Network Dynamics of Social Influence on E-cigarette Use Among an Ethnically Diverse Adolescent Cohort.

Introduction: The objective of this study was to examine the mechanisms of social influence driving e-cigarette use in adolescent social networks and differentiate between the effects of exposure to friend behavior and social norms on individual use.

Aims and methods: Surveys on health behaviors and friendship networks from nine high schools in Southern California (N = 2245; 48% Hispanic) were collected at three time points from Spring 2021 of grade 9, Fall 2021, and Spring 2022 of grade 10. Stochastic actor-oriented models for the co-evolution of social networks and behavior dynamics tested for friendship network social influences on e-cigarette use. Two mechanisms of social influence were estimated, exposure to friend behavior (e-cigarette use among friends) and pro-e-cigarette social norms (perceived peer approval and use of e-cigarettes), while controlling for social selection, individual covariates, and endogenous network effects. Results from the nine schools were combined in a meta-analysis.

Results: Findings revealed social influence effects through exposure to friend e-cigarette use and pro-e-cigarette social norms, which both had significant positive influences on individual e-cigarette initiation over time. Furthermore, Hispanic/Latine individuals and females were more likely to initiate e-cigarette use compared to males and non-Hispanic/Latine students.

Conclusions: The importance of these effects should be considered in tobacco prevention initiatives. Designing culturally tailored interventions that target youth social networks and e-cigarette social norms could be effective at curtailing adolescent use. Changing perceptions and social acceptability of e-cigarettes could be one way to slow or prevent the spread of e-cigarette use in adolescent networks.

Implications: These findings demonstrate the role of social influence on adolescent e-cigarette use through two mechanisms, both friend behavior and social norms. A shift in prevention strategies toward addressing social dynamics and social norms rather than focusing solely on individual-level factors may be effective in curtailing use. Changing social perceptions and reducing the social acceptability of e-cigarette use may help slow the spread in adolescent networks.