Peer effects of health behaviors and the moderating role of Internet use among middle-aged and older adults: a nationally representative cross-sectional survey in China.

Objective: This study investigates peer effects on the health behaviors of middle-aged and older adult people in China and examines the moderating role of Internet use. Methods: A total of 16,188 respondents were selected from the China Health and Retirement Longitudinal Study (CHARLS) 2020 data set. Ordinary Least Squares and Quantile Regression were used to validate the peer effect of health behaviors on middle-aged and older adults, and a moderating effects model was used to test the moderating roles of Internet use and Internet proficiency. Finally, the peer effect was analyzed for heterogeneity according to Internet use preferences. Results: The peer effect had a positive influence on the individual health behaviors of middle-aged and older adult people in China (ß = 0.5341, p < 0.001). Middle-aged and older adult people were more sensitive to the average health behavior level of the community when they lived in rural communities and/or had a low level of education. Internet use positively moderated the health behavior peer effect in the older adult population (ß = 0.0094, p < 0.1), and Internet proficiency negatively moderated the peer effect of the health behaviors of the middle-aged population (ß = 0.1589, p < 0.1). According to the magnitude of the influence of peer effect, the Internet preference type can be ranked from social and entertainment (ß = 0.6250, p < 0.01), to cultural and entertainment (ß = 0.5835, p < 0.01), to comprehensive (ß = 0.4622, p < 0.01). Conclusion: There is a peer effect on the health behaviors of middle-aged and old-aged individuals, in which Internet use plays a moderating role. The construction of healthy communities should be promoted, giving full play to the community's active role in health promotion. Attention should be paid to the health-enabling function of the Internet, encouraging middle-aged and older adult people to use the Internet actively, moderately, and diversely, and making full use of the advantages of short videos for online health education.

Bullying and oral health in Egyptian adolescents: the moderating role of sense of coherence and resistance to peer influence.

BACKGROUND: Bullying is the intentional, repeated and prolonged aggressive behavior towards victim(s) who feel powerless to defend themselves. It could influence adolescents' mental health. Some adolescents possess coping skills which enable them to overcome such adversities. The present study assessed the association between bullying, sense of coherence (SOC), resistance to peer influence (RPI) and oral health in Egyptian adolescents. MATERIALS AND METHODS: A cross-sectional survey that included 12-16 year old adolescents attending 6 schools in Damanhour, Egypt was conducted from March to December 2023. Data were collected through clinical examination and self-administered questionnaires. Clinical examination assessed dental caries (DMFT), oral hygiene (plaque index) and gingival condition (gingival index). Toothbrushing frequency and sugar consumption were assessed by (World Health Organization-child form), bullying (Revised Olweus Bully Victim Questionnaire), SOC (Sense of Coherence Scale-Short Form) and RPI (Resistance to Peer Influence Questionnaire). The independent variables were bullying, SOC and RPI. The dependent variables were untreated caries, gingival inflammation and toothbrushing frequency. Multivariable multilevel regression assessed the relationship between the independent and dependent variables after adjusting for potential confounders. Adjusted regression coefficients (B), adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. Effect modifications by SOC and RPI were evaluated. RESULTS: The response rate was 95.25% (N = 602), mean (SD) age was 14.01 (1.15). Half of the students (49.83%) were girls. About 42% had untreated caries, only 15.78% brushed their teeth twice daily and the mean (SD) gingival index was 1.57 (0.40). About 25% were victims, (9.30%) bullies and (18.60%) bully-victims. Victims showed significantly lower odds of twice daily toothbrushing (AOR = 0.52, p = 0.04). Bullies and bully-victims showed non-significantly higher odds of untreated caries (AOR = 1.42, p = 0.25), (AOR = 1.21, p = 0.42), respectively. Bullying was not associated with gingival inflammation. Higher SOC and RPI mitigated the impact of bullying on untreated caries and toothbrushing frequency. CONCLUSION: Bullying was associated with higher odds of untreated caries and lower odds of twice daily toothbrushing in Egyptian adolescents. Higher SOC and RPI alleviated this relationship, highlighting the importance of individual coping strategies to oral health.

Peer influence on eating behaviour in early childhood: A scoping review.

OBJECTIVE: Peers can significantly influence eating behaviours in school-aged children and adolescents. Studies vary in methodology and terminology and report inconsistent age and sex differences. No review has collated evidence within early childhood. This review aims to explore what is currently known about peer influence and eating behaviours in young children and identify knowledge gaps regarding commonly assessed eating behaviours, peer definitions, peer influence assessment methods, and theoretical frameworks. METHODS: A search of electronic databases (Embase, ERIC, Medline, APA PsycInfo, Scopus) was conducted. The review included peer-reviewed, primary research that explored peer influence on eating behaviour in any group context, published between 1980 and 2023, available in English full-text. Participants were aged between two and seven years. Primary and secondary screening were conducted by two authors. Data extraction was conducted by one author with a second author duplicating 25%. RESULTS: Twenty-six of the 3961 unique identified studies met inclusion criteria. Most studies (76%) report peers to influence eating behaviours. Peer influence was a primary aim in 18 studies, of which 17 were experimental, and peer influence emerged as a finding in seven studies. All phenomena of interest varied widely. Eating behaviour concept definitions were inconsistent, with four studies assessing hypothetical eating behaviours. Peers varied by age, familiarity, and in-person versus remote exposures. Six theoretical frameworks were referenced, and eleven studies lacked theoretical underpinning. No studies measured peer influence directly or obtained children's perspectives. CONCLUSIONS: Peers may influence eating behaviours within early childhood. Peer familiarity and age potentially impact peer influence magnitude. Variations in study design and peer definitions make comparisons challenging. Future research should utilise observational designs to explore peer influence on child eating behaviours within naturalistic settings.

Cultural Values Influence the Developmental Trajectory of Resistance to Social Influence Over the Course of Adolescence.

The opinions of peers are among the most potent factors influencing human decision-making. Research conducted in Western societies suggests that individuals become more resistant to peer influence from late adolescence to adulthood. It is unknown whether this developmental trajectory is universal across cultures. Through two cross-national studies, we present consistent self-report and behavioral evidence for culturally distinct developmental trajectories of resistance to peer influence (RPI). Our findings from the US samples replicated prior findings that reported increasing RPI. Yet, data from the Chinese participants were better fitted using a nonlinear model, displaying a U-shaped trajectory with lowest RPI levels at around 20 years old. In contrast to the long-held belief that increasing RPI from adolescence to early adulthood is a universal developmental trait, we propose that this developmental trajectory may depend on cultural context.

My friends made me do it: Peer influences and different types of vaping in adolescence.

Vaping is one of the most common forms of substance use among adolescents. Social influences play a key role in the decision to use substances and frequency of use during adolescence, and vaping is no exception. Using a sample of 891 adolescents across two time points (Mage = 15.1 and Mage = 17.2) in this pre-registered study, we explored whether the frequency of vaping nicotine and the frequency of vaping marijuana at age 17 were related to concurrent reports of resistance to peer influence (RPI), perceptions of friends vaping, and perceptions of classmates vaping. Then, we investigated whether resistance to peer influence reported at age 15 was similarly related to age 17 vaping of both substances. Higher RPI at both ages 15 and 17 was associated with a higher probability of abstaining from vaping both substances but was not related to the frequency of vaping among those who vaped. Perceiving that a higher proportion of friends - but not classmates - vaped was associated with a lower probability of abstaining and a greater frequency of vaping among those who vape (for both substances). Higher RPI had an attenuating effect on the relation between perceptions of vaping among peers and an adolescent's own vaping behavior, but that differed by age and peer group (e.g., friends vs. classmates). Overestimation about the prevalence of classmate vaping may have played a role in the findings, but our results suggest that interventions to strengthen peer resistance across adolescence are warranted.

Peer Influence on Motivation to Use Pre-Exposure Prophylaxis Among Latino Sexual Minority Men in Miami, Florida: A Network Autocorrelation Model.

Despite the availability of pre-exposure prophylaxis (PrEP), Latino sexual minority men (LSMM) continue to experience disparities in PrEP uptake and subsequently, HIV vulnerability. Social network norms are an underutilized solution to increase PrEP uptake. We used a peer influence model (network autocorrelation model) to examine the role of social network descriptive norms (i.e., actual behaviors) surrounding PrEP use. A total of 11 sociocentric networks of 13 friends (n = 143 LSMM) were recruited into our study from 2018 to 2019 in South Florida. Most participants were in PrEP pre-contemplation (n = 44), and almost one-third of our sample were using PrEP (n = 38). Three network autocorrelation models were estimated using an empirically informed Bayesian analysis. We found a positive association between participants' Motivational PrEP Cascade (MPC) position and their network members' (friends') cascade position based on three different measures of connection even when accounting for PrEP knowledge: friendship (ρ = 0.22; 95% CIa = 0.01-0.42), emotional closeness (ρ = 0.24; 95% CI = 0.03-0.44), and frequency of interaction (ρ = 0.22; CI = 0.03-0.42). Our findings highlight that an individual's progress in the MPC may be influenced by their network members' progress in the MPC, suggesting that LSMM using PrEP may serve as role models to their peers for PrEP use due to descriptive norms. Our findings further suggest that PrEP interventions for LSMM along the MPC can be implemented at the social network level.

Applying Social Network Theory to Vaping in High School: Implications for Person-Centered Intervention.

BACKGROUND: Peer influence on risky behavior is particularly potent in adolescence and varies by gender. Smoking prevention programs focused on peer-group leaders have shown great promise, and a social influence model has proven effective in understanding adult smoking networks but has not been applied to adolescent vaping until 2023. This work aims to apply a social influence model to analyze vaping by gender in a high school network. METHODS: A high school's student body was emailed an online survey asking for gender, age, grade level, vape status, and the names of three friends. Custom Java and MATLAB scripts were written to create a directed graph, compute centrality measures, and perform Fisher's exact tests to compare centrality measures by demographic variables and vape status. RESULTS: Of 192 students in the school, 102 students responded. Students who vape were in closer-knit friend groups than students who do not vape (p < .05). Compared to males who vape, females who vape had more social ties to other students who vape, exhibiting greater homophily (p < .01). Compared to females who do not vape, females who vape were in closer-knit friend groups (p < .05) and had more ties to other students who vape (p < .01). CONCLUSION: Differences in vaping by social connectedness and gender necessitate school and state policies incorporating the social aspect of vaping in public health initiatives. Large-scale research should determine if trends can be generalized across student bodies, and more granular studies should investigate differences in motivations and social influence by demographic variables to individualize cessation strategies.

Exploiting relationship directionality to enhance statistical modeling of peer-influence across social networks.

Risky-prescribing is the excessive or inappropriate prescription of drugs that singly or in combination pose significant risks of adverse health outcomes. In the United States, prescribing of opioids and other "risky" drugs is a national public health concern. We use a novel data framework-a directed network connecting physicians who encounter the same patients in a sequence of visits-to investigate if risky-prescribing diffuses across physicians through a process of peer-influence. Using a shared-patient network of 10 661 Ohio-based physicians constructed from Medicare claims data over 2014-2015, we extract information on the order in which patients encountered physicians to derive a directed patient-sharing network. This enables the novel decomposition of peer-effects of a medical practice such as risky-prescribing into directional (outbound and inbound) and bidirectional (mutual) relationship components. Using this framework, we develop models of peer-effects for contagion in risky-prescribing behavior as well as spillover effects. The latter is measured in terms of adverse health events suspected to be related to risky-prescribing in patients of peer-physicians. Estimated peer-effects were strongest when the patient-sharing relationship was mutual as opposed to directional. Using simulations we confirmed that our modeling and estimation strategies allows simultaneous estimation of each type of peer-effect (mutual and directional) with accuracy and precision. We also show that failing to account for these distinct mechanisms (a form of model mis-specification) produces misleading results, demonstrating the importance of retaining directional information in the construction of physician shared-patient networks. These findings suggest network-based interventions for reducing risky-prescribing.

The Social Processes of Excessive Online Gaming Homophily: Peer Selection or Influence?

Adolescents who befriend online game using peers may be at risk for initiated and continued excessive game use (online gaming use homophily). The present article examined how adolescents' severity of online gaming use related to their friends' online gaming behavior bi-directionally across a semester (peer selection or peer influence effect). Students from two universities completed three waves of online surveys within four and a half months (N = 3079; 33.6% female; Mage = 19.16; SD = 0.97). Random-intercepts, Cross-Lagged Panel Model (RI-CLPM) analyses revealed that peer selection and peer influence both promote online gaming use homophily in adolescents' friendship groups. Furthermore, participants were more likely to form new friendships with peers exhibiting similar online gaming behavior as their behavior, subsequently reinforcing their online gaming use behaviors within these relationships. These social processes may exhibit a time lag among girls, which needs to be confirmed through longer-term follow-up. In general, findings suggest that effective prevention programs targeting excessive online gaming should not only focus on promoting social influence skills but also consider the structure of peer environments.

Expanding understanding of adolescent neural sensitivity to peers: Using social information processing theory to generate new lines of research.

Adolescence is a period of normative heightened sensitivity to peer influence. Individual differences in susceptibility to peers is related to individual differences in neural sensitivity, particularly in brain regions that support an increasingly greater orientation toward peers. Despite these empirically-established patterns, the more specific psychosocial and socio-cognitive factors associated with individual differences in neural sensitivity to peer influence are just beginning to gain research attention. Specific features of the factors that contribute to how adolescents process social information can inform understanding of the psychological and neurobiological processes involved in what renders adolescents to be more or less susceptible to peer influences. In this paper, we (1) review the literature about peer, family, and broader contextual influences on sensitivity to peers' positive and negative behaviors, (2) outline components of social information processing theories, and (3) discuss features of these models from the perspectives and social cognitive development and social neuroscience. We identify gaps in the current literature that need to be addressed in order to gain a more comprehensive view of adolescent neural sensitivity to peer influence. We conclude by suggesting how future neuroimaging studies can adopt components of this social information processing model to generate new lines of research.

Social influence in adolescence: Behavioral and neural responses to peer and expert opinion.

Social influence plays a crucial role during the teen years, with adolescents supposedly exhibiting heightened sensitivity to their peers. In this study, we examine how social influence from different sources, particularly those with varying normative and informational significance, affect adolescents' opinion change. Furthermore, we investigated the underlying neural dynamics to determine whether these two behaviorally similar influences share their neural mechanisms. Twenty-three participants (14-17 years old) gave their opinions about facial stimuli and received feedback from either a peer group or an expert group, while brain responses were recorded using concurrent magnetoencephalography. In a second rating session, we found that participants' opinions changed in line with conflicting feedback, but only when the feedback was lower than their initial evaluation. On the neural level, conflict with peers evoked stronger neural responses than conflict with experts in the 230-400 ms time window and the right frontotemporal magnetometer channels. Nevertheless, there was no greater conformity toward peers. Moreover, conflict compared to no conflict decreased neural oscillations in the beta frequency range (20-26 Hz) at the right frontal and parietal channels. Taken together, our findings do not support the general assumption that adolescent behavior is excessively vulnerable to peer norms, although we found heightened neural sensitivity to peer feedback.

Influence of perceived peer behavior on engagement in self-damaging behaviors during the transition to university.

As students transition to university, they experience significant social changes that can affect their behaviors, including self-damaging behaviors like disordered eating, problematic alcohol/drug use, suicidal thoughts, and non-suicidal self-injury (NSSI). Building on prior work, we examined the associations between (1) perceptions of peers' engagement in self-damaging behaviors predicting one's own subsequent engagement in such behaviors (i.e., socialization) and (2) one's own engagement in self-damaging behaviors predicting perceptions of peers' subsequent engagement in such behaviors (i.e., selection). We also examined whether these associations were moderated by the source of influence (close peer/acquaintance) and degree of social disconnection experienced by the student. First-year university students (N = 704) were asked to complete seven monthly surveys. Multilevel models indicated that when students perceived their close peers had engaged in NSSI or suicidal thinking, they had seven times greater odds of future engagement in the same behavior, implying that socialization increases the risk of these behaviors among university students. Perception of acquaintances' NSSI also predicted greater odds of a student's own NSSI the following month. Social disconnection increased the likelihood of matching own behaviors to perceptions of acquaintances' alcohol abuse, highlighting the importance of fostering connections/mentors to reduce self-damaging behaviors on college campuses. Furthermore, when students engaged in alcohol abuse, they had almost four times greater odds of reporting that their acquaintances abused alcohol the following month, emphasizing the importance of the wider social network in alcohol use behaviors.

Peer effects in weight-related behaviours of young people: A systematic literature review.

Individual preferences and beliefs are perpetually shaped by environmental influences, with peers playing a key role in this dynamic process. Compelling evidence from qualitative and quantitative studies has highlighted the significant impact of peer influence on health-related decisions. This systematic literature review critically synthesises findings from 45 studies published between 2011 and 2022, providing a comprehensive understanding of the nature of peer effects on dietary, physical activity and sleep behaviours during youth. The majority of studies indicated that social norms drive directional changes in eating and physical activity. Yet, our analysis revealed a notable gap in exploring alternative mechanisms, including social comparison and social identity, despite their potential relevance. Studies, generally classified as moderate to high quality, predominantly relied on self-reported data, potentially affecting the validity and reliability of measures. Meta-regression analyses suggest a small, but significant association of sample size with the magnitude, sign and significance of the reported peer effects. Moreover, studies focusing on physical activity are more likely to report significant outcomes, whereas findings on peer influence on sleep-related studies tend to reveal less pronounced effects, compared to studies on dietary behaviours. Experimental designs do not appear to increase the likelihood of finding significant effects when compared to other study designs. In conclusion, this synthesis emphasises the need for further research into the underlying mechanisms on peer effects to better inform policy-makers in designing effective policies for improving weight-related behaviours in young people.

Promote to protect: data-driven computational model of peer influence for vaccine perception.

Vaccine hesitancy and acceptance, driven by social influence, is usually explored by most researchers using exhaustive survey-based studies, which investigate public preferences, fundamental values, beliefs, barriers, and drivers through closed or open-ended questionnaires. Commonly used simple statistical tools do not do justice to the richness of this data. Considering the gradual development of vaccine acceptance in a society driven by multiple local/global factors as a compartmental contagion process, we propose a novel methodology where drivers and barriers of these dynamics are detected from survey participants' responses, instead of heuristic arguments. Applying rigorous natural language processing analysis to the survey responses of participants from India, who are from various socio-demographics, education, and perceptions, we identify and categorize the most important factors as well as interactions among people of different perspectives on COVID-19 vaccines. With a goal to achieve improvement in vaccine perception, we also analyze the resultant behavioral transitions through platforms of unsupervised machine learning and natural language processing to derive a compartmental contagion model from the data. Analysis of the model shows that positive peer influence plays a very important role and causes a bifurcation in the system that reflects threshold-sensitive dynamics.

Investigating psychological distress and peer influence in the longitudinal path linking food insecurity to adolescent substance use: a nationwide low-income cohort study.

Food insecurity (FI), defined as the limited or uncertain availability of nutritionally adequate and safe foods, remains a major life concern among many poor subpopulations. Few investigations have been made into the mechanism underlying its impact on adolescent substance use. This study aimed to examine the longitudinal relationship between FI and cigarette and alcohol use among economically disadvantaged adolescents and then explore the role of psychological distress and peer substance use in the aforementioned association. Data of 1,243 adolescents (Mage = 13.3 years; 645 males) were obtained from a nationwide cohort study on Taiwanese adolescents from low-income families. Multiple hierarchical regression analyses based on generalized linear mixed-effects models with binomial distribution found that FI was consistently associated with cigarette smoking (ß = 0.458, p < 0.001) but not alcohol drinking (ß = 0.142, p = 0.143) when both psychological distress and peer substance use were adjusted. In the moderated mediation analysis based on bootstrap methods, we observed that psychological distress mediated the association between food insecurity and alcohol drinking (ß = 0.036, 95% CI = 0.015-0.063) but not cigarette smoking (ß = 0.018, 95% CI =-0.001-0.037). Furthermore, the indirect effects varied by peer drinking status (index of moderated mediation = 0.04, 95% CI 0.015-0.072). Clinical and public health attention should be given to evaluating food-insecure adolescents' psychological well-being and peer influence when counseling their substance use issues.

Peer Pressure and Risk-Taking Behaviors Among Adolescent Girls in a Region Impacted by HIV/AIDS in Southwestern Uganda.

PURPOSE: This paper uses data from a 3-arm Cluster Randomized Control Trial, Suubi4Her (N = 1260; 14-17-year-old school-going girls) to (1) assess the relationship between peer pressure and adolescent risk-taking behaviors; and (2) test the mediating effect of peer pressure on an intervention on adolescent risk-taking behaviors. METHODS: Students in the southwestern region of Uganda were assigned to three study arms: control (n = 16 schools, n = 408 students) receiving usual care comprising of sexual and reproductive health curriculum; and two active treatment arms: Treatment 1 (n = 16 schools, n = 471 students) received everything the control arm received plus a savings led intervention. Treatment 2 (n = 15 schools, n = 381 students) received everything the control and treatment arms received plus a family strengthening intervention. We used multilevel models to assess the relationship between peer pressure and risk-taking behaviors. We ran structural equation models for mediation analysis. RESULTS: Using baseline data, we found that direct peer pressure was significantly associated with substance use risk behaviors, (ß = 0.044, 95% CI = 0.008, 0.079). We also found a statistically significant effect of the intervention on acquiring STIs through the mediating effect of sexual risk-taking significant (ß = -0.025, 95% CI: -0.049, -0.001, p = .045) and total indirect (ß = -0.042, 95% CI: -0.081, -0.002, p = .037) effects. Also, there was a significant mediation effect of the intervention on substance use through peer pressure (ß = -0.030, 95% CI: -0.057, -0.002, p = .033). DISCUSSION: Overall, the study points to the role of peer pressure on adolescent girls' risk-taking behaviors; and a need to address peer pressure at an early stage.

Health-risk behaviors and peer pressure of adolescents in the child protective services in Türkiye: A cross-sectional study.

PROBLEM: This study was carried out to investigate the health-risk behaviors and peer pressure of adolescents aged 12-18 years in need of protection at child protective services. METHODS: The data of this cross-sectional study were collected using individual interviews with 85 adolescents living in child homes and child homes buildings complex between February 25 and May 31, 2019. The data were collected using the "Descriptive Information Form," the "Health-Risk Behaviors Questionnaire," and the "Peer Pressure Questionnaire." FINDINGS: The results of study in adolescents were 34.1% were in the risk group in terms of weight, and 41.2% had a psychiatric problem. Among the health-risk behaviors of adolescents; 56.5% did not pay attention to daily nutrition, 51.8% had fast food every day, 54.1% injury behaviors were doing dangerous sports, only 15.3% wore seat belts, 78.8% did not exercise three or more days per week, 38.8% watched television and computer three or more hours per day, 27.1% used painkillers without consulting a doctor, 24.7% applied the health recommendations they read on the internet, 20.0% of the adolescents reported that they went on a diet without consulting the healthcare personnel, and 14.1% voluntary vomited to lose or maintain their weight. And 21.2% of the adolescents were exposed to peer pressure. CONCLUSIONS: It was concluded that adolescents in need of protection at child protective services have health-risk behaviors and low-level peer pressure.

Shaping Citizenship in the Classroom: Peer Influences on Moral Disengagement, Social Goals, and a Sense of Peer Community.

Despite the important role of peers in the social process of classroom citizenship, the peer influence related to moral disengagement, social goals, and a sense of peer community remain unclear. To this end, it was examined to what extent youth become similar to their friends in moral disengagement, social goals, and a sense of peer community. Participants were 283 South Korean third to sixth graders (Mage = 9.60 years, SD = 0.97; 51.6% girls) who completed an online survey for moral disengagement, social goals, the sense of peer community and friendship network across the beginning (Time 1) and end (Time 2) of the school semester (September to December). Longitudinal social network analyses indicated that youth became more similar to their friends concerning moral disengagement and a sense of peer community, but did not select friends based on these aspects. The strength of these influence effects varied in terms of different levels of these aspects. Specifically, youth were more likely to become similar to their friends at lower levels of moral disengagement. Youth tended to be similar to the friends' level of sense of peer community. This tendency was relatively strong at the lowest and the highest levels of a sense of peer community. Future research should address the role of friendship in shaping classroom citizenship and the importance of classroom daily teaching practice in youth citizenship development.