Future Opinion Leaders of America Future Opinion Leaders of America? The Influence of Popularity on Smoking Behavior in Middle Schools Public Health 259

Article Summary Smoking behaviors formed in adolescence Adolescents subject to peer influence Popular kids and opinion leaders may have more peer influence and influence smoking Measured effect of popularity on smoking among 1486 middle school kids in LA County Surveys: baseline and at 1 year follow-up Found significant increase smoking and susceptibility associated with popularity (OR 5.09 and 5.64, respectively) Kids with fewer friends also more likely to smoke

Introduction 80-90% of adult smokers start before age 18 Opinion leaders: initiate widespread change Are popular kids opinion leaders? Popular kids conform to norms Is this actually true? Depends on community’s smoking norms Isolates Race and gender Influence of best friends vs. boyfriends/girlfriends Discuss: what are opinion leaders? How are norms part of the equation (opinion leaders in a way anticipate likely norms and spread them) While smoking norms may vary across communities, this study used only schools with high smoking prevalence, so weren’t able to measure whether popular kids smoke less when the norm is less smoking

Research Questions Is popularity associated with smoking behavior? Do race and gender influence the relationship? Are isolates more likely to smoke or become susceptible to smoking? Discuss: how do race/gender influence; boys more influenced by best friends? Why isolates might be more likely to smoke……marginalized/outside interests? Lead into how would isolates be defined (can measure it by # friends, but what’s the cut-off? 1 friend or fewer?)

Hypotheses Stance on 1st and 3rd questions not very clear Acknowledge controversy in literature over popular kids vs. isolates and smoking May not have to mutually exclusive Theorize that gender and race likely contributors Relationships usually matched gender/race at this age Smoking also thought to vary by race and gender

Measures Smoking: Susceptibility to smoking: Popularity: Taking a puff or finishing a cigarette Susceptibility to smoking: Refusing to commit not to smoke in future Popularity: # kids naming the index as a friend # kids naming the index as a leader Is popularity the same as having many friends? Are popular kids always leaders? Are they really measuring opinion leaders? Is it important to know if the smoking becomes a habit or just if one cigarette is tried? Can’t differentiate with this measure Maybe popular kids don’t uphold norms…….more likely to smoke/drink/etc regardless of norms?

Methods 1486 sixth and seventh graders in LA County Nested within smoking intervention study Only used intervention schools (not controls) Surveys Baseline survey: demographics, smoking behavior Social network survey: 5 closest friends 5 best leaders in class 1 year follow-up survey: smoking behavior Discussion: why “5 closest friends” may not be the best measure of popularity….measure of # contacts? Best leaders good measure of opinion leaders

Methods Multivariate logistic regression Clustered by school Independent variable: popularity (by # kids choosing them as a friend) Control variables: age, gender, race, college-educated parent, foreign-born parent, parent who smokes, expectations for high academic performance, number of rooms in house Dependent variables: Smoking (puff or full cigarette) Susceptibility to smoking (refusing to commit to not smoking in future) Clustering is to control for intra-school variability; # rooms is substitute for household income, but some of these variables not well explained

Results Popularity associated with increased susceptibility to smoking: OR=5.64, p<0.001 And to smoking: OR=5.09, p<0.05 Association was not stronger in schools with higher smoking prevalence No significant interaction between popularity and gender or race Association between smoking and naming fewer friends in the social network survey This may explain the increased smoking seen with isolates Do they have more influences outside of school? But no good measure of isolates!!

Limitations Surveys: social desirability bias Sample limited to Los Angeles Schools with high numbers of Latinos/Hispanics and Asian Americans Known to have higher smoking prevalence Weren’t able to show that popular kids smoke more at schools with higher prevalence May be because all schools have high prevalence