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

2. 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

3. 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

4. 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?)

5. 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

6. 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?

7. 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

8. 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

9. 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!!

10. 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