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Myr R. Promoting, protecting, and supporting breastfeeding in a community with a high rate of tobacco use. J Hum Lact. Maternal smoking and infantile gastrointestinal dysregulation: the case of colic. Nicotine exposure in breastfed infants. Acta Paediatr. Iodine nutrition in breast-fed infants is impaired by maternal smoking.

J Clin Endocrinol Metab. Use of nicotine patches in breast-feeding mothers: transfer of nicotine and cotinine into human milk.

Clin Pharmacol Ther. Earlier smoking habits are associated with higher serum lipids and lower milk fat and polyunsaturated fatty acid content in the first 6 months of lactation. Eur J Clin Nutr.

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Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence. Breastfeed Rev. J Epidemiol Community Health Jun;57 6 In this study, researchers examined school results of nine-year-old children who were born in a Dutch hospital between and and whose mothers smoked during the pregnancy. The researchers suggested that breastmilk promoted brain development and helped to counteract the adverse effects of cigarette smoking during pregnancy.

Mohrbacher N, Stock J. Association between smoking during pregnancy and breastfeeding at about 2 weeks of age. Hale TW. Medications and Mothers Milk , Tenth Edition. Amarillo, Texas: Pharmasoft Publishing, American Academy of Pediatrics Committee on Drugs.

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Amir LH. Maternal smoking and reduced duration of breastfeeding: a review of possible mechanisms. Early Hum Dev. Najdawi F, Faouri M. Maternal smoking and breastfeeding. East Mediterr Health J. Smoking and the Flavor of Breast Milk. N Engl J Med. Influence of smoking on vitamin E status during the third trimester of pregnancy and on breast-milk tocopherol concentrations in Spanish women.

Christakis and Fowler found that if someone was on the receiving end of a generous exchange, that person would become more generous to the next set of partners — until the entire larger group was infected, as it were, with altruistic behavior, which meant the altruist would benefit indirectly. Many health care experts are thrilled. After years of observing patients, they suspected that behaviors spread socially; now there was data that appeared to prove it.

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View all New York Times newsletters. But many of those who study networks are more cautious in their reactions. Unlike medical experts, these scientists specialize in the study of networks themselves — anything ranging from neighborhoods linked via the power grid to teenagers linked on Facebook — and they are familiar with the difficulty of ascertaining cause and effect in such complex constructs.

Christakis and Fowler can show what appear to be waves of obesity or smoking moving across the map. There are at least two other possible explanations. People who are gaining weight might well prefer to hang out with others who are also gaining weight, just as people who are happy might seek out others who are happy. The other possible explanation is that the shared environment — and not social contagion — might be causing the people of Framingham to change in groups.

The cluster of people would appear as though they are sharing a contagious form of behavior, but it would be an illusion. As Alex Pentland, former academic head of the M. Last year, he and an economist named Ethan Cohen-Cole published two papers arguing that Christakis and Fowler had not successfully stripped out all possible homophily effects from their calculations.

Among the questionnaires the researchers distributed was one that asked students to list up to 10 of their friends. Before they stumbled upon the Framingham data, Christakis and Fowler themselves had considered using the Add Health surveys to look for social contagion. But they decided the data sets were too limited — each of the schools had only several hundred students interlinked — to produce results in which they could have confidence. They also wanted to study adults, figuring that the peer effects among teenagers are qualitatively different. When Fletcher analyzed the student cliques using statistical tools that he says are similar to those used by Christakis and Fowler, he found that social contagion indeed existed.

But the behaviors and conditions that were apparently contagious were entirely implausible: they included acne, height and headaches. How could you become taller by hanging around with taller people? When I spoke to Fletcher, he said that he, too, believes social-contagion effects are real. When the Framingham participants checked in every four years, they were asked to list all their family members — but only one person they considered a close friend.

This could arguably mean that those eerie three-degree effects might be an illusion. For example, if John lists Allison as his friend, and Allison lists Robert as her friend, and Robert lists Samantha as his friend, then Christakis and Fowler could conclude that John is three links away from Samantha. But he said he believes their map of the Framingham connections has far fewer holes than critics charge.

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One helpful fact was that many participants listed more than one friend, despite the instructions on the green sheets. He and Fowler also acknowledged that it is impossible to completely remove the problems of homophily and environmental effects. When they ran their own statistical technique on the Add Health data, they found that obesity followed precisely the same three-degree pattern of contagion as they found in Framingham. And Christakis and Fowler point to two other findings to bolster their case for social contagion over environmental effects. One is that in the Framingham study, obesity seemed to be able to jump from friend to friend even over great distances.

When people moved away, their weight gain still appeared to influence friends back in Massachusetts. Their other finding is more intriguing and arguably more significant: They discovered that behaviors appear to spread differently depending on the type of friendship that exists between two people. In the Framingham study, people were asked to name a close friend. Though Steven might designate Peter as his friend, Peter might not think of Steven the same way; he might never designate Steven as a friend. In Framingham, Christakis and Fowler found this directionality effect even among people who lived and worked very close to each other.

In , the smoking rate for adults was 37 percent.

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It fell to 33 percent by and then fell even more precipitously between and But after that, the rate at which people quit smoking began to slow. Between and , in fact, the smoking rate stayed steady; on balance, nobody quit smoking those years. Antismoking forces successfully pushed the number of smokers down to one in five people, but they now seem stuck.

Smoking-cessation experts have debated why it has become so hard to get the final holdouts to quit. Perhaps, some said, it was because the average cost of a pack of cigarettes remains largely unchanged nationally since When Christakis and Fowler mapped out the way Framingham people quit smoking during roughly the same period — to — they found that the decline was not evenly distributed across the town.

Instead, clusters of friends all quit smoking at the same time, in a group. It was like a ballroom emptying out one table at a time. But this meant that by , the remaining smokers were also not evenly distributed: instead, they existed in isolated, tightly knit clusters of like-minded nicotine fiends. Worse, those clusters had migrated to the edges of the social network, where they were less interlinked with the mass of Framingham participants.

The federal government has officially set a goal of reducing the number of smokers in the country to 12 percent of the population by But the very shape of our social networks is working against that goal, Fowler says, and this poses a potential public-health challenge. Meanwhile, public-health strategists who want to counteract obesity face the opposite problem. Since the country is gradually becoming more and more obese, when individual people do lose weight, they are more likely to be surrounded by people who are still heavy.

Even if they form a weight-loss group to lose weight with their close friends, they will still be influenced by obese people two or three links away — people they barely know. Hill says this is possible with obesity. Last year, he collaborated with David Bahr, a physicist at Regis University in Denver, to construct a computer model of society that replicates the way obesity spreads. They created a simulation of hundreds of thousands of individuals, each programmed to influence one another in precisely the same way that Christakis and Fowler documented in Framingham.

To test whether their model accurately mimicked reality, they seeded it with a few obese people and set it running.

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The virtual society slowly became obese in the same pattern and at the same rate as Framingham. If they could accurately copy the way Framingham became obese, they figured, they could then use the model to test different ways that the spread might be halted. They began trying different experiments — like focusing on specific individuals and seeing whether or not they could use them to create a counterepidemic of skinniness.

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One solution jumped out at them. It is to encourage them to skip a link and to diet with friends of friends.

That way, in your immediate social network, everyone would be surrounded on at least one side by people who are actively losing weight, and this would in turn influence those other links to begin losing weight themselves. When Hill and Bahr ran the simulation with this sort of staggered dieting, it worked: the virtual society began slimming down, and the obesity epidemic reversed itself. Bahr also found that the obesity epidemic could be reversed quickly, with only 1 percent of the entire population losing weight, so long as the dieters were placed in precisely the right spots.

In reality, of course, this sort of intervention would be quite difficult to pull off. You would have to figure out some way to persuade friends of friends to form dieting groups together. The idea, Cobb says, is to take your invisible, internal battle to quit smoking and make it visible so that it can influence your friends and friends of friends who are still puffing away. And obviously this is possible; people change their friends often, sometimes abruptly. But reshaping your social network may be more challenging than altering your behavior.

These patterns in our life are relatively stable, and they might, weirdly, be partly innate. Christakis and Fowler first noticed this effect when they examined their happiness data.