The purpose of this R15 proposal is to (1) introduce social network analysis (SNA) into the study of forced migrants, (2) compare forced migrants'networks to culturally comparable voluntary migrants'networks, and (3) measure structural effects of these networks on biobehavioral outcomes (psychological distress and cardiovascular measures). Although 30 years of research on forced migrant populations (refugees, asylum seekers) has established that they are characterized by high rates of posttraumatic stress disorder (PTSD), depression and trauma-related physical ailments and that these health problems are associated with high rates of exposure to trauma3, considerable variance in health outcomes remains unexplained. We propose that much of this unexplained variance is best accounted for by the social ecological damage that occurs during displacement5. Central to individuals'social ecologies are their social networks. Social networks have been linked to multiple health outcomes among native-born populations12, and are particularly important for help seeking among immigrant populations19-22. We propose that social networks are damaged during forced migration and that this damage has measureable effects on forced migrants'mental and physical well-being that goes beyond the effects of exposure to trauma alone. In order to appropriately describe forced migrants'networks within a meaningful context, we must compare their networks to networks of individuals who have also immigrated and have similar patterns of social behavior. We therefore propose to study the social networks of forced migrants by comparing them to networks of voluntary migrants within a single West African immigrant community - the Fulani. The Fulani ethnic community in New York City is characterized by substantial numbers of both forced and voluntary migrants, and hails from countries across West Africa, a region with a recent history of widespread political conflict and outmigration. Our preliminary studies with Fulani and other West African communities in New York has established that, like many new migrants, individuals and families within the Fulani community rely on social networks much more than on official public health sources when seeking help, and that forced migrants rely on a smaller number of institutions than voluntary migrants to support their families'needs. The research proposed here is foundational in that its purpose is to establish a base of knowledge upon which intervention research can be built.
Social networks have been suggested as particularly important for judging the reliability of information among forced migrants. Describing forced migrants'social networks and identifying how they differ from voluntary migrants'networks has important consequences for designing and delivering public health interventions to this vulnerable population.
