Using Game Theory to assess the effects of social norms and social networks on adolescent smoking in schools: a proof of concept study

点击翻译按钮获取中文摘要

In order to develop better public health interventions, it is important to understand the mechanisms by which they exert their effects. Interventions that act on groups of people or whole populations may be more effective at reducing health inequalities than those that target individuals. Changing social norms is one way of affecting behaviour in groups of people, but these social norms often depend on connections and shared "understandings" between members of the population. The connections between people are what characterise their shared "social network", and this may affect the way that social norms spread among people. Public health scientists know surprisingly little about how best to measure and evaluate the spread of social norms and their effects on behaviour. This proof of concept proposal is innovative because we will harness the perspectives from scientists from different disciplines, for example, from economics and computer science, to compare and contrast two school-based interventions that aim to prevent smoking uptake among adolescents (13/14 year olds) in the UK and in Colombia - a LMIC and high income setting where smoking rates and norms are different - in order to reveal potential differences in the social norms-based mechanisms of action. Overall Aims:1. To improve the measurement of social norms around smoking behaviours in adolescents. 2. To use these improved measures to better understand the spread of social norms in school settings. 3. To better characterise the potential mechanisms of action of smoking prevention interventions in schools.4. To learn lessons for the design and evaluation of behaviour change interventions that invoke mechanisms which change social norms. 5. To build a legacy of transdisciplinary research capacity in public health science in a LMIC setting, with clear pathways to impact.Of the two evidence-based interventions, one is designed to harness the influence that peers have on their friends while the other is based on classroom teaching. In a before and after design, we will obtain baseline information on psychosocial characteristics, friendship groups and behaviours (e.g including attitudes and intentions towards smoking and vaping) from 300 students from three schools for each intervention (i.e. six schools in total, n=600) in the UK and the same number from six schools (three receiving one intervention each) in Bogota, Colombia. We are studying schools in two countries because the social norms around smoking are so different and the contrast between the two will provide richer explanations. Before the intervention each participant will take part in economic experiments that will allow us to assess their judgments about the social appropriateness of a range of smoking and vaping-related behaviours, also enabling the estimation of individual sensitivity to social norms. At the end of the semester (after the interventions), participants will again take part in the same behavioural economic experiments, allowing us to estimate how the social norms (related to smoking and vaping) have changed, how individual sensitivity to classroom social norms has changed and how closely individual changes are related to changes among friends in the student's social network. We will then analyse how measuring social norms in these novel ways has helped us learn more about the mechanisms of action of the interventions, and how the social norms spread in classrooms and year groups. We will use the quantitative data from the experiments and qualitative data from interviews with participants in these schools to "triangulate" our findings and sharpen the explanations that are possible from the overall analysis. At the end of the study we will meet with experts from different fields of research, to help us interpret our findings in a deeper way and discover how they might apply to other contexts and to other interventions to change health behaviours.