Social Contagion Theory PDF

Social Contagion and Innovation: Cohesion versus Structural Equivalence
Author(s): Ronald S. Burt

Source: American Journal of Sociology, Vol. 92, No. 6 (May, 1987), pp. 1287-1335
Published by: The University of Chicago Press
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Social Contagion and Innovation:
Cohesion versus StructuralEquivalence'
Ronald S. Burt
Columbia University
Two classes of networkmodelsare used to reanalyzea sociological

classic oftencitedas evidenceofsocial contagionin thediffusion
of
technologicalinnovation:Medical Innovation.Debate betweenthe
cohesion and structuralequivalence models poses the following
question for study:Did the physiciansresolvethe uncertainty of
adoptingthenew drugthroughconversations withcolleagues(cohe-
sion) or throughtheirperceptionof the actionproperforan occu-
pant oftheirpositionin thesocial structure
ofcolleagues(structural
equivalence)?The alternativemodels are defined,compared,and
tested.Four conclusionsare drawn:(a) Contagionwas notthedom-
inantfactordrivingtetracycline'sdiffusion.Wherethereis evidence
of contagion,thereis evidence of personal preferencesat work.
' Beginning in 1979,workon thispaperhas beensupported directly

bya grantfrom
theNationalScienceFoundation(SOC79-25728)and indirectly bya varietyoffunds,
includinggrantsfromthe National ScienceFoundation(SES82-08203and SES85-
13327 to the authorand BNS-8011494to the CenterforAdvancedStudyin the
BehavioralSciences).Mostimportant to thecompletionoftheworkwerethesupport
ofPercyTannebaum'sSurveyResearchCenterat theUniversity ofCalifornia,Berke-
ley;RumiPrice'spainstaking researchassistancein revivingtheMedicalInnovation
data fromancient,water-damaged, multipunched computer cards;and thetimepro-
videdby a fellowship at theCenterforAdvancedStudyin theBehavioralSciences.
Portionsofthismaterialwerepresented at the 1982AnnualSunbeltSocial Network
Conference, a social networkscolloquiumin 1985 at the University of California,
Irvine,and the 1986 annualmeetingof theAmericanSociologicalAssociation.The
discussionhas been improvedin responseto comments fromAllenBarton,Noshir
Contractor,CharlesKadushin,TormodLunde,EverettRogers,ThomasSch0tt,and
a carefulreadingby theAJS reviewers. I am especiallygrateful
forRobertMerton's
detailedcommentson the manuscript.A copy of the data discussedherecan be
obtainedbyrequesting TechnicalReportno. TR3, "TheMedicalInnovationNetwork
Data," fromColumbiaUniversity's Centerforthe Social Sciences.A copy of the
microcomputer network-analysis software thatincludestheprocedures used hereto
generateadoptionnormscan be obtained,witha programmanual,by requesting
TechnicalReportno. TR2, "STRUCTURE, Version3.0" fromthe center.Enclose a
check($25 forno. TR2, $10 forno. TR3) made out to the ResearchProgramin
StructuralAnalysiswithyourrequestto help defrayduplicationand mailingcosts.
Data and softwarearesenton diskettes inDOS 360K format foran IBM microcompu-
ter.Requestsforreprints shouldbe sentto RonaldS. Burt,Department ofSociology,
ColumbiaUniversity, New York,New York 10027.
? 1987byThe University
of Chicago.All rightsreserved.
.50
0002-9602/87/9206-0001$01
AJS Volume 92 Number(May 1987):1287-1335 1287

AmericanJournalof Sociology
(b) Where contagionoccurred,its effectwas throughstructural

equivalencenotcohesion.(c) Regardlessofcontagion,adoptionwas
strongly determinedbya physician'spersonalpreferences, butthese
preferences did not dampen or enhancecontagion.(d) There is no
evidenceof a physician'snetworkpositioninfluencing his adoption
when contagionis properlyspecifiedin termsof structuralequiva-
lence. The ostensibleprestigeeffectis spurious, resultingfrom
biases createdwhen cohesionis used to modelcontagion.In short,
theproductofreanalyzingtheMedical Innovationdata withrecent
developmentsin networktheoryis clearer,strongerevidence of
social contagionand a redefinition
ofthesocial structural
conditions
responsibleforcontagion.
The spreadofnew ideas and practicesis oftenarguedto be contingent on

the way in which social structurebringspeople together.Adoptingan
innovationentailsa risk,an uncertainbalance of costsand benefits,and
people managethatuncertainty by drawingon othersto definea socially
acceptableinterpretation of the risk. Social contagionarisesfrompeople
proximatein social structure usingone anotherto managetheuncertainty
of innovation. At the heart of social contagion is the interpersonal
synapseover which innovationis transmitted. Here, agreementbreaks
down. What is it about the social structural circumstancesof two people
thatmakesthemproximatesuchthatone's adoptionofan innovationcan
be expectedto triggertheother'sadoption?Debate in networktheoryhas
crystallized
aroundtwo answersto thisquestion:cohesionand structural
equivalence. This paper is a comparisonof the two answers.I draw out
the theoreticalargumentsforcohesionand structuralequivalence,high-
lightingthe empiricalcircumstancesin whichtheycould contradictone
another,and use themto reanalyzea sociologicalclassic oftencited as
evidenceof social contagionin the diffusion of technologicalinnovation:
Coleman, Katz, and Menzel's (1966) Medical Innovation.
CONTAGION IN THEORY
In the simplestcase, the interpersonalsynapseover whichsocial conta-
gion occurs involvesone individual,ego, who has not yet adopted the
innovationunderstudy,and a secondindividual,alter,who has adopted.
Somethingabout the social structuralcircumstancesof ego and alter
makes them proximatesuch that ego's evaluation of the innovationis
sensitiveto alter'sadoption. Contact,communication, and competition
have been argued,each in turn,as makingego and alterproximate.
Physicalproximity alone has some capacityto cause social contagion.
The closerthe physicalcontactis betweenego and alter,themorelikely
thatalter'sadoptionwill triggerego's. Merelywitnessingalter'sadoption
1288

Contagionand Innovation
can transmitsignificant informationto ego. He notonlybecomesaware of

theinnovation,he also has thebenefitof a vicarioustrialuse, witnessing
theconsequencesadoptionhas foralter.This senseofsocial contagionis
mostarticulatelydevelopedin geography(see, e.g., Cliffet al. 1981)and
epidemiology(see, e.g., Bailey 1976), but it is occasionallyfoundin a
social networkanalysis(see, e.g., White,Burton,and Dow 1981)and of
coursehas precedentsin earlysociologicaland anthropological accounts.
Cohesionand structural equivalencegeneralizephysicalproximity, ad-
dressinga fundamental changein theavailabilityofinformation on inno-
vations. With the omnipresenceof mass media and people paid to dis-
seminateinformation on an innovation,obtaininginformation is less a
problemforthemoderninnovatorthanfindingtrustworthy information;
evenworse,theproblemlies in findingwaysto ignoreas muchas possible
of the otherwiseoverwhelming hordeof facts.2Cohesionand structural
equivalence shiftattentionfromthe question of whetherpeople are
adoptingin ego's physicalsurroundings to the questionof who is adopt-
ing. Taking access to information forgranted,theyfocuson theproblem
of managinguncertainty in makingthe properresponseto information.
Cohesion
The cohesionmodelfocuseson socializationbetweenego and alter.The
morefrequentand empathicthecommunication is betweenego and alter,
the more likelythat alter's adoption will triggerego's. Discussingthe
innovationwithothers,ego comesto a normativeunderstanding ofadop-
tion'scostsand benefits, coloredbytheinterests
a social understanding of
the people withwhomthe innovationhas been discussed.
Withthe spread of mass media and developmentof sociometricsocial
psychology in thedecades surrounding WorldWar II, it was shownthat
social proximity(such as friendships)developedfromphysicalproximity
and that shared attitudesdeveloped fromsocial proximity.Homans's
2 This themeis entertainingly

elaboratedby Klapp (1978)withrespectto conditions
underwhichwe are openor closedto receiving information.Colemanet al. makethe
samepoint,seeingthisas a routinedilemmafacingthephysician evaluatingmedical
innovations:"The problemexistsnot because information is inaccessible.On the
contrary.... The physician's seriousproblemis in knowinghowto siftthrough the
delugeof materialthatreacheshim,and how to assess the value of it. . . . Most
practitioners,
of course,are fartoo busyto followtheadvancesin all specialtyjour-
nals,totaketimeoutfora postgraduate refresher
course,ortoattendmorethana very
fewout-of-town conventions.... At thesametime,thephysicianis underpressure
fromhis own conscienceand his professional commitment to affordhis patientsthe
benefitofrecentdiscoveries.... Decisionsas to whatto use, whento use it,and on
whom,mustconstantly be made-even whenthedoctorhas littlebasis on whichto
decide"(1966,pp. 13-14).
1289

(1950) The Human Groupprovidesa theoreticalexemplarforthisperiod

(continuedin Homans's Social Behavior [1961, pp. 112-29]). Festinger,
Schachter,and Back's (1950) studyof housing,friendship, and involve-
mentin a voluntaryassociationprovidesa researchexemplar.Building
explicitlyon Sherif's (1935) experimentalstudies of interpersonalin-
fluencescreated by physicalproximitybetweensociallysimilarpeople
(Columbia Universityundergraduatepsychologystudents),Festingeret
al. (1950)emphasizethecausal forceofnormativeunderstandings created
in informalsocial groups (see Homans 1961, pp. 120-25). When con-
frontedwithan empiricallyambiguousquestion,a questionthatcannot
be resolvedby concretefacts,people turnto thepeople withwhomsuch
questions are discussed and, in their reciprocallysocializingdebate,
createa consensual,normativeunderstanding of the question,resolving
thequestion'suncertainty in theirown minds,ifnotin fact.As a resultof
this understanding, ego's adoption quicklyfollowsalter'sbecause they
have come to sharethesame evaluationof adoption'scostsand benefits.
This line of thoughtunderliestheseminalstudiesofinformalsocial pres-
sureson votingin the 1940 and 1948 presidentialelections(Lazarsfeld,
Berelson,and Gaudet 1944; Berelson,Lazarsfeld,and McPhee 1954);it
lies behindthe studiesof opinionleaders in the two-stepflowof mass-
media diffusion (Merton1949, see also 1957; Katz and Lazarsfeld1955);
and it is thedrivingforcein Colemanet al.'s (1966)Medical Innovation.3
EchoingFestingeret al., Coleman et al. (1966, pp. 118-19) argue:"Con-
frontedwiththe need to make a decisionin an ambiguoussituation-a
situationthatdoes notspeak foritself-people turnto each otherforcues
as to the structureof the situation.When a new drug appears, doctors
who are in close interactionwiththeircolleagueswill similarlyinterpret
forone anotherthenew stimulusthathas presenteditself,and willarrive
at somesharedway oflookingat it." They go on to presentevidenceofa
tendencyforphysiciansto begin prescribingthe new drugat about the
same timeiftheyhad a relationshipofsharingadvice on cases or discuss-
ing medical matters.This theme continuestoday in studies reporting
attitude,belief, or behavior similaritybetween people connectedby
strongcommunicationrelations(see, e.g., Duncan, Haller, and Portes
[1968]on occupationaland educationalaspirations;Fischer[1978]on the
diffusionof innovationsbetweendistanturban centersbeforereaching
surroundingruralareas; Shroutand Kandel [1981] on the use of illegal
drugs;and Friedkin[1984]on perceivedconsensuson educationalpolicy).
3 Of course,theseare merelyhighlights
in thebroadprogramof empiricalinterper-
sonalinfluence fromColumbiaUniversity's
researchdisseminated BureauofApplied
Social Researchduringthe 1940s and 1950s. Barton(1982) providesan informal
insider'saccountofhow theresearchprogramdevelopedat thebureau.
1290

StructuralEquivalence
The structuralequivalence model highlightscompetitionbetweenego

and alter. This includes, in the extreme,the competitionof people
fighting one anotherforsurvivalbutappliesmoregenerallyto thecompe-
titionof people merelyusingone anotherto evaluate theirrelativeade-
quacy-for example, two siblingsclose in age and tryingto get good
grades in the same subjects who are encouragedby theirparents,two
graduatestudentspublishingthe same kind of workand trainedby the
same professors,or two physicianstryingto keep up withthe rush of
medicaldevelopmentsin orderto live up to theirimageof a good physi-
cian and maintaintheirpositionin thesocial structure of medicaladvice
and discussion.The more similarego's and alter'srelationswith other
personsare-that is, the morethataltercould substituteforego in ego's
role relations,and so the moreintensethatego's feelingsof competition
with alter are-the more likelyit is that ego will quicklyadopt any
innovationperceivedto make altermoreattractiveas theobjector source
ofrelations.Discussingan innovationwithothers,ego comesto a norma-
tiveunderstanding of adoption'scostsand benefits
to a personfulfilling
his
roles,a social understanding sharedby othersin thoserolesand colored
by ego's interestin theadvantageaccruingto anyoneperforming his roles.
Structurally equivalentpeople occupythe same positionin the social
structureand so are proximateto the extentthat theyhave the same
patternof relationswithoccupantsof otherpositions.More specifically,
two people are structurally equivalentto theextentthattheyhave identi-
cal relationswithall otherindividualsin the studypopulation.As illus-
trated by the starklyoversimplified situationsin figure1, structural
equivalenceoverlaps,restricts, and extendsthe conceptof cohesion.
Figure 1A illustratesthe kind of situationin whichstructuralequiva-
lenceand cohesionmake identicalpredictions.Ego and alterhave strong
relationswitheach other,so thatcontagionbetweenthemis predictedby
cohesion.At the same time,theyhave identicalpatternsof relations-
havingstrongrelationswith the safnepeople and no relationswiththe
same people-so thatcontagionbetweenthemis also predictedby struc-
tural equivalence. More generally,structuralequivalence and cohesion
bothpredictcontagion(iffordifferent reasons)betweenpeople strongly
tied to each otherand similarlytied to otherpersons.
Figure 1B illustratesthe kind of situationin whichcohesionpredicts
contagionand structural equivalencedoes not. Ego and alterhave strong
relationswitheach otherand so are again expectedto act similarlyun-
der cohesion. However, theyhave different patternsof relations-ego
strongly tiedto one personand alterstrongly tiedto another-so thatthey
are not structurally equivalent. More generally,structuralequivalence
1291

A. Structural Equivalence Equals Cohesion
ego
person person
alter
B. Structural Equivalence Restricts Cohesion
ego
person person
alter
C. Structural Equivalence ExtendsCohesion
ego
person person
alter
FIG. 1.-Kinds of social structuralsituationsin whichstructural
equivalence
and/orcohesionpredictcontagionbetweenego and alter.

predictsthatthesocializinginfluenceof cohesivetieswithina clique can

be eliminatedby conflicting ties outsidethe clique.
Finally,figure1C illustratesthe kind of situationin whichstructural
equivalencepredictscontagionand cohesiondoes not.Ego and alterhave
no relationswitheach otherand so do not socialize each otherdirectly.
However,ego and alterare structurally equivalentbecause oftheiriden-
tical patternof relationswithothers-both ego and alterare tied to the
same people-so thatcontagionbetweenthemis predictedby structural
equivalence. Contagionis expected,forthe same reason as forthe two
people in figure1A,because theyare identicallyoutsidersto theego-alter
clique. More generally,structuralequivalence predictsthattwo people
identicallypositionedin the flowof influentialcommunicationwill use
each otheras a frameof reference forsubjectivejudgmentsand so make
similarjudgmentseven if theyhave no directcommunication witheach
other.Frequentor empathiccommunication is notessentialto theirkeen
awareness of each other. People involved in relationswith the same
people are likelyto have a directand indirectawarenessof each other:
directby meetingwhen interacting withtheirmutualacquaintancesand
indirectby hearing about each other throughmutual acquaintances.
They may or may not have strongrelationswitheach other.It is their
similarrelationswithothersthatdeterminetheirstructural equivalence,
not theirrelationswitheach other.4
These are familiarideas, fundamentalto thetraditionalview of social
structureas a systemof statusesinterlockedby role relations(see, e.g.,
Linton 1936; Merton 1957; Nadel 1957); indeed, structuralequivalence
models were developed duringthe 1970s explicitlyas a vehicleforde-
scribingthe structureof role relationsdefiningstatusesacross multiple
networks(see, e.g., Burt 1982, pp. 42-49, 63-69, and 333-47 forre-
' It is easyto misperceive theshiftin theorythatstructuralequivalencerepresents.A

vulgarunderstanding of structuralequivalenceviewssocial contagionby structural
equivalenceto be no morethanan indirect effectofcohesion.To theextentthattwo
peoplehave identicalrelationswithothers,theyare involvedin thesamesocializing
communication and so cometo sharethesame evaluationof empirically ambiguous
objects(see, e.g., Burt1978;Friedkin1984).Figure1C illustrates thisin theextreme
case, in whichego and alterhave no directcommunication witheach otherbut
extensive indirectcommunication through sharedcontacts.So viewed,however,there
is no difference betweencohesionand structural equivalenceas thedrivingforcein
socialcontagion; ineithercase,egois expectedtoreflect and behaviorsof
theattitudes
thepeople withwhomhe has strongrelations.Consistent empiricaldifferencesbe-
tweenthepredictions ofcohesionand structuralequivalencecannotbe explainedwith
suchan understanding of structuralequivalence.E.g., ifwe returnto figure1C and
anticipatethelack ofempiricalsupportin theMedicalInnovationdata forcontagion
by cohesion,it seemswrongto attribute evidenceof ego-altercontagionto indirect
communication through sharedcontactswhenthereis no evidenceofcontagion where
communication is direct.
1293

view). More important, therelationalmeaningofthestatus/role-set dual-

itygained enormousrigorin networkmodelsof structuralequivalence,
and therapiddeployment ofthesemodelsin empiricalresearchmarkeda
major departurefromthe cohesion models dominantat the time. In
structuralequivalence models, the analyticalframeof referenceshifts
fromdyad to social system,and the process responsiblefor social in-
fluenceshiftsfromcommunication withina primarygroupto competition
and relativedeprivationwithina status(Burt 1982, chaps. 5-6).
With respectto innovationadoption, who adopts is still important.
However, adoption by people in otherstatuses-people above, below,
and apart fromego-do not matterin ego's evaluation of innovation
adoption,regardlessof the frequencyand empathyof ego's communica-
tionwiththem.Their adoptionmightbeginto make ego nervousabout
his own adoptioninasmuchas theyindicateto ego thathe will soon have
to resolvehis own evaluationof the innovation,but the triggerto ego's
adoption is adoption by the people with whom he jointlyoccupies a
positionin the social structure,the people who could replacehim in his
role relationsif he were removedfromthe social structure.It is here
wherefeelingsof envy,relativedeprivation,and advantageare felt,and
it is herewheretheinterpersonal synapseis fired.Thus, ego can enjoythe
luxuryofpayinglittleattentionto information about theinnovationuntil
diffusion reacheshis status.Once theoccupantsofhis statusbeginadopt-
ing,ego is expectedto followsuitrapidlyin orderto avoid theembarrass-
mentof beingthe last to espouse a beliefor practicethathas becomea
recognizedfeatureof occupyinghis status.5
Formal Theory
Of the alternativeways to derivethe predictionsof social contagionby
cohesionversusstructural equivalence,thereare advantagesto beginning
in psychophysics.Suppose, for a moment,that the desirablequalities
affectedby adoptingan innovationcould be measuredquantitatively in
one dimension.Let tj be the discerniblelevel of thoseresourcesheld by
some personj, ego in the above discussion.Empirical evidence from
psychophysicsindicates that ego's subjective perceptionof these re-
sources,uj, can be describedin many circumstancesby the following
powerfunctionofthediscernibleresourceshe in facthas: uj = utjv,where
,uand v are parametersdescribinganyonein thestudypopulationmaking
thisevaluation(see Stevens1957 and 1962 forillustrative review).Ego's
5The driving in innovation

forceofrelativedeprivation adoptionis discussedindetail
elsewhere,withnumericalillustrationforthe formalmodelsto be presented(Burt
1982,pp. 198-211).
1294

evaluationof the advantagesto be had by adoptingthe innovationis a

functionof the rate at whichsubjectiveperceptionwould increasewith
an actual increase:
dujldtj = vLt(v-1) = vu1It1.
Note themarginalnatureof thisevaluation.Perceivedadvantageis con-
tingenton thecurrentlevelofresource.Withv greaterthanone, as seems
likely(see, e.g., Hamblin 1971), the perceivedadvantage of adopting
would be small for people already holdinghigh levels of the resource
increasedby adoption.6
The experimentalevidence supportingthis formulationis obtained
frompeople in isolation. Suppose that the marginalevaluationin the
above derivativeis extendedin a social situationto includethosepeople
who providea frameof reference forego's perceptions.Beginningwitha
simple,additive linear form,ego's evaluationof adoption'sadvantages
could be expressedas follows:
dUjldtj = bp(vujItj)+ b,(i wjiuj1Iti),
wherewji is a fraction(wjj = 0, 0 c wji ' 1) expressingthe extentto
whichpersoni definesthe social frameof reference forego's evaluation.
Given networkdata on the studypopulation,one set of wji could be
definedto measure cohesion and another set to measure structural
equivalence.The firsttermin parenthesesin thisexpressionis ego's per-
sonal evaluation,givenabove as dujIdtj.The secondtermin parentheses
is his social evaluation,generatedby ego asking himselfhow advanta-
geousadoptionwould be (definedby vujlti)ifhe wereeach otherpersoni
sociallysignificant to his evaluation(definedby wji). The coefficients
bp
and bs expressthe relativeimportanceof personaland social factorsin
ego's overallevaluation.
This equationhas to be statedin crudertermsbeforeit can be used to
guide empiricalresearchon innovationdiffusion.The unidimensional
resourcetjaffectedbyinnovationis in factan unknownmixtureofempir-
ical circumstances in ego's life.Anyeffortto measuresucha qualitywith
currentmethodsand conceptsseemsat bestcapricious.For thepurposes
of thisstudyI operationalizethe generalequationwiththe following:
xj = bp(pj)+ b,(Ii wjixi) + ej = bp(pj)+ b,(x*j)+ ej, (1)
forrecognizing
6 Cancian(1967; 1979,p. 12) elaboratesthisidea in hisargument the
inhibiting of wealthon innovation:
effect thegreaterego's wealth,theless he has to
gain by runningthe riskof adoptinga bad innovation.Cross-cutting the negative
ofwealthon innovation
effect againstthefactthatwealthmakesiteasierto innovate,
Cancianidentifiesa well-documented, middle-class in agricultural
conservatism inno-
vation(see Homans[1961],pp. 349-55, fora similarcost-benefitanalysispredicting
leadersto be innovativeand themiddleclass to be conservative).
1295

wherexj is ego's responseto an innovation,pj is somemixtureofpersonal

backgroundvariablessignificant in determining ego's response(vujItjin
theabove equationdefiningdUjldtj),ej is a residualterm,and x* is ego's
adoptionnorm,the responseexpectedof ego based on the responsesof
people definingthe social frameof referenceforhis evaluation.For ex-
ample, I will presentresultsin whichxj is the date on whichj adopted
(measuredin monthsaftertheinnovationwas available) and x*is thedate
on whichj's altersas a groupadopted. In manycircumstances, thebetas
in equation(1) can be estimatedas parametersin a networkautocorrela-
tion model (see App.). To the extentthat social contagionaffectsego's
responseto theinnovation,observedadoptionwillbe strongly associated
withnormativeadoption,makingbs significantly greaterthanzero.
I have two reasons for takingthis theoreticalrouteto equation (1).
First,it clarifiestheway in whichthemodelto be appliedin thisstudyis
groundedin more generaltheory.IntegratingdUjldtj yields a general
model to studythe associationbetweensubjectiveevaluationand social
structure(Burt 1982, pp. 178-85). Taking partial derivativesof that
model with respectto ti opens an avenue to studythe social structural
conditionsresponsibleforfeelingsof envyand relativedeprivation(see,
e.g., Burt 1982, pp. 191-98). Conclusionsreachedhere on the relative
meritof cohesionand structuralequivalencethushave clearimplications
forresearchwell beyondthe questionof innovationadoption.
Second,myrouteto equation(1) highlights thefactthatconcretesocial
structuralconditionsthemselvescan be subjectivelydistortedby ego as
he evaluates an innovation.The social frameof referencein whichone
kind of innovationis evaluated need not be the same as the framefor
evaluatinga different innovation.Given some concretemeasureof ego's
proximity in social structure
to alteri, ego's subjectiveperceptionofthat
proximity can be describedby thefamiliarpowerfunctionii (proximity j
to i)v,and thenetworkweightsin equation(1) can be writtenas follows:
wji (proximityj to j)V k =#j (2)

Ek (proximityj to k)v
wherethesummationis acrosseveryonein thestudypopulation,exclud-
ing ego. The extentto which ego is conservativein relyingon othersis
givenby the magnitudeof the exponentv. Values of v muchlargerthan
one indicatethat ego's evaluation of the innovationunder studyis af-
fectedonlyby his closestconfidants (cohesion)or his nearestrivals(struc-
tural equivalence). Small, fractionalvalues of v indicatethat the eval-
uation is affectedby almost anyone with whom ego communicates
(cohesion)or shares mutual acquaintances (structuralequivalence). In
otherwords,v definesthescope of the social frameofreference forego's
evaluation,withhighvalues ofv indicatingthatonlytheclosestaltersare
1296

pertinent.The high values of v obtained for the Medical Innovation

physicians(see App.) indicate that contagionoperatedonly over very
shortdistancesbetweenthe physicians.
Cohesion and structuralequivalence models of social contagionin
equation(1) can be testedby manipulatingtheway in whichproximity is
measuredforequation(2). If proximity is measuredbythefrequency and
empathyofj's communication to i, thenw i operationalizescohesion,and
x* is the normativeresponseexpectedfromego reflecting the adoption
behaviorofthepeople withwhomhe discussesthingssuchas theinnova-
tion.If proximity is measuredby thesimilarity in each person'srelations
withj and i, thenwji operationalizesstructural equivalence,and x* is the
normativeresponseexpectedfromego reflecting theadoptionbehaviorof
the people who jointlyoccupy his status in the social structureof the
study population. The associations between xj and the alternative
definitions ofx* indicatetheextentto whichsocialcontagion had an effect
on innovationdiffusion and theextentto whichitwas drivenby cohesion
versusstructural equivalence.The networkdata used to definethewjifor
thisstudyare describedbelow in the reviewof theMedical Innovation
study,withtechnicaldetailsgivenin the Appendix.
BeforeI describetheMedical Innovationdata, it is worthnotingthat
thesocial structure ofa studypopulationdetermines thepowerofempir-
ical researchtestingcohesion against structuralequivalence. As illus-
tratedin figure1, thetwo networkconceptslead to identicalpredictions
in certainsocial structures(ego and alterin fig. 1A). A studypopulation
composedof cohesivegroupsof structurally equivalentpeople-for ex-
ample, a populationof unconnectedcliques-cannot be used to distin-
guish the two networkmodels because both models predictcontagion
withinsuchgroups.It is onlywhererelationships cutacrossstatuses(figs.
1B, 1C) thatthecontagionpredictions ofcohesioncan differ fromthoseof
structuralequivalence-not will differbut can differ.The magnitudeof
theirdifference is an empiricalquestion.Thus, past empiricalsupportfor
cohesion'seffecton attitudesand behaviorcarriesno implicationof re-
jectingstructuralequivalence. Dependingon the social structureof the
populationsselectedforstudy,past supportcould just as well have been
structuralequivalenceeffectsmisinterpreted as cohesioneffects.Such is
the case in Medical Innovation.
THE MEDICAL INNOVATION STUDY

Colemanet al.'s (1966)Medical Innovationis a description
ofthemanner
in whicha new antibioticfoundacceptanceduringthemid-1950samong
selectedphysiciansin theMidwest.The studypopulationwas confinedto
a smallgeographicarea so thatphysicianscould be studiedin thecontext
1297

of theirprofessionalrelationswith colleagues. Because of a varietyof

practicalconstraints,fourIllinois citieswere selectedas researchsites:
Peoria, Bloomington,Quincy,and Galesburg.7The studyfocusedon the
physiciansespeciallylikelyto findtetracycline useful:generalpractition-
ers, internists,
and pediatricians.There were 148 such physiciansin the
fourcities,and interviewswere completedwith 126 (85%) of them.An
additionalfourphysicians,listedas havingotherspecialties,turnedoutto
have essentiallya generalpractice,so theywere added to the sample,
bringingthetotalto 130 physicians.Each was asked in a personalinter-
view whetherhe had ever used the new antibioticand thenwas asked
follow-upquestionson when he became aware of it and what sources
providedhim withinformation on it.8
The drugselectedforstudy,tetracycline (discussedin the studyunder
the name "gammanym"),was well suitedto revealingevidenceof social
contagionfor the followingreasons: (a) It could only be obtained by
prescription,so thatany physicianadoptingthenew drughad to leave a
writtenrecordof his adoption.(b) It was arguedto be usefulfora wide
varietyof conditions,so thatit could have found"almostdailyuse by a
physicianin generalpractice"(Coleman et al. 1966, p. 17). (c) It was a
powerfuldrug, especiallyusefulin acute conditions,so that its virtues
could be quicklydeterminedand spread by word of mouth.(d) There
were fewalternativesto the new antibiotic,so thata physicianwho did
notprescribetetracycline was unlikelyto be prescribing someotherdrug
as a substitute.The new antibioticwas released in 1953 and gained
widespreadacceptancebythecompletionoffieldwork late in 1954.Physi-
cians could have begun prescribingtetracycline at any timeafterits re-
7 Thesewerenotmajorurbancenters(Colemanet al. 1966,p. 192):"Allfourofthese

citiesare somewhatindustrialized and are surrounded by richfarmingareas. The
largestofthecitieshad a populationofover100,000and had 182physicians in active
practiceat thetimeofinterviewing. It containedtwohospitalsoffering residencies and
a thirdhospitalthatofferedno residencies.The otherthreecitieshad populations
varying from30,000to 40,000;each containedbetween45 and 75 physicians in active
practice,and twoor threehospitals,noneofwhichoffered residencies."
8
A dummyvariableof recalledadoptionwas constructed fromthesedata ("1" if a
physicianrecalledadoptingtetracycline, "0" otherwise),but thevariablerevealsno
evidenceofcontagion, so resultsobtainedwithitare notpresented, underpressure to
conservespace. In additionto elicitingdata on recalledadoption,thepersonalinter-
viewscovereddiversetopics,including therespondent's socialand professional back-
ground,his attitudestowardthecommunity and variousmedicalpractices,his own
healthhabits(e.g., smoking),his medicalpractice,theinformation channelsthrough
whichhe keptup withmedicaldevelopments, and sociometric data on hissocialand
professionalrelationships.Portionsofthesurveyinstrument are reproduced in Med-
ical Innovation(Colemanet al. 1966,pp. 195-205).Much ofthedata in theoriginal
study,and all thevariablesmentioned here,can be obtainedon microcomputer disk-
ette(seen. 1). Alsocontainedon thediskettearethepreference and network variables
nrenaredfor this stidv.
1298

lease. Most wereprescribingit but variedconsiderablyin whentheyhad

firstacceptedit. The studywas designedto answerwhytheybeganwhen
theydid.
The main conclusionadvanced in Medical Innovationis thatinformal
professionaldiscussionsbetweenphysicianscreatedsociA contagionin
tetracycline's
diffusion,especiallyforphysiciansextensivelyinvolvedin
such discussions,and especiallywhen the new antibioticwas released.I
have threereasons for returningto this study:the adoptiondata, the
networkdata, and the study'semergenceas an exemplarfordetecting
social contagion.
A BehavioralMeasure of Adoption
Beyond the usual retrospectiveadoption data in personalinterviews,
behavioral adoption data were obtained in the study. Records at the
pharmaciesfillingthe bulk of thetetracycline prescriptions forthestudy
populationwereaudited. Prescriptions writtenduringthree-day periods,
separatedby intervalsof about one month,were auditedforover a year
followingtetracycline's release.9 The resultwas an adoption-date variable
rangingfrom1 to 17, roughlyindicatingthe monthaftertetracycline's
release in which a physicianfirstbegan prescribingthe new antibiotic.
Withinthetimecoveredby thestudy,16 physicianswerenonadoptersin
thattheprescription samplingturnedup prescriptions thattheyhad writ-
tenbutno tetracycline prescriptions. As did theoriginalstudy,I use these
physiciansto definea finalpointin tetracycline's diffusion,category18 on
the adoption-datevariable. They eithernever adopted tetracycline, or
adoptedit afterthe timeperiodcoveredby thestudy,or wroteprescrip-
tionsforit on days not coveredin the prescription sampling.Since they
were exposed to the same risk of being missed in the samplingas the
physicianswhose tetracycline prescriptions were detected,eitherof the
firsttwo possibilitiesseemsmorelikelythanthethird.In contrast,there
werefivephysiciansforwhomno prescriptions werefound,neithertetra-
cyclineprescriptions norprescriptions foranything else. As in theoriginal
study,I have made no attemptto predictadoptionsby thesefivephysi-
cians-leaving 125 physicianswhose adoption date is definedby the
prescriptionsamplingand to be explained.
9 The originalstudyprovidesa detailedaccountoftheprescription

sampling
(Coleman
et al. 1966, pp. 193-94). Prescriptions
wereauditedforsamplingperiodsof three
successivedays at approximately monthly intervals.The three-day
sampleperiods
werestratifiedto occuron different
daysoftheweek,skippingSundaysand holidays,
over the courseof tetracycline's
diffusion.The averageintervalbetweensampling
periodswas 28.5 days, defining17 intervalsforthe adoptionvariableover the 16
monthsforwhichprescriptions wereaudited.
1299

These adoption data should be much more reliable than the retro-
spectivesurveydata typicalofdiffusion research,sincetheyare based on
behavioraltracesratherthana physician'smemoryof morethana year's
prescriptions. At the same time,the data are not a census. Prescriptions
wereonlyauditedforthreeworkingdays per month.It is quite possible
fora physicianto have begun prescribing tetracyclineand have had his
prescriptions filledduringthe days forwhichprescription recordswere
not audited. However, such samplingerrorscould only occur in one
direction.It is possiblefora physicianto have begunprescribing tetracy-
cline earlier than the prescriptiondata would indicate, but he had
definitelybegunprescribing bythetimeone ofhis prescriptions forit was
located. In otherwords(and thiswill be importantin aggregating conta-
gionevidence),an unexpectedly late adoptioncould be a samplingerror,
but an unexpectedlyearlyadoptioncould not.
ThoroughNetworkData on the Social Structureof Physicians

A second reason for returningto Medical Innovation is the thorough
networkdata obtainedforthestudy.A varietyof data wereobtainedon
social and professionalrelations, but choice data elicited by two
sociometric itemsweretheprincipalbasis forevidenceofsocial contagion
in Medical Innovation.One itemelicitedthe names of advisers("When
you need information or advice about questionsof therapywheredo you
usuallyturn?"),and the otherelicitedthe names of discussionpartners
("And who are the threeor fourphysicianswithwhomyou mostoften
findyourselfdiscussingcases or therapyin the course of an ordinary
week-last week forinstance?").These citationsindicatethechannelsof
informalprofessionaladvice and discussionamongthe physicians.They
also indicatethe importanceof physiciansoutsidethe prescription sam-
ple. Fifty-two percentof theprescription-sample citationsforadvice and
discussionwentto individualsoutsidethe prescription sample,and this
figuredoes not reflectthe extentto whichrelationsfromoutsidephysi-
cians stratifiedphysicianswithinthe prescription sample. To represent
betterthe social contextin which the prescription-sample physicians
worked, interviewswere conductedwith an additional 98 physicians
selectedto representthe physicians,by specialty,who were mostoften
cited as friends,advisers,and discussionpartnersby the prescription-
sample physicians.The studydesignwas successful.Only 18 physicians
beyondthe 228 contactedforthe studywere citedby two or morepre-
scription-sample physicians;that is, 93% of the physiciansinvolvedin
professionalrelationshipswith two or more of the prescription-sample
physicianswere interviewedforthe study.The medicaladvice and dis-
cussion citationselicitedfromall 228 physicianshave been pooled to
1300

definea networkof professionalties in each city.10These citationdata

have been used to computenetworkweightsforcohesionand structural
equivalencein each city.The networkweightshave been used to define
the adoptionexpectedof each prescription-sample physician-first,as a
functionofhisadvisersand discussionpartners(cohesion)and, second,as
a functionof his positionin the social structureof medical advice and
discussion(structuralequivalence). Computationaldetails are given in
the Appendix.
A SociologicalExemplar
The sociologyof scienceprovidesa thirdreasonforreturning to Medical
Innovation.The studyhas becomean exemplar.The difficulty ofobtain-
ingbehavioraladoptiondata and thoroughnetworkdata, notto mention
theskillfulanalysisof thesedata in theoriginalstudy,have combinedto
make it unique in diffusionresearch.Researchpriorand subsequentto
Medical Innovation provides a wealth of information on nonnetwork
variablesaffecting innovationadoptionand associationsbetweenaspects
of networkpositionsand recollectionsof adopting.Rogers(1983) con-
tinuesto providethe encyclopedicsynthesisof thisresearch.Littlenew
knowledgehas emerged,however,on the mannerin whichsocial conta-
gion operates;cohesionremainsthe assumed social forcedrivingconta-
gion,and Medical Innovationremainstheclassicevidentialreference (see
Rogers1983,chap. 8, on diffusion networksin generaland pp. 65-68 and
288-93 on Medical Innovationin particular).Thus, theoriginaldata are
a strategicresearchsitefortestingnew understandingsofthesocial struc-
turalconditionsresponsibleforcontagion.
CONTAGION AT THE POPULATION LEVEL

I beginwiththe shape of diffusion.If social contagionwas a dominant
factorin tetracycline's
diffusion,
thenthe distribution of adoptionsover
timein thestudypopulationwould have had an identifiable form.This is
a long-standingthemein diffusionresearch(see, e.g., Pemberton1936),a
textbookexemplarin mathematicalsociology(see, e.g., Leik and Meeker
1975, pp. 128-39), and a centralpointin Medical Innovation,withthe
rapid diffusionof tetracycline
amongprominentphysiciansadvanced as
10 This figureincludes12 physiciansinterviewedas informants forthestudy.Their

interviews are notstrictly
comparablewiththoseconductedwiththeother216 study
respondents. Analysisofadviceand discussionas separatenetworks did notproduce
contagioneffectsdifferent fromthoseobtainedwiththe simplerpooled network.
Additionally,multiplexitywithsocialrelationsand hospitalaffiliations
and thesocial
structure ofadviceand discussionin each cityhave beenstudied.
1301

k = .9
08
04
A. DiffusionWithoutContagion
02 dy/dt = k 1-y)
0
1 3 5 6 8 to 12 14 16
B. DiffusionWith
Contagion
0.8 dy/dt = ky (I-y)
0 6
0.4 k .5
02
k=.2
0 2 4 6 8 10 12 14 16
MonthsAfterTetracycline'sRelease
FIG. 2.-Diffusion in theory(cumulativeproportionof physiciansadopting
over time)
evidenceofsocial contagion(Colemanet al. 1966,pp. 95-111). The point

is illustratedin figure2, withhypotheticaldiffusioncurvesfortheMed-
ical Innovationpopulationdescribingthe cumulativeproportion of phy-
siciansadoptingtetracycline at each of the 17 roughlymonth-long sam-
plingintervalscoveredby the study.
In the absence of contagion,tetracycline's diffusionwould have re-
1302

sembledthe curvesin figure2A. Diffusionis drivenby two factors:the

averagephysician'spredisposition to adopt independentlyofotherphysi-
cians(probability k) and theproportion ofthephysicianpopulationavail-
able to adopt (one minusy, wherey is the proportionthathas adopted).
The expectedrate of tetracycline's diffusionis the productof the two
factors:dyldt = k(1 - y). If the average physician'spreference forthe
new drugwas low, say a .2 probability,as in thebottomcurvein figure
2A, then diffusionwould have progressedvery slowly:21% would be
expectedto have adopted duringthe firstmonth,37% by theend of the
second month,and so on across the diffusionprocess,endingwith98%
adoptingby the end of the timecoveredby thestudy." Diffusionwould
have been muchmorerapid if each physicianhad been equallylikelyto
adopt or rejectthe new drug(themiddlecurvein fig.2A). If each physi-
cian had a strongpredispositiontowardadoptingtetracycline, say a .9
probabilityof adopting,thendiffusionwould have progressedveryrap-
idly,as illustratedby the top curvein figure2A. Adoptionswould have
spreadto 90% ofthepopulationduringthefirstmonthand to 99% bythe
end of the second month,completingthe bulk of tetracycline's diffusion
onlytwo monthsafterits release.
Contagionchangesdiffusionto the familiarS-shaped curvesin figure
2B. The rateoftetracycline's diffusionis givenby thetwo factorsabove,
weightedbytheextentto whichtheinnovationis alreadywidelyadopted:
dyldt = ky(1 - y). If affectedby contagion,use of tetracycline would
have spread rapidlyas a functionof physicians'personalpreferences for
thenew drug(k),thevolumeofphysiciansavailable to adopt(1 - y), and
the volume of physicianswho had alreadyadopted (y). Thus, familiar
distinctionsemergebetweenstagesin thediffusion process.Initially,few
adoptionshave takenplace, so thatsocial contagiondampenstherateat
whichdiffusion occurs. Even withhighpersonalpreferences and a large
proportion ofpotentialadopters,a low proportion ofactual adopterswill
keep new adoptionslow. The productky(1 - y) is low whiley is low. As
adoptionsseep throughthe system,morepotentialadoptersare exposed
to someonewho has alreadyadopted, so thatthe producty(1 - y) ap-
proachesits maximumvalue of one-half.Diffusionis mostrapid at this
" Severalbold assumptions are requiredto legitimate

thesecomputations, including
constantpersonalpreferences independent ofdiffusion'sprogress (i.e., k independent
ofy) and constantratesofdiffusion withinmonthly intervals(i.e., dyldtconstantin
eachofthe17samplingintervals). I am notproposing thatsuchassumptions arevalid
or invalidforthestudypopulation.I am merelyusingfig.2 to recalltheargument in
MedicalInnovationand to highlight thefactthatsocialcontagion is uniquelycharac-
terizedbya slowinitialrateofdiffusionratherthana fastsubsequent rate;thissetsthe
stageforobserving thatthereis no suchevidenceofsocialcontagion in theobserved
physician population.
1303

pointand graduallyslows down afterwardas thereare fewerand fewer

peopleremainingto adopt (i.e., ky[1- y] decreasesas [1 - y]decreases).
I wishto notetwo differences in figure2 betweena diffusion processin
whichsocial contagionoccursand one in whichit does not. First,a steep
rate of diffusionneed not indicatesocial contagion.Rapid diffusion can
be generatedby strongpersonalpreferences towardadoptionin a study
population(top curve in fig.2A) or by social contagion(middleand top
curvesin fig.2B). Second, the mostdistinctevidenceof social contagion
is the initialperiodof slow diffusionamongpioneeradopters.Diffusion
driven by personal preference(fig. 2A) begins as a rapid rate, which
becomesslowerand slower.Diffusiondrivenbysocial contagion(fig.2B)
begins at a slow rate, which increases until half the populationhas
adoptedand thereafter becomesslowerand slower.In fact,social conta-
gion coupled with low physicianpreferences foradoption-the bottom
curve in figure2B-could have slowed tetracycline's diffusiondown to
thepointat whichonly16% ofthestudypopulationwould have adopted
by the end of the studyperiod.12
I notethesepointsin figure2 because thecurvesin figure3 describing
tetracycline'sobserved diffusionshow no evidence of the slow initial
diffusioncharacteristic of social contagion.The bold lines in figures3A
and 3B tracethecumulativeproportion ofthestudypopulationadopting
at each of the samplingintervals.Note thatthereis no delay in tetracy-
cline'sdiffusion;it spread quicklyand progressedat a diminishing rate.
As illustratedin figure2, thisdiffusioncould be due to social contagionor
strongpersonalpredispositions among the physicianstowardadoption.
The slow initial diffusioncharacteristicof social contagionis missing
altogether.Moreover,the same conclusionholds forphysicianswho are
eitherprominentor marginalin the networksof medical advice and
discussion.In figure3A, physicianscited by fouror moreothersas an
adviseror discussionpartneradoptedat a fasterratethanphysiciansnot
12
The diffusioncurvesin fig.2 beginwiththefirst physician'sadoption(yo= 1/125).
The formof the diffusion curvesproducedby personalpreference is stableover a
reasonablerangeofalternative startingproportions,butthecurvesproducedbysocial
contagionare quitesensitiveto thenumberof physicians initiallyadoptingtetracy-
cline.E.g., ifdiffusion
weresaid to have begunwith10 physicians adopting,thenyo
would be 10/125,and the contagioncurvein fig.2B withk = .2 would predict
adoptionby 70% of thestudypopulationby theend of timeperiodcoveredby the
studyratherthanthe 16% in fig.2B. In fact,one way to speedcontagiousdiffusion
through itsinitially
slow rateis to seed thepopulationwitha smallnumberofinitial
adoptions.Nevertheless, contagionwouldhave had itscharacteristic effecton diffu-
sioncurvesin theMedicalInnovationstudypopulation.Even ifthecurvesin fig.2B
are begunwiththe 8.8% of the studypopulationadoptingby the end of the first
month,theystillshowthecharacteristic slowinitialdiffusion
phase,butitis brieffor
physicians stronglypredisposed towardadoptingthenewantibiotic.
1304

all WW "
0 8 physiciains
physicians
receiving four or
morecitations
0.6 uncited physicians
0.4
A. Variation by Interpersonal
02 Prominence
0
0 2 4 6 8 10 12 14 16
cohesion/ /
0.8 e
t - 4 ~~~~~~~diffusion
0.6
0.4 diffusion by
structural
equivalence
0.2 B. Variationby Predicted

Contagion
0 2 4 6 a 10 12 14 16
proportion
FIG. 3.-Diffusionobserved(cumulative adopting
of physicians
overtime)
cited by anyone. However, diffusionin both subpopulationsbegan

quicklyand progressedat a constantor diminishing rate.
It seemsclearthatcontagionwas nottheprincipalfactordrivingtetra-
The slow initialdiffusion
cycline'sdiffusion. ofcontagionis
characteristic
missing,and the steep rate of diffusionobserved is evidence of both
contagionand strongpersonalpredispositions towardadoption-where
1305

evidenceof per-
thereis evidenceof contagion,thereis simultaneously
sonal preferences
at work.13
13 This conclusion
can be statedmoreprecisely witha diffusionmodeldevelopedin
marketing researchto describethespreadofnew products.I am grateful to Donald
Lehmannforcallingmyattention tothiswork.Mahajanand Peterson (1985)providea
briefreviewof the work,and the papersassembledin Mahajan and Wind (1986)
providedetaileddiscussion.The modelis usefulherebecauseitdistinguishes
personal
and contagioncomponents in populationdiffusion
curves.The basicmodelproposed
by Bass (1969)definesthenumberofpeopleexpectedto adoptin timeintervalt (see
Mahajan and Wind 1986, p. 6):
dN(t)ldt = [p + (q/m)N(t)][m -N(t)],
whereN(t)is thecumulative numberofindividualsadoptingbytimet,mis a diffusion
"ceiling"equal to the numberof individualswho will eventuallyadopt, p is a
"coefficient
of innovation"describingthe tendencyforindividualsto adopt before
anyoneelsehas adopted(notethattheequationreducestopmwhenN(t) = 0), and q is
a "coefficient
ofimitation"describingthetendency forindividualsto adoptas others
adopt.This modelcan be restatedin termsofthefactorsfamiliar to sociologists
from
Colemanet al.'s analysis(see Bass 1969, pp. 217-18): dy/dt = (p + qy)(1 - y)
= p(1 - y) + qy(1 - y), wherey is the cumulativeproportionof adopterswho adopted
by timet (i.e., y = N(t)lm).In otherwords,themarketing modeldisaggregates the
averageadoptionprobability in fig.2, k, intoa personalcomponentand a social
component. The p(1 - y) termis thepersonalcomponent displayedin fig.2A and the
qy(1 - y) termis thecontagioncomponent displayedin fig.2B. To estimatethemag-
nitudeof thesecomponents in an observeddiffusion curve,one can integrate the
partialderivative dy/dtand compareadoptionfrequencies insuccessivetimeintervals.
The number of adoptions in time interval t, dN(t), is the differenceN(t) - N(t - 1),
whichequalsthedifference m(yt)- m(yt-1),which,wheny is replacedwiththeresults
ofintegratingdy/dt,yieldsan equationwithwhichtheunknown parametersm,p, and
q can be estimated(see Srinivasanand Mason 1986):
dN(t) =- m[1 - e-(+q)(t) _ m[1 -e-(p+q)(t-1)

[1 + (q/p)e-(p+q)(t)] [1 + (q/p)e-(p+q)(t-l)]
I have estimatedtheparameters fromadoptionfrequencies in the 17 samplinginter-
vals by usingthe nonlinear,least-squaresalgorithm in SYSTAT, theceilinginitially
beingsetto a singleadopter(m = 1) and theadoptionprobabilities beingsetto their
maximumvalue (p = q = 1), whichforcesthe algorithm to computederivatives
acrossdistantalternatives beforereaching thefinalestimates. Fortheboldlineinfig.3
describing all prescription-sample physicians, theestimated personalcomponent, p, is
.081 and 5.4 timesitsstandarderror.The estimated socialcomponent, q, is .207 and
2.4 timesitsstandarderror.Stronger evidenceofcontagion can be foundinthefig.3A
curvedescribing thespreadoftetracycline amongsociallyprominent physicians. The
estimateofq increasesto .409, whichis 3.5 timesits standarderror.However,per-
sonalpreferences remaina highlysignificant factor.The estimateofp forthesocially
prominent physiciansis .061 and 2.8 timesitsstandarderror.As was concludedinthe
originalstudy,thereis no evidenceofcontagion inthefig.3A curvedescribing tetracy-
cline'sdiffusionamongsociallymarginal physicians. The estimate ofq is . 102,whichis
less than its standarderrorand quite obviouslyless significant thanthe personal
component, p, estimated to be .057 and 1.9 timesitsstandarderror.Thus,I reachthe
conclusionstatedin the text:wherethereis evidenceof contagionin tetracycline's
diffusion,thereis simultaneously evidenceofpersonalpreferences at work.
1306

The missingcharacteristicevidenceofsocial contagionis moreobvious

in figure3B, wherethe observedpopulationcurveis plottedwithcorre-
spondingplotsof adoptionnormsundercohesionand structuralequiva-
lence. Continuousadoptionnormvariableshave beenroundedto integers
to definethe monthin which a physicianshould have adopted under
structuralequivalence or cohesion. The cohesioncurve describeswhat
diffusionwould have looked like if physicianshad adopted when their
advisers and discussionpartnersadopted. The structuralequivalence
curve describesdiffusionunderthe assumptionthatphysiciansadopted
when theirpeers in the medical hierarchyadopted. In contrastto the
observeddiffusion curves,bothnetworkmodelsproducediffusion curves
obviouslyinfluencedby social contagion,in the sensethatbothdescribe
tetracyclinediffusingat a slow rate for the firstfew monthsafterits
release,spreadingrapidlyin bandwagonfashionaftera handfulofphysi-
cians made thefirst,tentativeadoptions,and slowingrapidlyto complete
diffusion throughout thestudypopulation.In otherwords,bothnetwork
modelsdiffer fromtheobserveddata bypredicting diffusioncurvesdomi-
natedby contagioneffectsand evidencingthe slow initialdiffusion char-
acteristicof contagion.14
To summarize,thereis evidenceofcontagionin tetracycline's diffusion
at thesame timethatcontagionwas farfromthedominantfactordriving
thenew drug'sadoption.These resultsprovidea usefulindicationofthe
magnitudeof contagion'seffects.They glaringly failto indicatehow con-
tagiontookplace. Contagionremainsan assumedprocessat thislevel of
analysis,typicallyattributedto cohesionand isolatedfromempiricaltest-
ing. To studythesocial structuralconditionsresponsiblefortheapparent
contagioneffectsin tetracycline's I have to examinethe inter-
diffusion,
personalenvironments in whichindividualadoptionsoccurred.
CONTAGION AND THE INDIVIDUAL PHYSICIAN

The networkdata on advice and discussionrelationsmake it possibleto
dig past thepopulationlevel ofanalysisdown to thelevel ofsocial conta-
gion'seffecton the individualphysician'sadoption.To beginwith,it is
14 This conclusion,too, can be statedmorepreciselywiththe marketing research

modelgivenin thepreceding footnote.
For thediffusion curvepredictedbystructural
equivalence,theestimatedpersonalcomponent in a marketingdiffusionmodel,p, is
.018 and 2.3 timesitsstandarderror,whiletheestimated contagioncomponent, q, is
.414and 5.8 timesitsstandarderror.Forthecurvepredicted bycohesion, theestimate
ofp is .013 and 2.6 timesits standarderror,whiletheestimateof q is .933 and 8.0
timesitsstandarderror.Thus, I reachtheconclusionstatedin thetext:thecohesion
andstructural equivalencecurvesinfig.3B illustratediffusion
processes
dominated by
contagion.
1307

alters of immediateadopters
0.8
0.6 alters of
nonadopte rs
0.4
0.2
A. StructuralEquivalence
0
0 2 4 6 8 0o ?2 ?4 ?6
1
alters of immediateadopters
0.8
alters of
0.6 nonadopters
0.4
0.2 B. Cohesion
0
0 2 4 6 a ?0 ?2 ?4 ?6
FIG. 4. -Alter adoptionsforphysiciansadoptingextremely
earlyor extremely
late (cumulativeproportionof altersadoptingover time).
possibleto comparephysiciansin termsoftetracycline's diffusionamong

each physician'sadvisersand peers. In contrastto the plotsin figures2
and 3 of the cumulativeproportionof physiciansadoptingover time,
figure4 plotsthe cumulativeproportionof altersadopting.The altersof
physiciansadoptingimmediately(withinthe firsttwo monthsof tetra-
duringtheslow diffusion
cycline'sdiffusion, predictedin fig.3B bycohe-
1308

sion and structuralequivalence) are comparedwiththe altersof physi-

cians who had not adopted by the end of the studyperiod.
It is clear fromthesegraphsthatphysiciansat theverybeginningand
veryend oftetracycline's diffusionwereexposedto similaradoptionrates
among their alters. Physicians adopting immediatelywere not sur-
roundedby alterswho also adoptedimmediately.On average,it tooksix
monthsformore than half of theiradvisersand discussionpartnersto
adopt (fig.4B) and anothermonthformorethanhalfoftheirstructurally
equivalent altersto adopt (fig.4A). Similarly,physicianswho delayed
adoption beyond the time period covered by the studywere not sur-
roundedby alterswho adopted late.
At the same time,it is clear thatthereis moredifference betweenthe
structuralequivalence alters.Under structuralequivalence,the altersof
immediateadopterswere at all timesduringtetracycline's diffusion more
likelythanthealtersof nonadoptersto adoptthenew drug.The thinline
in figure4A is higherthan the thick line. In contrast,there is no
significantdifferenceat any time between the cohesion alters of im-
mediateadoptersand nonadopters,and thereare even timeswhenadop-
tionswere higheramong the nonadopteralters.The thinline and thick
line are intertwined in figure4B. The visible difference in figure4 be-
tweenstructural equivalence and is
cohesion repeated in the moresystem-
atic resultsto follow.
The comparisonin figure4 betweenimmediateand late adoptersis
extendedin table 1 to all physicians.The resultsconsistently supportthe
conclusionthat a physician'sadoptionwas stronglydeterminedby the
behaviorofhis peersin themedicalhierarchy (thestructural equivalence
columnin table 1) and virtuallyunaffected by thebehaviorofthepeople
fromwhomhe soughtadvice or withwhomhe discussedcases (thecohe-
sion columnin table 1).
Regressingobservedadoptiondate over the adoptiondates predicted
by structuralequivalence and cohesionis the mostobvious way to look
fora social contagioneffect.The resultsare reportedin the firstrow of
table 1. The monthin whicha physicianbeganprescribing tetracyclineis
significantly predictedby themonthin whichpeople structurally equiva-
lentto hinm began prescribingit and statistically
independent ofthemonth
in whichhis advisersand discussionpartnersbegan prescribing it. More
specifically, physicians,on average, began writingtetracycline prescrip-
tions3?/2monthsafterits releaseif the physicianswithwhomtheywere
structurally equivalentadoptedthenew drugimmediately; and theypost-
poned theirown adoptionfora littlemorethan halfa monthforevery
monththattheiraltersdelayedadopting(i.e., the.32 standardizedcoeffi-
cientin table 1 refersto a metricregressionlinewitha 3.50 intercept and
.58 slope).
1309

TABLE 1
EVIDENCE OF CONTAGION IN ADOPrION
Structural
Equivalence Cohesion
Continuous contagion effecta ......... .32 .07

(t = 3.8) (t = 0.7)
Independenceof detaileddiffusion
phasesb ......................... 68.78 29.56
(P < .001) (P = .24)
Independenceof aggregatediffusion
phasesc . ............... 29.83 4.92
(P < .001) (P = .30)
Contagioneffectin innovationrolesd .. 1.29 .95
(z = 2.59) (z = -.54)
(P = .005) (P = .71)
a Standardized,ordinaryleast-squaresestimatesobtainedbyregressing month
ofadoptionovernormativemonthofadoptionfortheprescription-sample physi-
cians (see App. on computingadoption-monthnorm). Structuralequivalence
adoptionnormsare available for124 physicians,and cohesionnormsare avail-
able for117 physicians.Routinet-testsare presentedto providesome sense of
effectmagnituderelativeto residualvariance;however,routinestatisticalinfer-
encesshouldnotbe made fromthesetests(see App.). If datesare standardizedby
city means and standard deviations,effectsof .32 and .02 are obtained for
structuralequivalenceand cohesion,respectively.
b Likelihood-ratio x2statisticsare reported,but inferencesis difficultbecause
ofthemanylow frequenciesin thesedetailedtables(see table 2). The six catego-
ries of observedand normativeadoptiondate in table 2 create 25 df forthese
statistics.
c Likelihood-ratio x2statisticsare reported.As describedin thetext,observed
and normativeadoptiondate data are tabulatedacross aggregatephases in the
diffusion of tetracycline(early,median,and late adopters),creating4 df.
d The effect is the multiplicativeinteractionbetweenobservedand normative
adoptionin a log-linearmodel of the innovationroles in table 3. It equals the
numberof physiciansconforming to alterbehavior(earlyand late conformers)
divided by the numberof physiciansdeviatingfromalter behavior(eager in-
novatorsand deviantlaggards),quantityto thefourthroot,and so measuresthe
tendencyforphysiciansto conformto alterbehavior.
These estimatesof a continuoussocial contagioneffectpresumeequal

intervalsbetween months,but the monthsof tetracycline's diffusion,
equivalentin physicaltime,werenotequivalentin social time.Thereare
fourmonthsseparatingan adoptionin thethirdmonthfroman adoption
in theseventhmonthoftetracycline's diffusionand fourmonthsseparat-
ing an adoptionin the thirteenthmonthfroman adoptionin the seven-
teenthmonth.However,thefirstdifference has greatersocial significance
than the second difference.As illustratedby the populationdiffusion
curvesin figures2B and 3B, thefirstdifference
separatesa physicianwho
adopted duringthe earlyphase of tetracycline'sdiffusion-whenadop-
1310

tionswere fewand tentative-froma physicianwho adoptedduringthe

middlephase ofthenew drug'sdiffusion-whentherewas a greatrushof
physiciansadoptingthedrugand severalmonthsofcollectiveexperience
withthe new drug. In otherwords,the four-month gap betweenadop-
tionsin monthsthreeand seven spans sociallydistinctphasesoftetracy-
cline's diffusion.In contrast,and as again illustratedin figures2B and
3B, thefour-month differencebetweenadoptionsin months13 and 17is a
negligibledifference betweenadoptionsduringthefinalphase oftetracy-
cline'sdiffusion,a periodofveryfewadoptionsbecause mostofthestudy
populationhad alreadyadopted the new drug. The distinction between
physicaland social timesuggeststhatit is improperly preciseto evaluate
contagionby the tendencyfor physiciansand alters to have adopted
tetracyclinein thesame monthafteritsrelease.Rather,contagionshould
be estimatedin termsof the tendencyof physiciansand altersto have
adopted tetracycline duringthe same phase of its diffusion.'5
The resultsin thesecond,third,and fourthrowsoftable 1 are based on
alternativepartitionsof adoptionmonthsintodiffusion phases. All sup-
portthe conclusionthatobservedadoptionwas contingent on structural
equivalencenormsand independentof cohesionnorms.For each of the
threeadoptionvariables (observeddate of adoption,structuralequiva-
15 In addition,thereare two important methodological reasonsforestimating social

contagion effects fromaggregate categoriesofadoptiondates.First,theordinary least-
squaresestimates ofa continuous socialcontagioneffect in thefirstrowoftable1 are
not maximumlikelihoodbecause of variablecorrelations betweenthe residualsin
predicting observedfromprescribed adoption.Contagionis moreproperly estimated
as a networkautocorrelation, and that,unfortunately, cannotbe estimated herebe-
cause of problemswithmissingdata (see App.). In otherwords,one methodological
reasonforaggregating adoptiondatesis to recodeautocorrelations betweenmonthly
responsecategoriesintointracategory correlations to facilitatestatisticalinference.
Second,thereis thequestionof how to putthesmallMedical Innovationsampleto
bestuse in studying socialcontagion.In orderto studytheformofsocialcontagion's
effect, i.e., theformoftheassociationbetweenobservedand normative adoption,the
smallsampleofphysicians can be distributed
acrossthecellsin table2, createdwhen
six categories ofobservedadoptiondatesare tabulatedwithinsix categories ofadop-
tionnorms.But notethesmallfrequencies in table2. Cross-tabulating table2 across
thirdvariablesmeasuring personalpreferences or socialstructural conditions further
lowerscell frequenciesand createsmoreemptycells, makingestimatesof effects
unreliable.Aggregating adoptiondatesintodiffusion phasesincreasescellfrequencies
in three-way tabulations.This is a secondreasonforaggregating adoptiondatesinto
diffusion phases:to shiftanalyticalpowerfrommakingstatements abouttheformof
social contagionto makingstatements aboutthestability of social contagionacross
variationsin personalpreference and social structural conditions.Of course,this
aggregation is legitimate onlyiftheoriginalevidenceofsocialcontagion is preserved.
Therefore, I presentestimatesof social contagionin table 1 foralternative aggrega-
tionsto demonstrate thattherelativestrength ofstructural equivalenceovercohesion
is reproduced at each levelofaggregation.
1311

TABLE 2
CATEGORIES OF OBSERVED AND NORMATIVE ADOPTION DATES
ADOPTION DATE NORM AMONG ALTERS

OBSERVED DATE
OF ADOPrION 1 2 3 4 5 6
Early adopters:
................. 7 3 6 4 2 7
(5) (3) (4) (2) (5) (8)
2 ................. 3 5 2 1 0 1
(3) (1) (1) (3) (2) (2)
Median Adopters:
3 ................. 6 3 5 6 0 1
(5) (2) (4) (3) (1) (5)
4 ................. 10 0 3 1 1 6
(8) (4) (3) (3) (2) (1)
5 ................. 4 0 1 0 1 4
(4) (0) (0) (0) (0) (5)
Late adopters:
6 ................. 0 0 5 9 6 11
(6) (1) (6) (6) (3) (6)
NOTE.-Frequencies foraltersdefinedby cohesionare presentedin parenthesesbeneathfrequencies

foraltersdefinedby structuralequivalence.Categoriesare definedby rankingphysiciansin each cityby
adoptiondate and aggregating adjacentphysicians.Withinthelimitsoftiesbetweenphysiciansadopting
duringthesame month,category1 containsthefirst25% ofphysiciansadoptingin each city,category2
containssubsequentadoptersup to thefirst33% in each city,category3 containssubsequentadoptersup
to the first50% in each city,category4 containssubsequentadoptersup to the first66% in each city,
category5 containssubsequentadoptersup to the first75% in each city,and the remaining25% of
physicians,consistingof verylate adoptersand the nonadoptersin each city,fallintocategory6.
lence date, and cohesiondate), phases in tetracycline's diffusionhave

been definedby orderingphysiciansin each cityby adoptiondate and
aggregating adjacentphysicians.Table 2 presentsthedistribution ofphy-
sicians across six adoption categoriesdefiningthreeand fourphases in
tetracycline's diffusion.For each city,categories1 and 2 containthefirst
thirdofphysiciansadopting,categories3 and 4 containthesecondthird,
and categories5 and 6 containthe last third(includingphysiciansfor
whomno tetracycline prescriptions were found).Alternatively, category
1 containsthe firstquarterof physiciansadopting,categories2 and 3
containthe second quarterof adopters,categories4 and 5 containthe
thirdquarterofadopters,and category6 containsthefinalquarter.Note
two things.First, the frequenciesare verylow in this table. The data
mustbe aggregatedintobroaderdiffusion phases in orderto studyeffects
in tableswithadditionalvariables.Second,even at thislevelofdetail,the
x2 statisticsin the second row of table 1 show thatobservedadoptionis
strongly associatedwithstructural equivalence(lessthana .001 probabil-
ityofindependence)and is statistically independentofcohesion(.24 prob-
1312

abilityof independence).Three aggregatephases in tetracycline's diffu-

sion are distinguishedin table 2: early,median,and late.
The firstthirdof a city'sphysiciansadoptingthenew drugwereearly
adopters.These 41 physiciansadopted duringthe firstfourmonthsof
tetracyline'sdiffusionin each city'6-a periodwhenadoptionswererare
and tentative(as illustratedin fig.3B; see Colemanet al. 1966,p. 32) and
theonlyperiodin whichevidenceofinterpersonal influencefromadvisers
and discussionpartnerswas observedin the originalstudy.'7Further,
thereis no significant difference in the adoptionnormsto whichphysi-
cians in the firsttwo rows of table 2 were exposed (4.88 and 2.94 x2
statisticswith5 dfforstructuralequivalenceand cohesion,respectively).
The finalfourthof a city'sphysiciansremainingafterthe city'sother
physicianshad begunprescribing tetracyclinewerelate adopters.Half of
these 31 physicianswere nonadoptersin that theywrote none of the
sampled tetracyclineprescriptions.The otherhalf of the late adopters
began prescribingtetracyclinea year or more afterthe new drug was
released. As illustratedin figure3, the rate of tetracycline's diffusion
duringthisperiodwas veryslow, almostnonexistent, exceptamongthe
16
One earlyadopter,the last in Galesburg,adoptedduringthe fifthmonth,but
tetracyclinedid notbegindiffusing amongthesampledGalesburgphysicians untilthe
thirdsamplingperiod,so thatthislastadoptionis wellwithinthefirst fourmonthsof
tetracycline'sdiffusionwithinGalesburg.
17 Interpersonal influencefromadvisersand discussionpartners was reportedinMed-
icalInnovationforthefirst fivemonths oftetracycline'sdiffusion
(Colemanetal. 1966,
pp. 114-30). This suggeststhatthelack of a cohesioneffectin table 1 mightbe a
consequence ofestimating contagion acrosstheentiretimeperiodcoveredbythestudy
ratherthanfocusing on thefirstfivemonthswhencohesionhad itseffect. Suchis not
thecase. The evidenceof interpersonal influence reportedin theoriginalstudyde-
pendson censoring theadoptiondata and is duplicatedhereiftheadoptiondata are
similarlycensored.Answering thequestionofwhennetworks had theireffect,
Cole-
manet al. (1966,pp. 117-20)estimated interpersonalinfluencebycomparing thedate
on whicha physician adoptedwiththedatesofadoptionbyhisadvisersanddiscussion
partnerswhohad alreadyadopted.Advisersanddiscussion partnersadoptinglater,or
notadoptingat all, weredeletedfromtheestimation. Thus,variationin theadoption
behaviorofphysicians adoptingearlywas censored,givingtheappearanceofsimul-
taneousadoptionsearlyin tetracycline's diffusion.The laterthemonthwas inwhicha
physicianadopted,the greaterthe acknowledgedvariationin the dates on which
advisersand discussionpartners adoptedand thelowerthelikelihood offindingevi-
denceof contagion.Similarly, thedate on whichan earlyadopterbeganprescribing
tetracyclineis stronglypredicted herebystructural equivalenceand cohesionifphysi-
cianswhosealtersadoptedlaterare ignored(r = .72, 4.16 t-test for18 earlyadopters
understructural equivalence;r = .56, 2.16 t-testfor12 earlyadoptersundercohe-
sion).However,expandingthecalculations toall 41 earlyadoptersregardlessofwhen
theiraltersadoptedshowsthatthereis no associationbetweenthemonthin whichan
earlyadopterbeganprescribing and themonthin whichhisalters,on average,began
prescribing(r = .06 forstructural equivalence;r = .03 forcohesion).
1313

physiciansnot cited as advisersor discussionpartnersby anyonein the

study.18
Finally,physiciansadoptingduringtheintervening monthsoftetracy-
cline'sdiffusionwere median adopters.As illustratedin figure3, these
adoptionsoccurredat a timewhentetracycline was spreadingrapidly,the
principalshiftoccurringduringthetenthmonthto a slowerspreadofthe
new drugamong physiciansgenerally.In addition,thereare no signifi-
cant differences in the adoptionnormsto whichphysiciansin rows3, 4,
and 5 oftable 2 wereexposed(15.66 and 11.65 x2 statisticswith10 dffor
structuralequivalenceand cohesionnorms,respectively).
The resultsin thethirdrowoftable 1 showthatthedistinction between
early,median, and late phases in tetracycline's diffusionpreservesthe
strongevidence of contagionpredictedby structuralequivalence and
continuesto revealno evidenceofcontagionby cohesion.The hypothesis
of no contagioneffecthas less than a .001 probabilityof being truein
structuralequivalencepredictionsand a .30 probabilityof beingtruein
cohesionpredictions.
Enrichingtheseresults,thegraphsin figure5 show thatthecontagion
effectpredictedby structural equivalenceoperatedcontinuously overthe
entirecourseof tetracycline's diffusion.The figurepresentsthe propor-
tionof adoptersin each monthwho had earlyadoptersas alters,median
adoptersas alters,and late adoptersas alters.'9Considerthe physicians
who beganwritingtetracycline prescriptionsfourmonthsafteritsrelease.
Understructural equivalence(fig.5A), 64% ofthesephysicianshad alters
adoptingearlyin tetracycline's diffusion,27% had altersadoptingduring
themedianphase, and 9% had altersadoptinglate or notadoptingat all.
In otherwords,physiciansadoptingduringthe fourthmonthtendedto
have alterswho also adopted early. In the same graph,noticehow the
tendencyfor early adopters to have had alters adoptingearly shifts
smoothlyto late adoptersexposed to alterswho adopted late. Contrast
thiswiththegraphforcohesionnormsin figure5B. Thereis no shiftfrom
earlyto late adoptionamongthealters.Physiciansadoptingat thebegin-
ningand end of tetracycline's diffusionwere exposed similarlyto alters
18 Categories5 and 6 are notcombinedto definethelast 33% of physicians as late

adoptersbecausethereis a significant in the kindsof adoptionnormsto
difference
whichthelate adopters(category 6) and late medianadopters(category 5) wereex-
posed.The hypothesis thatobservedand normative adoptionareindependent in rows
5 and 6 doesnotfitthedata (X2= 12.59,with4 dfforstructural equivalence,P = .01,
and theusual negligibleresultwithcohesion:x2= 7.01 with5 df).
l9 In orderto highlight
trendsovertimein fig.5, movingaveragesare plotted.The
proportion ofphysiciansat timet exposedto altersadoptingearly,e.g., is theaverage
oftheproportion exposedtoearlyadoptingaltersat timet - 1, t, and t + 1. For this
figure,the proportionsobservedat the end of thefirstmonthhave been extended
backwardto time0, theinitialreleaseoftetracycline.
1314

lOOX
a0X~~~~~~~~~
s i
S~
~~~~~~~~~t
~ ~~~~~~~~~~~~~~~~~~
,orm
3- i- t 9 t El
Adoption
A. Percent _
Physicians
Exposed to
Structural
Equivalence 40%-
Norm
20% Early AdoptionNorm
B. Percent 10%
Physicians
Exposed to
Cohesion
2 4 6 8 10 12 14 16
Monthsafter Tetracycline'sRelease in
which PhysicianAdopted
FIG. 5.-Adoptionnormsovertime
adoptingearlyand altersadoptinglate. Evidenceofcontagionis notonly

strongerunder structuralequivalence, it is also more consistentover
time.
Further,thereare lags in the contagioneffectsamongearly,median,
and late adoptions that highlightfourinnovationroles played by the
physicians,roles that capturethe most basic evidenceof social conta-
gion in tetracycline'sdiffusion.The followingtabulationof physician
adoptions(rows)by structuralequivalencealters(columns)is takenfrom
1315

table 2:
early 18 15 8
median 23 18 11
late 0 20 11,
and the followingmultiplicative
interactioneffectsare takenfroma log-
linear model of the frequencies(increasedby .5 to eliminatethe zero
frequency):
early 2.4 0.7 0.6
median 2.4 0.6 0.7
late 0.2 2.4 2.3.
The thirdcolumndescribesphysicianswhose alterspostponedadopting
tetracyclineuntil very late in its diffusionor never adopted it at all.
Physiciansexposedto such alterstendednotto adopt duringtheearlyor
middlephasesoftetracycline's diffusion.The numberofthempostponing
adoption,as did theiralters,untillate in thediffusionprocessis 2.3 times
thenumberthatwould be expectedifphysicianadoptionswereindepen-
dentof alteradoptions.The secondcolumndescribesphysiciansexposed
to alters adoptingduringthe middle phase of tetracycline's diffusion.
These physicianstoo were likelyto delay writingprescriptions forthe
new antibioticuntillate in itsdiffusion.The firstcolumndescribesphysi-
cians whose altersadopted tetracycline soon afterit was available. The
numberofsuch physicianswho themselvesadoptedearlyis 2.4 timesthe
numberthatwould be expectedifphysicianadoptionswereindependent
of alteradoptions.This effectcontinuesintothe middleof tetracycline's
diffusion.The numberofphysiciansexposedto early-adopting altersand
themselvesadoptingduringthemiddleperiodoftetracycline's diffusion is
2.4 timesthenumberthatwould be expectedunderindependence.What
physiciansexposedto early-adopting alterswereunlikelyto do was post-
pone theiradoptionto the late phase of tetracycline's diffusion.In sum,
contagionhad a directand lagged effect.Physiciansexposed to alters
adoptingduringa givenphase of tetracycline's diffusiontendedto adopt
duringthatphase or in thesubsequentphase. Theytendednotto adoptin
thephase precedingtheone in whichtheiraltersadoptedand tendednot
to postponeadoptionformorethan a phase afterthe one in whichtheir
altersadopted.20
20 ofthewayin whichprescriptions
Thislag couldbe an artifact weresampled.Recall
thatprescriptionswereauditedforthreeworking dayspermonth.It is quitepossible
fora physicianto have begunprescribing and have had hisprescriptions
tetracycline
filledduringthedaysforwhichprescription recordswerenotaudited,butsuchsam-
plingerrorscouldonlyoccurin one direction.It is possiblefora physicianto have
begunprescribing tetracycline datawouldindicate,buthe
earlierthantheprescription
1316

TABLE 3
INNOVATION ROLES
AltersDo Not
AltersAdopt Early Adopt Early
Physicianadopts early ....... ..... Early conformer Eager innovator

27 34
(19) (38)
Physicianadopts late or not at all .. Deviant laggard Late conformer
14 49
(23) (37)
NOTE-Frequencies foraltersdefinedby cohesionare presentedin parenthesesbeneathfrequencies

foraltersdefinedbystructural equivalence,and bothare combinationsofthefrequencies in table2. With
1 df, the likelihood-ratio
x2 statisticforindependenceis unacceptableforthe structuralequivalence
frequencies(6.89, P < .01) and quite acceptableforthe cohesionfrequencies(.32, P = .57).
Four innovationroles,which show the ways in whichthe physicians

respondedto interpersonalinfluence,can be distinguishedin these ef-
fects.Physiciansadoptingtetracyclinein the diffusionphase ahead of
theiralters were eager innovators,pioneersin theirreferencegroups.
These eagerinnovatorswentagainstthetendencyforphysiciansto avoid
adoptingthe new druga phase ahead of theiralters.Physiciansexposed
to alters adopting duringthe middle and late phases of tetracycline's
diffusionand themselvesadoptingduringthese phases were late con-
formers.These physiciansfellwithintheboundsofthetypicalresponseto
middle-and late-adoptingalters.Physiciansin thefirsthalfoftheircity's
adoptersand exposed to alters adoptingearly were early conformers.
They wereexposedto a normof adoptingearlyand respondedwiththeir
own early adoption, as was typical of physiciansexposed to early-
adoptingalters.Finally,physicianspostponingtheirown adoptionuntil
over halfof theircity'sphysicianshad begun usingtetracycline, despite
the earlyadoptionsof theiralters,were deviantlaggards.These physi-
cians contradictedthe tendencytowardearlyor median adoptionin re-
sponseto altersadoptingearly.
In thisfinalaggregation,displayedin table 3, contagionis a tendency
forearlyand late conformersto outnumbereagerinnovatorsand deviant
laggards. The diagonal frequenciesin table 3 exceed the off-diagonals
under structuralequivalence and are about equal to the off-diagonals
had definitely
begunprescribing bythetimeoneofhisprescriptions foritwas located.
This meansthatan unexpectedly late adoptioncould be a samplingerrorbut an
unexpectedly earlyadoptioncouldnot.The physicians seemingto adoptin thephase
aftertheiraltersadopted,in otherwords,couldeasilyhavewrittenearliertetracycline
prescriptionsthatwentunnoticed in theprescription
sampling.
1317

TABLE 4
ATTRIBUTES PREDISPOSING PHYSICIANS TO TETRACYCLINE
REGRESSION COEFFICIENTS
PREDICTING ADOPTION DATE
ATTRIBUTES MEAN Metric Standardized t-test
Belief in science .................. 1.13 - 2.31 -.33 -3.9

Professional age .................. .25 3.53 .28 3.3
Many journal subscriptions .1.94 -2.63 -.29 -3.5
Prescription-prone medical practice .23 - 3.30 - .25 - 2.9
Detail-man contact .85 -2.50 -.16 -2.0
NOTE.-Adoption date is thefirstsamplingperiodin whicha physician'sprescriptions

fortetracycline
were found. Effects are estimated with pairwise deletion for the 125 physicians in the prescription
sample,yieldingan intercept of 17.65 and a .348 squaredmultiplecorrelation.Beliefin scienceis a three-
categoryvariableweighingtherelativeimportanceofkeepingup withscientific developments vs. spend-
ing time with patients(0 forphysiciansstressingpatients,1 forthose stressingboth,and 2 forthose
stressingscience;data missingon fourphysicians).Professionalage distinguishes (0) physiciansgraduat-
ing frommedicalschoolin 1930 or later(physiciansroughlyunder40 yearsold at thetimeofthestudy)
from(1) thosegraduatingbefore1930 (data missingon one physician).Journalsubscriptions is a three-
categoryvariable indicatingextensivesubscriptions to professionaljournals (1 forthosesubscribingto
two of threejournals, 2 forthosesubscribingto fourto seven journals, and 3 forthosesubscribingto
morethan seven journals). Prescription-prone medical practiceis a dichotomybased on a physician's
frequencyof house calls and officevisits(see n. 22; data missingon 12 physicians).Detail-mancontact
distinguishesphysicianswho (1) remembered havingbeen contactedbya detailman aboutthedrugthey
mostrecentlybegan usingvs. (0) thosenot recallingsuch contact(data missingon 13 physicians).
undercohesion.The resultsin the bottomrow of table 1 show thatthe

evidenceof physiciansconforming to alterbehavioris strongwhenalters
are definedby structuralequivalence(2.59 z-score,P = .005) and con-
tinuesto be negligiblewhenaltersare definedbycohesion( - 0.54 z-score,
P = .71). These resultsare in proportionto the resultsobtainedwith
moredetailedadoptiondata, but forthe fourinnovationroleshighlight
the criticaldistinctionsin adoption dates that providethe evidence of
social contagionin tetracycline's
diffusion.This reductionin thenumber
of distinctionsmade amongadoptiondates makes it possibleto see evi-
dence of contagionmore clearlyand to studycontagionmore reliably
under varyingconditionsof personal predispositionstoward adoption
and varyingsocial structuralconditions.
CONTAGION,PERSONAL PREFERENCE, AND PROMINENCE

Many backgroundattributesare discussedin Medical Innovation,but
few show an independenteffecton adoptionwhen otherattributesare
held constant.The mostsignificant
are presentedin table 4.21 On aver-
21 Data on theattributes highlighted
in Medical Innovationare availablein thedata
setcitedin n. 8. For thepurposesofthisstudy,attributes
werecombinedto maximize
1318

age, physiciansin the fourcities began prescribingtetracyclineabout

eightmonthsafterits release.Varyingfromthismean,youngphysicians
began prescribingthe new antibiotic3.5 monthsbeforeold physicians.
Physicianswho rememberedbeing contactedby a drugcompanysales-
man ("detailman") began prescribing the new antibiotic2.5 monthsbe-
forethose not remembering such contact. In addition,early adopters
tendedto subscribeto manyprofessional journals,to make manyhouse
calls, to have a moderatenumberof officevisits,22and to emphasizethe
importanceof keeping up to date with scientificdevelopmentsin
medicineas opposed to emphasizingthe importanceof devotingtimeto
patients.23 In sum,physicianspredisposedtowardadoptingthenew anti-
theirassociationwithadoption.The mean adoptiondate was computedforphysi-

cians,witheach attribute identified as havingan effecton adoptionin theoriginal
study.Attribute categories werecombinedto maximizedifferences in meanadoption
dateacrossattributes. Manyoftheseaggregate categories weretakenfromtheoriginal
study;e.g., the major differences betweenphysicians,by the yearin whichthey
completedmedicalschool,are betweenthosewho receivedtheirdegreebefore1930
and thosewhoreceivedtheirdegreeafterward. Therefore, a professional
age attribute
was codedas "young"(obtaining thedegreein 1930or after)versus"old" (obtaining
thedegreebefore1930;see Colemanetal. 1966,p. 165).The manyattribute variables,
codedto have as clearand strongan associationwithadoptionas possible,werethen
specifiedas simultaneous predictors of adoptionin a multiple-regression equation.
Thosehavinga strongindependent effectwereretainedfora finalregression model,
reported in table4. In theory and method,thisprocessofscalingand selecting predic-
torsis inelegant.However,thepurposeoftheexercisewas notto specify a structural
equationmodeloftheattributes affectingadoption;thepurposewas tosortphysicians
bytheirpredisposition towardadoptingtetracycline so thatpreferencecouldbe held
constantin orderto revealevidenceofsocialcontagionbetter.
22 The number oftetracycline prescriptions thata physician wrotewas strongly associ-
ated withearlyadoption(Colemanet al. 1966,p. 39) and so heldconstantin many
graphspresented as evidencein theoriginalstudy.Thisassociationseemsreasonable,
inasmuchas thosephysicians firstadoptinghad a longerperiodoftimein whichto
writetetracycline prescriptions. In ordertomeasureprescription behaviorina manner
moreindependent of the dependentvariable,I consideredseveralattributes of a
physician's medicalpractice:numberofoffice visits,numberofhousecalls,hispercep-
tionofhistendency to prescribe drugs,and hisperception ofthistendency relativeto
otherphysicians'.The strongest associationbetweentheseattributes was obtained
witha combination ofoffice visitsand housecalls,indicating a physician's
opportuni-
tiesto prescribetetracycline. Physiciansmakingmorethan 15 housecalls perweek
tendedto beginprescribing tetracyclineearly.Thosereceiving a moderatenumberof
office visits,26-100 perweek,tendedto beginprescribing earlierthanthosereceiving
an extremenumber,morethan 100 or fewerthan 26. Physicianswhose medical
practicemadethempronetoearlyadoption(manyhousecallsanda moderate number
ofoffice visits)are coded"1" on the"prescription-prone medicalpractice"variablein
table4, and othephysicians are coded"O". This variableis morestrongly associated
withadoptionthaneitherofficevisitsor housecalls alone.
23 Detailedinformation on theseeffects can be obtainedintheoriginalstudy(Coleman
et al. 1966,pp. 164-66 on age, pp. 47-48, 182-85on orientation towardsciencein
medicine,and pp. 44-46 on subscriptions to professionaljournals).No associationis
1319

bioticwereyoung(professionally), keptup to date withscientific

develop-
mentsin medicine,and believed that such behaviorwas importantto
being a good physician.To measureeach physician'spredisposition to-
ward adoption,an aggregatepersonalpreference variablehas been con-
structedby computingtheadoptiondate expectedofa physicianfromhis
attributeslistedin table 4.24
Althoughpersonal preferenceshad an obvious effecton adoptions,
thereis equallystrongevidenceofcontagion,regardlessofpersonalpref-
erence. Summaryresultsfroman analysis of contagionand personal
preferenceare presentedin table 5. Three conclusionscan be drawn.
First,the evidenceof contagionobservedwithpersonalpreference held
constantis nearlyidenticalto theevidenceobservedwithoutcontrolsfor
personaldifferences among the physicians.Regressinga physician'sob-
servedadoptionover his adoptionnormand the fivebackgroundvari-
ables in table 4 yields:(a) no evidenceof contagionfromhis advisersand
discussionpartnersand (b) strongevidence of contagionbetweenthe
monthin which he adopted and the monthin whichthe physiciansto
whomhe was structurally equivalentadopted.This evidenceis presented
in thefirstrowoftable 5, corresponding to thezero-order effects
reported
in the firstrow of table 1. Similarly,the evidenceof contagionbetween
adoptionsin aggregatephases of tetracycline's diffusionis unaffected
by
controlsforpersonalpreference.The resultsin thesecondrow oftable 5
correspondto theresultsin thefourthrow of table 1, withthedominant
effectbeingthe tendencyforphysiciansto have conformedto the adop-
tion behaviorof physiciansto whom theywere structurally equivalent
(2.61 z-score,P = .005).
reported betweenadoptionand thenumberofdetailmenseen(p. 180),buttheeffect

reported hereis betweensomevs. no contact.A strongassociationis reported in the
originalstudybetweenadoptionand attendingspecialtymeetings(p. 45), but the
physicians who attendedmanysuch meetingsalso subscribedto manyprofessional
journals,and thelatteris morestrongly associatedwithadoption.Attending specialty
meetings, alongwithseveralotherattributes associatedwithadoptionin theoriginal
study,has a negligibleeffecton adoptionwhenthe attributes in table 4 are held
constant.
24 Specifically,
thefiveattribute variableshave beenaggregated byusingthemetric
regression coefficients in table4: pj = 8 + I,b&(x1i-3-k), wherepj is physician j's
personalpreference (expectedadoptiondate),xi is hisscoreon theithattribute having
effect b,on adoptionand mean3x,summation is acrossthefiveattribute variablesi,
and 8 is themeanadoptiondate.Wherexj, is missing, itis setequal to itsmeanvalue
3x,,so thatphysician j's preference is neitherincreasednordecreasedrelativeto other
physicians' bythemissingattribute. A preference scoreis availableon each prescrip-
tion-sample physician,representing his predispositiontowardadoptingtetracycline
relativeto theotherprescription-sample physicians'.
1320

TABLE 5
CONTAGION AND PERSONAL PREFERENCE
Structural
Equivalence Cohesion
Continuous contagion effect, holding

preference constanta .............. .24 .05
(t = 3.0) (t = .5)
Contagion effectin innovation roles
across personal preferencesb ....... 1.31 .96
(z = 2.61) (z = -.42)
(P= .005) (P = .66)
Personal preference effect across adop-
tion normsc ..................... 1.20 1.21
(z= 1.81) (z= 1.89)
(P= .04) (P= .03)
Adoption norms independent of per-
sonal preferencesd ................ 1.57 6.59
(P=.46) (P=.04)
a Standardized, ordinaryleast-squaresestimatesofb,in eq. (1) are reportedfor

multiple-regression models predictingobservedmonthof adoptionfroma con-
tinuous adoption-normvariable (see App.) and the five variables in table 4
indicatinga physician'spredisposition towardadoption.Routinet-testsare pre-
sentedto providesome sense of effectmagnituderelativeto residualvariance;
however,routinestatisticalinferences shouldnotbe made fromtheseresults(see
App.). Resultsare based on thoseprescription-sample physicianson whomcom-
pletedata are available (101 understructuralequivalence,96 undercohesion).
The same resultsare obtainedif missingvalues of variablesin table 4 are set
equal to means(N increasesto 124 understructural equivalenceand to 117under
cohesion). Standardizingadoption dates by city means and standard devia-
tionsyieldscoefficients of .21 and .05 forstructuralequivalenceand cohesion,
respectively.
b The effectis the multiplicativeinteractionbetweenobservedand normative
adoptionin a log-linearmodel of the three-waybinarytabulationof observed
adoption,adoptionnorm,and personalpreference (the aggregatevariablecon-
structedfromthe fivevariablesin table 4 and dichotomizedat the mean). The
structuralequivalence table is based on 124 physicians.The cohesiontable is
based on 117 physicians.The effectmeasuresthetendencyforphysiciansto have
been conformers ratherthan deviants,across personalpreference categories(cf.
effectsin the fourthrow of table 1).
c The effectis the multiplicative interactionbetweenpersonalpreference and
adoptionin a log-linearmodel of the three-waybinarytabulationin n. b. The
effectmeasures the tendencyfor high-preference physiciansto have adopted
earlyand low-preference physiciansto have adoptedlate, regardlessofthedates
at whichtheiraltersadopted.
d Likelihood-ratio x2statisticsare reportedforthethree-way binarytabulation
eliminatingbothinteractions betweenadoptionnormsand personalpreferences
and so have 2 df.Corresponding x2statisticsof3.07 (P = .80) and 7.44 (P = .28)
with6 dfare obtainedifadoptiondate is categorizedintoearly,median,and late
adoption,as in the thirdrow of table 1.

Second, a physician'spersonalsituationstrongly determinedhis adop-

tion,regardlessof adoptionsby thephysiciansaroundhim. This is illus-
tratedby the resultsin the thirdrow of table 5. Physicianspredisposed
toward adoptiontended to adopt early, and those predisposedagainst
adoptiontendedto adopt late, regardlessof adoptionsby theirstructur-
allyequivalentpeers(1.81 z-score,P = .04) or adoptionsbytheiradvisers
and discussionpartners(1.89 z-score,P = .03). More specifically, the
beliefin science, professionalage, and journal subscriptionvariables
stronglypredictingadoption date in table 4 remainstrongpredictors,
withcontinuousadoptionnormsheld constant(t-testsof -4.3, 3.9, and
-3.3, respectively, withstructuralequivalencenormsheld constant).
Third, contagionand personalpreferencecan be treatedas indepen-
dentfactorsin tetracycline's diffusion. The x2statisticsin thebottomrow
of table 5 show thatthereis no director three-wayinteraction between
personalpreference and thetendencyfora physician'sstructurally equiv-
alent altersto have adopted early(X2 = 1.57, P = .46). The data on
cohesionare slightlymore complexbecause of a significant three-way
interaction, but thereis no directtendencyforhigh-preference physicians
to have had advisersand discussionpartnersadoptingearlyin tetracy-
cline'sdiffusion. The 6.59 x2 statisticwith2 dfin table5 is thesumoftwo
x2 statisticswith 1 df,a negligible2.16 X2 statistic(P = .16) createdby
eliminatingthe directinteraction betweenpersonalpreferences and alter
behavior,and a significant 4.43 x2 statistic(P = .04) createdbyeliminat-
ing the three-wayinteractionfromthe table.
The significantthree-wayinteractioncreatedby the cohesionmodel
can be tracedto systematic bias in themodel.High-preference physicians
tended to be prominentwithinthe networkof advice and discussion
relationships,and cohesionbrokedownin predicting adoptionsbypromi-
nentphysicians.This is illustratedby figures6 and 7.
Associationsamong prominence,personal preference,and adoption
date are illustratedin figure6. Four categoriesof prominenceare distin-
guished.A physiciannot named by anyoneas an adviseror discussion
partnerwas at the bottomof the medical hierarchy,and a physician
namedby fouror moreotherphysicianswas at thetop. Someonenamed
by a singleotherphysicianwas below average, and someonenamed by
two or threewas about average.25
25 Thesefourcategoriesarebasedon theadoptionbehaviorofphysicians at eachlevel

ofchoicestatus.Thosereceiving no citationswerequitedifferent
fromthosereceiving
one citation,and bothweredifferent fromphysiciansreceivingtwoormorecitations.
Physiciansreceiving two or threecitationsweremoresimilarto one anotherthanto
physiciansreceivingfourormore,and no further categories
wereapparentamongphy-
siciansreceivingmorethanfourcitations(bear in mindthe verysmallnumberof
physiciansin highercategories).
The fourcategoriesroughly to categories
correspond
1322

0OOX
Predisposed to Adopt
80%-
60%X/
Percent
Physicians
AotnEarly
20x
Adopting Lae
None OneCitation Twoor Three Fouror More

In=37) 131) 124) (33)
Prominence as an Advisor and Discussion Partner
(citationsreceived)
FIG. 6.-Adoptionacrosslevelsofprominence
There is a sharp tendencyforthe mostprominentphysiciansto have

been predisposedtoward adoptingthe new antibiotic.There are few
differencesamong the low- and average-prominence physicianson the
dichotomouspersonalpreferencevariable (X2 = 1.43, 2 df,P = .49).
Amongthe physiciansof low to average prominence,43% were predis-
posed toward adoptingthe new antibiotic.This morethan doubles, to
88%, forthemostprominent physicians,creatinga strongoverallassocia-
tionbetweenprominence and predisposition
towardadoption(X2 = 22.93,
3 df,P < .001).
There is also a strongassociationbetweenprominenceand adoption
date. This associationwas emphasizedin the originalstudy(see, e.g.,
Coleman et al. 1966, pp. 79-112) and has become an often-replicated
findingin diffusionresearch (Rogers 1983, p. 277 ff.). Here, city-
standardizedchoicestatus(thenumberof citationsa physicianreceived,
standardizedforcity-specific means and standarddeviations)is strongly
associatedwithadoptiondate, withprominent physiciansadoptingearly
diffusion(-2.6 t-test,P = .01).26
in tetracycline's
constructed fromcity-standardized choicestatus:low (z-scoreof - 1 or less),below

average(z-scoresfrom- 1 to 0), above average(z-scoresfrom0 to 1), and high(z-
scoresgreaterthan1). I have usedthecitationcategoriesin figs.6 and 7 becausethey
are moreobviouslytiedto theobservedsociometric data.
analogyto Homans's(1961,p. 352 ff.)and Cancian's(1967,1979)
26 In an interesting
descriptions of middle-classconservatism,thisassociationis kinkedin the middle.

Mean adoptiondatesdecreasefrom10.4monthsforphysicians receiving no citations
1323

More precisely,figure6 illustratesthe uneven association between

prominenceand adoptiondate. There is no associationbetweenpromi-
nence and early adoption, but a strongnegativeassociationwith late
adoption.The thinsolid line in figure6 shows the proportionof physi-
cians at each level of prominencewho were earlyadopters(ratherthan
medianor late adopters;see table 2). City-standardized choicestatushas
a .10 correlationwithearlyadoption,and earlyadoptionis statistically
independentof the fourchoice-statuscategoriesin figure6 (X2 = 2.53,
3 df,P = .47). In contrast,city-standardized choice statushas a -.24
correlationwithlate adoption(-2.7 t-test, P = .004), and late adoption
varies significantly across the in
categories figure6 (X2 = 15.35, 3 df,P
= .002). The bold solidlinein figure6 showstheproportion ofphysicians
at each level of prominencewho were late adopters.The line decreases
linearlyacrosslevelsofprominence,from43% ofphysiciansreceivingno
citationsto 6% of physiciansreceivingfouror morecitations.In keeping
withthestructuralequivalenceconceptionof contagion,thestrongasso-
ciationbetweenearlyadoptionand prominenceis not a resultof promi-
nentphysiciansrushingto have been the firstto adopt. It is createdby
theirtendencyto have avoided beingthe last to adopt.
The prominenceeffectis virtuallyunaffectedby the behavior of a
physician'sadvisersand discussionpartners.Regardlessof adoptionsby
theiradvisersand discussionpartners,marginalphysicianstendedto be
late adopters(3.10 z-score,P = .001), and prominentphysicianstended
not to be (-2.51 z-score,P = .006). Aggregatingacross prominence
levels, the directassociationbetweenlate adoption and prominenceis
equally significantbeforeand aftercohesion normsare held constant
(X2 = 15.35, 3 df,P = .002, beforeand 18.90, 6 df,P = .004, after).
Nevertheless,the prominenceeffectis in one sense spurious.It disap-
pears whencontagionby structuralequivalenceis held constant.Merely
holdingconstantthe distinctionbetweenearly-adopting altersand me-
dian- or late-adoptingalters (the distinctionused to defineinnovation
roles in table 3) eliminatesany associationbetweenlate adoptionand
prominence(X2 = 5.54, 6 df,P = .48).
This difference betweencohesionand structuralequivalencein elimi-
natingthe prominenceeffectis illustratedin figure7. Contagionis esti-
matedwithinprominencecategoriesand measuredon theverticalaxis by
a z-scoreexpressingthetendencyforconforming physiciansto outnumber
deviants(see contagionamong innovationrolesin tables 1 and 5). The
to 7.9 monthsforphysicians
citedbyonephysician.
Physiciansreceivingtwoand three
citationsadoptedat aboutthesame timeas thephysicians
receivingone citation(7.4
months).Above threecitations,mean adoptiondate again decreasesto 5.8 months
amongphysicians receiving
fouror morecitations.
1324

Structural Equivalence
Contagion
Effectat
Each Level
Prominence
Cohesion
Dashed lines -2
contagion with None One Citation Twoor Three Four or More
personal [n=36) (31) (24) (33)
preference held Prominenceas an Advisorand Discussion Partner
constant. (citations received)
FIG. 7.-Social contagion

withinlevelsofprominence
contagioneffectis positiveto the extentthat a physicianand his alters

adopted duringthe same phase of tetracycline'sdiffusion.A zero effect
indicatesthatphysicianadoptionswerenotcontingent on alteradoptions,
and a negativeeffectindicatesthatphysiciansadoptedduringa diffusion
phase otherthan thatin whichtheiraltersadopted.27
27 The conclusionsillustrated
infig.7 forcategorical
adoptiondatesarealso supported
by analysis-of-covariance modelsdescribing continuous
contagioneffects.Withob-
served(X) and normative (X*) adoptiondatesstandardizedby citymeansand vari-
ances(so thatinteraction effectsmeasureslopeadjustmentsfortheaveragephysician
in a city),ordinaryleast-squaresestimatesofparameters
in thefollowinganalysis-of-
covariancemodelhave beenobtained(see App.):
X = (a, + a2P2 + a3P3 + a4P4) + (b, + b2P2+ b3P3+ b4P4)X*+ E,
whereP2, P3, and P4 are dummyvariablescorresponding
to thesecond,third,and
fourthcategories of network prominence in fig. 7 (respectively,equal to one for a
physicianreceivingone, two or three,or fouror morecitations).Termsin thefirst
parentheses definetheequationintercept, and termsin thesecondparentheses define
theequationslope.The continuous contagion effectamonguncitedphysicians is mea-
suredbybI. The effect amongphysicians citedbyone otherphysician is measuredby
b1 + b2.The effect amongphysicians citedbytwoorthreephysicians is measuredby
b, + b3,and theeffect amongthemostprominent physiciansis measuredbybi + b4.
Routinet-tests forbl, b2,b3,and b4indicatethemagnitude oftheseeffects relativeto
residualvariationbut are uncertainindicatorsof statistical significance(see App.).
WhenX* is definedbycohesion,thet-tests forbI, b2,b3,and b4are 2.7, -2.1, - 3. 1,
and -2.2, respectively. The same patternof effectsis observedif the aggregate
personalpreference variableconstructed fromtable4 is enteredintotheaboveequa-
tion(t-testsof 2.4, -2.4, -2.4, and -1.7, respectively). WhenX* is definedby
structural equivalence,in contrast,
theslopeadjustments areall negligible.
The t-tests
are .7, .9, -.1, and - .1, respectively,beforeholdingpersonalpreference constant
and .9, .4, -.2, and -.3, respectively, afterholdingpersonalpreference constant.
1325

The two lines at the top of figure7 illustratethestabilityof contagion

understructuralequivalence.There is a slighttendencyforcontagionto
declineamongthemostprominent physicians,but thatdeclineis statisti-
callynegligible(X2 = 2.16, 3 df,P = .54) and completelyeliminatedby
holdingdichotomouspersonalpreferences constant(see dashed and solid
lines in fig. 7). Finally,the evidenceof contagionby structuralequiva-
lence is significantacross the four prominencecategories.28In other
words,all physicians-marginaland prominent-beganadoptingtetra-
cyclineat about the same time as otherphysiciansoccupyingsimilar
positionsin the social structureof medicaladvice and discussion.
Physiciansclearlywere not followingthe behaviorof the people from
whomtheysoughtadvice or withwhomtheydiscussedcases. Acrossthe
levels of networkprominence,thereis the now-familiar lack of support
for contagionby cohesion.29The two lines at the bottomof figure7
illustratetheinstability of thisaggregateeffect.Contagionby cohesionis
evidentamongphysiciansnevercitedas an adviseror discussionpartner
(1.70 z-score,P = .04). Amongthe mostprominentphysicians,in con-
trast,the negligibleaggregatecontagioneffectis negative. Prominent
physiciansactuallydeviatedfromtheiradvisersand discussionpartners
morethantheyconformed to them(- 1.98 z-score,.05 two-tailprobabil-
ity).In sum, theinteraction in table 5 betweenpreference and contagion
by cohesionreflectscohesion'sfailureto predictadoptionby prominent
physicians.Prominentphysicianswere predisposedto adoptingtetracy-
clineearlyand appear morewillingto deviatefromtheadoptionnormsof
theiradvisersand discussionpartners.The same physicians,however,
conformedto the adoptionnormsof theirstructurally equivalentpeers.
CONCLUSIONS
To summarizein a sentence,two factorsdrove the diffusionprocess:
personalpredispositions
and contagionby structuralequivalence.Cohe-
28 This constantis based on three-way tabulations ofobservedadoption(early,late),

adoptionnorm(early,late),and a measureofnetwork structure (low,belowaverage,
above average,high).The likelihood-ratio x2statisticforobservedand normative
adoptionbeingindependent acrossthefourlevelsofprominence infig.7 is 7.13,with4
df.This is thesumofa negligible tendency forcontagion to declinewithprominence
(X2 = 2.16,3 df,P = .54) and a significanttendency forphysicians tohaveconformed
toratherthandeviatedfromtheadoptionbehaviorofalters(X2= 4.97, 1 df,P = .03).
29 This conclusion is based on the three-way tabulationdescribedin the preceding
note,here by usingcohesioninsteadof structural equivalenceto defineadoption
norms.The likelihood-ratio x2 statisticforobservedand normative adoptionbeing
independent acrossthefourlevelsofprominence in fig.7 is 7.10,with4 df.Thisis the
sumofa tendency forcontagion todeclinewithprominence (X2= 6.95,3 df,P = .07)
and negligibletendency forphysicians tohaveconformed toratherthandeviatedfrom
theadoptionbehaviorofalters(X2= 0.15, 1 df,P = .90).
1326

sion and structuralequivalencehave been comparedfortheiradequacy

as the drivingmechanismin social contagion.The alternativemodels
have been defined,compared, and applied to behavioraldata on the
diffusion of a new antibiotic,tetracycline,amongphysiciansin fourmid-
westerncitiesduringthe mid-1950s.Four conclusionshave been drawn
fromthe analysis:(a) Puttingthe effectsintoperspective,it is clear that
contagionwas not the dominantfactordrivingtetracycline's diffusion.
The slow initialdiffusion,characteristic of social contagion,is missing
altogether.Where thereis evidence of contagion,thereis evidence of
personalpreferencesat work. (b) Where contagionoccurred,however,
thereis strongevidenceof contagionthroughstructuralequivalenceand
virtuallyno evidenceof contagionthroughcontagion.(c) Regardlessof
contagion,adoption was stronglydeterminedby physicians'personal
preferences, but thesepreferences did notdampenor enhancecontagion.
Personalpreferenceand social contagioncan be treatedas independent
componentsin tetracycline's diffusion.(d) Thereis no evidenceofa physi-
cian's networkpositioninfluencing his adoptionwhencontagionis prop-
erlyspecifiedin termsof structuralequivalence.Ostensibleevidenceof a
prestigeeffectis spurious,resultingfrombiases createdwhencohesionis
used to modelcontagion.In short,theproductofreanalyzing theMedical
Innovationdata in lightof recentdevelopmentsin networktheoryis
clearer,strongerevidence of social contagionand a redefinition of the
social structuralconditionsresponsibleforcontagion.
There is a centralmessagehere. When one studieseithercontagionin
the diffusionof an innovationor, more generally,informalsocial pres-
sureson subjectiveopinions,principlesof cohesionor structural equiva-
lencecan be used to guidetheanalysis.Structuralequivalenceis a recent
development;cohesionis typicallythe principleassumedto generateso-
cial pressure.The centralmessageof thisanalysisis thattheorderingof
cohesion and structuralequivalence should be reversed. Structural
equivalenceis the principlemorelikelyto generatesocial pressure.The
resultsof thisanalysisshow thatcohesionis muchweakerin the aggre-
gatethanstructuralequivalenceand is systematically biased againstcor-
rectpredictionsin certainsocial structuralconditions.Burtand Doreian
(1982; Burt 1982, chap. 6) reach the same conclusionin theirstudyof
perceptionsof journal significanceamong elite sociologicalmethodolo-
gistsin themid-1970s.As in theresultspresentedhere,structural equiva-
lence is moreaccuratethan cohesionin predictingexpertperceptionsof
journal significance, and cohesionis systematically biased in certainso-
cial structural conditions.Unliketheresultsofthisanalysis,cohesiondid
have some effecton expertperceptions,and the social structuralcondi-
tionsin whichcohesionbrokedown could be identified moreeasilybe-
cause statusesin the social structureof elitemethodological advice were
1327

much more evident than is true of advice and discussionamong the

Medical Innovationphysicians.Cohesion has littleto recommendit in
theresultsofthesestudies.The resultssuggestthatevidenceofcontagion
and social pressurethat has in the past been attributedto cohesionis
probablyevidenceof structuralequivalenceobtainedin social structural
circumstanceswhere the two models make identicalpredictions.The
resultsfurthersuggestthat strongerevidence of contagionand social
pressurein theearlierstudiescould be obtainedbyreanalyzingtheirdata
withnetworkmodelsbased on structuralequivalence,as has been done
herewiththeMedical Innovationdata.
In closing,a note of caution. The Medical Innovationdata concern
highlytrainedtechnicalprofessionals evaluatingtheriskof prescribinga
new drug. The elite methodologydata concernhighlytrainedtechnical
professionals evaluatingthevalue ofpublishingtheirworkin alternative
obvious in thesetwo sen-
journal outlets.In additionto the similarities,
tences,peoplein bothstudypopulationswereoverexposedto information
on the objects beingevaluated. The marketingcampaignsof drugcom-
panies leave few physiciansignorantof the latest releases. Eighty-five
percentoftheprescription-sample physiciansrecalleda visitfroma drug
companysalesman(detailman) advocatingthe drugthattheyhad most
recentlybegunprescribing.Similarly,no social scientistpretendsto keep
up with all the latestdevelopmentsin statisticalmodels,mathematical
models, and researchdesigns. The barrageof information on method-
ological developmentsis simplycrushing.Any of these similaritiesbe-
tweenthe Medical Innovationphysiciansand the elitemethodology ex-
pertscould be responsibleforthe obvious failureof cohesion.Perhaps,
cohesionis weakerin predictingresponsesto excessiveinformation. Per-
haps, it is weakerin predictingtheperceptionsofhighlytrainedtechnical
professionals. These are cautionsbut no morethanspeculations.Whatis
factis thatcohesionyieldspredictionsthatare nearrandomin theaggre-
gate and systematically biased in certainsocial structuralconditions,
while structuralequivalence yields strong,stable predictionswith the
same data.
APPENDIX
EstimatingContagionEffects
It is convenientto discussequation(1) as a networkautocorrelation
model
expressedin matrixterms:
X = bpP + bSWX + E,
whereX is a vectorofadoptiondates,P is a vectorofpersonalpreference
data, E is a vectorofresiduals,and W is a matrixofthenetworkweights
1328

definedin equation (2). The productWX definesa vectorof adoption-

date norms,X*; bp measuresthe effectof personalpreference on adop-
tion; and b,-the network autocorrelationeffect-is a linear-slope
coefficientmeasuringthe contagioneffectof alters'adoptionson ego's
adoption.In theMedical Innovationdata, W is a square,block-diagonal
matrixwith networkweightsfor each of the 216 study respondents
defininga row of the matrix:nonzerowji withincitiesand zero wji be-
tweencities.There is a richstatisticalliteratureon estimationproblems
posed by such models(see Ord 1975;Davis and McCullagh 1975;Tobler
1975; Haining 1980; Ripley 1981; and Cliffand Ord 1981forreviewand
references),and the generalproblemhas been broughtintosociologyby
networkanalysts(see, e.g., Doreian 1980, 1981;Dow, Burton,and White
1982; Dow et al. 1984; Dow 1984). The main pointhereis thatan ordi-
naryleast-squaresestimateof b, is unsatisfactory; correlationsbetween
the residualsin E make the ordinaryleast-squaresestimateinefficient,
and (excludingtriangularW) correlationbetweenE and the predictor
WX makestheordinaryleast-squaresestimateinconsistent (see, e.g., Ord
1975,pp. 121-22). Maximum-likelihood estimatesof bsare obtainednu-
merically.
Unfortunately, maximum-likelihood estimatesofbscannotbe obtained
withthe Medical Innovationdata. Of the 216 elementsin X, adoption
date is only known for the 125 physiciansin the prescription sample.
Available estimationprocedurescannotbe used withmissingdata and so
cannotbe used here,althoughtheyare usefulin imputingmissingdata,
as describedbelow.
I have adoptedthefollowingguidelinesin presenting evidenceofsocial
contagion:(1) Ordinaryleast-squarescoefficients are presentedbecause of
theirgeneralfamiliarity, withtheprovisothatroutinestatisticalinference
cannotbe used to interpret theirsignificance.(2) The responsevariables
X and X* are collapsed into broad categories.To the extentthat the
networkweightsdefiningX* are correctly specified,mostof thecorrela-
tion betweenresidualtermswill occur withincategories.Inferencesare
then made throughgeneralizedleast squares in the formof log-linear
statistics.As discussed in the text,this aggregationof responseshas a
substantiverationalein the difference betweensocial and physicaltime
and a methodologicalrationalein shiftingprecisionfromdescribingthe
formof contagion'seffectto describingthe circumstancesunderwhich
contagionoperates.(3) Effectsare notstudiedtoo closelyfortheirstatisti-
cal significance.Contagioneffectsare interpreted only where the null
hypothesisis extremelyunlikely,with a .01 or less probability.Fortu-
nately,theevidenceofsocial contagionis strongunderstructural equiva-
lence and verynearlyrandomundercohesion.
1329

WeightingAlters
Altershave been definedwiththeweightsin equation(2), definedby the
sociometricadvice and discussionchoicesmade by the 228 interviewed
physicians.The 18 uninterviewedphysicianscitedby two or morepre-
scription-samplephysiciansare includedin the sociometriccalculations
because theydefinepoints of similarityin the relationpatternsof the
physicianscitingthem and so contributeto variationin the structural
equivalencesamongthem.The pooled advice and discussiondata define
a choice matrixin which cell (j, i) is one if j cited i as an adviser or
discussionpartnerand zero otherwise.The choicematrixis 117 x 117 in
Peoria, 50 x 50 in Bloomington,34 X 34 in Quincy,and 32 X 32 in
Galesburg.Path distanceshave been computedand normalizedto define
relationvariablesZji varyingbetweenzero and one, withthe minimum
numberof choicesrequiredto reach physiciani fromphysicianj, where
zeroindicatesthatthereis no chainofintermediary advisersor discussion
partnersthroughwhich physicianj can reach physiciani. Structural
equivalencehas been definedby the Euclidean distancedij betweenthe
positionsof physiciansi and j in the networkof medical advice and
discussion,
di= [(j - zji)2 + Yk(Zik - Zjk) + lk(Zki -

Zkj)2],
wheresummationis acrossall physiciansk otherthani and j. These are

standardnetworkdistance measuresand are reviewedelsewhere(see,
e.g., Burt 1982, pp. 42-49).
Cohesion adoptionnormshave been computedfromraw choice data
and normalizedpath distancesamongthe216 studyrespondents (exclud-
ing the 12 physiciansinterviewedonlyas informants).Insertingthenor-
malized path distancesforproximity in equation(2) yields:
wji = (zji)vIYk(zjk)v, k $ j.
This cohesionweight,based on pathdistance,generatesnegativecorrela-

tionsbetweenobservedand normativeadoptionforintegervalues of v
fromone to six. Betterresultsare obtainedwithraw choicedata (zji equal
to one or zero)-the limitingcase of wji forinfinitev. The correlation
betweenobservedand normativeadoptionreportedin table 1 is negli-
giblypositiveacross the fourcities. Using raw choice data to measure
relationstrength,we can dropv fromtheequation(becausezji = zr) and
theabove networkweightforcohesionis as follows:wji is 1/Kifj citedi
as adviseror discussionpartnerand zero otherwise,whereK is thenum-
ber of the 216 studyrespondentsthatj cited as advisersor discussion
1330

partners.Note thatwji variesfromzero to one and sumsto one acrossall

physiciansi.
Structuralequivalence adoptionnormshave been computedfromthe
above-definedEuclidean distancesamong the 216 studyrespondentsin
each city. These distancescapturethe similarityof directand indirect
relationsin which physiciansi and j were involved. Given the largest
distancebetweenj and anyotherphysicianin his community, dmaxj,the
proximity ofsomephysiciani toj can be expressedbytheextentto which
dji is smallerthan dmaxj, i.e., dmaxj - dij, which can be insertedin
equation(2) to definea structuralequivalencenetworkweight(see Burt
1982, pp. 176-77; Burt and Doreian 1982, p. 117):
wji = (dmaxj - dij)vlIk(dmaxj- dkj)v,k $ j.

This weightvariesfromzero to one, measuringtheextentto whichi was
structurally equivalenttoj and sumsto one acrossall physiciansi. Struc-
tural equivalence norms have been computedfor integervalues of v
rangingfromone to 15. In Galesburg,the maximumcontagioneffectis
obtainedwithv equal to two. The associationis negligibly positiveforv
equal to six or morein Quincy,so theexponenthas beenleftat six. In the
morecomplexsocial structures of Bloomingtonand Peoria, the associa-
tionbetweenobservedand normativeadoptionincreaseswithincreasing
values ofv but changeslittlepast 12 in Bloomingtonand 10 in Peoria,so
normshave been definedat thesevalues.
The methodused to selecta value of v is exceedinglycrude,but the
lack ofan estimatorforv and thecostofcomputingnormsforalternative
values ofv severelyconstrainanypracticalsearch.Whatis clearfromthe
highvalues ofv forcohesionand structural equivalenceis thatphysicians
onlyreliedon the closestof altersas a social frameof reference fortheir
own evaluationsofadoptingtetracycline (see Burt 1982,p. 234; Burtand
Doreian 1982; and Friedkin1983forsimilarconclusions).It is reassuring
to notethatthisfindingis consistentwiththe standardpracticeof using
directsociometriccitationsto testcohesioneffectsand ignoringindirect
connectionsthroughintermediaries (see, e.g., Colemanet al. 1966,p. 113
ff.).
MissingData on AlterAdoptions
The precedingcalculationsinvolveall 216 studyrespondents,but adop-
tion date is only available on the 125 prescription-sample
physicians.
Unfortunately, thereis no allowance for missingdata in the class of
networkmodels under consideration.Considera five-person systemin
1331

whichadoptiondata are missingon thefourthperson(i.e., xj = xl, X2, x3,

?, X5)and altersare definedby the followingnetworkweights:
.0 .5 .5 .0 .0
.5 .0 .0 .6 .0
.0 .4 .0 .0 .3
.5 .5 .0 .0 .0
.3 .4 .0 .3 .0,
so that adoption normsforthe first,third,and fourthpersonscan be
computedfromequation(1) (x* = .5x2 + .5x3,x* = .4x2 + .3x5,and x*
- .5x, + .5x2), but adoption normsforthe second and fifthpersons
cannotbe computedbecause of the missingdata on the fourthperson's
adoption. If we sum the networkweightsto alterswhose adoptionis
unknown,60% of x* is undefinedand 30% of x5 is undefined.
Doing the same computationforphysiciansin theprescription sample
reveals that 40% of the average physician'sadoption-datenormis un-
definedunderstructuralequivalence and 37% is undefinedundercohe-
sion. In otherwords, a large proportionof physicianreferencegroups
extendedbeyondthe limitsof the prescription sample.
Deletingobservationshaving missingdata does not seem wise here.
Ignoringthe physiciansbeyondthe prescription sample would seriously
distortthesocial situationsin whichprescription-sample physicianseval-
uated tetracycline.Limitingthe analysis to prescription-sample physi-
cians on whom alter data are complete,however,would leave too few
physiciansto estimateeffects:one physicianunderstructural equivalence
and 28 undercohesion.
The missingadoptiondata on physiciansoutsidetheprescription sam-
ple have been imputed.The networkmodel defininga normis used to
make a best guess of how missingaltersrespondedto tetracycline adop-
tion.A missingalter'sadoptionwas imputedfromhis alters'.Imputation
was carriedout as partof theprocessgeneratingadoptionnorms.Given
physicianj in theprescription sample and some physiciani in or beyond
theprescription sample,forwhomwji is nonzeroand on whomadoption
data are missing,imputexi fromXkfora physiciank who can speak as a
surrogatealterfori: (1) Locate thephysiciank best defining an adoption
normforthemissingalteri, thatis, locatethelargestWikforall k, k $&j. If
two or morephysiciansare equally the strongestweightsin definingi's
adoptionnorm,thenone ofthemis selectedat randomto speak fori. (In
orderto minimizeregressiontowardthemean on thenormvariableand
keep alterresponsesas close as possibleto observedresponsedata, this
seemspreferable to averagingtheirresponses.)(2) Imputexi fromXk.(3) If
the data on k's adoptionare also missing,thenlocate thephysicianwith
the nextstrongestweightin definingan adoptionnormforthe missing
1332

alteri. Continueuntilthemissingdata on i are imputed.If no surrogates

fori are found(e.g., ifcohesionnormsare beingcomputedand i citedno
advisersor discussionpartners),thendeletei fromrespondent j's alters
and increasetheremainingweightsto sumto one. If morethanhalfofj's
alterscannotbe imputed,thendeletehis adoptionnormas missingdata.
Considerthefive-person examplegivenabove. In orderto computean
expectedadoptiondate forperson5, person4's adoptionhas to be im-
puted. Persons 1 and 2 are equally the strongestweightsin definingan
adoptionnormforperson4; person1 is selectedat random.The value of
X4 iS set equal to x2. An adoptionnormforperson5 is now defined:X*5
= .3x1 + .4X2 + .3X2-

Tests were made againstthe possibilitythatimputingalterresponses
affectedthe studyconclusions.As describedabove, the level of imputa-
tionon physicianj was computedas the sum of nonzerowji,wheredata
on i's adoptionwereimputed.The resultsofthesetestshave beendeleted
to conservespace but onlysupporta negativeconclusion:imputationis
uncorrelatedwiththe adoption,network,and preference variables.
The finalpointto noteis thatfailingto eliminateego fromtheimputa-
tion can bias the evidence of social contagion.In the above example,
supposethatperson4's missingadoptiondata wereimputedfromdata on
person2. This poses no problemin predictingperson5's adoption,but it
would createa problemin predictingperson2's adoption;x2 would be
used to predictx2,and an erroneouslyinflatedmeasureofsocialcontagion
would result.More generally,failureto eliminateego fromimputation
would resultin the strongestevidenceof social contagionbeingfoundin
studypopulationsof nonoverlappingcohesiveor structurally equivalent
dyads withdata missingon one memberof each dyad. In sum, imputa-
tion mustbe, and has been, carriedout independently forthe altersof
each prescription-sample physician.
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Social Contagion and Innovation: Cohesion versus Structural Equivalence

Author(s): Ronald S. Burt

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Two classes of networkmodelsare used to reanalyzea sociological

' Beginning in 1979,workon thispaperhas beensupported directly

AJS Volume 92 Number(May 1987):1287-1335 1287

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(b) Where contagionoccurred,its effectwas throughstructural

The spreadofnew ideas and practicesis oftenarguedto be contingent on

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can transmitsignificant informationto ego. He notonlybecomesaware of

2 This themeis entertainingly

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(1950) The Human Groupprovidesa theoreticalexemplarforthisperiod

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The structuralequivalence model highlightscompetitionbetweenego

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B. Structural Equivalence Restricts Cohesion

C. Structural Equivalence ExtendsCohesion

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predictsthatthesocializinginfluenceof cohesivetieswithina clique can

' It is easyto misperceive theshiftin theorythatstructuralequivalencerepresents.A

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view). More important, therelationalmeaningofthestatus/role-set dual-

5The driving in innovation

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evaluationof the advantagesto be had by adoptingthe innovationis a

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wherexj is ego's responseto an innovation,pj is somemixtureofpersonal

wji (proximityj to j)V k =#j (2)

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pertinent.The high values of v obtained for the Medical Innovation

THE MEDICAL INNOVATION STUDY

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of theirprofessionalrelationswith colleagues. Because of a varietyof

7 Thesewerenotmajorurbancenters(Colemanet al. 1966,p. 192):"Allfourofthese

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lease. Most wereprescribingit but variedconsiderablyin whentheyhad

9 The originalstudyprovidesa detailedaccountoftheprescription

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ThoroughNetworkData on the Social Structureof Physicians

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definea networkof professionalties in each city.10These citationdata

CONTAGION AT THE POPULATION LEVEL

10 This figureincludes12 physiciansinterviewedas informants forthestudy.Their

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evidenceofsocial contagion(Colemanet al. 1966,pp. 95-111). The point

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sembledthe curvesin figure2A. Diffusionis drivenby two factors:the

" Severalbold assumptions are requiredto legitimate

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pointand graduallyslows down afterwardas thereare fewerand fewer

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0.6 uncited physicians

0.2 B. Variationby Predicted

cited by anyone. However, diffusionin both subpopulationsbegan

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dN(t) =- m[1 - e-(+q)(t) _ m[1 -e-(p+q)(t-1)

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The missingcharacteristicevidenceofsocial contagionis moreobvious

CONTAGION AND THE INDIVIDUAL PHYSICIAN

14 This conclusion,too, can be statedmorepreciselywiththe marketing research

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