Using social networks to understand and prevent substance use: a transdisciplinary perspective

Preventing Adolescent Substance Use: A Content Analysis of Peer Processes Targeted Within Universal School-Based Programs

Universal school-based substance use prevention programs are widely disseminated and often include a focus on peer relationships. Network theory and social network analysis (SNA) have emerged as useful theoretical and methodological frameworks for examining the role of peer relationships in prevention and intervention research. We used content analysis to systematically code the peer processes targeted by three universal school based prevention programs. We found that programs focused on peer socialization more than peer selection, and programs focused about evenly on descriptive and injunctive norms. Programs varied in their focus on positive and negative peer processes and behaviors, but most references to peer processes focused on positive processes and negative behaviors. The focus on peer processes at the dyadic, subgroup, and network levels varied across the three programs, with the heaviest focus on network level processes. When peer processes were targeted, it was rare that lessons focused on peer processes for an extended (> 50%) amount of the lesson content. However, when peer processes were a focus, discussion and reflection were commonly encouraged. These patterns are considered in the context of non-intervention research on adolescent peer relations, which highlights the importance of peer selection and dyad-level processes, and the existence of positive peer processes that promote adolescent development. In doing so, we provide a framework that can be used to (1) examine the extent to which a particular program focuses on the different peer processes, and (2) inform systematic experimental studies of the extent to which particular peer processes are malleable in response to intervention efforts.

Social network analysis for assessing college-aged adults' health: A systematic review

OBJECTIVE

Social network analysis (SNA) is a useful, emerging method for studying health. College students are especially prone to social influence when it comes to health. This review aimed to identify network variables related to college student health and determine how SNA was used in the literature.

PARTICIPANTS

A systematic review of relevant literature was conducted in October 2015.

METHODS

Studies employing egocentric or whole network analysis to study college student health were included. We used Garrard's Matrix Method to extract data from reviewed articles (n = 15).

RESULTS

Drinking, smoking, aggression, homesickness, and stress were predicted by network variables in the reviewed literature. Methodological inconsistencies concerning boundary specification, data collection, nomination limits, and statistical analyses were revealed across studies.

CONCLUSIONS

Results show the consistent relationship between network variables and college health outcomes, justifying further use of SNA to research college health. Suggestions and considerations for future use of SNA are provided.

Characterizing peer roles in an overdose crisis: Preferences for peer workers in overdose response programs in emergency shelters

OBJECTIVES

A growing body of research points to increasing peer involvement in programs for people who use drugs, although this work has focused primarily on naloxone education and distribution. This study extends this work by examining the roles of peers in leading a novel overdose response program within emergency shelters.

METHODS

Semi-structured qualitative interviews were conducted with 24 people who use drugs, recruited from two emergency shelters, as well as ethnographic observation in these settings. Interviews were transcribed and analyzed thematically with attention to peer roles.

RESULTS

Four themes emerged from the data. First, participants discussed the development of peer support through relationship building and trust. Second, participants described a level of safety using drugs in front of peer workers due to their shared lived experience. Third, peer workers were described as favorable compared to non-peer staff because of nominal power dynamics and past negative experiences with non-peer staff. Last, given the context of the overdose crisis, peer worker roles were often routinized informally across the social networks of residents, which fostered a collective obligation to respond to overdoses.

CONCLUSIONS

Findings indicate that participants regarded peer workers as providing a range of unique benefits. They emphasized the critical role of both social networks and informal roles in optimizing overdose responses. The scaling up of peer programming in distinct risk environments such as emergency shelters through both formal and informal roles has potential to help improve overdose prevention efforts, including in settings not well served by conventional public health programming.

The Influence of Adolescents' Social Networks on Alcohol Consumption: A Descriptive Study of Spanish Adolescents Using Social Network Analysis

In adolescence, friends are important due to their influence on the acquisition of habits such as alcohol consumption. However, there is a lack of studies that describe the structural context of adolescents, which would be useful to implement prevention strategies. Therefore, our research question was how adolescent friendship networks influence alcohol consumption. Our goal was to determine the structural profile of adolescent at-risk alcohol users and their relational context in the classroom. We designed a descriptive cross-sectional study based on social network analysis to analyze structural patterns. We recruited 195 students. Social-network and alcohol-consumption variables were analyzed using the UCINET and STATA programs. Some 86.67% of participants had consumed alcohol at some time in their lives and the prevalence of at-risk alcohol use was higher in females (50.48% vs. 49.52%; OR: 1.84; CI 95%: 0.99⁻3.43%; p = 0.036). The lower the intensity of friendship, the more contacts adolescent at-risk alcohol users had within the network, and the easier it was for them to access their peers. Consequently, we conclude that the structure of a class is a key factor that merits further research.

Syringe Sharing in Drug Injecting Dyads: A Cross-Classified Multilevel Analysis of Social Networks

We examined the association of dyadic-level factors with syringe sharing among people who inject drugs (PWID) in Kerman, Iran. In a cross-sectional study, we collected data on 329 drug-injecting dyads by individual face-to-face interviews. An injecting dyad was defined as 2 PWID who knew each other and injected drugs together during the last 6 months. If they reported at least 1 occasion of syringe sharing, the dyad was considered high-risk. Dyadic-level factors associated with syringe sharing were assessed using cross-classified multilevel logistic regression. The rate of syringe sharing was significantly higher for dyads who were more intimate (adjusted odds ratio [AOR] 4.5, CI 95%, 2.3-8.6), who had instrumental support (AOR 2.1, 95% CI 1.1-4.5), and who pooled money for drugs (AOR 4.1, 95% CI 2.0-8.3). The rate was lower in same-sex dyads (AOR 0.4, 95% CI 0.2-0.9) and in dyads who shared health information (AOR 0.5, 95% CI 0.2-0.9). Findings highlight close-peer influences on syringe-sharing behavior.

Social Network Implications of Normative School Transitions in Non-Urban School Districts

This article expands research on normative school transitions (NSTs) from elementary to middle school or middle to high school by examining the extent to which they disrupt structures of friendship networks. Social network analysis is used to quantify aspects of connectedness likely relevant to student experiences of social support. Data were drawn from 25 communities followed from sixth to ninth grades. Variability in timing of NSTs permitted multi-level longitudinal models to disentangle developmental effects from transition effects. Results indicated that friendship networks were most interconnected in smaller schools and among older students. Beyond these effects, transitions from a single feeder school to a single higher level school were not associated with changes in friendship patterns. Transitions from multiple feeder schools to a single higher level school were associated with diminished friendship stability, more loosely connected friendship networks, increased social distance between students, and friendship segregation between students who formerly attended different schools.

Effect of socio-economic status, family smoking and mental health through social network on the substance use potential in adolescents: a mediation analysis

OBJECTIVES

Understanding pathways that influence substance use potential (SUP) can help with effective substance use prevention interventions among adolescents. The aim of the present study is to contribute to a better understanding of the SUP of adolescents by examining the mediating role of social network quality in the SUP of Iranian adolescents.

STUDY DESIGN

A cross-sectional study.

METHODS

Structural equation modeling was conducted to assess the hypothesized model that social network quality would mediate the association of family socio-economic status, a mental health disorder, and family smoking with addiction potential.

RESULTS

The model shows a good fit to the data. Social network quality mediated the effect of family smoking on the SUP for boys. A mental health disorder had a positive significant direct effect on addiction potential for both girls and boys.

CONCLUSIONS

Social network quality mediates the effect of family smoking on boys' addiction potential in the context of Iran. Educational programs based on local societal ways and cultural norms are recommended to change tobacco smoking behavior among family members. In addition, to prevent subsequent substance use among adolescents, more effort is needed to improve their mental health.

Rape Myth Acceptance in Sexually Assaulted Adolescents' School Contexts: Associations with Depressed Mood and Alcohol Use

High school students exposed to sexual assault (SA) are at risk for negative outcomes like depressed mood and high-risk drinking. Although evidence suggests that both social contexts and internalized stigma can affect recovery from SA, no research to date has directly examined the presence of stigma in social contexts such as high schools as a correlate of adjustment after SA. In this study, the self-reported rape myth acceptance (RMA) of 3080 students from 97 grade cohorts in 25 high schools was used to calculate grade-mean and school-mean RMA, which was entered into multilevel models predicting depressed mood and alcohol use among N = 263 SA survivors within those schools. Two forms of RMA were assessed (i.e., rape denial and traditional gender expectations). Results indicate that higher grade-mean rape denial was associated with higher risk for depressed mood among high school boys and girls exposed to SA, and higher grade-mean traditional gender expectations were associated with higher risk for alcohol use among girls exposed to SA. Survivors' own RMA and school-level RMA were not significantly associated with their depressed mood or alcohol use. Although causality cannot be concluded, these findings suggest that interventions that reduce stigma in social contexts should be explored further as a strategy to improve well-being among high-school-aged survivors of SA.

Determinants of hazardous drinking among black South African men who have sex with men

BACKGROUND

There is a known heavy burden of hazardous drinking and its associated health risks among black South African MSM; however, no study to date has identified risk factors for hazardous drinking among this nor any other African MSM population.

METHODS

A cross-sectional survey was conducted among 480 black South African MSM recruited using respondent-driven sampling. All analyses were adjusted using an RDS II estimator. Multivariable logistic regression was used to assess the relationship between demographic characteristics, psychosocial factors, behavioral attributes and hazardous drinking.

RESULTS

More than half of the men (62%, 95%CI=56%-68%) screened positive as hazardous drinkers. In multivariable analyses, living in a township (versus the city of Pretoria) (aOR=1.9, 95%CI=1.2-3.1, p<.01), more gender dysphoria (aOR=1.4, 95%CI=1.0-1.8, p=.03), having ever received money or other incentives in return for sex (aOR=2.4, 95%CI=1.3-4.3, p<.01), having been sexually abused as a child (aOR=2.6, 95%CI=1.1-6.4, p=.03), having anxiety (aOR=5.4, 95%CI=1.2-24.3, p=.03), and social network drinking behavior (aOR=5.4, 95%CI=1.2-24.3, p=.03) were positively associated with hazardous drinking. Being sexually attracted only to men (aOR=0.3, 95%CI=0.1-0.8, p=.01) was negatively associated with hazardous drinking.

DISCUSSION

Hazardous drinking is highly prevalent among black South African MSM. Multiple indicators of social vulnerability were identified as independent determinants of hazardous drinking. These findings are of heightened concern because these health problems often work synergistically to increase risk of HIV infection and should be taken into consideration by efforts aimed at reducing hazardous drinking among this critical population.

Building abstinent networks is an important resource in improving quality of life

AIMS

To investigate changes in social network and quality of life of a substance use disorder cohort as they progressed through treatment.

DESIGN

Multi-site, prospective, observational study of 338 adults entering substance use disorder treatment.

SETTING

Patients at 21 facilities across Norway contributed baseline data when they initiated treatment, and follow-up data was collected from them one year later.

METHODS

The cohort was divided into those who completed, dropped out, and remained in treatment one year after treatment initiation. For each treatment status group, general linear models with repeated measures analyzed global and social quality of life with the generic QOL10 instrument over time. The between-group factor was a change in social network variable from the EuropASI.

FINDINGS

Those who gained an abstinent network reported the largest quality of life improvements. Improvements were smallest or negligible for the socially isolated and those who were no longer in contact with the treatment system.

CONCLUSIONS

Developing an abstinent network is particularly important to improve the quality of life of those in substance use disorder treatment. Social isolation is a risk factor for impaired quality of life throughout the treatment course.

The Role of Social-Emotional and Social Network Factors in the Relationship Between Academic Achievement and Risky Behaviors

BACKGROUND

We examined whether standardized test scores and grades are related to risky behaviors among low-income minority adolescents and whether social networks and social-emotional factors explained those relationships.

METHODS

We analyzed data from 929 high school students exposed by natural experiment to high- or low-performing academic environments in Los Angeles. We collected information on grade point average (GPA), substance use, sexual behaviors, participation in fights, and carrying a weapon from face-to-face interviews and obtained California math and English standardized test results. Logistic regression and mediation analyses were used to examine the relationship between achievement and risky behaviors.

RESULTS

Better GPA and California standardized test scores were strongly associated with lower rates of substance use, high-risk sexual behaviors, and fighting. The unadjusted relative odds of monthly binge drinking was 0.72 (95% confidence interval, 0.56-0.93) for 1 SD increase in standardized test scores and 0.46 (95% confidence interval, 0.29-0.74) for GPA of B- or higher compared with C+ or lower. Most associations disappeared after controlling for social-emotional and social network factors. Averaged across the risky behaviors, mediation analysis revealed social-emotional factors accounted for 33% of the relationship between test scores and risky behaviors and 43% of the relationship between GPA with risky behaviors. Social network characteristics accounted for 31% and 38% of the relationship between behaviors with test scores and GPA, respectively. Demographic factors, parenting, and school characteristics were less important explanatory factors.

CONCLUSIONS

Social-emotional factors and social network characteristics were the strongest explanatory factors of the achievement-risky behavior relationship and might be important to understanding the relationship between academic achievement and risky behaviors.

Social Determinants of Health, Violent Radicalization, and Terrorism: A Public Health Perspective

Background: Terrorism-related deaths are at an all-time high as there were 32,685 and 29,376 terrorism-related deaths in 2014 and 2015, respectively. Terrorism is defined as the use of violence and intimidation in the pursuit of political aims. Terrorism is detrimental for mental health, premature mortality, and economic losses and undermines the central tenets of public health to improve the health and well-being of populations. Despite the impact terrorism has on avoidable morbidity and mortality, population health research largely overlooks social determinants of terrorism and risk factors that contribute to terrorist activities.

Methods: Drawing from what is known about commonly studied social determinants of health topics, including the relationships between structural and interpersonal discrimination, social cohesion, and gang violence and health, we present a public health framework, rooted in the social determinants of health, for identifying potential factors influencing terrorism and violent radicalization.

Results: Social determinants of health provide unique insight into how interpersonal and structural factors can influence risk for violent radicalization and terrorist activity. Each of the topics we review provides an entry point for existing public health and behavioral science knowledge to be used in preventing and understanding violent radicalization and terrorism. For example, anti-Muslim sentiment has promoted discrimination against Muslims, while also serving to marginalize and stigmatize Muslim communities. These conditions limit the social resources, like social cohesion, that Muslims have access to and make political violence more appealing to some.

Conclusions: Public health can contribute much to the ongoing debate around terrorism. The field must take a more prevention-focused approach to the problem of terrorism. Failure to do so only perpetuates approaches that have not been successful.

Understanding the process of social network evolution: Online-offline integrated analysis of social tie formation

It is important to consider the interweaving nature of online and offline social networks when we examine social network evolution. However, it is difficult to find any research that examines the process of social tie formation from an integrated perspective. In our study, we quantitatively measure offline interactions and examine the corresponding evolution of online social network in order to understand the significance of interrelationship between online and offline social factors in generating social ties. We analyze the radio signal strength indicator sensor data from a series of social events to understand offline interactions among the participants and measure the structural attributes of their existing online Facebook social networks. By monitoring the changes in their online social networks before and after offline interactions in a series of social events, we verify that the ability to develop an offline interaction into an online friendship is tied to the number of social connections that participants previously had, while the presence of shared mutual friends between a pair of participants disrupts potential new connections within the pre-designed offline social events. Thus, while our integrative approach enables us to confirm the theory of preferential attachment in the process of network formation, the common neighbor theory is not supported. Our dual-dimensional network analysis allows us to observe the actual process of social network evolution rather than to make predictions based on the assumption of self-organizing networks.

Determinants of modern contraceptive use among sexually active men in Kenya

Background

Research in Kenya has focussed on family planning from women’s perspectives, with the aim of helping reduce the burden of unintended pregnancies. As such, the determinants of modern contraceptive use among sexually active women are well documented. However, the perspectives of men should be considered not only as women’s partners, but also as individuals with distinct reproductive histories and desires of their own. This study seeks to understand the determinants of modern contraceptive use among sexually active men, by exploring factors that are correlated with modern contraceptive use.

Methods

The data source is the nationally representative 2014 Kenya Demographic and Health Survey (DHS) of men aged 15–54 years. The analysis is restricted to 9,514 men who reported being sexually active in the past 12 months prior to the survey, as they were likely to report either doing something or not to avoid or delay pregnancy. We use bivariate and multinomial logistic regression to assess factors that influence modern contraceptive use among sexually active men.

Results

Findings from the bivariate and multinomial logistic regression indicate that region of residence, marital status, religion, wealth, interaction with a health care provider, fertility preference, number of sexual partners and access to media were all significantly associated with modern contraceptive use among sexually active men.

Conclusion

Provider-client interaction as well as dissemination of information through mass media has the potential to increase knowledge and uptake of modern contraceptives. Similar efforts targeting segments of the population where contraceptive uptake is low are recommended.

Implementation of evidence-informed practice through central network actors; a case study of three public health units in Canada

BACKGROUND

Workforce development is an important aspect of evidence-informed decision making (EIDM) interventions. The social position of individuals in formal and informal social networks, and the relevance of formal roles in relation to EIDM are important factors identifying key EIDM players in public health organizations. We assessed the role of central actors in information sharing networks in promoting the adoption of EIDM by the staff of three public health units in Canada, over a two-year period during which an organization-wide intervention was implemented.

METHODS

A multi-faceted and tailored intervention to train select staff applying research evidence in practice was implemented in three public health units in Canada from 2011 to 2013. Staff (n = 572) were asked to identify those in the health unit whom they turned to get help using research in practice, whom they considered as experts in EIDM, and friends. We developed multi-level linear regression models to predict the change in EIDM behavior scores predicted by being connected to peers who were central in networks and were engaged in the intervention.

RESULTS

Only the group of highly engaged central actors who were connected to each other, and the staff who were not engaged in the intervention but were connected to highly engaged central actors significantly improved their EIDM behavior scores. Among the latter group, the staff who were also friends with their information sources showed a larger improvement in EIDM behavior.

CONCLUSIONS

If engaged, central network actors use their formal and informal connections to promote EIDM. Central actors themselves are more likely to adopt EIDM if they communicate with each other. These social communications should be reinforced and supported through the implementation of training interventions as a means to promoting EIDM.

Developmental Patterns of Adolescent Marijuana and Alcohol Use and Their Joint Association with Sexual Risk Behavior and Outcomes in Young Adulthood

Urban populations disproportionately experience poor sexual outcomes, including high rates of teenage pregnancy and sexually transmitted infections. However, the contribution of substance use across adolescence to poor sexual outcomes in young adulthood has not been investigated in depth, despite offering opportunities for more targeted prevention. This study aimed to estimate joint trajectories of adolescent alcohol and marijuana use to determine if they relate differently to four sexual outcomes: multiple sexual partners, sex without a condom, teenage pregnancy, and contraction of a sexually transmitted infection in young adulthood (by age 25). Data came from a longitudinal study of urban youth followed from age 6 to age 25, with annual assessments during adolescence and young adulthood (n = 608). The sample showed high levels of sexual risk, with young adults on average having sex without a condom once in the past month, 28.5% having multiple sexual partners in the past month, one quarter having contracted a sexually transmitted infection, and over 60% of the women being pregnant as a teenager and 36% of the men having gotten a partner pregnant. Applying longitudinal latent profile analysis to estimate joint trajectories of alcohol and marijuana use from grades 8-12, we identified four classes representing high dual use, moderate alcohol use, moderate alcohol use with increasing marijuana use, and non-use. Class membership differently predicted all four outcomes investigated with high dual users having the highest level of teenage pregnancy and the increasing marijuana trajectory having the highest risk of engaging with multiple sexual partners in the past month. Results suggest implications for both sexual risk and substance use prevention for urban youth.

Teachers and Coaches in Adolescent Social Networks Are Associated With Healthier Self-Concept and Decreased Substance Use

BACKGROUND

Poor academic (eg, "I am a bad student") and behavioral (eg, "I am a troublemaker") self-concepts are strongly linked to adolescent substance use. Social networks likely influence self-concept. However, little is understood about the role teachers and athletic coaches play in shaping both academic and behavioral self-concepts.

METHODS

We analyzed cross-sectional surveys of 929 9th-12th grade low-income minority adolescents in Los Angeles assessing self-concept, social networks, and 30-day use of alcohol, marijuana and other drugs. We performed generalized estimating equations, accounting for clustering at the school level and controlling for family and peer influences and contextual factors. We also tested whether self-concept-mediated associations between relationships with teachers or coaches and 30-day substance use.

RESULTS

More perceived teacher support was associated with lower odds of marijuana and other drug use and better academic and behavioral self-concepts. Behavioral self-concept mediated the associations between teacher support and substance use.

CONCLUSIONS

By facilitating relationships with adults and improving teachers' capacity to build supportive environments, schools may positively shape how adolescents see themselves, which might help reduce adolescent substance use.

Depression, Smoking, and Ego-Centric Social Network Characteristics in Ohio Appalachian Women

Depression is a serious, costly, and debilitating disorder that is understudied in rural women. Studies show that depression is associated with low social integration and support, but few studies investigate the relationship between depression and social network characteristics. This study examined the associations among women from three Ohio Appalachian counties enrolled in a health study, which aimed to collect information for a future social network smoking cessation intervention. An address-based sampling method was used to randomly select and recruit 404 women. A cross-sectional survey and interview were used to collect information about demographic, psychosocial, behavioral factors, and ego-centric social network characteristics, which are variables derived from an individual (ego) and her first degree contacts (alters). The CES-D scale assessed depressive symptoms. A multivariable logistic regression analysis described the association between these factors and participants with depression (defined as CES-D≥16). Higher network density, or greater number of relationships among alters divided by the total amount of alters, reduced the risk for depression (OR = 0.84, 95% confidence interval [CI] 0.73-0.95). Additionally, women with a high percentage of smoking alters were at greater risk for depression (OR = 1.19, 95% CI 1.02-1.39). Other factors associated with risk for depression included perceived stress score (OR = 1.34, 95% CI 1.24-1.45), loneliness score (OR = 1.37, 95% CI 1.05-1.80), and days with poor physical health (OR = 1.06, 95% CI 1.02-1.11). Findings suggest that psychosocial factors and social networks should be considered when addressing depression in clinical practice.

The Social Determinants of Chronic Disease

This review article addresses the concept of the social determinants of health (SDH), selected theories, and its application in studies of chronic disease. Once ignored or regarded only as distant or secondary influences on health and disease, social determinants have been increasingly acknowledged as fundamental causes of health afflictions. For the purposes of this discussion, SDH refers to SDH variables directly relevant to chronic diseases and, in some circumstances, obesity, in the research agenda of the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research. The health effects of SDH are initially discussed with respect to smoking and the social gradient in mortality. Next, four leading SDH theories-life course, fundamental cause, social capital, and health lifestyle theory-are reviewed with supporting studies. The article concludes with an examination of neighborhood disadvantage, social networks, and perceived discrimination in SDH research.

Advancing Cancer Prevention and Behavior Theory in the Era of Big Data

The era of “Big Data” presents opportunities to substantively address cancer prevention and control issues by improving health behaviors and refining theoretical models designed to understand and intervene in those behaviors. Yet, the terms “model” and “Big Data” have been used rather loosely, and clarification of these terms is required to advance the science in this area. The objectives of this paper are to discuss conceptual definitions of the terms “model” and “Big Data”, as well as examine the promises and challenges of Big Data to advance cancer prevention and control research using behavioral theories. Specific recommendations for harnessing Big Data for cancer prevention and control are offered.

Sociometric network structure and its association with methamphetamine use norms among homeless youth

Homeless youths' social networks are consistently linked with their substance use. Social networks influence behavior through several mechanisms, especially social norms. This study used sociometric analyses to understand whether social norms of drug use behaviors are clustered in network structures and whether these perceived norms (descriptive and injunctive) influence youths' drug use behaviors. An event-based approach was used to delineate boundaries of the two sociometric networks of homeless youth, one in Los Angeles, CA (n = 160) and the other in Santa Monica, CA (n = 130). Network characteristics included centrality (i.e., popularity) and cohesiveness (location in dense subnetworks). The primary outcome was recent methamphetamine use. Results revealed that both descriptive and injunctive norms influenced methamphetamine use. Network cohesion was found to be associated with perception of both descriptive and injunctive norms in both networks, however in opposite directions. Network interventions therefore might be effective if designed to capitalize on social influence that naturally occurs in cohesive parts of networks.

Gangs, clubs, and alcohol: The effect of organizational membership on adolescent drinking behavior

How does adolescent organizational membership in general, and simultaneous membership in distinct types of organizations in particular, impact drinking behavior? While past studies have focused either on the learning effect of involvement with gangs or on the constraining influence of conventional organizations on adolescent problem behavior, we explore the possibility that conventional school clubs can serve as socializing opportunities for existing gang members to engage in drinking behavior with non-gang club members. Using the Add Health data, we show that gang members drink more often, and engage in more binge drinking, than non-members. More importantly, individuals who are members of both gangs and school clubs drink alcohol at greater levels than those who are solely involved in gangs. In addition, non-gang adolescents who are co-members with gang members in the same school club are more likely to drink alcohol than non-members. This result has important implications for understanding the role of organizations in adolescent behavior and suggests that the study of delinquent behaviors would benefit from devoting more attention to individuals who bridge distinct types of organizations.

Peer Contexts in Schools: Avenues Toward Behavioral Health in Early Adolescence

Peer contexts play an important role in the behavioral health of early adolescents in schools. Behavioral health involves the observable academic and social behaviors that relate to and influence youths' subsequent health and development. Setting-level research on peer networks and social norms indicates these aspects of peer contexts vary by peer group, classroom, and school and dynamically relate to individual students' academic and social behaviors. Yet, although peer contexts are both influential and potentially malleable, little research examines the effects of school and classroom interventions on the development and maintenance of positive and productive peer contexts in schools. The current article identifies school structures and classroom processes theorized to directly or indirectly shift peer networks and social norms-and thereby increase the behavioral health of early adolescents in schools. We discuss the need for more rigorous and relevant research to better understand the role of schools and classrooms in strengthening these peer contexts and promoting behavioral health in early adolescence.

Social network and inequalities in smoking amongst school-aged adolescents in six European countries

Objectives

Smoking contributes to socio-economic health inequalities; but it is unclear how smoking inequalities emerge at a young age. So far, little attention has been paid to the role of friendship ties. We hypothesised that the combination of peer exposure and friendship social homophily may contribute to socio-economic inequalities in smoking at school.

Methods

In 2013, a social network survey was carried out in 50 schools in six medium-size European cities (Namur, Tampere, Hanover, Latina, Amersfoort, and Coimbra). Adolescents in grades corresponding to the 14-to-16 age group were recruited (n = 11.015, participation rate = 79.4 %). We modelled adolescents’ smoking behaviour as a function of socio-economic background, and analysed the mediating role of social homophily and peer exposure.

Results

Lower socio-economic groups were more likely to smoke and were more frequently exposed to smoking by their close and distant friends, compared with adolescents of higher SES. The smoking risk of the lowest socio-economic group decreased after controlling for friends smoking and social homophily.

Conclusions

Smoking socio-economic inequalities amongst adolescents are driven by friendship networks.

Electronic supplementary material

The online version of this article (doi:10.1007/s00038-016-0830-z) contains supplementary material, which is available to authorized users.

The Role of Social Capital in African Americans' Attempts to Reduce and Quit Cocaine Use

BACKGROUND

Research examining substance users' recovery has focused on individual-level outcomes while paying limited attention to the contexts within which individuals are embedded, and the social processes involved in recovery.

OBJECTIVES

This paper examines factors underlying African American cocaine users' decisions to reduce or quit cocaine use and uses practice theory to understand how lifestyle changes and shifts in social networks facilitate access to the capital needed to change cocaine use patterns.

METHODS

The study, an in-depth analysis of substance-use life history interviews carried out from 2010 to 2012, included 51 currently not-in-treatment African American cocaine users in the Arkansas Mississippi Delta region. A blended inductive and deductive approach to data analysis was used to examine the socio-cultural and economic processes shaping cocaine use and recovery.

RESULTS

The majority of participants reported at least one lifetime attempt to reduce or quit cocaine use; motivations to reduce use or quit included desires to meet social role expectations, being tired of using, and incarceration. Abstinence-supporting networks, participation in conventional activities, and religious and spiritual practices afforded access to capital, facilitating cocaine use reduction and sobriety.

CONCLUSIONS

Interventions designed to increase connection to and support from nondrug using family and friends with access to recovery capital (e.g., employment, faith community, and education) might be ideal methods to reduce substance use among minorities in low-income, resource-poor communities.

The Role of Gender in Adolescents' Social Networks and Alcohol, Tobacco, and Drug Use: A Systematic Review

BACKGROUND

Despite previous research indicating an adolescents' alcohol, tobacco, and other drug (ATOD) use is dependent upon their sex and the sex composition of their social network, few social network studies consider sex differences and network sex composition as a determinant of adolescents' ATOD use behavior.

METHODS

This systematic literature review examining how social network analytic studies examine adolescent ATOD use behavior is guided by the following research questions: (1) How do studies conceptualize sex and network sex composition? (2) What types of network affiliations are employed to characterize adolescent networks? (3) What is the methodological quality of included studies? After searching several electronic databases (PsycINFO, EBSCO, and Communication Abstract) and applying our inclusion/exclusion criteria, 48 studies were included in the review.

RESULTS

Overall, few studies considered sex composition of networks in which adolescents are embedded as a determinant that influences adolescent ATOD use. Although included studies all exhibited high methodological quality, the majority only used friendship networks to characterize adolescent social networks and subsequently failed to capture the influence of other network types, such as romantic networks.

CONCLUSIONS

School-based prevention programs could be strengthened by (1) selecting and targeting peer leaders based on sex, and (2) leveraging other types of social networks beyond simply friendships.

Measuring peer socialization for adolescent substance use: a comparison of perceived and actual friends' substance use effects

OBJECTIVE

There has been an increase in the use of social network analysis in studies of peer socialization effects on adolescent substance use. Some researchers argue that social network analyses provide more accurate measures of peer substance use, that the alternate strategy of assessing perceptions of friends' drug use is biased, and that perceptions of peer use and actual peer use represent different constructs. However, there has been little research directly comparing the two effects, and little is known about the extent to which the measures differ in the magnitude of their influence on adolescent substance use, as well as how these two effects may be redundant or separate constructs.

METHOD

Using Waves I and II of the National Longitudinal Study of Adolescent Health (Add Health) saturated subsample, we directly compared effects of perception of friends' use (PFU) and actual friends' use (AFU) on alcohol, cigarette, and marijuana initiation and persistence of use 1 year later. We also examined potential moderating effects of friendship quality and individual use on the relationship between perceived and actual friends' substance use and outcomes.

RESULTS

Results indicated that, overall, PFU effects were larger than AFU effects; however, these effects did not significantly differ in magnitude for most models. In addition, interaction effects differed for different substances and usage outcomes, indicating the meaning of PFU and AFU constructs (and thus, different types of peer socialization) may change based on substance and type of use.

CONCLUSIONS

These results highlight the multifaceted nature of peer influence on substance use and the importance of assessing multiple aspects of peer socialization while accounting for distinct contexts related to specific substances and use outcomes.

Adolescent social networks: general and smoking-specific characteristics associated with smoking

OBJECTIVE

Converging lines of research suggest that adolescents' smoking behaviors are strongly influenced by the characteristics of their social network and the social processes their network facilitates. The primary goal of this study was to conduct a detailed comparison of the social networks of adolescent smokers and nonsmokers to determine what aspects relate the most to smoking status. A secondary goal was to conduct within-group analyses to examine relationships between key measures of behavior-specific social support and (a) smoking susceptibility among nonsmokers, and (b) readiness to quit smoking among smokers.

METHOD

A matched sample of 190 adolescent smokers and nonsmokers (Mage = 16.8 years; 51% female) completed a questionnaire in which they nominated and reported on up to 10 important people in their lives. This measure allowed us to examine adolescents' overall networks (both peers and family) and to investigate numerous aspects, including general network characteristics (e.g., size of network, average contact with network members), social support (e.g., importance of people in the network), and the pervasiveness of smoking in the network (e.g., percentage of smoking peers).

RESULTS

The pervasiveness of smoking in adolescents' social network was the strongest distinguisher of smokers versus nonsmokers. In addition, behavior-specific social support was strongly associated with susceptibility to initiate smoking among nonsmokers and readiness to quit among smokers.

CONCLUSIONS

This research offers insight into potential targets for prevention and early intervention by demonstrating how social networks can both promote and attenuate risk for smoking.

What's love got to do with it? Adolescent romantic networks and substance use

This study examined how romantic aspiration network characteristics at the individual level (in-degree and out-degree) are associated with substance use (i.e. smoking and drinking) among a cross-sectional sample of US adolescents (10th grade, n = 1523) from 4 high schools in Los Angeles. Findings highlighted that, with an increase in out-degree (romantic aspiration nominations made), adolescents in our sample were less likely (OR = .824, CI = .688-.986, p < .05) to report smoking in the past 30 days. Additionally, with an increase in in-degree (romantic aspiration nominations received), adolescents were more likely (OR = 1.186, CI = 1.04-1.36, p < .05) to report drinking in the past 30 days. We conclude that romantic aspirations/relations influence adolescents' substance use behaviour (i.e. smoking and drinking alcohol), particularly because of the intensity of such relationships and the desire to please or be acceptable to the other person. Moreover, understanding adolescents' aspirations/relations can be useful for the development of intervention/prevention programmes to target adolescents' substance use.

Substance use network characteristics and drug and alcohol use behaviors among young men who have sex with men (YMSM)

BACKGROUND

Young men who have sex with men (YMSM) use alcohol and other drugs at rates higher than their heterosexual peers. While social networks of YMSM have been acknowledged as an important contextual influence on their health behavior, studies have largely focused on social and sexual networks rather than substance use networks, despite the potential importance of substance use alters in shaping substance use behavior.

METHOD

Using data collected from a diverse sample of YMSM (n=156), two multilevel models examined the associations between network (e.g., degree and transitivity), dyadic (e.g., strength of relationship), and individual characteristics and two alter level dependent variables: recent drug use (versus no recent drug use) and frequency of substance use.

RESULTS

Results indicated that transitivity was associated with both recent drug use (OR=1.21, p=0.012) and more frequent substance use (b=0.08, p=0.002). Degree was not significantly associated with either variable. Furthermore, participants were also less likely to have recently used drugs (OR=0.93, p<0.001) and tended to use substances less frequently (b=-0.01, p=0.028) with older alters.

CONCLUSIONS

Despite substantial interest in network influences on health, much remains unknown about the impact of network structures on substance use. The current findings suggest that structural characteristics of substance use networks may provide important information regarding the drug and alcohol use behavior of YMSM even when controlling for dyadic and individual characteristics.

Positive-Themed Suicide Prevention Messages Delivered by Adolescent Peer Leaders: Proximal Impact on Classmates' Coping Attitudes and Perceptions of Adult Support

Developing science-based communication guidance and positive-themed messages for suicide prevention are important priorities. Drawing on social learning and elaboration likelihood models, we designed and tested two positive-focused presentations by high school peer leaders delivered in the context of a suicide prevention program (Sources of Strength). Thirty-six classrooms in four schools (N = 706 students) were randomized to (1) peer leader modeling of healthy coping, (2) peer leader modeling plus audience involvement to identify trusted adults, or (3) control condition. Students' attitudes and norms were assessed by immediate post-only assessments. Exposure to either presentation enhanced positive coping attitudes and perceptions of adult support. Students who reported suicide ideation in the past 12 months benefited more than nonsuicidal students. Beyond modeling alone, audience involvement modestly enhanced expectations of adult support, congruent with the elaboration likelihood model. Positive peer modeling is a promising alternative to communications focused on negative consequences and directives and may enhance social-interpersonal factors linked to reduced suicidal behaviors.

[Binge drinking among 12-year-old adolescent schoolchildren and its association with sex, socioeconomic factors and alcohol consumption by best friends and family members]

This is a cross-sectional study with a convenience sample of 101 twelve-year-old adolescents enrolled in public and private schools in the city of Diamantina in the State of Minas Gerais. The scope was to evaluate the prevalence of binge drinking among 12-year-old schoolchildren and its association with gender, socioeconomic status and alcohol consumption by family members and best friends. The participants completed a self-administered questionnaire entitled the Alcohol Use Disorders Identification Test (AUDIT-C) and the consumption of alcoholic beverages by friends and family. Parents/guardians answered the form on sociodemographic questions. Descriptive analyses and association tests were performed (p < 0.05). The prevalence of binge drinking was 24.8%. Alcoholic beverage consumption began at the age of 10 (16.8%), though sex was not associated with binge drinking by adolescents. However, attending a public school (0.005) and alcohol consumption by best friends (p < 000.1) were associated with binge drinking by adolescents in the bivariate analysis. The prevalence of binge drinking was high and was associated with low socioeconomic status and alcohol consumption by the best friend. No association between sex and alcohol consumption by the family members of adolescents was detected.

Teen Alcohol Use and Social Networks: The Contributions of Friend Influence and Friendship Selection

Background

We evaluated the contributions of teen alcohol use to the formation and continuation of new and existing friendships while in turn estimating the influence of friend drinking on individuals’ regular use and heavy drinking.

Method

Longitudinal network analysis was used to assess the mutual influences between teen drinking and social networks among adolescents in two large Add Health schools where full network data was collected three times. Friendship processes were disaggregated into the formation of new friendships and the continuation of existing friendships in a joint model isolating friendship selection and friend influences.

Results

Friends have a modest influence on one another when selection is controlled. Selection is more complicated than prior studies suggest, and is only related to new friendships and not their duration in the largest school. Alcohol use predicts decreasing popularity in some cases, and popularity does not predict alcohol consumption.

Conclusion

Intervention efforts should continue pursuing strategies that mitigate negative peer influences. The development of socializing opportunities that facilitate relationship opportunities to select on healthy behaviors also appears promising. Future work preventing teen substance use should incorporate longitudinal network assessments to determine whether programs promote protective peer relationships in addition to how treatment effects diffuse through social networks.

Peers and social network on alcohol drinking through early adolescence in Taiwan

OBJECTIVES

This study aims to identify peers and social network characteristics associated with drinking occasions through early adolescence.

METHODS

The study sample of 1808 middle school students (aged 13-15 years) in northern Taiwan was collected via a two-wave longitudinal study of the Alcohol-Related Experiences among Children (AREC). Data concerning individual sociodemographics, family characteristics, peer influence, and alcohol drinking behaviors were collected via web-based self-administered questionnaire. Building upon the maximum of five friends nominated by young respondents at 7th grade, class-based social network was first constructed via the UCINET and Pajek; the network position (i.e., member, bridge, and isolate) for each student was subsequently ascertained. Complex surveys analyses and negative binominal regression models were used to evaluate concurrent and prospective relationship estimates.

RESULTS

Effects of peers and social network were found to operate differentially by childhood alcohol experience. For the alcohol naïve youngsters, receiving higher peer's nomination at baseline was linked with subsequent increased drinking occasions (adjusted Incidence Rate Ratio [aIRR]=1.06; 95% CI=1.01-1.10), whereas having peers against alcohol drinking may reduce drinking occasions at 9th grade (aIRR=0.59; 95% CI=0.41-0.87). For the alcohol experienced youngsters, having parental alcohol offer, drinking peers, and attending classes of higher drinking norms may increase future drinking occasions by 90%, 80% and 44%, respectively.

CONCLUSIONS

Our results demonstrated that parental alcohol offer, peer norms, and social network may affect adolescent drinking occasions differentially depending on childhood drinking experience. The findings have implications for the interventions to reduce alcohol consumption in underage population.

Social network and census tract-level influences on substance use among emerging adult males: An activity spaces approach

Social network and area level characteristics have been linked to substance use. We used snowball sampling to recruit 90 predominantly African American emerging adult men who provided typical locations visited (n=510). We used generalized estimating equations to examine social network and area level predictors of substance use. Lower social network quality was associated with days of marijuana use (B=-0.0037, p<0.0001) and problem alcohol use (B=-0.0050, p=0.0181). The influence of area characteristics on substance use differed between risky and non-risky spaces. Peer and area influences are important for substance use among men, and may differ for high and low risk places.

US adolescents' friendship networks and health risk behaviors: a systematic review of studies using social network analysis and Add Health data

Background. Documented trends in health-related risk behaviors among US adolescents have remained high over time. Studies indicate relationships among mutual friends are a major influence on adolescents' risky behaviors. Social Network Analysis (SNA) can help understand friendship ties affecting individual adolescents' engagement in these behaviors. Moreover, a systematic literature review can synthesize findings from a range of studies using SNA, as well as assess these studies' methodological quality. Review findings also can help health educators and promoters develop more effective programs. Objective. This review systematically examined studies of the influence of friendship networks on adolescents' risk behaviors, which utilized SNA and the Add Health data (a nationally representative sample). Methods. We employed the Matrix Method to synthesize and evaluate 15 published studies that met our inclusion and exclusion criteria, retrieved from the Add Health website and 3 major databases (Medline, Eric, and PsycINFO). Moreover, we assigned each study a methodological quality score (MQS). Results. In all studies, friendship networks among adolescents promoted their risky behaviors, including drinking alcohol, smoking, sexual intercourse, and marijuana use. The average MQS was 4.6, an indicator of methodological rigor (scale: 1-9). Conclusion. Better understanding of risky behaviors influenced by friends can be useful for health educators and promoters, as programs targeting friendships might be more effective. Additionally, the overall MQ of these reviewed studies was good, as average scores fell above the scale's mid-point.

A 2-year young adult obesity prevention trial in the US: Process evaluation results

Our objective was to conduct a process evaluation of the CHOICES (Choosing Healthy Options in College Environments and Settings) study, a large, randomized, controlled trial designed to prevent unhealthy weight gain in young adults (aged 18-35) attending 2-year community colleges in the USA. The 24-month intervention consisted of participation in an academic course and a social networking and support website. Among intervention participants, completion rates for most course activities were >80%, reflecting a high level of dose received. Course retention and participant satisfaction were also high. Engagement results, however, were mixed with less than half of participants in the online and hybrid sections of the course reporting that they interacted with course materials ≥3 h/week, but 50-75% reporting that they completed required lessons 'all/very thoroughly'. Engagement in the website activities was also mixed with more than half of intervention participants logging onto the website during the first month, but then declining to 25-40% during the following 23 months of the intervention. Intervention engagement is a challenge of online interventions and a challenge of working with the young adult age group in general. Additional research is needed to explore strategies to support engagement among this population, particularly for relatively long intervention durations.

Alcohol Use and Older Māori in Aotearoa

This study investigated alcohol use, hazardous and binge drinking prevalence, and their relationships to socio-demographic variables in community dwelling older Māori adults in New Zealand. Alcohol use, hazardous drinking, and binge drinking were assessed with the AUDIT-C in a cross-sectional postal survey of 1042 older Māori people randomly selected from the New Zealand Electoral Roll. A total of 41.2% of all participants reported drinking at hazardous levels. Odds ratios from binomial logistic regression showed hazardous drinking was significantly more likely to occur among males, current smokers, and those with higher local self-contained network scores. Binge drinking was reported by 19.6% of the sample, with odds ratios indicating that males, current smokers, and those with higher Māori cultural identification scores were significantly more likely to report binge drinking. The high rates of hazardous and binge drinking prevalence reported in the current study raise issues of concern when considering the health of older Māori people. Results indicate that social networks, gender, smoking status, and Māori cultural identification may influence hazardous and binge drinking alcohol use. However, limitations of the present study also highlight the need for more focused and in-depth research to be conducted with older Māori people to understand the sociocultural context in which alcohol use occurs.

Interpersonal communication outcomes of a media literacy alcohol prevention curriculum

Media literacy intervention efficacy literature has focused on media-relevant (e.g., knowledge and realism) and behavior-relevant outcomes (e.g., attitudes and behaviors), without much attention paid to interpersonal communication outcomes. This project examined interpersonal communication after participation in two versions (analysis plus analysis and analysis plus planning) of the Youth Message Development (YMD) intervention, a brief media literacy curriculum targeted at preventing high school student alcohol use. Participants attended a 75-mins media literacy YMD workshop and completed a delayed posttest questionnaire 3 to 4 months later. Overall, 68 % participants replied affirmatively to interpersonal communication about the YMD intervention. Communication about the workshop moderated the effects of the type of workshop (analysis plus analysis or analysis plus planning) on self-efficacy to counter-argue (but not critical thinking). Interpersonal communication moderated the effects of the YMD intervention on self-efficacy to counter-argue, thereby signaling the importance of including interpersonal communication behaviors in intervention evaluation.

Influencia de pares, familia, espiritualidad, entretenimiento y consumo de drogas en estudiantes de Universidad en Manabi, Ecuador

Se examinó el efecto de las relaciones familiares, la espiritualidad y el entretenimiento sobre la relación entre la resistencia a la influencia de compañeros y el consumo de drogas entre estudiantes en una universidad en Manabí, Ecuador. Estudio con un diseño transversal, cuantitativo de tipo descriptivo (n=250). Se aplicó el Cuestionario Factores Socio-culturales y el Consumo de Drogas CICAD-CAMH 2011-2012. El 55.2% de la población manifestó haber consumido drogas legales (8.4% para las drogas ilegales) en los últimos doce meses y el 58.8% (9.6% para las drogas ilegales) en los últimos tres meses. Las drogas de mayor uso en los últimos 12 meses fueron el alcohol y el tabaco, con 52.8% y 24.4% respectivamente. El nivel de error de la muestra se fijó en el 0.01%. Se determinó que existe relación entre la influencia de compañeros y el consumo de drogas. Las relaciones familiares y la espiritualidad (con diferencias de género) son factores protectores.

Peer influences on alcohol expectancies in early adolescence: a study of concurrent and prospective predictors in Taiwan

The effects of peers on three domains of alcohol expectancies through early adolescence were prospectively examined over 2 years. Information on pubertal development, parental drinking, peer characteristics, network structure, alcohol expectancies, and alcohol consumption was assessed in a three-wave longitudinal study of 779 6th graders (~12 years of age) randomly selected from northern Taiwan. Complex survey regression analyses, stratified by drinking experience in 6th grade, were performed to identify predictors of two positive (i.e., enhanced social behaviors and relaxation/tension reduction) and one negative alcohol expectancies (i.e., cognitive/behavioral deterioration) in 7th grade. The results showed that the effects of peer influence on adolescents' alcohol expectancies varied by prior drinking experiences and by expectancy domains. For the alcohol naive, recent exposure to peer drinking was significantly associated with positive and negative alcohol expectancies in grade 7, and this association was moderated by advanced pubertal development (ESBlate puberty: ßwt=0.55; ESBearly puberty: ßwt=-0.40; PRTRlate puberty: ßwt=0.01; PRTRearly puberty: ßwt=1.22; CBD late puberty: ßwt=-0.84; CBDearly puberty: ßwt=0.56). For the alcohol experienced, neither peer drinking nor pubertal development showed any significant links with alcohol expectancies. Occupying a bridge position was slightly linked with negative expectancy (ßwt=0.25). Concurrent drinking serves as a strong predictor for the endorsed alcohol expectancy in both groups, particularly for the domain of enhanced social behaviors. If these effects are confirmed, knowledge of the effect of interplay between peer factors and pubertal development on alcohol expectancies in early adolescence can provide effective targets in prevention programs.

Leadership networks in Catholic parishes: implications for implementation research in health

Through two case studies of Catholic parishes in Massachusetts, this study explores the implications of leader-centered versus distributed leadership in Catholic parishes for the implementation of evidence-based health interventions. The two parishes involved in the study differ from each other in several ways. In the first, parishioners are less engaged in leadership activities at the decision-making level in the parish. A small group of lay volunteers work with the parish priest and other ordained leaders on parish activities. In the second parish, a large and active lay volunteer leadership have forged an organizational structure that allows more independence from the pastor's direct oversight. In this parish, lay volunteer leaders are the prime drivers of organizational programs and events. In 2012-2013, three types of networks were assessed at each parish: discussion, collaboration, and outside-of-parish ties. The contrasts between each parish include differences in density of collaboration, in frequency of discussion, and network centrality of the respective parish priests. We further identified key actors in the network structures at each parish. We discuss the implications of these findings for understanding organizational capacity in the context of health program implementation.

Measuring social networks for medical research in lower-income settings

Social networks are believed to affect health-related behaviors and health. Data to examine the links between social relationships and health in low- and middle-income country settings are limited. We provide guidance for introducing an instrument to collect social network data as part of epidemiological surveys, drawing on experience in urban India. We describe development and fielding of an instrument to collect social network information relevant to health behaviors among adults participating in a large, population-based study of non-communicable diseases in Delhi, India. We discuss basic characteristics of social networks relevant to health including network size, health behaviors of network partners (i.e., network exposures), network homogeneity, network diversity, strength of ties, and multiplexity. Data on these characteristics can be collected using a short instrument of 11 items asked about up to 5 network members and 3 items about the network generally, administered in approximately 20 minutes. We found high willingness to respond to questions about social networks (97% response). Respondents identified an average of 3.8 network members, most often relatives (80% of network ties), particularly blood relationships. Ninety-one percent of respondents reported that their primary contacts for discussing health concerns were relatives. Among all listed ties, 91% of most frequent snack partners and 64% of exercise partners in the last two weeks were relatives. These results demonstrate that family relationships are the crux of social networks in some settings, including among adults in urban India. Collecting basic information about social networks can be feasibly and effectively done within ongoing epidemiological studies.