Social Media, Health Consciousness, and Cultural Influences on Sugar Reduction Behaviors in Chinese Youth: Extending the Stimulus-Organism-Response Model

Background: The rising prevalence of sugar-related diseases, such as obesity and diabetes, has intensified efforts to reduce 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 sugar reduction has become a prominent youth-led movement. Objective: This study extends the Stimulus-Organism-Response (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: We conducted a national web-based cross-sectional survey through proportionate probability sampling of 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 (575/883, 74.1%) had used social media for 3–10 years. Chinese youth reported relatively high sugar-reduction behavior scores 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=.508, P<.001) and health consciousness (β=.353, P<.001). These factors in turn significantly predicted sugar reduction behaviors (β=.139 and β=.498, respectively; both 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 embedding cultural influences like face concern alongside enabling competencies like eHealth literacy an extended SOR model, we enhance our understanding of social media’s influence on health behaviors. The findings highlight cultural nuances in health communication and position the enhanced SOR model as a framework for health promotion. Furthermore, The study underscores the primary mediating effect of health consciousness—surpassing that of conformity—while also delineating the moderating roles of face concern and eHealth literacy, offering actionable insights for digital-age public health strategies.