Aim 2 rationale

Aim 2

Assess the level of social influence on young men’s sexual risk behaviors, and the moderating role of social norms in the relationship between mental health and sexual risk behaviors within camp networks.

Empirical evidence

Previous studies have shown that peers’ mental health status affects an individual’s own mental health [16, 17] and sexual risk behaviors [18], but we have little understanding of the potential influence of peers in patterns of mental health and sexual risk within the same network. Understanding such an influence on the relationship between mental health and sexual risk in young men’s social networks would allow us to discern if there is something social or learned about sexual risk as a response to poor mental health. Experts have called for combined sexual risk reduction and mental health promotion interventions [31], and the results of the dissertation research provide essential evidence to determine the appropriateness of such interventions in this setting.

Past studies indicate that individuals’ sexual behaviors, including partner concurrency [58] and condom use [59-62], reflect their peers’ behavior. Specifically, these studies found that youth who perceived higher levels of concurrency or lower levels of condom use among their peers were more likely to display concurrency or lower levels of condom use themselves. Peer influence and similarity in sexual behavior has been less frequently studied from a social network perspective than mental health, indicating a need for further research in this area. Though the influence of mental health and peer norms have been studied separately as predictors of sexual risk, to my knowledge there were no studies prior to the dissertation study assessing the interaction between individual-level mental health and peer norms in predicting sexual risk behaviors.

Theoretical rationale

Berkman’s model. Development of hypotheses pertaining to social network influence on the

relationship between mental health and sexual risk was guided by Berkman’s model of social network influence on health behaviors [63]. This model offers a multilevel framework for understanding the influence of social network structure and ties on individual behaviors. Berkman posits that both the structure of a social network and qualities of the ties between individuals within the network shape interpersonal social processes including social support, social influence, social engagement and role formation, and access to goods and resources; in turn, these social processes influence individual behaviors [63]. I used this model to guide my thinking and review of the literature on the potential role of social networks in shaping young men’s sexual risk behaviors in interaction with their mental health. Social influence emerged as the most salient psychosocial mechanism through which the form and function of social networks might shape the behaviors in question.

Figure 2. Berkman et al., 2000

Social influence

Focusing on the mechanism of social influence from Berkman’s model, the hypotheses related to peer influence on individual sexual risk behaviors, and the relationship between mental health and sexual risk were guided by additional theories specific to social influence. Social networks shape social influence by providing structural opportunities for interactions between network members [64, 65]. Network peers who are structurally proximal, or who have direct connections, have the ability to directly influence one another. In this way peers develop shared attitudes, perceptions, and behaviors with structurally proximal peers in social networks [65]. Network members not only have the ability to influence one another through direct contact, but can also indirectly influence peers to whom they are not directly tied [66]. An individual may watch and model a friend’s behavior, such as partner concurrency, and may

in turn influence other friends, thereby mobilizing a process of behavioral contagion throughout a whole network [67].

In this Aim, I focused on direct interactions as the basis of peer influence. I hypothesized that network members who have strong relationships (i.e. friendships) interact frequently and by

consequence develop similar behaviors. Young men’s interactions with friends in their network will create opportunities to directly observe and model how their friends think, feel, and behave. Following Marsden and Friedkin’s hypothesis that the more proximal two individuals are in a network, the more influence these actors will have on one another [34], I hypothesized:

Hypothesis 2a: Young men’s sexual risk behaviors will be more correlated with those of friends than with those of other members of their camp network.

I further explored the interaction between individual mental health and peer risk behavior norms in shaping young men’s sexual risk behaviors. Peer influence not only acts independently to shape behavior but peers also serve as a reference groups which individuals look to in behavioral decision- making [68]. In Aim 1, I hypothesized that increases in symptoms of anxiety or depression would increase the likelihood of engagement in sexual risk behaviors. In Aim 2, I further hypothesized that more normative risk behaviors among direct peers will serve to magnify this individual-level risk. In other words, men who experience increased levels of anxiety or depression may have a higher inclination toward risk behaviors, and the influence of riskier norms among their friends may increase the likelihood that this inclination manifests in actual risk behaviors. Specifically, I tested the following hypothesis:

Hypothesis 2b: The relationship between mental health and sexual risk will be moderated by peer sexual risk behavior norms such that the relationship will be stronger for young men exposed to riskier peer norms than for men exposed to less risky peer norms.