Title: Using social network analysis to understand the role of school-based social diffusion processes in smoking initiation among adolescents in contemporary Western society
Funder: Cancer Research UK

Abstract: Background: One billion tobacco-related deaths are predicted to occur worldwide this century, many of which are cancer-related. Tobacco use is typically initiated in adolescence before persisting into adulthood, with schools providing a primary focal point for prevention efforts. In contemporary UK society, anti-smoking norms have become increasingly prevalent among adolescents since the early 2000s. However, whilst the overall prevalence of smoking has decreased, inequalities have increased with students from poorer families, schools and areas remaining more likely to take up smoking. To date, research has demonstrated the utility of social network analysis in understanding peer influence on smoking. Despite this, current understandings of social diffusion within schools have largely framed social diffusion processes as universal across schools, neglecting to differentiate by socioeconomic composition. Thus, a multi-level analytical method has been advocated for. Aims: To test the influence of social diffusion processes on adolescent smoking uptake in contemporary UK society, with a focus on how these processes differ according to school-level socioeconomic contexts and smoking norms. Methods: This fellowship project will comprise 4 interlinked stages. Stage1: Mixed methods systematic review to produce a generalised model of causation for the role of school-based social diffusion processes for adolescent smoking, with a focus on how these vary over time and by socioeconomic status. Stage 2: Multiple Membership, Multiple Classification social network analysis to understand whether any relationship between network structure and smoking prevalence can be partially explained by school and area-level effects. Year 10 students will be recruited within 20 schools. The network survey will measure friendship, smoking and e-cigarette behaviour and socioeconomic status. Stage 3: Qualitative interviews to investigate adolescents’ perceptions of how student interactions may lead to differing social diffusion processes for smoking within and between schools. Visualisations of each schools’ social network from stage 2, will be used as visual elicitation. Ten Year 11 students from 6 case study schools will be recruited on the basis of maximal variation. Stage 4: Quantitative and qualitative data will be integrated using a cross-case analysis to develop several logic models to represent processes of social diffusion of smoking within different school contexts. How the results of this research will be used: The results of this research will inform recommendations for peer-led adolescent smoking interventions, policy and practice. They will also inform the development of a school-based intervention which will form the basis of a grant application to submit to CRUK’s Population Research Committee.

Lay abstract: Background: One billion tobacco-related deaths are predicted to occur worldwide this century, many of which are cancer-related. Tobacco use is typically initiated in adolescence before persisting into adulthood, with schools providing a primary focal point for prevention efforts. In contemporary UK society, anti-smoking norms have become increasingly prevalent among adolescents since the early 2000s. However, whilst the overall prevalence of smoking has decreased, inequalities have increased with students from poorer families, schools and areas remaining more likely to take up smoking. To date, research has demonstrated the utility of social network analysis in understanding peer influence on smoking. Despite this, current understandings of social diffusion within schools have largely framed social diffusion processes as universal across schools, neglecting to differentiate by socioeconomic composition. Thus, a multi-level analytical method has been advocated for. Aims: To test the influence of social diffusion processes on adolescent smoking uptake in contemporary UK society, with a focus on how these processes differ according to school-level socioeconomic contexts and smoking norms. Methods: This fellowship project will comprise 4 interlinked stages. Stage1: Mixed methods systematic review to produce a generalised model of causation for the role of school-based social diffusion processes for adolescent smoking, with a focus on how these vary over time and by socioeconomic status. Stage 2: Multiple Membership, Multiple Classification social network analysis to understand whether any relationship between network structure and smoking prevalence can be partially explained by school and area-level effects. Year 10 students will be recruited within 20 schools. The network survey will measure friendship, smoking and e-cigarette behaviour and socioeconomic status. Stage 3: Qualitative interviews to investigate adolescents’ perceptions of how student interactions may lead to differing social diffusion processes for smoking within and between schools. Visualisations of each schools’ social network from stage 2, will be used as visual elicitation. Ten Year 11 students from 6 case study schools will be recruited on the basis of maximal variation. Stage 4: Quantitative and qualitative data will be integrated using a cross-case analysis to develop several logic models to represent processes of social diffusion of smoking within different school contexts. How the results of this research will be used: The results of this research will inform recommendations for peer-led adolescent smoking interventions, policy and practice. They will also inform the development of a school-based intervention which will form the basis of a grant application to submit to CRUK’s Population Research Committee.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE