Tobacco Control and Child Health | School of Health Colloquium with Márta Radó

Summary

Dr. Marta Rau from the Karolinska Institute discusses the impact of tobacco control policies on child health, particularly in low and middle-income countries. She presents findings that smoke-free legislation leads to a decrease in infant mortality and that raising cigarette taxes is associated with lower mortality rates, especially in lower middle-income countries. Rau also explores how social networks can influence smoking behaviors and contribute to health inequalities, suggesting potential for network-based interventions.

Takeaways

• 📍 Concordia University acknowledges that it is located on unceded indigenous lands, respecting the past, present, and future connections with indigenous peoples.
• 🚭 Dr. Marta Rau's research focuses on the social factors affecting child health and health inequalities, with a particular interest in the impact of tobacco control policies.
• 👶 The case of 'Baby An' is used to illustrate the potential risks of hospitalization due to lung disease, influenced by social factors such as tobacco exposure and low household income.
• 🌍 78% of the world's population is not protected by comprehensive smoke-free policies, indicating a significant global health issue.
• 💔 Smoking is the leading preventable cause of premature mortality and morbidity, with children being particularly vulnerable to secondhand smoke.
• 📉 Smoke-free legislation has been associated with a significant decrease in both neonatal and infant mortality rates.
• 💲 Raising cigarette taxes is an effective policy measure, with a stronger impact on child health in lower-middle income countries.
• 🚗 Smoke-free car policies have been shown to reduce children's exposure to tobacco smoke, contributing to a decrease in asthma diagnoses.
• 🔄 Social networks play a significant role in the spread of smoking behaviors, with potential implications for health inequalities.
• 🌐 Dr. Rau's current projects aim to understand how social networks can be leveraged to reduce smoking prevalence and health inequalities, including the impact of new nicotine products.

Q & A

What is the significance of acknowledging indigenous lands at the beginning of the colloquium?

The acknowledgment recognizes the historical and ongoing relationship with indigenous peoples and their custodianship of the land where Concordia University is located. It also respects the continued connections with the past, present, and future within the Montreal community.

What is the primary focus of Dr. Marta Rau's research?

Dr. Marta Rau's research primarily focuses on understanding the social factors that influence child health and health inequalities, with a particular emphasis on the impact of tobacco control policies.

What is the importance of Baby An's health outcomes in Dr. Rau's presentation?

Baby An's health outcomes serve as a case study to illustrate the potential risks and factors that can influence a child's health, such as living in a country without tobacco control policies and being surrounded by smokers.

What was the methodology used in Dr. Rau's study on the impact of smoke-free policies on infant mortality?

Dr. Rau's study used a synthetic control method, where they created a 'synthetic Thailand' based on a combination of other countries that hadn't introduced smoke-free policies, and compared it to the actual Thailand after implementing the policy.

What were the findings from the study on smoke-free policies and infant mortality?

The study found that smoke-free legislation was followed by an annual 1.6% decrease in neonatal mortality and a 1.3% decrease in infant mortality.

How effective are increased cigarette taxes in reducing infant mortality according to Dr. Rau's research?

The research showed a strong association between increasing cigarette taxes and decreasing both neonatal and infant mortality, with a stronger effect in lower middle-income countries.

What is the potential global impact of raising cigarette taxes to the recommended 75%?

It was estimated that raising cigarette taxes to the recommended 75% could avert over 200,000 infant deaths annually.

What is the role of social networks in the spread of smoking behavior according to Dr. Rau's research?

Social networks can contribute to the spread of smoking behavior through popularity and social segregation, which can lead to increased smoking prevalence and health inequalities.

What are the potential interventions that can be developed based on the understanding of social networks and smoking?

Potential interventions could aim to reduce smoking prevalence and decrease inequalities by targeting network mechanisms, such as reducing popularity-driven smoking and addressing social segregation.

What are the two new projects that Dr. Rau is leading at the Karolinska Institute?

One project involves collecting complete social network data to understand how alternative nicotine products spread in networks, and the other uses administrative data to study how fertility behavior spreads in segregated social networks in Sweden.

Why is it important to consider ethnic groups when developing interventions based on social network studies?

Considering ethnic groups is important because one-size-fits-all strategies may not be effective, and tailored strategies can better address the specific social dynamics and inequalities within different ethnic communities.

Outlines

00:00

🌍 Introduction to Concordia University and Tobacco Control

The speaker begins by acknowledging the indigenous lands upon which Concordia University stands and introduces the topic of the colloquium focusing on Tobacco Control and child health. The speaker, Dr. Marta Rau, provides a background on her expertise in sociology and statistics as they relate to child health and health inequalities. She introduces a hypothetical case study of a child named Baby An, born with good health outcomes, to discuss potential risks of hospitalization due to lung disease. Dr. Rau highlights the importance of social factors such as tobacco control policies, or the lack thereof, in low and middle-income countries where smoking is prevalent and can impact child health.

05:00

🚭 Impact of Tobacco Control Policies on Child Health

Dr. Rau discusses the negative health effects of smoking, emphasizing the need for tobacco control policies to protect children who are particularly vulnerable to secondhand smoke. She points out that a significant portion of the world's population still lacks comprehensive smoke-free policies. The speaker then describes a study she conducted, which aimed to estimate the impact of tobacco control policies on child health and survival, especially in low and middle-income countries. The methodology involved creating a 'synthetic Thailand' by combining data from countries without such policies to compare with the actual impact in Thailand, which implemented smoke-free legislation.

10:03

📊 Analysis of Smoke-free Legislation and Cigarette Tax Policies

In this section, Dr. Rau presents findings from her research on the impact of smoke-free legislation on infant and neonatal mortality rates. The study showed a significant decrease in mortality after the implementation of such policies. Additionally, she discusses the effectiveness of increasing cigarette taxes as a tobacco control measure, particularly in lower middle-income countries. The research indicated a strong correlation between higher taxes and reduced infant mortality. A hypothetical scenario of globally increased taxes suggested that over 200,000 infant deaths could be averted annually.

15:03

🌐 Expanding Tobacco Control Policies to Private and Outdoor Spaces

Dr. Rau addresses the extension of tobacco control policies beyond public spaces to private and outdoor areas, such as cars and playgrounds. She reviews the current evidence, which is limited but suggests a positive impact on reducing children's exposure to tobacco smoke in cars. The speaker emphasizes the need for more research in this area to draw concrete conclusions about the effectiveness of such policies.

20:04

🔗 Social Networks and Smoking Inequalities

The speaker explores the role of social networks in the spread of smoking behaviors and how they contribute to health inequalities. Dr. Rau discusses four theoretical mechanisms by which social networks can create disparities in smoking: segregated networks, popularity of smokers, oppositional culture, and selection to file. She presents findings from a longitudinal study in Hungarian high schools that investigated how smoking and friendship formation are influenced by these mechanisms, particularly focusing on ethnic differences between Roma and non-Roma students.

25:06

📈 Future Research on Social Networks and Health Behaviors

Dr. Rau outlines two new research projects she has been granted to work on. The first project aims to understand how alternative nicotine products spread within social networks, using complete social network data collection methods. The second project will utilize detailed administrative data in Sweden to study how fertility behaviors spread within segregated social networks at a population level. Both projects aim to provide insights that could inform future policy interventions to reduce health inequalities.

🤔 Closing Remarks and Q&A

The speaker concludes her presentation by inviting questions from the audience. She emphasizes the importance of addressing health inequalities through targeted interventions and notes the quietness of the audience, suggesting a potential lack of questions. The session ends with thanks to Dr. Rau for her informative talk.

Keywords

💡Concordia University

Concordia University is an institution of higher learning located in Montreal, Canada. The script acknowledges that the university is situated on unceded indigenous lands, highlighting the importance of recognizing the historical and ongoing relationships with indigenous peoples. This sets a respectful tone for the event and emphasizes the significance of indigenous land rights and cultural recognition.

💡Indigenous lands

The term 'indigenous lands' refers to territories that are traditionally inhabited by indigenous peoples. In the script, it is mentioned that Concordia University is located on such lands, emphasizing the importance of acknowledging the custodianship of the land by the Kanien'kehá:ka Nation of the St. Lawrence. This is crucial for understanding the historical context and the ongoing dialogue with indigenous communities.

💡Tobacco Control

Tobacco Control refers to the implementation of policies and strategies to reduce tobacco use and its health impacts. The speaker, Dr. Marta Rau, discusses her research on the impact of tobacco control policies on child health and survival, particularly in low and middle-income countries. This keyword is central to the video's theme, as it explores the effectiveness of public health interventions.

💡Child health

Child health encompasses the well-being and medical care of children from birth through adolescence. The script mentions a hypothetical child, Baby An, to illustrate the potential risks of hospitalization due to lung disease, underscoring the importance of tobacco control policies in safeguarding child health.

💡Smoke-free policy

A smoke-free policy is a regulation that prohibits smoking in certain areas, such as public spaces or vehicles, to protect non-smokers from secondhand smoke. The script discusses research findings that show a decrease in infant mortality following the implementation of smoke-free policies, highlighting the effectiveness of such measures in improving public health.

💡Infant mortality

Infant mortality refers to the death of infants before their first birthday. The script uses infant mortality rates as an indicator to measure the impact of tobacco control policies, showing a decrease in these rates after the introduction of smoke-free legislation.

💡Social networks

Social networks are the webs of connections among individuals within a community. Dr. Rau's research delves into how social networks can influence smoking behaviors and potentially exacerbate health inequalities. The script mentions that while population-level policies are effective, they may not adequately address smoking inequalities, suggesting the importance of considering social networks in public health interventions.

💡Health inequalities

Health inequalities refer to disparities in health status or outcomes between different population groups. The script discusses how social networks can contribute to these inequalities, particularly in the context of smoking behaviors and their impact on different ethnic groups.

💡Ethnic minorities

Ethnic minorities are subgroups within a larger population that experience cultural, economic, or political differences. The script uses the example of Roma students in Hungary to discuss how social networks can create or exacerbate health inequalities, such as smoking rates, among different ethnic groups.

💡Fixed effects regression

Fixed effects regression is a statistical method used to estimate the effect of a policy or treatment while controlling for unobserved heterogeneity. The script mentions the use of fixed effects regression to analyze the impact of increasing cigarette taxes on infant mortality rates, demonstrating the application of statistical methods in health policy research.

💡Micro-simulation

Micro-simulation is a modeling technique used to estimate the impact of policies or interventions on individual-level outcomes over time. The script refers to a micro-simulation model developed to estimate the long-term health benefits of tobacco policies on children, illustrating the use of complex modeling techniques in public health research.

Highlights

Concordia University acknowledges its location on unceded indigenous lands and recognizes the custodians of these lands.

Introduction of Dr. Marta Rau, an assistant professor at Karolinska Institutet in Sweden, and her focus on social factors affecting child health and health inequalities.

The importance of tobacco control policies in protecting children's health, especially in low and middle-income countries.

The lack of comprehensive smoke-free policies and high tobacco taxes in many countries, leaving a significant portion of the world's population unprotected.

A study estimating the effect of tobacco control policies on child health and survival, using innovative methods to create synthetic control countries for comparison.

Findings that smoke-free legislation leads to a significant decrease in neonatal and infant mortality rates.

The strong association between increasing cigarette taxes and decreased neonatal and infant mortality, particularly in lower middle-income countries.

A hypothetical scenario where increasing cigarette taxes to the recommended level could avert over 200,000 infant deaths annually.

The development of a microsimulation model to estimate the long-term health benefits of tobacco policies on child health outcomes.

Research on the impact of smoke-free car policies on children's exposure to tobacco smoke and the subsequent reduction in asthma diagnoses.

The role of social networks in the spread of smoking behaviors and the potential for network-based interventions to reduce smoking inequalities.

A study examining how smoking spreads in socially and economically segregated networks and the mechanisms that contribute to smoking inequalities.

Findings that social networks contribute to health behavior inequalities due to segregation and majority group exclusion of minority individuals who do not smoke.

The potential for network-based interventions to address smoking inequalities by targeting specific characteristics within different ethnic groups.

Two newly funded projects that will extend research on social networks and smoking behaviors, including the study of alternative nicotine products and online interactions.

The use of administrative data in Sweden to construct population-level social networks and study the spread of fertility behavior in segregated networks.

The conclusion of the presentation with an invitation for questions and the acknowledgment of the importance of ongoing research in this field.

Transcripts

[Music]

all right so good afternoon everyone i'

would like to begin by acknowledging

that Concordia University is located on

unseated indigenous lands the Gan Gaga

nation is recognized as the custodians

of the lands and Waters on which We

Gather today JJ or Montreal is

historically known as a Gathering Place

for many First Nations today is home to

a diverse population of indigenous and

other peoples we respect the continued

connections with the past present and

future in our ongoing relationships with

indigenous and other peoples within the

Montreal

Community before we begin our school of

health colloquium Tobacco Control and

child health I would just like to ask

all attendees to save your questions and

enter them in the Q&A feature at the

bottom of your screen we'll do our best

to answer all questions at the end of

the talk I would now like to introduce

our speaker Dr Marta Rau who is an

assistant professor at kolinska

Institute in Sweden and a visiting

researcher here at Migel

University over to you Marta thank

youy so I will share

my

screen um do you see that my screen

changes yes we do okay super So yeah

thank you so much um a little bit about

my background so I'm I have a PhD in

sociology and I graduate degree in

statistics and U applied uh for um

understanding the social factors for

child health and health inequalities and

I will talk a little bit about this so

um uh and before I talk about it let me

introduce you baby an who is um um

was her mother attended a prenal visits

really regularly and then she was born

in April 29th so she's almost one year

old and she had really good health

outcomes born term with good weight and

everything what you want so um yeah the

big question is that what is the risk

for baby an to get hospitalized with

some lung disease and yeah her Health

outcomes are really really good um

respiratory um negative respiratory

outcomes are quite common so maybe there

is some risk but nothing alarming here

and um if I tell you some additional

information about baby an baby an is

living in a country which has no uh

Tobacco Control policy at Place uh and

uh uh in a low and middle- income

country

and surrended by people who smoke so

mother smoke father smoke the neighbor

smokes and um from a a household which

has low income uh so these are like the

social factors uh for babym and this is

the core of my interest uh beyond the

previously mentioned factors so this

might modify what we think of bbn's risk

for getting hospitalized respiratory

disease so let's see um I will talk

about two projects uh which I had the

first one was um that I conducted VI was

terasos MC in the Netherlands um and

this was about estimating the effect of

tobacco control policies on child health

and

survival and the next one is something

which I'm currently doing uh and this

projects um is about estimating the

smoke the the impact of social networks

on smoking in

activities so first the Tobacco Control

policies so this is not going to be very

surprising for you but smoking is really

really bad for the health it's the

leading preventable cause of uh

premature mortality and

morbidity and

um Beyond The Smokers there are people

who uh are also negatively impacted by

smoking and that that is um

that are childrens uh who have uh in

general low ability to control their own

exposure so we need to protect them uh

particularly them uh about uh tobacco

Contra

policies about the harm of tobacco uh

and uh Tobacco Control policies are a

really good measures for for this but um

uh there is uh still in 78% of the world

population is not protected by

comprehensive smoke report policy which

means that a smoke F policy which covers

all public um and closed places such as

hospitals

schools um governmental

buildings um and U

86% of the world population is still

living in um a country without a

sufficiently high taxes uh defined by

the World Health Organization so there

is way to go to extend these policies to

um um other countries or uh regions

which doesn't have sufficiently uh good

measures but there were uh some

knowledge gaps um in this uh topic and

the first one was um whether we saw it

in a lot of high income countries that

um these measures are really effective

for protecting child health but it was

still unknown that whether these

measures

are like working in low and middle

income countries uh where other air

pollutions uh might be higher uh where

the knowledge of tobacco related harm

may be lower and there are different

cultural aspects about toing smoking

also so this was one question and the

other question was uh that we always

looked into uh enclosed public places

and these are this is the definition of

comprehensive small free policy based on

the wh but there are a lot of countries

uh including Canada which started to

introduce uh

policies um uh uh smoke free policies to

private or outdoor places for example to

uh private cars or

playgrounds so um there there were some

evidence but the systematic

overview was missing so this is what we

we did so first this is

a uh one of our publication about small

cry policies in infant on the impact of

small cry policies on infant mortality

in multiple middle inome countries and

um here are the two uh senior authors on

the project yper and

Frankland and um basically what we did

uh what we should do if we wanted to

estimate this

policy ideally what we would do is that

we would have a country like Thailand

and investigate this country uh with the

legislation and then have the same

country at the same time without

legislation well I don't need to detail

why this is impossible so we cannot have

a country at the same time at the same

uh country uh observing it with and

without uh legislation so we could have

another strategy uh we could randomly

select countries and in introduce uh the

legislation in these countries and then

um the other countries don't introduce

this policies so this is a like conduct

a randomized uh try uh but this is also

not really feasible um I cannot really

tell to countries that you should uh

introduce this policy or not even the

evidence uh it's really hard but let

alone just for the sake of research so

this is a not really feasible and not

even

ethical so the second thing is that we

could have Thailand which introduced the

policy and comate with an other country

without the policy but again this is not

truly feasible uh because um yeah

because there is no other country like

Thailand we cannot really find like uh a

comparable country CH China and Malaysia

let's say they are a bit similar but

still not the same so the next strategy

and that's what we did actually is that

we um had a country which introduced the

policy that's Thailand and we had um

bunch of other countries which didn't

introduce this policy and based on them

like Bangladesh China Bhutan and

Malaysia and based on them we created a

synthetic Thailand which is like 20%

Bangladesh 50% Malaysia and

the uh 30% China let's say uh so then we

had the real Thailand uh which

introduced the policy and a synthetic

Thailand based on countries which uh

haven't introduced this policy uh and

this is just to say it in an other way

mathematically so the synthetic uh

Thailand would be the weighted

combination of the control

countries and then we would compare this

Thailand and the synthetic Thailand in

the post legislation period uh and see

how they um differ and that would be the

policy impact so this is what we did

here and we did this not only for

Thailand but for 34 uh countries

um which introduced The Smoke free

legislation and we could find a good

synthetic control for 20 two of them and

here in figure one you can see the

findings so what you see here is that

there is the mortality in one of the

axes and the time from implementation in

the other axis this vertical line is

when the polic was

introduced uh the red red lines are

infant mortality uh the blue lines are

neonatal mortality and the solid line is

um uh

the in interv the average of the

intervention countries which introduced

the policy and the dash line is the

average of the synthetic control

countries uh so you can see that in the

pre legislation period they don't differ

a lot they are the same this is how we

set up the syntic control countries and

in the post legislation period they

start to uh defer and this is what we

call the policy impact So based on this

we estimated that the Smoke free

legislation was followed by an annual

1.6% decrease in Neal

mortality uh so this uh annually and U

uh

1.3% decrease in infant morality

annually so this was about smoke

registration um but there are other

policies and uh probably the the most

effective one is uh raising uh cigarette

taxes so we had this uh paper also which

looked in into the global impact of

increasing cigarette taxes with um

colleagues from Imperial College

um

and uh yasper ban from Rasmus

MC uh and what we did here is that we

did fixed effect B regressions and we uh

looked how much uh increasing 10% um the

cigarette taxes is associated with uh

lower nealan infant Mor

um and we find that there was a strong

Association uh for both decreasing

neonatal and infant

mortality and uh this ass Association

was stronger in lower middle income

countries um and there was a dose

response effect um and uh all of there

was all of the taxes the type of taxes

so specific tax ADV imported all of them

were associated with the decrease in

infant and un mortality and then we we

estimated that what would happen in a

hypothetical world where all of a sudden

all countries increased the their taxes

to the recommended

75% and we find that annually based on

our estimation Ann annually over 200 uh

um infant death could have been averted

so that's lot if they do

this uh yes and then we had the a micro

simulation this was U also done by asper

Bane and Tim more

Faber and the the idea here was that um

we estimated the impact of tobacco taxes

for different

outcomes uh but in the overall and

longterm health benefit

U uh was missing so uh previous micro

simulation models uh mostly looked into

adult Health outcomes so we calibrated

this micro simulation model for

estimating the overall long-term impact

of uh um uh tobacco policies on child

health outcomes and basically what this

model does is that we follow up a

synthetic population from fetal life to

Childhood so the child the the fetus

first has a a risk to burn pret term uh

or term or born dead and then uh they

have a risk for die uh in the first 30

days or um uh go to the

Pediatric part of the model where they

have a certain risk for getting admitted

uh to hospitals for asthma or

respiratory their respiratory track

infection and and this risk based on

whether they were born pre- term or

term and uh here is a bit about the the

finding so um we estimated the number of

the deaths and the number of total

hospitalizations uh okay and then the

last question is that I talked a little

bit about that um this smoke rep

policies are usually estimated for

unclosed public uh uh places but there

are other places which are extending to

private and outdor places but the

systematic uh overview was missing so

this is what we did and here fol and was

the other lead author author

here um and um we identified basically

11 studies and seven uh fit uh for the

uh prespecified criteria

uh five of them investigated smoke free

cars uh one of them investigated a smoke

free school policy and uh one

comprehensive policy covering multiple

areas including outter places so we

could based on this um were the results

in meta analysis for the Smoke free Car

policies and uh and their impact on um

tobacco smoke exposure in children for

children in the car and uh uh we find a

considerable reduction when we

considered all of this evidence

here um and then we translated this uh

we estimated how uh that this translate

to uh uh 0.2 to a 2.4% decrease in

asthma diagnosis uh this level of

tobacco smoke exposure in cars which

doesn't sound a lot but given the high

uh Global burden of U asthma this is

considerable effect and there were some

studies for out policies but not enough

to uh come uh for any conclusion

regarding

them okay so this was um my poog project

in um at arasmus MC and U now kolin

Institute and um I lead a project about

um social networks and uh what's the

role of social networks in um PA in

acuities uh and basically what um what I

showed you before is that these

population level uh uh policies were

really good at decreasing uh smoking

inequality decreasing smoking prevalence

and um increasing uh child improving

child health outcomes but they were not

that good in uh decreasing smoking

inequalities so they were mostly

effective among the uh High income

population and um yeah there are

different reasons why this could be I

investigated one uh uh Factor uh the

meso factors so the social

networks and um basically uh here what

we did is that we knew that smoking

spreads in the network but there were

but it was still unclear how smoking

spreads in a social economically

segregated

network uh so this is what we looked at

and this is very important because there

are um this network-based interventions

which use this uh social network studies

to intervene and they were mostly

successful so there is this sis try is I

think the one of the most uh um famous

one but uh it even this assist tribe

which looked at how um an netor based

intervention can um decrease smoking

prevalence among adolescence they didn't

look into how it could reduce smoking

inequities and um that's the motivation

to inform a policy

intervention and uh show this so what we

did is we tried to disentangle Social

Network meis mechanisms uh to develop an

um po intervention and this is the first

paper what we had here which was

published not too long ago in

addiction uh but I will present um a new

finding about ethnic inabilities this

was about social income in

acilities so the theoretical background

basically uh uh social networks can

create uh inequalities in smoking in

four ways so um it could uh increase

inequalities if smoking spreads in a

segregated neck fare smoking can spread

in two ways first if um I influence I'm

a smoker and I influence you to smoke

then smoking will spread the other thing

is that um uh the way how it could uh um

spread in the network if I'm a smoker

and I'm extremely popular so others want

to be uh popular too so they will start

a smoke so this is basically the two

mechanisms the segregated networks means

that um people from similar background

social economical background ethnic

background will uh interact with each

other more often or befriend each other

more often so if these two uh things

stands then we know that inequalities

will accelerate the other thing which

hasn't been um investigated for health

outcome is a so-called oppositional

culture theory which was developed for

um mostly for um uh academic outcomes

but it could be applied for health in

acces also so this one States uh

basically that if a minority students

start to study well or do something

which is against the school Norm like uh

not smoke or not not to drink alcohol

then the minority group will exclude

them so this is a another way

how it could happen and the fourth one

is what we call selection to fil this

just PR assume that people who meet more

often like they smoke together uh has

higher chance to interact and uh be

friend and this could also accelerate

smoking in aties if uh this smoking is

the bridge only brid between majority

and minority students so what we had is

that we collected longitudinal network

data in 52 uh high schools in Hungary uh

we investigated the one of the outcome

was friendship the other was smoking um

and the individual characteristics which

we um looked into was smoking ethnicity

so there are the biggest minority in

Hungary ethnic minorities are Roma

students and

um they had data about whether some

somebody is Roma or non Roma and gender

and we conducted the longitudal network

analysis using multi-group uh methods

this method basically produce something

very similar to a regression model but

it's simultaneously um uh model has two

outcomes so in the one hand we look into

how uh smoking smoking Behavior changes

in the individual and the other hand we

are looking into whether friendship type

formation changes

um based on uh this is based on

structural characteristics Network

characteristics for example um we know

that if I um befriend vendy then vendy

will have higher risk to befriend me too

um this is one structural characteristic

which we consider and individual factors

and here we consider two type individual

Factor so the person the ego who sends

the tie and the person who is the alter

who received the tie and we looking to

whether the for example the alter

characteristic could be whether the

alter is a smoker is he or she's going

to receive more ties so this is the

outcome but I will explain it a bit so

you can see that there is a friendship

Dynamic part and the smoking diic part

of the mother here are the structural

effects and here are the uh

characteristics of the people so this is

pretty similar to uh our aggression just

instead of one person you have two

people's characteristics and this part

is really similar to the the smoking

Dynamics part is really similar to a

fixed effect

model so basically what we find is that

smoking spreads uh smoking

uh uh spreads because um smokers are

popular we also found that uh SE the

network is segregated so Roma people

have um um higher risk to nominate other

Romas and non- Romas tend to nominate uh

non- Romas as

friends there is a very good news we

didn't find opposition oppositional

culture and I say that it's very very

good uh because it's very very hard to

change it with policy

measures but we find something else we

find that uh actually it's the uh

non-ras who exclude uh Romas who don't

smoke so this is a bit of evidence for

this selection to Fore so maybe smoking

is the one which can breach ethnic

divide and if a Roma doesn't smoke then

they are left excluded so this is what

we find here that um non Romas tend to

nominate Romas this is just uh instead

of interpreting the three Bay

interactions this is just a table to

explain so here is what we

find uh the the the results shows that

social networks contribute to

inequalities in health

behaviors uh and um we find that it's

contributes because the network is

segregated and because a majority group

excludes minority people who don't

smoke uh and these are uh

characteristics uh which could be

addressed by uh um potential netbase

intervention and we could develop

netbase interventions which not only aim

to reduce smoking in smoking prevalence

in general but also decrease in acuities

and it's very important to emphasize

that one one size may not fit all ethnic

groups um so we need to have a smart

strategy for this and um most recently I

got um two grants uh uh to extend this

word so I will just talk very very

briefly what what are this projects

so what we uh the first one is from um

fora which is a Swedish Grant

agency uh basically what we we did

before and what I just presented is that

we always looked into help smoking

spreads in the

network uh but there are new alternative

nicotine products and uh um there hasn't

been any complete social network data

collection to my knowledge which

distinguish between these two and

complet social network data is very

important to be able to distinguish the

network mechanisms uh complete complete

social network data means that we know

the relationship between each member of

the

population so uh this is one and the

other is that there uh has been only uh

some studies for complete social network

data for uh uh looking into online

interactions also uh but these were for

University students so this is what we

will do we will collect uh um data from

online and we will distinguish uh

different network

mechanisms and um so we will collect

these data in Sweden and then analyze

them with social network analysis

methods and the other project is that um

we know that uh that there there is an

other type of complete social network

and this is embedded in the population

level networks uh so in Sweden the

administ there is very detailed

administrative data so we know exactly

uh where people live so I can tell who

is who is neighbor with whom and this is

for the whole population of Sweden we

know who is the family members so we can

construct U the family Network we know

um who works together so we can

construct a call colleag network but I

even know who goes to the same prison so

we can construct even a prison Network

and we will use this population level

social networks to understand how um

fertility Behavior Uh spreads in

segregated social networks so this is

the second project which I got funded

and uh thank you so

much B okay thank you so much um so now

uh well take questions so if anyone has

any question uh since we're a small

group if you want you could just raise

your hand uh or if you're more

comfortable you can enter your question

in the Q&A

feature I guess it was a very clear talk

I don't see any questions we can wait uh

a few more a couple more minutes um but

uh if not uh Martha I just want to thank

you very much for your presentation

today and uh

I guess uh for everyone else who's very

quiet and has no questions have a great

afternoon thank you ly thank you

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