How Initial Prevalence Moderates Network-based Smoking Change: Estimating Contextual Effects with Stochastic...

We use an empirically grounded simulation model to examine how initial smoking prevalence moderates the effectiveness of potential interventions designed to change adolescent smoking behavior. Our model investigates the differences that result when manipulating peer influence and smoker popularity as intervention levers. We demonstrate how a simulation-based approach allows us to estimate outcomes that arise (1) when intervention effects could plausibly alter peer influence and/or smoker popularity effects and (2) across a sample of schools that match the range of initial conditions of smoking prevalence in U.S. schools. We show how these different initial conditions combined with the exact same intervention effects can produce substantially different outcomes-for example, effects that produce smoking declines in some settings can actually increase smoking in others. We explore the form and magnitude of these differences. Our model also provides a template to evaluate the potential effects of alternative intervention scenarios.