Effects of Public Health Interventions on Aged Adults in Village Social Networks

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ABSTRACT Aging adults play a central role in the formation and maintenance of social ties in traditional settings. Much observational and experimental work has demonstrated that health effects can spread across such social ties, affecting the health of the aging adults themselves and also others. Less well understood is whether and how exogenous interventions might restructure social ties, fundamentally altering the role aging adults play in their communities and potentially leading to their isolation or compromising their social relevance or health. In an existing RCT involving 30,862 people aged 12-93 in 176 villages in rural Honduras, we are assessing “social network targeting algorithms” to maximize the diffusion of public health interventions. Each village is randomly assigned to have a different percentage of its inhabitants (from 0-100%) get the intervention. In the proposed work, we wish to evaluate how the introduction (with experimentally varied penetrance) of a public health intervention might alter the social fabric of the villages, especially among the older adults, focusing on the 4,589 subjects ≥50 years old. The parent RCT provides an ideal platform on which to build the current project, collecting new data, asking new questions, and performing new analyses. We have four specific aims. First, we will re-map the complete face-to-face networks of the 30,862 people in the 176 villages, constituting the third wave of network mapping, roughly 2 years after the completion of our second wave in 2019. The result will be a very unusual dataset, capturing how the structures of real-world social networks, and the position of aging adults in them, change over time, in response to randomized exposure to a formal public health intervention. Our second aim is to quantify changes in the structure of the whole-village-level social networks over a 2-year interval. Using various statistics that characterize network structure (e.g., degree distribution, transitivity, network “motifs”), we will assess the stability of village networks. We will also study how aging adults’ social ties, and in particular health-related social ties, within the villages are affected by the introduction of varying doses (across villages) of the public health intervention. The introduction of formal institutions might be expected to attenuate the informal institutions that had previously served the same purpose, leading to potential social isolation and less relevance of aging adults in these communities. Our third aim is to characterize changes in the ego-level networks of aging villagers, based on whether their social connections received (or adopted) the public health intervention. Our fourth aim is to evaluate the impact of exogenously induced changes in network position upon the subsequent physical and mental health of the elderly. Overall, our work will allow us to explore experimentally whether and how the social connections of aging adults, the role of aging adults in networks related to health, and the health of those individuals change when formal health-relevant institutions are exogenously introduced into a social system.