Adolescent smoking networks: the effects of influence and selection on future smoking

Examining gender difference in disordered eating behaviour and its associated factors among college and university students in Sarawak

Background: Disordered eating is common among late adolescents and young adults who pursue an idealised body image. Aims: This study aims to determine the prevalence of disordered eating between males and females and its associated factors among college and university students in Sarawak. Methods: A cross-sectional study involving 20 public and private colleges and universities in Sarawak, from September 2017 to March 2020. Respondents completed self-administered questionnaires both in the English and Malay language. Data about sociodemographic characteristics, body mass index, eating attitude, body dissatisfaction, perceived sociocultural pressure, self-esteem, drive for muscularity and perfectionism were collected. Results: A total of 776 respondents (male: 30.9%; female: 69.1%) aged 19 to 25 years old took part in the study. The overall prevalence of disordered eating was 25.2% (95% confidence interval (CI) 21.9; 28.7) with females (28.6%, 95% CI 24.6; 32.9) higher than males (15.6%, 95% CI 10.5; 21.9). Multivariate analysis showed for both male and female models, perceived sociocultural pressure (male: β = 1.125, p < 0.01; female: β = 1.052, p = 0.003), drive for muscularity (male: β = 1.033, p = 0.017; female: β = 1.032, p < 0.01) and perfectionism (male: β = 1.098, p = 0.02; female:β = 1.119, p < 0.01) were predictors for disordered eating. Conclusion: The prevalence of disordered eating among college and university students in Sarawak was high. The findings suggest that although there were gender differences in the prevalence of disordered eating, its associated factors were the same. The findings of this study will be useful for designing and implementing disordered eating prevention and intervention programme.

Prevalence and Determinants of Current Cigarette Smoking Among Adolescents in Thailand: Evidence From 2021 Global School-Based Health Survey

BACKGROUND

Adolescent cigarette smoking remains a concern globally, including in Thailand. This research aimed to elucidate the prevalence and determinants of cigarette smoking among Thai adolescents. Study Design: A cross-sectional study.

METHODS

A cross-sectional analysis of data from the 2021 Thailand Global School-Based Health Survey with 5545 adolescents aged 13-17 with complete information was conducted on their cigarette smoking status. Bivariate analysis and multivariable logistic regression were performed to discern the determinants of tobacco smoking among adolescents.

RESULTS

The overall weighted prevalence of cigarette smoking was 11.5% (95% confidence interval [CI]=9.7%, 13.5%), with adolescent males at 18.2% (95% CI=15.3%, 21.4%) and adolescent females at 5.6% (95% CI=4.2%, 7.4%). The multivariable logistic regression also revealed that males were more likely to be smokers (Adjusted Odd Ratio [AOR]=1.58; 95% CI=1.02, 2.45, P=0.040) compared to females. The presence of smokers in their vicinity significantly increased the odds of smoking (AOR=2.21, 95% CI=1.46, 3.36, P<0.001). Current alcohol use (AOR=3.37, 95% CI=2.21-5.14, P<0.001) and current marijuana use (AOR=4.53, 95% CI=2.06, 9.99, P<0.001) were both significant determinants of smoking. Notably, early initiation of cigarette use (before age 14) was associated with a lower likelihood of current smoking (AOR=0.54, 95% CI=0.33, 0.92, P=0.022).

CONCLUSION

With an overall prevalence of smoking among adolescents at 11.5%, our study highlights a significant public health concern. The positive determinants of the identified tobacco smoking include being male, having smokers in their vicinity, and currently using alcohol, and marijuana, while early initiation of cigarette use before age 14 is identified as an inverse determinant.

Injection network drivers of HIV prevention service utilization among people who inject drugs: results of a community-based sociometric network cohort in New Delhi, India

INTRODUCTION

Injection drug networks may influence their network members' health-seeking behaviours. Using data from a sociometric injecting partner network of people who inject drugs (PWID) in New Delhi, India, we assessed the role of injecting partner (alter) behaviours on individual engagement in HIV prevention services.

METHODS

We enumerated injecting partner linkages among 2512 PWID using coupon referrals and biometric data from November 2017 to March 2020. Participants completed interviewer-administered questionnaires and provided information on injection behaviours, injecting partners, HIV/hepatitis C (HCV) testing and service engagement. Multilevel multiple-membership models (MMMM) evaluated individual PWID HIV testing, medication for opioid use disorder (MOUD) and syringe service engagement as a function of alter attributes, accounting for membership across multiple ego-networks. Logistic regression models assessed parallel associations among socially proximal injecting peers, defined as PWID ≤3 path length from ego.

RESULTS

Median age was 26 years; 99% were male. PWID had median 2 injecting partners and 8 socially proximal peers; 14% reported HIV testing, 33% accessed MOUD and 13% used syringe services 6 months prior. In MMMM analyses, PWID with ≥1 versus 0 injecting partners who received HIV testing were significantly more likely to report HIV testing (adjusted odds ratio [aOR]: 2.27, 95% confidence interval [CI]: 1.68-3.16), MOUD (aOR: 1.99, 95% CI: 1.60-2.53) and syringe service use (aOR: 1.66, 95% CI: 1.21-2.39). We observed similar findings for individual MOUD and syringe service use. Having ≥1 versus 0 HIV-positive partners was associated with decreased HIV testing and MOUD but increased syringe service use (aOR: 1.54, 95% CI: 1.09-2.17). PWID with ≥1 versus 0 socially proximal peers who used non-sterile injection equipment reported increased HIV testing (aOR: 1.39, 95% CI: 1.01-1.92), MOUD (aOR: 1.40, 95% CI: 1.10-1.77) and syringe service use (aOR: 1.82, 95% CI: 1.23-2.68).

CONCLUSIONS

We found differential associative relationships between individual HIV prevention service engagement and the health or risk behaviours of direct and indirect alters. Characterizing network exposure beyond direct injecting partnerships provided important context on possible mechanisms of behavioural influence. Findings could be leveraged to design peer-based interventions that promote network diffusion of health-seeking behaviours.

Impact of social networks and norms on e-cigarette use among adolescents in Southern California: a prospective cohort study

Objective

Using social network analysis, we assessed the mechanisms of social influence that promote e-cigarette use in adolescent networks.

Methods

Data on health behaviours and friendship networks from a cohort of 10 high schools in Southern California (N=1599) were collected in grade 9 Spring 2021 (W1), grade 10 Fall 2021 (W2) and Spring 2022 (W3). Two mixed effects logistic regression models were estimated (full sample and subsample of non-vapers only) to evaluate the associations of W1 and W2 pro-vaping norms, peer e-cigarette use exposure and prior e-cigarette use (full sample) on past 6-month vaping at W3, adjusting for demographic covariates and school clustering.

Results

Previous vaping was the strongest predictor of past 6-month vaping at W3 among the full sample. Greater exposure to friend e-cigarette use at W2 (adjusted OR (AOR)=12.2, 95% CI 4.04 to 36.5) and greater pro-vaping norms at W2 (AOR=2.63, 95% CI 1.24 to 5.55) were significantly and positively associated with increased odds of initiating e-cigarette use at W3 among students with no lifetime e-cigarette use.

Conclusion

Peer network exposure and pro-vaping norms are significant predictors of vaping initiation even when network vaping prevalence is low.

Prevalence and associated factors of smoking among chinese adolescents: a school-based cross-sectional study

BACKGROUND

Shenzhen has made great efforts to address the tobacco epidemic in the past decade. This study aims to evaluate the current status of the tobacco epidemic among adolescent in Shenzhen, China.

METHODS

The multi-stage random cluster sampling method was used in the school-based cross-sectional study in 2019 and a total of 7,423 junior and high school (both senior and vocational) students were recruited. Information on cigarette use was collected by the electronic questionnaire. Logistic regression analysis was used to examine the associations between current cigarette use and associated factors. ORs with their 95% CIs were reported.

RESULTS

The prevalence of current cigarette use among adolescents was 2.3%, with boys (3.4%) significantly higher than girls (1.0%). Smoking rates in junior high schools, senior high schools, and vocational senior high schools were 1.0%, 2.7%, and 4.1%, respectively. The results of multivariate logistic regression analysis indicated that gender, age, parental smoking, teachers smoking in schools, friends smoking, exposure to tobacco marketing, and misconceptions about cigarette use were associated factors for adolescent smoking behaviour.

CONCLUSIONS

The prevalence of current smoking was relatively low among adolescent in Shenzhen, China. Personal characteristics, family, and school were associated with current adolescent smokers.

Network and Proximity Effects on LGBTQ Youth's Psychological Outcomes during a Camp Intervention

Research has found a tendency for youth's psychological states to influence their friendship development, and vice versa. Whether this occurs among LGBTQ youth in the context of identity-affirming intervention programming has not been established. The current study provides a longitudinal assessment of self-esteem, depressive symptoms, and anxiety in a network of 238 youth ages 12 to 18 participating in a summer camp for young LGBTQ people. Results showed youth experienced significant increases in self-esteem and decreases in depressive symptoms and anxiety at camp. Peer proximity based on cabin assignment influenced youth's depressive symptoms over time. The network processes of peer selection and influence did not significantly affect psychological outcomes. Our findings highlight the impact of affirming programming on the self-esteem, depressive symptoms, and anxiety of LGBTQ youth and the influence of intervention-based proximity on youth's depressive symptoms over time.

Social Network Influences on Adolescent E-cigarette Use

Background: Determine if individual adolescent vaping is associated with the vaping behavior of their school-based friendships; whether that association stems from peer influence or peer selection; and whether it varies by age. Methods: Two wave longitudinal survey of 1,208 students in one Midwestern US school district. Students were asked if they ever vaped and to name their seven closest friends within the school district. A roster of all eligible students was pre-loaded into the survey to facilitate network data collection. Terms for network exposure, the proportion of vaping friends; and selection, the number of new friends who vape, were created. Logistic regression and Stochastic Actor Oriented Models were used to test both influence and selection effects. Results: A cross-sectional logistic regression model indicated that friend vaping was associated with individual vaping (AOR = 4.96, p < 0.01); and lagged logistic models indicated that increased friend vaping was associated with individual vaping initiation (AOR = 1.72, p < 0.05). Selecting new friends who vape was also associated with becoming a vaper (AOR = 1.25, p < 0.01). Both influence and selection were present for those less than 14 years old. Conclusions: This is the first study to use social network analysis to show that adolescents who vape or initiate vaping are more likely to do so if their friends vape, and/or they make new friends who vape. Prevention and cessation programs should address the role of friend influence and selection on e-cigarette use; particularly at younger ages.

The Diffusion of Smoking: Association Between School Tobacco Policies and the Diffusion of Adolescent Smoking in 38 Schools in 6 Countries

Social network research has evidenced the role of peer effects in the adoption of behaviours. Little is known, however, about whether policies affect how behaviours are shared in a network. To contribute to this literature, we apply the concept of diffusion centrality to school tobacco policies and adolescent smoking. Diffusion centrality is a measure of centrality which refers to a person's ability to diffuse a given property-in our case, smoking-related behaviours. We hypothesized that stronger school tobacco policies are associated with less diffusion centrality of smoking on school premises and of smoking in general. A whole network study was carried out in 2013 and 2016 among adolescents (n = 18,805) in 38 schools located in six European cities. Overall, diffusion centrality of smoking in general and of smoking on school premises significantly decreased over time. Diffusion centrality of smoking significantly decreased both in schools where the policy strengthened or softened over time, but for diffusion of smoking on school premises, this decrease was only significant in schools where it strengthened. Finally, stronger school tobacco policies were associated with lower diffusion centrality of smoking on school premises and of smoking in general, though to a lesser extent. With such policies, smoking may, therefore, become less prevalent, less popular, and less clustered, thereby lowering the risk of it spreading within networks in, and even outside the school.

Social Network Ties and Responses to COVID-19 Among E-Cigarette Users

Social networks can enhance behavioral changes or entrench existing patterns of behavior. We aimed to identify how network ties to other e-cigarette users shaped responses to the pandemic and e-cigarette considerations. A national U.S. survey of 562 e-cigarette users was conducted during April 2020. Participants self-reported network ties to other e-cigarette users and pandemic outcomes: receiving expressions of concern about vaping, risk for a bad COVID outcome, changes in e-cigarette risk perceptions, and considerations of quitting. Each additional e-cigarette user tie was associated with a 0.014 unit increase in expressions of concern (p < 0.001), a 0.034 unit increase in perceived risk of a bad outcome (p < 0.05), and 3.9% higher odds of quit considerations (OR = 1.039; p < 0.01). Family ties to e-cigarette users were particularly important. Additional e-cigarette users within a network shaped risk perceptions in response to COVID-19. Network ties to other e-cigarette users have implications for cessation or reduction of e-cigarette use.

Improving knowledge and attitudes about prevention and cessation of smoking using comics: study on youth with smoker's social environment

Introduction

it is needed the innovative interventions to promote smoking cessation behavior. This research analyzed the influence of comic as the communication media to the knowledge and attitude of the respondent in the various determinant of smoking behavior.

Methods

this research measured the knowledge and attitude of the respondent after they have been given comic as the educational media. It also explored the information about smoking status and social context of the smokers, such as smoker parents, friends, and teachers. The population was the students. The sample size was 1000 students of junior high school. The research aimed to find out the difference of knowledge and attitude based on the smoking status, social context, and training experience.

Results

the mean score of knowledge between the respondents who had trained was higher than respondents who had no trained was significantly different (p<0.05). There was also significantly different of the mean score of knowledge and attitude (p<0.05) between the respondents whose family were smoker and non-smoker. The mean score of knowledge and attitude between the smoker and non-smoker respondents was also significantly different (p<0.05).

Conclusion

the comic is more effective as an educational media for non-smoker adolescents, adolescents who have not smoker family, and health educated adolescent.

Impact of Self-Control and Social Network of Friends on the Amount of Smoking among Out-of-School Youth

The aim of this study is to understand the effects of self-control and social networks of friends on the amount of smoking among out-of-school adolescents. The subjects of this study were 187 out-of-school adolescent smokers from the J-province Youth Counseling Welfare Center as of 2020. Data were collected through self-report questionnaires that contained questions about sociodemographic characteristics, self-control, social networks of friends, and amount of smoking. The dependent variable was smoking amount. Descriptive statistics, χ2 tests, correlation analyses, and regression analysis were performed. The predictors of smoking in OSY (out-of-school youth) were analyzed with respect to self-control and social networks of friends. The significant variables in model 3 were age, living with parents, and average allowance. The smoking rate of friends (β = 0.256) and the degree of penetration of friends smoking (β = 0.341) were significant variables. The higher the percentage of friends smoking and the higher the degree of penetration of smoking among the members of social networks, the higher the amount of smoking.

The Role of Social Position Within Peer Groups in Distress-Motivated Smoking Among Adolescents

OBJECTIVE

The relationship between smoking and adolescents' peer relationships is complex, with studies showing increased risk of smoking for adolescents of both very high and very low social position. A key question is whether the impact of social position on smoking depends on an adolescent's level of coping motives (i.e., their desire to use smoking to mitigate negative affect).

METHOD

We assessed how social position predicts nicotine dependence in a longitudinal sample (N = 3,717; 44.8% male; mean age = 13.41 years) of adolescent lifetime smokers measured between 6th and 12th grades. Using both social network analysis and multilevel modeling, we assessed this question at the between-person and within-person level, hypothesizing that within-person decreases in social position would lead to increased risk of nicotine dependence among those with high levels of coping motives.

RESULTS

In contrast to our hypotheses, only interactions with the between-person measures of social position were found, with a slight negative relationship at low levels of coping motives. In addition, the main effect of coping motives was considerably stronger than that of social position at the between-person level, and social position had no significant within-person main effect on nicotine dependence risk.

CONCLUSIONS

These results suggest that adolescents with higher overall levels of social position among their peers may have slightly decreased risk for nicotine dependence, but only when coping motives are low. Counter to expectations, higher levels of nicotine dependence risk were not linked to fluctuations in social position.

Exploring the association between school-based peer networks and smoking according to socioeconomic status and tobacco control context: a systematic review

BACKGROUND

Whilst prevalence of youth smoking in middle and high income countries has decreased, inequality has prevailed. The introduction of legislation regulating tobacco use in public spaces varies across countries, impacting the tobacco control context. Thus reviewing our knowledge of how social networks may influence smoking differently within different contexts is required to facilitate the development of context-specific interventions.

METHODS

The search, conducted on 31st May 2019, included the following smoking-related terms; schools, adolescents, peers and social networks. Inclusion and exclusion criteria were applied throughout the title and abstract screening and full text screening. Quality assessment and synthesis followed. Studies were narratively synthesised to identify changes according to legislative context. This synthesis was conducted separately for findings relating to three categories: socioeconomic status; social selection and influence; and network position.

RESULTS

Thirty studies were included. Differences in the relationship between network characteristics and smoking according to socioeconomic status were measured in five out of fifteen studies in Europe. Results varied across studies, with differences in network characteristics and their association with smoking varying both between schools of a differing and those of a similar socioeconomic composition. For studies conducted both before and after the introduction of comprehensive smoking legislation, the evidence for selection processes was more consistent than influence, which varied according to reciprocity. Findings showed that isolates were more likely to smoke and in-degree and out-degree centrality were related to smoking both before and after the introduction of legislation. The relationship between popularity and smoking was contingent on school level smoking prevalence in studies conducted before the introduction of legislation, but not after.

CONCLUSIONS

Overall, effects according to socioeconomic status were underreported in the included studies and no consistent evidence of change after the introduction of a comprehensive smoking ban was observed. Further network analyses are required using more recent data to obtain a comprehensive understanding of how network processes may influence smoking differently according to socioeconomic status, and how adaptation could be used to enhance intervention effectiveness.

SYSTEMATIC REVIEW REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42019137358 .

Primary Care Patient Social Networks and Tobacco Use: An Observational Study

IMPORTANCE

Tobacco use remains the leading cause of preventable deaths and is susceptible to social influence. Yet, we know little about the characteristics of primary care social networks and how they influence tobacco use.

OBJECTIVE

To determine what primary care patient social network characteristics are associated with individual smoking behavior.

DESIGN

Cross-sectional.

SETTING

Two primary care practices in West Philadelphia, Pennsylvania (PA), USA.

PARTICIPANTS

A random sample of 53 primary care patients and 155 of their nominated social ties.

MAIN OUTCOME AND MEASURES

We examined the association between social network characteristics (degree, communicated weighted social ties, and presence of social reinforcement) and tobacco use history (never smoker, successful quitter, or current smoker). Other covariates included age, race/ethnicity, sex, education, income, and employment status, self-efficacy, depression status, provider-patient relationship.

RESULTS

Of those enrolled in our study (n = 208), 101 identified as never smokers, 59 as successfully quitters, and 48 as current smokers. Social reinforcements from connected alter pairs that never-smoked (OR = 1.20, 95% CI: 1.08, 1.34) was significantly associated with a participant being a never smoker. Participants with stronger ties with successful quitters were significantly more likely to identify as successfully quitting (OR = 1.37, 95% CI: 1.11, 1.69) and conversely had a negative association with stronger ties to unsuccessful quitters (OR = 0.59, 95% CI: 0.44, 0.80) or current smokers who had not tried to quit in the last year (OR = 0.82, 95% CI: 0.68, 0.98). Social reinforcement from connected pairs of alters that were unsuccessful quitters was significantly associated with the participant being a current smoker (OR = 1.26, 95% CI: 1.10, 1.45).

CONCLUSIONS

Our study suggests that smoking behaviors do not occur in isolation, nor because of 1 or 2 prominent social network members. Rather, our findings suggest that both strong ties and social reinforcement from clusters of similarly-behaving persons influence smoking behavior. Primary care practices have an opportunity to leverage these insights on patient networks to improve cancer prevention.

Network-based Analysis of Prescription Opioids Dispensing Using Exponential Random Graph Models (ERGMs)

The United States has been experiencing an unprecedented level of opioid overdose-related mortality due in part to excessive use of prescription opioids. Peer-driven network interventions may be beneficial. A key assumption of social network interventions is that of some members of the network act as key players and can influence the behavior of others in the network. We used opioid prescription records to create a social network of patients who use prescription opioid in the state of Rhode Island. The study population was restricted to patients on stable opioid regimens who used one source of payment and received the same opioid medication from ≥ 3 prescribers and pharmacies. An exponential random graph model (ERGM) was employed to examine the relationship between patient attributes and the likelihood of tie formation and modularity was used to assess for homophily (the tendency of individuals to associate with similar people). We used multivariable logistic regression to assess predictors of high betweenness centrality, a measure of influence within the network. 372 patients were included in the analysis; average age was 51 years; 53% were female; 57% were prescribed oxycodone, 34% were prescribed hydrocodone and 9% were prescribed buprenorphine/naloxone. After controlling for the main effects in the ERGM model, homophily was associated with age group, method of payment, number and type of opioid prescriptions filled, mean daily dose, and number of providers seen. Type of opioid and number of prescribers were identified as significant predictors of high betweenness centrality. We conclude that patients who use multiple prescribers or have a diagnosis of opioid use disorder may help promote positive health behaviors or disrupt harmful behaviors in an opioid prescription network.

Physical activity promotion in an urban district: Analyzing the mechanisms of interorganizational cooperation

Past research has identified the importance of cooperation among community-based organizations from different sectors to address public health problems such as insufficient physical activity. However, little is known about how and why interorganizational cooperation occurs. The present study sought to analyze the structure and emergent patterns of interorganizational cooperation within a network promoting physical activity based in an urban district neighborhood of a city in Southwestern Germany. Survey data on cooperative relations among 61 network organizations and organizational attributes (e.g., possession of sport facilities) were collected. Social network analysis was applied to examine network properties and exponential random graph models were estimated to test hypotheses concerning mechanisms and conditions of cooperative tie formation. The results show that the network of cooperation is sparse but characterized by a tendency for cooperation to occur in triangular structures. Other significant mechanisms of cooperative tie formation are preferential attachment, with the community department for education and sports being the most central network actor, and heterophily regarding the cooperation of organizations from different sectors. This study provides valid and reliable findings on conditions of network formation and significant mechanisms of interorganizational cooperation in the field of physical activity promotion. Knowledge about these mechanisms can help to manage networks effectively and efficiently and reveal potentials for improvement and intensification of interorganizational cooperation in both the present and other research areas of health promotion.

Correlational study between online friendship network and internet game disorder among university students

PURPOSE

The purpose of this study was to provide basic information about the analysis of the correlation between online friendship network and internet game disorder among university students.

METHODS

Study subjects were 77 university students. For analysis of online friendship among them, social network analysis was performed and the analysis of degree, closeness, and betweenness centrality was measured. Assessment of internet game disorder was done using the Korean version of Internet Gaming Disorder Scale.

RESULTS

As per the results, the positive correlation showed between in-closeness centrality and internet gaming disorder (IGD) and the negative correlation showed between out-closeness centrality and internet gaming disorder.

CONCLUSIONS

Online friendship is considered to contribute to the changes of internet game disorder level. Thus, in the relationship between online friendship and internet game disorder, closeness centrality should be considered, and causal relation analysis should be performed in further studies.

Do high school friends still matter for health behavior in adulthood? Variations in smoking trajectories by adolescent peer smoking networks, race/ethnicity, and gender

Peers play an influential role in the initiation of smoking during adolescence. However, there has been limited literature examining whether adolescent peers are associated with longer-term patterns of smoking. This study uses data from the National Longitudinal Study of Adolescent to Adult Health to examine whether age-based trajectories of smoking likelihood from adolescence to adulthood are associated with the number of adolescent friends who smoked and how this association differs by race/ethnicity and gender. Findings using multilevel growth curve models indicate that individuals who have more adolescent friends who smoked have higher probabilities of smoking during adolescence than those with no adolescent smoking friends. As individuals age into adulthood, the association between adolescent friends’ smoking behavior and individual-level smoking begin to dissipate but does not completely disappear. Further analyses show that there are no differences in this association by gender, but there are differences by race/ethnicity. These findings suggest that high school friends continue to be associated with trajectories of smoking even twenty years after high school. These results indicate that anti-smoking campaigns should take a network approach to preventing smoking in adolescence as well as recognize that the same campaign strategy may not work for all groups.

•

Adolescent friends are associated with smoking trajectories into adulthood.

•

The friends-smoking association wanes with age but does not completely dissipate.

•

This friends-smoking association increases with age for Black adults.

•

There are no significant differences in the friends-smoking association by gender.

Has increasing internet use due to smartphone uptake contributed to the decline in adolescent smoking?

INTRODUCTION

The emergence of low-cost smartphone technology has coincided with major declines in adolescent smoking and other risk behaviours. This study explores the relationship between internet use and smoking in adolescents and investigates whether rising internet use contributed to the decline in smoking between 2012 and 2018.

METHODS

Data were drawn from a nationally representative New Zealand survey of students aged 14-15 (N = 11 299), conducted biennially between 2012 and 2018. We used logistic regression to explore the association between internet use and smoking and test whether increasing time on the internet was associated with declining adolescent smoking over the study period.

RESULTS

The proportion of students spending 5+ hours per day online increased from 15% to 35%. Heavy internet use was not a protective factor for smoking at the individual level. In 2016/2018, some types of past week internet use were associated with decreased risk of smoking (e.g. doing schoolwork, finding out about news), some were associated with increased risk (e.g. social media use) and others appeared to have no association with smoking (e.g. gaming, online shopping). The relative risk of smoking was lower in 2018 relative to 2012 (relative risk 0.68, 95% confidence interval 0.51, 0.90, after adjustment for demographic factors). Adding internet use to the model did not help to account for smoking decline.

DISCUSSION AND CONCLUSIONS

We found no evidence that increasing time spent on the internet during the 2012-2018 period (during which smartphones became ubiquitous) contributed to the decline in adolescent smoking.

Investigation of college student smoking perceptions, behaviors and communication about smoking with smoking friends and family

Purpose

Communication plays an important role in health decisions and behaviors. Friends and family exert influence through communication and, when considering smoking, this is particularly salient among those friends and family who smoke. Guided by primary socialization theory and integrated behavioral model, the present study examined the effects of having smoking friends and family on smoking beliefs (e.g. negative consequences, positive reinforcement and negative reinforcement), cultural normative beliefs, pro-smoking injunctive norms, smoking intentions and recent smoking behaviors.

Design/methodology/approach

Cross-sectional online survey data were collected from college students (N = 227). Multivariate analysis of covariance and path analysis were performed.

Findings

College students who reported having smoking friends were more likely to report higher levels of positive reinforcement, cultural normative beliefs, pro-smoking injunctive norms, positive attitudes, smoking intentions and recent smoking behaviors than those without smoking friends. Frequent communication with smoking friends was significantly related to cultural normative beliefs, pro-smoking injunctive norms, positive attitudes and smoking intentions. The analysis, however, did not yield statistical support for the associations between frequent communication with smoking family and smoking perceptions, norms and behaviors.

Originality/value

The present study highlights the vital roles of friends' influence for college students' smoking behaviors. Communication-based intervention can help better equip college students with communication strategies that prevent tobacco use by promoting more effective conversations with friends.

Exposure to new smoking environments and individual-level cigarette smoking behavior: Insights from exogenous assignment of military personnel

Despite overall declines in cigarette smoking prevalence in the United States (U.S.) in the past several decades, smoking rates remain highly variable across geographic areas. Past work suggests that smoking norms and exposure to other smokers in one's social environment may correlate with smoking risk and cessation, but little is known about how exposure to other smokers in one's community is causally linked to smoking behavior - in part due to endogeneity and inability to randomly assign individuals to different 'smoking environments.' The goal of this study was to evaluate how exposure to localities with high population-level smoking prevalence affects individual-level cigarette smoking behaviors, including quitting. The study addresses key limitations in the literature by leveraging a unique natural experiment: the plausibly exogenous compulsory assignment of military personnel to installations. Logistic and multivariate regressions estimated cross-sectional associations between smoking/quitting behaviors and our proxy for social environments for smoking, county-level smoking prevalence (CSP). Across 563 U.S. counties, CSP ranged from 3.8 to 37.9%. Among the full sample, a 10 percentage point increase in CSP was associated with an 11% greater likelihood of smoking. In subgroup analyses, young adults, women, those without children in the household, and risk/sensation-seekers were more likely to smoke and less likely to quit when exposed to counties with higher CSP. Relocation to areas with high population-level smoking prevalence may increase likelihood of smoking and impede quitting, and may disparately affect some population subgroups. Findings provide novel evidence that community smoking environments affect adult smoking risk and underscore a need for sustained, targeted efforts to reduce smoking in areas where prevalence remains high.

Diffusion of innovations: a guiding framework for public health

Exploring the behavior change process has been of interest and importance to public health professionals, to translate research into practice. Diffusion of innovations (DOI) model has been extensively applied in public health to examine the process by which innovation is passively communicated to individuals and groups. It builds on a staged model of awareness, persuasion, decision, implementation, and confirmation; and categorizes communities into innovators (2.5%), early adopters (13.5%), early majority (34%), late majority (34%) and laggards (16%). It reflects on the diversity of strategies to be applied for different cadres of the society to bring about a wholistic change. Nonetheless, DOI suffers from 'pro-innovation' and 'individual blame' bias, as it fails to account for the influence of societal, cultural, and extraneous factors affecting individual behavior change. The social networks theory (SNT) in contrast, explains behavior change based on social networks and their influences. It builds on the constructs of homophily, centralization, reciprocity, transitivity, and density; and fills the void in the DOI model. We suggest public health professionals to combine the constructs of DOI and SNT in rolling out behavior change interventions, to yield a comprehensive approach.

Smoking prevalence, core/periphery network positions, and peer influence: Findings from five datasets on US adolescents and young adults

Smoking prevalence has decreased significantly among US adolescents and young adults in the past 20 years. It is possible that adolescent and young adult smokers were moving from core to peripheral positions in social networks and thus less influential as suggested in previous research on adult smokers. We construct five sample datasets to test these hypotheses but none of them receives much support. When the proportion of smokers is relatively higher in two sample datasets, smokers tended to be at more marginal network positions than nonsmokers, both smokers and nonsmoker could exert peer influence, and the magnitude of peer influence from smokers was even greater than that from nonsmokers. When smoking was less frequent in the other three sample datasets, smokers and nonsmokers were at random network positions and no peer influence on smoking behavior was detected. Therefore, core/periphery network positions are still the key linking smoking prevalence and peer influence among US adolescents and young adults but operating through a different mechanism from their adult counterparts. When scientists design and conduct prevention programs against adolescent and young adult smoking behavior, core/periphery network positions, smoking prevalence, and peer influence should all be taken into consideration.

Factors associated with smoking susceptibility among high school students in western Spain

The Expanded Susceptibility to Smoking Index (ESSI) is based on the combination of susceptibility to smoking and curiosity about smoking. The ESSI can identify young people who are at risk of starting to smoke cigarettes and related products. The objective of this study was to analyse the ESSI results and to examine factors associated with ESSI scores in students between 12 and 16 years of age. Sociodemographic, social/environmental and personal variables were analysed, and the ESSI value was determined for non-smoking students recruited from three schools in western Spain. Regression models were used to examine the factors associated with smoking for the entire sample and the factors associated with ESSI scores in the non-smoking population. Of the 377 participants who were analysed, 20.4% were smokers. Among the non-smokers, 53.5% and 55.3% presented medium-high ESSI scores for cigarettes and e-cigarettes, respectively, and 39.8% presented medium-high ESSI scores for hookah use. A higher ESSI score was associated with greater exposure to people smoking in the home, having more friends who smoke, alcohol consumption, and a higher impulsivity scale score. These findings reinforce the importance of reducing peer pressure and suggest the important role of resolve under conditions of positive affect on reducing impulsivity. Approaches based on self-efficacy could be addressed in preventive programmes developed in educational settings.

Statistical methods for the estimation of contagion effects in human disease and health networks

Contagion effects, sometimes referred to as spillover or influence effects, have long been central to the study of human disease and health networks. Accurate estimation and identification of contagion effects are important in terms of understanding the spread of human disease and health behavior, and they also have various implications for designing effective public health interventions. However, many challenges remain in estimating contagion effects and it is often unclear when it is difficult to correctly estimate contagion effects, or why a particular method would need to be applied. In this review I explain the challenges in estimating contagion effects, and how they can be framed as an omitted variable bias problem. I then discuss how such challenges have been addressed in randomized experiments and traditional statistical analyses, as well as several state-of-the-art statistical methods. Finally, I conclude by summarizing recent advancements and noting remaining challenges, as well as appropriate next steps.

Associations between network-level acculturation, individual-level acculturation, and substance use among Hispanic adolescents

Acculturation is associated with substance use behaviors in Hispanic adolescents. However, there is limited research determining whether the individual's friends' acculturation patterns also influence substance use. Tenth-grade students (N = 970) participated in Project RED, a study of substance use and social networks among Hispanic youth in Southern California. Acculturation and substance use data from both the respondent and their nominated friends were regressed on lifetime cigarette use, marijuana use, and alcohol use controlling for sibling substance use, sex, depressive symptoms, and network measures. Respondent's Hispanic orientation was significantly associated with lower odds of both cigarette and marijuana use, whereas respondent's friends' US orientation was associated with higher odds of cigarette use. When controlling for network-level acculturation, individual-level U.S. orientation was not associated with substance use. Participants who nominated more friends had lower odds of cigarette use. Among this sample of Hispanic adolescents, affiliating with U.S.-oriented friends was associated with a higher risk for smoking. Substance use prevention efforts should consider encouraging Hispanic youth to maintain their cultural heritage and foster friendship groups that support abstinence and promote Hispanic and bicultural identity.

Parents modelling, peer influence and peer selection impact on adolescent smoking behavior: A longitudinal study in two age cohorts

Understanding the key factors that influence smoking behavior, especially during adolescence, has a meaningful impact on public health. This study examined the impact of parent modelling, peer influence and peer selection on adolescent smoking behavior in two Portuguese cohorts followed for three years. A questionnaire was delivered in classes and schools randomly selected, three times, one per year (cohort1: time1-7th, time2-8th, time3-9th; cohort2: time1-10th, time2-11th, time3-12th graders). The sample included a total of 656 students (402 younger [time1 Mage = 13.17, SD = 0.53, 63.7% girls;] and 254 older [time 1 Mage = 16.20, SD = 0.53, 65% girls]). Longitudinal data were examined through an autoregressive cross-lagged model (ARCL). The model explained 35% of the variance in smoking behavior at T3 for the global sample (4% for the younger and 58% for the older). Over time, in both cohorts, the percentage of never smokers decreased sharply and the percentage of regular smokers increased rapidly. We observed that participants in the older cohort had higher chances of smoking if their parents smoked. Nevertheless, we did not find a parental modelling effect in the longitudinal model. Peer influence and peer selection influenced smoking behavior. However, peer selection influenced the youngest group, both processes influenced the middle age group, and only peer influence influenced the oldest. Best friend and friends had a stronger impact on the younger while friends and same grade students had a stronger impact on the older. Prevention programs should regard these differences of interpersonal influences through adolescent development and specific strategies for different age groups should be considered.

The association between gender roles and smoking initiation among women and adolescent girls

Smoking cigarettes is a leading global cause of preventable death and disease. Men historically smoke more than women, but the prevalence of smoking among women in low and middle-income countries is increasing at an alarming rate. Understanding the factors that influence smoking initiation among women and girls is needed to address the growing epidemic of women smokers and the looming impact on women's health worldwide. We assume that smoking initiation is embedded in socio-culturally influenced gendered context and use a social cognitive model with a gendered lens as a framework for organizing and synthesizing the research. Guided by this framework, we identified gaps in the literature and make recommendations for future research in this review paper. The results suggest that psychological and environmental determinants are rooted in fluctuating cultural influences and values, but few research studies provide a gendered analysis or systematically examine these factors in the context of gender and culture. Sex/gender is a significant construct through which women and girls experience the psychological, environmental, and other influences on smoking initiation. Much more research is needed to understand the psychological and environmental influences as well as the intersection of gender roles and other social categories on female smoking initiation.

Differences in norms towards the use of nicotine vaping products among adult smokers, former smokers and nicotine vaping product users: cross-sectional findings from the 2016 ITC Four Country Smoking and Vaping Survey

AIMS

To examine whether norms towards nicotine vaping product (NVP) use varied between Australia, Canada, England and the United States and by socio-demographics, smoking and NVP status.

DESIGN

Cross-sectional data from the 2016 ITC Four Country Smoking and Vaping Survey.

SETTING

Four countries with distinct regulatory policies relating to the sale and advertising of NVPs: Australia (most restrictive), Canada (restrictive), England and the United States (least restrictive).

PARTICIPANTS

A total of 10900 adult (age 18+) current smokers, former smokers, or at least weekly NVP users. Respondents were from Australia (n = 1366), Canada (n = 3309), England (n = 3835) and the United States (n = 2390).

MEASUREMENTS

Questions permitted the categorization of respondents as current smokers, former smokers, NVP users and socio-demographic categories (sex, age, country, ethnicity, income and education). Further questions were asked regarding the frequency of exposure to NVPs in public, whether they had a partner or close friends who vaped and whether they believed society or those considered important to them approved of NVPs.

FINDINGS

Adjusting for relevant covariates, compared with Australian respondents, those in England, Canada and the United States were more likely to report frequent exposure to NVPs in public (83.1%, 57.3% and 48.3%, respectively, compared to 19.8% in Australia; P < 0.0001), having a partner who vaped (13.8%, 7.1% and 7.7%, respectively, compared to 2.1% in Australia; P < 0.0001) and having close friend(s) who vaped (31.7%, 25.3%, 20.9%, respectively, compared to 10.0% in Australia; P < 0.0001). Compared with Australian respondents, respondents from England were more likely to report that society (27.6% compared to 12.3% in Australia; P < 0.0001) and people important to them approved of NVP use (28.9% compared to 14.3% in Australia; P < 0.0001).

CONCLUSIONS

Norms towards nicotine vaping product (NVP) use appear to vary among countries with different regulatory contexts regarding sales and advertising.

Tackling smoking among out of school youth in South Africa: An analysis of friendship ties

Background

Friendships during adolescence play a significant role in the initiation and maintenance of tobacco use. Smoking behaviour among adolescent friends has not been explored among out of school youth (OSY) in South Africa. Out of school youth (OSY), described as those between 13 and 20 years old, have not completed their schooling and are not currently enrolled in school, are at greater risk for tobacco use.

Aim

The main aim of this study is to examine whether the smoking behaviour of OSY is associated with that of their OSY friends.

Methods

Respondent driven sampling was used to recruit OSY and their OSY friends. A mixed effects logistic regression with a random intercept across school-province combinations was used to analyse survey data. Race and gender were also incorporated into the analyses as effect moderators (n = 391).

Results

Results of this study confirm that cigarette smoking was common among OSY and their OSY friends, with 53.5% of the respondents smoking in the past month (SD = 0.44). When OSY friends were either all non-smokers or half their friends were non-smokers, Coloured (mixed race) OSY were less likely to smoke compared to Black African and Other (mostly Asian descent) OSY.

Conclusion

Cultural norms and values associated with the different race groups may play a role in the smoking behaviour of out of school youth friends. Understanding this relationship is useful for identifying those OSY that are vulnerable to the behaviours that place them at risk of tobacco related morbidity and mortality.

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Smoking was common among out of school youth and their out of school youth friends.

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Racial differences were found in out of school youth smoking and their friends.

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Cultural norms and values influence smoking behaviour of out of school youth friends.

Smoking Diffusion through Networks of Diverse, Urban American Adolescents over the High School Period

This study uses recent data to investigate if smoking initiation diffuses through friendship networks over the high school period and explores if diffusion processes differ across schools. One thousand four hundred and twenty-five racially and ethnically diverse youth from four high schools in Los Angeles were surveyed four times over the high school period from 2010 to 2013. Probit regression models and stochastic actor-based models for network dynamics tested for peer effects on smoking initiation. Friend smoking was found to predict adolescent smoking, and smoking initiation diffused through friendship networks in some but not all of the schools. School differences in smoking rates and the popularity of smokers may be linked to differences in the diffusion of smoking through peer networks. We conclude that there are differences in peer effects on smoking initiation across schools that will be important to account for in network-based smoking interventions.

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.

Peer Smoking and Smoking-related Beliefs Among College Students in Bangladesh

Objectives

Smoking is a significant public health issue in Bangladesh. The purpose of this study was to examine peer smoking and smoking-related beliefs among college students in Bangladesh.

Methods

College students at two universities in Dhaka, Bangladesh participated in a self-administered survey in May and June 2017.

Results

First, being a current or former smoker is associated with lower levels of beliefs among respondents that they would not smoke even with smoker friends or nervousness, and lower levels of intentions that they would not smoke, while current smokers and former smokers have different smoking-related beliefs. Second, having smoker friends is associated with lower levels of intentions that they would not smoke. Third, higher levels of normative beliefs that it is important not to smoke are associated with higher levels of beliefs that they would not smoke even with smoker friends or nervousness, higher levels of intentions that they would not smoke, and higher levels of avoidance of smoking.

Conclusions

Smoking-related beliefs and perceived norms in individuals’ social networks are important components in promoting tobacco cessation in Bangladesh. But it is challenging to prevent or intervene in smoking because of the high rates of smoking in this country and the high prevalence of smokers in individuals’ social networks. Future studies should examine the most effective interventions to combat smoking in high-smoking social networks, such as using mobile apps or social media, and evaluate the effectiveness of such interventions.

Different Kinds of Lonely: Dimensions of Isolation and Substance Use in Adolescence

Social isolation is broadly associated with poor mental health and risky behaviors in adolescence, a time when peers are critical for healthy development. However, expectations for isolates' substance use remain unclear. Isolation in adolescence may signal deviant attitudes or spur self-medication, resulting in higher substance use. Conversely, isolates may lack access to substances, leading to lower use. Although treated as a homogeneous social condition for teens in much research, isolation represents a multifaceted experience with structurally distinct network components that present different risks for substance use. This study decomposes isolation into conceptually distinct dimensions that are then interacted to create a systematic typology of isolation subtypes representing different positions in the social space of the school. Each isolated position's association with cigarette, alcohol, and marijuana use is tested among 9th grade students (n = 10,310, 59% female, 83% white) using cross-sectional data from the PROSPER study. Different dimensions of isolation relate to substance use in distinct ways: unliked isolation is associated with lower alcohol use, whereas disengagement and outside orientation are linked to higher use of all three substances. Specifically, disengagement presents risks for cigarette and marijuana use among boys, and outside orientation is associated with cigarette use for girls. Overall, the adolescents disengaged from their school network who also identify close friends outside their grade are at greatest risk for substance use. This study indicates the importance of considering the distinct social positions of isolation to understand risks for both substance use and social isolation in adolescence.

An exploration of the Facebook social networks of smokers and non-smokers

BACKGROUND

Social networks influence health behavior, including tobacco use and cessation. To date, little is known about whether and how the networks of online smokers and non-smokers may differ, or the potential implications of such differences with regards to intervention efforts. Understanding how social networks vary by smoking status could inform public health efforts to accelerate cessation or slow the adoption of tobacco use.

OBJECTIVES

These secondary analyses explore the structure of ego networks of both smokers and non-smokers collected as part of a randomized control trial conducted within Facebook.

METHODS

During the trial, a total of 14,010 individuals installed a Facebook smoking cessation app: 9,042 smokers who were randomized in the trial, an additional 2,881 smokers who did not meet full eligibility criteria, and 2,087 non-smokers. The ego network for all individuals was constructed out to second-degree connections. Four kinds of networks were constructed: friendship, family, photo, and group networks. From these networks we measured edges, isolates, density, mean betweenness, transitivity, and mean closeness. We also measured diameter, clustering, and modularity without ego and isolates. Logistic regressions were performed with smoking status as the response and network metrics as the primary independent variables and demographics and Facebook utilization metrics as covariates.

RESULTS

The four networks had different characteristics, indicated by different multicollinearity issues and by logistic regression output. Among Friendship networks, the odds of smoking were higher in networks with lower betweenness (p = 0.00), lower transitivity (p = 0.00), and larger diameter (p = 0.00). Among Family networks, the odds of smoking were higher in networks with more vertices (p = .01), less transitivity (p = .04), and fewer isolates (p = .01). Among Photo networks, none of the network metrics were predictive of smoking status. Among Group networks, the odds of smoking were higher when diameter was smaller (p = .04). Together, these findings suggested that compared to non-smokers, smokers in this sample had less connected, more dispersed Facebook Friendship networks; larger but more fractured Family networks with fewer isolates; more compact Group networks; and Photo networks that were similar in network structure to those of non-smokers.

CONCLUSIONS

This study illustrates the importance of examining structural differences in online social networks as a critical component for network-based interventions and lays the foundation for future research that examines the ways that social networks differ based on individual health behavior. Interventions that seek to target the behavior of individuals in the context of their social environment would be well served to understand social network structures of participants.

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.

New Zealand adolescents' discouragement of smoking among their peers

OBJECTIVE

This study examines the extent to which young people are acting as 'agents of change' in discouraging smoking among their peers.

METHODS

This study used data from a survey of 2,919 New Zealand secondary school students who participated in the 2014 national Youth In-depth Survey. Relevant questions were used to assess the extent to which students engaged in behaviours to discourage or promote smoking among their peers.

RESULTS

About half of all students reported some form of behaviour discouraging others from smoking, while only one in ten reported encouraging smoking. Discouragement was associated with non-smoking or lower levels of smoking, having more friends who smoked, and exposure to more health promotion messages about not smoking. Māori and Pacific young people also reported more discouraging behaviours.

CONCLUSIONS

The results highlight the positive impact that young people can have on discouraging smoking among their peers. Implications for public health: The findings of this study point to encouraging and training young people as 'agents of change' to spread the smokefree message.

“Just Doing a Favor for a Friend”: The Social Supply of Ecstasy Through Friendship Networks

The current project focused on the “not for profit” supply of illicit drugs within social networks. The aims of the study were to (a) explore the characteristics of social supply of ecstasy and the typical ways in which social dealing occurs, and (b) explore the benefits of social supply as perceived by those who engage in social supply. Overall, the results suggest that social supply of ecstasy occurs in dense, closely knit friendship networks and that mutual supply may be common. Users within friendship networks source ecstasy independently and concurrently supply to members of the group to ensure consistent supply of quality product and to minimize risks of health harms and criminal justice consequences. Social dealing produces little or no financial profit, yet the majority of participants in this study purchased ecstasy in amounts that expose them to significant criminal justice penalties.

Adolescent Social Networks and Alcohol Use: Variability by Gender and Type

BACKGROUND

Scientists have established that social networks influence adolescents' substance use behavior, an influence that varies by gender. However, the role of gender in this mechanism of influence remains poorly understood. Particularly, the role an adolescent's gender, alongside the gender composition of his/her network, plays in facilitating or constraining alcohol use is still unclear.

OBJECTIVES

This study examined the associations among the gender composition of adolescents' networks, select network characteristics, intrapersonal and interpersonal factors, and alcohol use among a sample of adolescents in the United States.

METHODS

We assessed cross-sectional data from a 2010 study of 1,523 high school students from a school district in Los Angeles. Analyses of adolescents' network characteristics were conducted using UCINET 6; and logistic regression analyses testing the associations between gender composition of the network and alcohol use were conducted using SPSS 20.

RESULTS

Our results indicate that the gender composition of adolescents' networks in our sample is associated with alcohol use. Adolescents in predominantly female or predominantly male friendship networks were less likely to report alcohol use compared to adolescents in an equal/balanced network. In addition, depending upon the context/type of network, intrapersonal and interpersonal factors varied in their association with alcohol use. Conclusions/Importance: Based on these findings, we make several recommendations for the future research. We call for researchers to further examine gender as a risk factor for alcohol abuse, particularly within the complex interplay between gender and network contexts.

Relationships Between Social Networks and Mental Health

Abstract. Social networks have an important effect on health, and social network analysis has become essential for understanding human behavior and vulnerability. Using exponential random graph models (ERGM), this study explores the associations between mental health and network structure (or more specifically, mental health homophily) and the association between poor mental health and social isolation. Two classes of Romanian adolescents aged 12–14 years participated in the study (n = 26 in each class). We assessed school network, sociodemographic covariates, and mental health using the Strengths and Difficulties Questionnaire (SDQ). ERGM was first used to test the presence of sex and mental health homophily and then to test whether mental health was a predictor of social isolation. The results showed homophily patterns regarding sex and mental health. Moreover, participants with a higher SDQ score had a lower probability of a tie. Overall, this study showed how social networks are structured with different forms of homophily and that adolescents with poor mental health are more likely to be social isolates. Thus, prevention and interventions should focus on these vulnerable adolescents. Methodological advances like ERGM constitute a promising avenue for further research.

An Appraisal of Social Network Theory and Analysis as Applied to Public Health: Challenges and Opportunities

The use of social network theory and analysis methods as applied to public health has expanded greatly in the past decade, yielding a significant academic literature that spans almost every conceivable health issue. This review identifies several important theoretical challenges that confront the field but also provides opportunities for new research. These challenges include (a) measuring network influences, (b) identifying appropriate influence mechanisms, (c) the impact of social media and computerized communications, (d) the role of networks in evaluating public health interventions, and (e) ethics. Next steps for the field are outlined and the need for funding is emphasized. Recently developed network analysis techniques, technological innovations in communication, and changes in theoretical perspectives to include a focus on social and environmental behavioral influences have created opportunities for new theory and ever broader application of social networks to public health topics.

Smoking and Looked-After Children: A Mixed-Methods Study of Policy, Practice, and Perceptions Relating to Tobacco Use in Residential Units

Despite the implementation of smoke-free policies by local authorities and a statutory requirement to promote the health and well-being of looked-after children and young people in England, rates of tobacco use by this population are substantially higher than in the general youth population. A mixed-methods study, comprising a survey of residential care officers in 15 local authority-operated residential units and semi-structured, face-to-face interviews with residential carers in three local authority-operated residential units, was conducted in the East Midlands. Survey data were descriptively analysed; and interview data were transcribed and analysed using thematic framework analysis. Forty-two care officers (18% response rate) completed the survey, and 14 participated in the interviews. Despite reporting substantial awareness of smoke-free policies, a lack of adherence and enforcement became apparent, and levels of reported training in relation to smoking and smoking cessation were low (21%). Potential problems relating to wider tobacco-related harms, such as exploitative relationships; a reliance on tacit knowledge; and pessimistic attitudes towards LAC quitting smoking, were indicated. The findings highlight the need for the development of comprehensive strategies to promote adherence to and enforcement of local smoke-free policy within residential units for looked-after children and young people, and to ensure appropriate support pathways are in place for this population.

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.

Social Networks and the Diffusion of Adolescent Problem Behavior: Reliable Estimates of Selection and Influence from Sixth Through Ninth Grades

Seeking to reduce problematic peer influence is a prominent theme of programs to prevent adolescent problem behavior. To support the refinement of this aspect of prevention programming, we examined peer influence and selection processes for three problem behaviors (delinquency, alcohol use, and smoking). We assessed not only the overall strengths of these peer processes, but also their consistency versus variability across settings. We used dynamic stochastic actor-based models to analyze five waves of friendship network data across sixth through ninth grades for a large sample of U.S. adolescents. Our sample included two successive grade cohorts of youth in 26 school districts participating in the PROSPER study, yielding 51 longitudinal social networks based on respondents' friendship nominations. For all three self-reported antisocial behaviors, we found evidence of both peer influence and selection processes tied to antisocial behavior. There was little reliable variance in these processes across the networks, suggesting that the statistical imprecision of the peer influence and selection estimates in previous studies likely accounts for inconsistencies in results. Adolescent friendship networks play a strong role in shaping problem behavior, but problem behaviors also inform friendship choices. In addition to preferring friends with similar levels of problem behavior, adolescents tend to choose friends who engage in problem behaviors, thus creating broader diffusion.

How Initial Prevalence Moderates Network-based Smoking Change: Estimating Contextual Effects with Stochastic Actor-based Models

We use an empirically grounded simulation model to examine how initial smoking prevalence moderates the effectiveness of potential interventions designed to change adolescent smoking behavior. Our model investigates the differences that result when manipulating peer influence and smoker popularity as intervention levers. We demonstrate how a simulation-based approach allows us to estimate outcomes that arise (1) when intervention effects could plausibly alter peer influence and/or smoker popularity effects and (2) across a sample of schools that match the range of initial conditions of smoking prevalence in U.S. schools. We show how these different initial conditions combined with the exact same intervention effects can produce substantially different outcomes-for example, effects that produce smoking declines in some settings can actually increase smoking in others. We explore the form and magnitude of these differences. Our model also provides a template to evaluate the potential effects of alternative intervention scenarios.

Social isolation, drunkenness, and cigarette use among adolescents

INTRODUCTION

This study compares isolated to sociable youth to investigate the relations between different network types of social isolation and alcohol and cigarette use.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health we developed a network measure that includes various types of social isolation. Types of social isolation were operationalized as socially avoidant, actively isolated, and socially disinterested, with sociable youth as the reference category. Random effects ordinal logit models were fit to estimate the association between different types of social isolation and drunkenness and cigarette use.

RESULTS

Different types of social isolation had varying effects on drunkenness and cigarette use. On the one hand, socially disinterested youth were at an increased risk for drunkenness and cigarette use. On the other hand, socially avoidant youth had lower odds of drunkenness and no significant differences in cigarette use when compared to sociable youth. Actively isolated youth showed no differences in drunkenness and cigarette use.

CONCLUSIONS

The role played by marginalized social positions in youth substance use is an important yet overlooked problem. This study can contribute to better targeted and more effective health behavior prevention efforts for vulnerable adolescents.

Peer beliefs and smoking in adolescence: a longitudinal social network analysis

BACKGROUND

Peer smoking is one of the strongest predictors of adolescent cigarette use, but less is known about whether other peer characteristics also contribute to this behavior.

OBJECTIVES

This study examined the links between adolescent cigarette use and peer beliefs about smoking. It tested whether peer beliefs about smoking are associated with changes in cigarette use, whether this association is a result of changes in individual beliefs about smoking, and how beliefs inform friendship choices.

METHODS

Analyses drew on data collected from 29 school-based networks, each measured at five occasions as students moved from 6th through 9th grade, as part of the study of the PROSPER partnership model. Longitudinal social network models provided estimates of friendship selection and behavior for an average of 6,200 students at each measurement point and more than 9,000 students overall.

RESULTS

Peer beliefs about smoking influenced cigarette use both directly and through their impact on individual beliefs. Respondents tended to name friends whose beliefs about smoking were similar to their own, and the likelihood of being named as a friend was higher for those who reported more positive beliefs about smoking.

CONCLUSION

The results from this study suggest that peer beliefs about smoking, in addition to peer cigarette use itself, are associated with adolescent smoking through several mechanisms. Because beliefs favorable to cigarette use are present before adolescents actually smoke, these results underscore the importance of implementing smoking prevention programs in early adolescence.

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.

Psychosocial Determinants of Intention to Use Tobacco Among Adolescents in India

Aim

The present study aims to determine the psychosocial factors associated with ‘intention to use tobacco’, because it is influenced by social norms and beliefs about smoking.

Method

A cross-sectional survey on a random sample of 665 individuals, aged 15-20 years, was conducted using a pretested questionnaire. Three logistic regression models were constructed to identify determinants of ‘intention to use tobacco’, with the total sample, with respondents under 18 years old, and with respondents 18 years old and above.

Results

Odds of intention to use tobacco were higher when friends used tobacco products, and perceived no negative effects on health. Parental use of tobacco increased the odds of intention to use tobacco, and a similar effect was observed when a celebrity was followed as a role model. Approval of occasional use of tobacco increased the odds of intention to use tobacco. Communication with parents about harmful effects of tobacco reduced the odds of intention to smoke among respondents younger than 18 years old.

Conclusion

Social factors and perception of risk significantly influenced the intention to use tobacco. Study results are useful in designing interventions for prevention of tobacco use among adolescents.