JMIR Publications

ABSTRACT

Background:

With the rising prevalence of sugar-related diseases such as obesity and diabetes, there is an increasing emphasis on reducing sugar intake, particularly among youth. In China, social media is playing an increasingly significant role in shaping health behaviors, including habits related to sugar consumption, as the trend of sugar reduction has become a prominent movement among the youth.

Objective:

This study extends the SOR model by incorporating the distinct cultural influence of "face" to investigate the impact of social media on sugar reduction behaviors among Chinese youth, as well as the mediating role of health consciousness and conformity, and the moderating effects of face concern and eHealth literacy.

Methods:

A national web-based cross-sectional survey was conducted by a proportionate probability sampling among 883 Chinese youth in July 2024., Descriptive statistics, Pearson correlations, Model fit indices and PLS (Partial Least Squares) SEM were employed to examine and explore the relationships among all the variables.

Results:

Nearly half the 883 participants were female (460/883, 52.1%), 91.9% (812/883)of the sample ages fall within the 15-30 range. Most of the participants (602/883, 68.2%) had undergraduate education levels; the majority of participants (688/883, 77.9%) had a bachelor's degree or higher, and a normal Body Mass Index (BMI) (654/883, 74.1%). Most had been using social media for between 3 to 10 years (575/883); 74.1%. The statistics reveal that Chinese youth have demonstrated a relatively high score in sugar reduction behaviors(mean score 3.621/5, SD 0.990). Male participants achieved notably higher scores in sugar reduction behaviors.(mean score 3.725/5, SD 0.933), Participants at the age of 15-18 showed significantly lower sugar reduction behavior scores(mean score 3.508/5, SD 1.052). Structural equation modeling revealed that social media usage positively influenced conformity (β=.51, p<.001) and health consciousness (β=.353, p<.001), which in turn significantly predicted sugar reduction behaviors (β=.139 and β=.498, respectively, p<.001). The influence of social media usage on sugar reduction behaviors is primarily facilitated through two mediating pathways.Health consciousness mediated the relationship between social media usage and sugar reduction behaviors (VAF=51.5%), while conformity's mediation was less pronounced (VAF=21.05%), indicating a secondary influence. Face concern (β=0.089, p=.02) and eHealth literacy (β=0.055, p=.04) moderated the respective relationships.

Conclusions:

This study demonstrates that social media effectively promotes sugar reduction behaviors among Chinese youth. By integrating cultural factors like face concern and eHealth literacy into an extended SOR model, we enhance our understanding of social media's influence on health behaviors. The findings underscore the importance of cultural nuances in health communication and establish the enhanced SOR model as a valuable framework for health promotion strategies. Furthermore, the study highlights the mediating role of health consciousness and the moderating effects of face concern and eHealth literacy, providing actionable insights for public health initiatives in the digital age.