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The Use of Social Network Analysis to Quantify the Importance of Social Venues in an Infectious Syphilis Outbreak in Calgary, Alberta: a Pilot Study

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The Use of Social Network Analysis to Quantify the Importance of Social Venues in an Infectious Syphilis Outbreak in Calgary, Alberta: a Pilot Study University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies Legacy Theses 2010 The Use of Social Network Analysis to Quantify the Importance of Social Venues in an Infectious Syphilis Outbreak in Calgary, Alberta: A pilot study Fur, Rhonda Lynne Fur, R. L. (2010). The Use of Social Network Analysis to Quantify the Importance of Social Venues in an Infectious Syphilis Outbreak in Calgary, Alberta: A pilot study (Unpublished master's thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/16933 http://hdl.handle.net/1880/47831 master thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca UNIVERSITY OF CALGARY The Use of Social Network Analysis to Quantify the Importance of Social Venues in an Infectious Syphilis Outbreak in Calgary, Alberta: A pilot study by Rhonda Lynne Fur A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE DEPARTMENT OF COMMUNITY HEALTH SCIENCES CALGARY, ALBERTA MAY 2010 © Rhonda Lynne Fur 2010 The author of this thesis has granted the University of Calgary a non-exclusive license to reproduce and distribute copies of this thesis to users of the University of Calgary Archives. Copyright remains with the author. Theses and dissertations available in the University of Calgary Institutional Repository are solely for the purpose of private study and research. They may not be copied or reproduced, except as permitted by copyright laws, without written authority of the copyright owner. Any commercial use or re-publication is strictly prohibited. The original Partial Copyright License attesting to these terms and signed by the author of this thesis may be found in the original print version of the thesis, held by the University of Calgary Archives. Please contact the University of Calgary Archives for further information: E-mail: [email protected] Telephone: (403) 220-7271 Website: http://archives.ucalgary.ca Abstract Objective: The purpose of this study was to explore the use of social network analysis as both an epidemiological and methodological tool to determine the relative importance of venues where people meet sex partners to the transmission of syphilis. Subjects and Methods: Cases and named contacts of infectious syphilis aged 18-75 were identified and enrolled at an Alberta Sexually Transmitted Disease clinic, between April-August, 2009. In addition to standard contact tracing information, participants were asked to list all venues attended in the last six months where sexual partnering occurred. Sexual affiliation networks were constructed by linking individuals to sex partner meeting venues. Algebraic measures of network position and permutation statistical methods were used to determine what type of venue connected the most individuals. Results: A total of 154 network members comprised of 46 cases of infectious syphilis and 108 named sexual contacts were connected to 52 venues. A densely connected network of 94 gay men linked together by 21 venues was identified. In this sexual affiliation network, Internet venues had significantly higher degree centrality than non- Internet venues (p<0.05). The three most central Internet venues, connected two thirds of all infectious syphilis cases in the network. Conclusion: Network analysis identified key venues that connected individuals who were infected with syphilis. These venues would be an ideal target for preventive interventions to prevent further dissemination of disease. iii Acknowledgements This thesis would not have been possible without the support and contributions of many great people. To my supervisor, Dr. Elizabeth Henderson, I express my sincere gratitude for granting me the opportunity to undertake this research and for her tremendous support, encouragement, and guidance during my graduate studies and in the preparation of this thesis. I also extend my deepest gratitude to my co-supervisor Dr. Ronald Read for generously giving his time and sharing his wisdom to assist me. His ardent dedication to the control of syphilis has been inspiring. It is a pleasure to thank Dr. Jenny Godley, without whose vision and knowledge this research project would not have been possible. Genuine appreciation is also due to the other members of my supervisory committee, Ms. Colleen Roy and Ms. Kathryn Bush of Alberta Health Services, for their unremitting support, comments and insightful suggestions. I am extremely grateful to Dr. Alberto Nettel-Aguirre for his advice regarding aspects of the statistical analyses and to Dr. Ameeta Singh, who as external examiner provided constructive feedback and thoughtful comments. Finally, a heartfelt thank you is extended to the staff of the Calgary Sexually Transmitted Disease clinic for their overwhelming support and enthusiasm in the project, and for giving their valuable time to assist with participant recruitment and aspects of data collection. iv Dedication To my husband John and our two beautiful daughters Alyssa and Robyn-Lynn; your endless love is a constant source of inspiration. v Table of Contents Approval Page.................................................................................................................ii Abstract..........................................................................................................................iii Acknowledgements ........................................................................................................iv Dedication.......................................................................................................................v Table of Contents ...........................................................................................................vi List of Tables .................................................................................................................ix List of Figures and Illustrations .......................................................................................x List of Symbols, Abbreviations and Nomenclature .........................................................xi CHAPTER ONE: INTRODUCTION.............................................................................1 1.1 Study context and motivation.................................................................................1 1.2 Study objective and research questions ..................................................................2 1.3 Thesis overview.....................................................................................................3 CHAPTER TWO: BACKGROUND ..............................................................................5 2.1 Syphilis .................................................................................................................5 2.1.1 Transmission .................................................................................................6 2.1.2 Epidemiology ................................................................................................6 2.1.3 Local characteristics of syphilis outbreak.......................................................8 2.1.4 Treatment and follow-up................................................................................8 2.1.5 Traditional partner notification ....................................................................10 2.2 Basic model of infection transmission..................................................................11 2.3 Social network approach to infection transmission...............................................13 2.4 The concept of a sexually transmitted disease core...............................................13 2.5 Social network analysis........................................................................................14 2.6 From high-risk people to high-risk places ............................................................17 2.6.1 Sexual risk behaviour and sex partner meeting venues .................................18 2.6.2 Place-based interventions.............................................................................20 2.6.3 Sexual affiliation network............................................................................21 2.7 Summary .............................................................................................................23 CHAPTER THREE: METHODS .................................................................................24 3.1 Study design ........................................................................................................24 3.1.1 Network sampling........................................................................................25 3.1.2 Network boundary .......................................................................................25 3.1.3 Survey instrument........................................................................................26 3.2 Study setting........................................................................................................27 3.3 Study procedure...................................................................................................29 3.3.1 Maximizing response rate ............................................................................30
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