The social clustering of health in rural areas

When we think about health, we often picture individual choices: Should I get vaccinated? Should I quit smoking? Should I eat better? This perspective reflects an individualization of health responsibility, whereby health outcomes are attributed solely to personal choice, obscuring the role of social, economic, and relational determinants. But what if these health-related decisions are rarely individual at all?

The paper can be accessed at https://revistasociologieromaneasca.ro/sr/article/view/1829/1752

Our study conducted in a rural village in Romania suggests that health outcome should be addressed in a supra-individual fashion. Using personal network analysis, we show that health behaviors, such as vaccination, smoking, and dietary habits, tend to cluster inside small social circles: families, close friends, neighbors, and everyday peers.

A village as a living laboratory

The research took place in Lerești, a rural community in Argeș County. Instead of relying on anonymous surveys or abstract statistics, we sat down with community residents and asked them about the people who matter most in their daily lives: who they talk to, who they trust, who they spend time with. Each participant described their own social world (family members, friends, acquaintances) and reported what they knew about these people’s health behaviors. This allowed us to move beyond individuals and see how health travels through relationships.

What we found

Across three different health topics, the same pattern emerged. Vaccination: People who relied exclusively on online sources for health information were embedded in networks where vaccination was less common. Meanwhile, vaccinated individuals tended to be surrounded by other vaccinated people. Smoking: Smoking clustered strongly within families. Smokers were often connected to other smokers, while non-smokers tended to live in smoke-free social environments. Diet: Consumption of processed foods high in salt also followed social lines, concentrating in small peer groups and households rather than being randomly distributed.

In simple terms: health behaviors are social behaviors.

Why this matters

If health risks and protective behaviors spread through social ties, then prevention strategies that focus only on individuals miss something essential. Our study suggests that: Vaccination campaigns work better when they engage trusted local figures rather than relying only on online messaging. Smoking cessation may be more effective when addressed at the household or family level, not just one person at a time. Healthier eating habits can spread by targeting small groups, especially those who shop, cook, and eat together. Instead of asking “How do we change people?”, our study encourages to ask: “How do we work with the social networks people already live in?”

Reviving an old sociological tradition with new tools

There is also a deeper story here. Romanian sociology has a long tradition of studying villages as living social systems, dating back nearly a century. This research reconnects with that tradition, but updates it using modern data collection tools, ethical standards, and open science practices.

The result is not just a set of findings, but a replicable way of studying health in real communities, where relationships matter as much as resources.

A simple takeaway

Health does not spread person by person. It spreads in groups or hypergraphs. And if we want prevention efforts to work, especially in rural or tightly knit communities, we need to stop thinking only in terms of individuals and start thinking in terms of networks.

Other publications

In relation to the fieldwork currently being conducted within the 4P-CAN research project, additional open-access publications are available.

Lerner, Hâncean, Perc. Modeling temporal hypergraphs. Journal of Complex Networks (Oxford University Press), 13, 6, cnaf054, 2025 https://doi.org/10.1093/comnet/cnaf054

Geantă, Cioroboiu, Mihăilă, Hâncean. ReThinking Cancer Prevention Through Participation: from 4P-CAN Rural Living Lab in Eastern Europe. European Journal of Public Health (Oxford University Press), 35, ckaf161.784, 2025 https://doi.org/10.1093/eurpub/ckaf161.784

Hâncean, Lerner, Perc, Molina, Geantă, Oană, Mihăilă. Processed food intake assortativity in the personal networks of older adults. Scientific Reports (Springer Nature), 15, 10459, 2025 https://doi.org/10.1038/s41598-025-94969-0

Mihăilă, Hâncean, Perc, Lerner, Oană, Geantă, Molina, Cioroboiu. Cross-sectional personal network analysis of adult smoking in rural areas. Royal Society Open Science (Royal Society Publishing), 11, 11, 241459, 2024 https://doi.org/10.1098/rsos.241459

Oană, Hâncean, Perc, Lerner, Mihăilă, Geantă, Molina, Tincă, Espina. Online media use and COVID-19 vaccination in real-world personal networks: Quantitative study. Journal of Medical Internet Research (JMIR Publications), 26, e58257, 2024 https://www.jmir.org/2024/1/e58257/

Hâncean, McCarty, Molina, Geantă, Lerner, Mihăilă, Oană, Cioroboiu. Adapting Longitudinal Personal Network Research through Participation: Reflections from a Rural Study. Preprint at Research Square. 2025 https://doi.org/10.21203/rs.3.rs-8064502/v1

Oană, Hâncean, Geantă, Cioroboiu, Maya-Jariego, Lerner, Mihăilă, Vidrașcu. Normalization of overweight and obesity in family relations: a personal network analysis study. Preprint at Research Square. 2025 https://doi.org/10.21203/rs.3.rs-8059527/v1

Mihăilă, Hâncean, Geantă, Cioroboiu, Lerner, Molina, Tron-Lozai, Vidrașcu, Oană. From stakeholder mapping to statistical modeling: An illustrative demonstration of end-to-end Net-Map methodology for health governance analysis. Preprint at Research Square. 2025 https://doi.org/10.21203/rs.3.rs-7837431/v1