A Smokers' Social Network Typology: Development and Prediction of Smoking Cessation Outcomes

Smoking remains the leading preventable cause of death in the United States. An increasing body of literature has highlighted the role that social relationships play in our health (Cohen, 2004). In particular, a wide range of health behaviors such as tobacco use are developed and reinforced in the context of a person’s social network, and social influence has been found to be an important factor in determining a person’s ability to quit smoking (Christakis & Fowler, 2008). However, little research has been devoted to defining the social network and social support systems of smokers who have successfully quit and maintained abstinence from smoking. Although a few studies have examined single characteristics of an individual’s social networks and their relation to smoking cessation, in general, a smokers’ social network has not been well-described from a multi-dimensional framework, nor have researchers examined how the network structure relates to abstinence outcomes.   The social environment is inherently complex; therefore, it may be more informative to examine social influences utilizing quantitative methods that capture this multidimensional interplay.

Using a large sample of smokers (N = 1571, 53% female, 84% Caucasian) who volunteered for a smoking cessation intervention, responses to 9 “indicator” items collected from a social network interview were analyzed utilizing a novel form of finite mixture modeling (FMM) which fit the underlying data with mixtures of student t-distributions. Five latent clusters were identified and revealed an underlying structure composed of significantly different social network sub-groups within the sample of smokers. Latent clusters were found to vary systematically with individual difference factors relevant to smoking behavior, psychopathology, health, and substance-use. Moreover, specific clusters were found to be predictive of smoking cessation success at 1-week and 6 months post-treatment while controlling for individual-level characteristics predictive of cessation success (nicotine-dependence, gender, ethnicity, education, and treatment). In particular, members of the Socially Isolated cluster were more likely to establish cessation at 1-week compared to all other social network clusters. This association held at 6-months when compared with smokers in the Stressfully Connected and the Social Risk Environment clusters.

The empirical development of a typology of smokers’ social networks sheds light on the diverse social world of smokers as they initiate a quit attempt and identifies naturally occurring sub-groups of smokers. In particular, the extracted typology highlighted key sub-groups within the population which were linked to an increased probability of successful cessation at abstinence milestones, highlighting the power of the social environment in smoking behaviors. The present study may improve interventionist’s ability to develop more subject-focused (e.g., targeted or subject/sub-group specific programs) interventions that address the social context of the smoker.