Participants were also asked whether they used the GSN app “to find people to drink or use drugs with” and whether “the last time [they] used the GSN app, was it during or immediately after [they] had been drinking alcohol or using drugs?” Substance use—To assess binge drinking, participants were asked a question adapted from the Centers for Disease Control and Prevention Behavioral Risk Surveillance System , “During the past 30 days, [have you] had 5 or more drinks of alcohol in a row at least once?” To assess illicit substance use, participants were asked to report on the frequency of their past 30 day use of marijuana, poppers, heroin, methamphetamine and ecstasy . Responses were subsequently collapsed and dichotomized to reflect at least one episode of marijuana use and one episode of recent illicit drug use. Social Networks—A single-item egocentric name generator asked participants to list their top five closest social network members using the following prompt: “The next several questions are about the most important people that you regularly communicate with on a social basis. These are people that you interact with, either through face-to-face contact or via the Internet or cell phone and could be family members, friends, sex-partners, seedling grow rack coworkers or anyone else who is important to you. Based on this criteria, we ask that you please list the five people you interact with the most and/or who are most important to you in the space provided below.”
Participants gave a first name or nickname for each alter; last names were not gathered to preserve confidentiality of nominated alters. Next, participants were asked to describe their relationship to each alter and the age, race/ethnicity, and sexual orientation of that alter. Alters described as husband, boyfriend, lover, sex partner and hook-up were grouped to represent “intimate partners”. In addition, participants were asked to report whether they had known each network alter for more than a year, whether they provided the participant with emotional support , and whether they provided the participant with instrumental support . Alters’ substance use was assessed by asking participants to select any of their alters who had engaged in recent alcohol, marijuana or illicit substance use. Specifically, participants were asked the following questions: “In the past month, who has drunk alcohol to the point of drunkenness?”; “In the past month, who smoked marijuana, pot, or weed?”; “In the past month, who used meth, crystal, or Tina?”; “In the past month, who used cocaine?”; and “In the past month, who used heroin?” All responses were scored dichotomously. An additional dichotomous item representing illicit drug use was created. Participants were also asked which of their network members would object to them “drinking to the point of drunkenness,” “smoking marijuana” or using any of the other substances named above.Bivariate tests of association determined associations between individual level variables and whether the participant had included a GSN app-met partner in his network.
Associations between individual and social network characteristics and each of the three substance use outcomes were determined using chi square tests of association. In social network analyses, family member alters were excluded from the total sample of alters because a primary aim of this analysis was to determine differences between GSN app-met and non-GSN app-met alters and family members were unlikely to be met through the GSN app. Due to the large number of tests that were conducted, we employed the false discovery rate controlling procedure described by Benjamini and Hochberg . Multivariate logistic regressions were also performed to simultaneously test for associations between individual- and network-level factors and substance use outcomes. All data were analyzed using SAS 9.2 .This study is among the first to examine the social networks of GSN app-using MSM in relation to substance use. Similar to other samples of MSM in Los Angeles, rates of binge drinking, marijuana use and illicit substance use were high , demonstrating the need for increased substance use/misuse prevention with MSM. Our first research question sought to identify the composition of the social networks of GSN app using MSM. Results indicate diversity in the composition of GSN app users’ networks, which are comprised of friends, intimate partners, family members , co-workers and others. While results indicate that a small subsample of MSM used the GSN app to find partners with whom to drink alcohol and use substances , large percentages of the GSN app-users had network members who engaged in binge drinking, marijuana use and illicit substance use.
Results from the present study may inform network-based interventions targeting these behaviors that are staged via GSN apps, which may be especially useful in reducing substance use/ misuse among MSM given the popularity and widespread use of these apps. Over one fifth of participants in the present study included a GSN app-met alter as a member of their closest social network and statistically significantly higher percentages of GSN app-met alters belonged to participants who had used the technology for greater than one year. GSN app-met network members were more likely to be “hook ups” than social network members met elsewhere, demonstrating, as has been shown by others , that sexual partner seeking is a primary purpose for using the GSN app. It is important to note that 12 % of GSN app-met alters were classified as husbands, life partners or boyfriends and 44 % were classified as friends. The popular press has characterizes GSN apps as platforms for casual sex seeking . While this is true for many GSN app-users, it is also true that primary romantic relationships and close friendships are formed via GSN apps. As such, these platforms represents important gay male social context for dating, serious relationship and friendship seeking. While larger percentages of alters providing emotional and instrumental social support were met elsewhere, over 40 % of alters met on the GSN app provided social support to participants. Our second research question sought to understand the influence of individual and social network factors on engagement in binge drinking, marijuana use and illicit substance use. Despite the pro-social roles that GSN app-met alters held in the lives of participants in this study, there were some individual-level GSN app use patterns that emerged as correlates of substance use outcomes. Specifically, older age, higher education and white race/ethnicity were associated with greater substance use. Furthermore, using the GSN app for longer than one year was correlated with recent use of marijuana and illicit substances. Finally, displaying naked chest or abs in their GSN app profile photos was associated with illicit substance use. These findings at the individual level are similar to those of Winetrobe and colleagues who analyzed data from the young men in this sample and found that those who had used the GSN app longer and displayed sexualized profile photos were more likely to have engaged in unprotected anal intercourse with their last GSN appmet partner. Taken together, these findings may indicate heightened risk behaviors for a subset of GSN app-users. However, the addition of network data presented here suggests that for substance use outcomes this heightened risk is primarily function of social network dynamics, rather than individual-level risk behaviors, as the strongest predictors of binge drinking, greenhouse growing racks marijuana use and illicit substance use were presence of a social network member who also engaged in these behaviors. Social network results from this study emphasize the importance of network influence on substance use, as has been shown by others.
Participants with alcohol users, marijuana users and illicit substance users in their networks were more likely to engage in those behaviors themselves. Described by McPherson , this phenomenon is referred to as homophily and refers to the idea that like individuals are more likely to affiliate with others who are similar to themselves . These results are intuitive given the powerful influence of peer norms and the fact that substance use among MSM often occurs in groups and social settings . Because our data is cross sectional it is impossible for us to determine whether substance users seek out other substance users for inclusion into their networks or whether peer influence processes operate within networks to promote greater substance use. Further longitudinal research with GSN app-using MSM should attempt to elucidate these processes over time, as their clarification may have important implications for preventing substance abuse and related risks among GSN app-using MSM. A key finding for the development of risk behavior prevention and harm reduction interventions is the protective nature of having a social network member who objects to binge drinking, marijuana use and illicit substance use. Network studies of young MSM have demonstrated lower levels of sexual risk behaviors among participants who have a “pro-social” peer as part of their social network. Tucker and colleagues found that homeless YMSM were less likely to engage in unprotected sex and had fewer sex partners if their networks included fewer sex partners and if the majority of their network members were not heavy drinkers . Social network based interventions that take into consideration the composition of MSM networks, leverage ties to peers who do not engage in risk behaviors and promote diffusion of peer norms that are discouraging of substance use and related risks may be especially effective . As mentioned above, this was a cross-sectional study, making it impossible to determine the direction of our findings or causality. Furthermore, our study did not include a comparison group of non-GSN app users, making it impossible to determine whether substance use is comparable between users and non-users. All data were collected via self report, which may underestimate or overestimate the actual prevalence of binge drinking, marijuana use and illicit substance use. Enabling MSM to take the survey using their private computers, smartphones or tablets likely contributed to veracity in reporting of behaviors; however, it is impossible to know for certain. In addition, we gathered data on the attitudes of participants’ social network members from the participants themselves, without consulting nominated network members. It is quite possible that participants’ perceptions of the attitudes and behaviors of their network members do not correspond to actual behavior. However, several studies have demonstrated the importance of perception of peer behavior on the actual risk behavior of participants, so this may be less of a concern for many readers . The recruitment methods used could also have introduced bias and limit the generalizability of our results, especially if there are underlying differences between those who were available or not available to participate in the study during the recruitment periods, for example. The large numbers of white, well-educated participants is likely a function of recruiting in affluent gay neighborhoods in Los Angeles . Future research with racial/ethnic minority and low-income GSN app users is needed. Additionally, because contact with GSN app representatives could not be made, we were unable to develop a fully collaborative research approach. As noted in previous work, collaborative approaches between GSN app companies and public health researchers are warranted to fully elucidate the role that GSN apps play in the lives of MSM .Despite the limitations of this study, the findings may have useful implications for the formulation of substance use/misuse prevention interventions for GSN-app using MSM. First, due to the widespread use of these technologies and high prevalence rates of binge drinking, marijuana use and illicit substance use among GSN app users, it appears that these platforms may be well suited for the dissemination of prevention and harm reduction messaging. Our previous research suggests high levels of acceptability of HIV prevention interventions delivered via smartphone among young MSM ; however, no research has been conducted on the acceptability of substance abuse prevention interventions in these contexts. Formative research is needed on the feasibility of app-based prevention interventions with this population as little is known about how MSM may respond to these efforts. Banner ads and push notifications can be easily purchased on GSN apps to remind users of relevant information regarding substance use and accompanying sexual risk behaviors ; however, it is unclear how effective these approaches may be in capturing the attention of MSM using GSN apps. Network homophily among GSN app-using MSM points to the possibility of network based interventions that can promote peer norms to discourage substance misuse. Facebook delivered popular opinion leader models to increase HIV testing have been successful with racially and ethnically diverse MSM previously .