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

为了制定更好的公共卫生干预措施，重要的是要了解它们发挥作用的机制。针对人群或整个人群的干预措施可能比针对个人的干预措施更有效地减少健康不平等。改变社会规范是影响群体行为的一种方式，但这些社会规范往往取决于群体成员之间的联系和共同的“理解”。人与人之间的联系是他们共享的“社会网络”的特征，这可能会影响社会规范在人与人之间传播的方式。令人惊讶的是，公共卫生科学家对如何最好地衡量和评估社会规范的传播及其对行为的影响知之甚少。这个概念证明提案是创新的，因为我们将利用来自不同学科的科学家的观点，例如，从经济学和计算机科学，来比较和对比两种基于学校的干预措施，旨在防止青少年吸烟（13/14岁）在英国和哥伦比亚-一个低收入和高收入环境中，吸烟率和规范不同-为了揭示基于社会规范的行动机制的潜在差异。总体目标:1。改善对青少年吸烟行为社会规范的测量。2. 使用这些改进的措施来更好地了解社会规范在学校环境中的传播。3. 更好地描述学校预防吸烟干预措施的潜在作用机制。为设计和评估行为改变干预措施吸取经验教训，这些干预措施可调用改变社会规范的机制。5. 在低收入和中等收入国家环境中建立公共卫生科学跨学科研究能力的遗产，并具有产生影响的明确途径。在两种基于证据的干预措施中，一种旨在利用同伴对朋友的影响，而另一种基于课堂教学。在前后设计中，我们将获得来自英国三所学校（即总共六所学校，n=600）和哥伦比亚波哥大六所学校（三所学校各接受一项干预）的300名学生的心理社会特征、友谊群体和行为（例如，包括对吸烟和电子烟的态度和意图）的基线信息。我们正在研究两个国家的学校，因为关于吸烟的社会规范是如此不同，两者之间的对比将提供更丰富的解释。在干预之前，每个参与者都将参加经济实验，这将使我们能够评估他们对一系列吸烟和电子烟相关行为的社会适当性的判断，也使我们能够估计个人对社会规范的敏感性。在学期结束时（在干预之后），参与者将再次参加相同的行为经济学实验，使我们能够估计社会规范（与吸烟和电子烟有关）是如何变化的，个人对课堂社会规范的敏感性是如何变化的，以及个人变化与学生社交网络中朋友之间变化的关系有多密切。然后，我们将分析以这些新颖的方式衡量社会规范如何帮助我们更多地了解干预措施的作用机制，以及社会规范如何在教室和年级组中传播。我们将使用来自实验的定量数据和来自这些学校参与者访谈的定性数据来“三角测量”我们的发现，并从整体分析中提炼出可能的解释。在研究结束时，我们将与来自不同研究领域的专家会面，以帮助我们更深入地解释我们的发现，并发现它们如何适用于其他环境和其他干预措施，以改变健康行为。

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.