Adolescent Social Influences and Smoking: A new framework through the lens of Social Media

Smoking behavior is one of the major public health threats faced by the world today. Adolescent smoking is of particular concern due to its addictive nature, and often acts as the gateway drug to future problem behaviors. Social influence has historically been recognized as a significant factor in the adolescent's decision-making process. Many behavioral research theories incorporate aspects of social influences, and use its constructs to guide health promotion interventions. The recent boom in social media outlets, however, has transformed traditional communication patterns and information exchange, as well as the dimensions of social influence. Examples include mobile phones and social network sites via the Internet that accelerate the transmission of information and adoption of new ideas or behaviors. Adolescents are one of the major consumers of these new technologies, which further support the use of new media to reach adolescents for smoking prevention and cessation interventions. Though there have been a surge in studies that have shown moderate success in using social media as an intervention tool, few are based on a sound theoretical foundation and even fewer address how and why they were effective. To address this research gap, we aim to 1) provide a theoretical overview of potential mechanisms by which social media influences may occur; 2) review the existing empirical studies in smoking prevention or cessation delivered through social media channels; and 3) propose a new theoretical framework to guide future studies using social media for adolescent health promotion interventions.