• social network analysis;
  • adolescent smoking;
  • systematic review

BACKGROUND: Social networks are important in adolescent smoking behavior. Previous research indicates that peer context is a major causal factor of adolescent smoking behavior. To date, however, little is known about the influence of peer group structure on adolescent smoking behavior.

METHODS: Studies that examined adolescent social networks with regard to their cigarette smoking behavior were identified through online and manual literature searches. Ten social network analysis studies involving a total of 28,263 adolescents were included in the final review.

RESULTS: Of the 10 reviewed studies, 6 identify clique members, liaisons, and isolates as contributing factors to adolescent cigarette smoking. Significantly higher rates of smoking are noted among isolates than clique members or liaisons in terms of peer network structure. Eight of the reviewed studies indicate that peer selection or influence precedes adolescents' smoking behavior and intent to smoke. Such peer selection or influence accounts for a large portion of similarities among smoking adolescents.

CONCLUSION: Adolescents who are identified as isolates are more likely to smoke and engage in risk-taking behaviors than others in the peer network structure. Given that the vast majority of current adult smokers started their smoking habits during adolescence, adolescent smoking prevention efforts will likely benefit from incorporating social network analytic approaches and focusing the efforts on isolates and other vulnerable adolescents from a peer selection and influence perspective.