosure of one's criminal past to employers. 

Findings highlight that the role and influence of employment on a parolee's reintegration is conditional on his or her supportive social networks, ability to manage stigma, and personal changes in identity, which elevate the importance of work in a parolee's life. 

Our findings also show how employment provides opportunities for offenders to self-construct and articulate new identities.

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By:   Cherney A1, Fitzgerald R2.

• 1University of Queensland, Brisbane, Australia a.cherney@uq.edu.au.
• 2University of Queensland, Brisbane, Australia. 

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Heroin Initiation Following Non-Medical Opioid Analgesic Use in New York City: Circumstances & Contexts of Transition

Background

As the prevalence of opioid analgesic (OA) misuse and associated harms have increased in the United States, the prevalence of heroin use and rates of unintentional overdose have concurrently risen. Research has begun to identify connections between OA misuse and heroin use, although this relationship remains under explored. The present study explores the context of heroin initiation among persons with histories of OA misuse in New York City.

Methods

In-depth interviews were conducted with 31 individuals with histories of OA misuse who initiated heroin use within the past five years. Data were collected between August 2013 and January 2015. All participants’ OA misuse temporally preceded their heroin use. Interviews were coded and analyzed utilizing thematic qualitative methods.

Results

Participants ranged in age from 18 to 44 years; 25 identified as male and 30 identified as non-Hispanic white and heterosexual. All participants had stable housing at the time of interview and all were high school graduates. Participants described several key points of transition along their trajectories from OA misuse to heroin initiation: dual- to single-entity OAs; oral to intranasal OA administration; and the development of physical opioid dependence. Participants described the breaking down of heroin-related stigma across social networks as new drug use permeated social groups.

Conclusion

Several points of transition were identified in participants’ trajectories from OA misuse to heroin initiation. In particular the development of physical dependence was a critical factor as existing heroin stigma was rapidly overcome in the face of opioid withdrawal. The relatively short time to heroin initiation documented among new user groups serves as an added challenge to the development of interventions.

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By:   Alex Harocopos, Bennett Allen, Denise Paone

New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, 42-09 28^th Street 19^th Floor Queens, NY 11101, United States

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Homeless Youths’ HIV Risk Behaviors with Strangers: Investigating the Importance of Social Networks

The purpose of this study was to examine the relationship between homeless youths' HIV risk behaviors with strangers and risk and protective characteristics of their social networks. Data were from the Social Network and Homeless Youth Project. 

A total of 249 youth aged 14-21 years were interviewed over 15 months in three Midwestern cities in the United States using a systematic sampling strategy. Multivariate results revealed that homeless youth with a greater average number of network members who engaged in more drug risk behaviors and who pressured them into precarious behaviors at least once were more likely to have participated in a greater number of HIV risk behaviors with strangers compared to homeless youth without such network characteristics. 

Additionally, 19-21 year olds, gay, lesbian, bisexual, and transgendered youth, and those who have run away from home more frequently, participated in more HIV risk behaviors with strangers than 14-18 year olds, heterosexual youth, and those who have run away less often. 

The final model explained 43 % of the variance in homeless youths' HIV risk behaviors with strangers. It is important to identify network characteristics that are harmful to homeless youth because continued exposure to such networks and participation in dangerous behaviors may result in detrimental outcomes, including contraction of sexually transmitted infections and potentially HIV.

Full article at:   http://goo.gl/XoWbap

By:   Tyler KA1.

• 1Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, 68588-0324, USA, kim@ktresearch.net. 

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