Faculty Insights: How Small Changes Lead to Epidemics

"My research broadly looks at how small changes in individual behavior and local resource environments cascade into larger social changes that often are described as epidemics," says Marissa King, assistant professor of organizational behavior.

King has studied a range of historical and contemporary topics, from the antislavery movement in the 19th century to autism diagnoses in the last decade.

In a study forthcoming in the American Sociological Review, King and her co-author identify the key social factors that have played a role in the rising prevalence of autism, which has increased roughly 10-fold in the past 40 years. They find that the amount of resources available in a community for making a diagnosis explains a lot of the increase in prevalence. "Parents' education and economic status is important, but independent of that, the type of neighborhood they live in really matters for autism diagnosis," she says. "A child living in a wealthy neighborhood is two and a half times more likely to be diagnosed than the same statistical child with the same level of parental support living in a poorer neighborhood."

King is drawing on this work in her current research examining the role of pharmaceutical marketing efforts, peer influence, and public policy in shaping the prescribing patterns of antidepressants, antipsychotics, and stimulants for children and adolescents.

"There was a long literature in the early part of the decade saying that there is definitely a tremendous increase in psychotropic prescribing — two- or three-fold increases over the course of 10 years. What we show is that those increases for the vast majority of drugs were flat [in the past four years]. It's not that they've decreased, but we're not seeing the same level of increases. They're stagnant at this point, except for antipsychotics, which are continually and steadily growing among kids ages 0–17."

King attributes this pattern to increasing regulation in pediatric prescribing, which has resulted in both a series of black box warnings for products like antidepressants and stimulants and increasing pediatric approvals for antipsychotics. "You have these different forces going on. How are they shaping prescribing patterns? And how are physician prescribing patterns being influenced by marketing efforts on one side and conflicts of interest policies trying to curb those marketing interests on the other?"

Various states have adopted disclosure laws for gifts and payments from pharmaceutical companies to physicians. King is examining how much these laws have affected whether companies are still marketing at the same level, and also how much that marketing influences prescribing rates.

In another piece of this research, King is focusing on how people respond to new information, and has identified characteristics of prescribers that make them more likely to be early adopters of new drugs. "Psychiatrists don't tend to quickly adopt drugs," she says, "but pediatricians and general practitioners seem much more likely to adopt these drugs. There are also other characteristics that seem to be associated with how quickly they adopt a new drug."

King is curious about how physicians who quickly respond to positive information about new drug approvals would respond to negative information. Her future research may examine whether their prescribing patterns also quickly change when negative information comes out.