Effects of gender in social control of smoking cessation

Health Risk Behaviour Inventory Validation and its Association with Self-regulatory Dispositions

We put forward a validation of the first instrument to measure the big four health risk behaviours (World Health Organization, Global status report on non-communicable diseases 2014, WHO, 2014) in a single assessment, the Health Risk Behaviour Inventory (HRBI) that assesses physical inactivity, unhealthy diet, smoking and alcohol in Italian- and English-speaking samples. Further, we investigate the instrument's association with self-regulatory dispositions, exploring culture and gender differences in Italian and US subgroup samples. Overall, 304 English- and 939 Italian-speaking participants completed the HRBI and the self-regulatory questionnaire. We explored the factorial structure, convergent validity, invariance and association with self-regulatory dispositions using structural equation modelling.The HRBI has a robust factorial structure; it usefully converges with widely used healthy lifestyle measures, and it is invariant across the categories of age, gender and languages. Regarding self-regulatory dispositions, the promotion focus emerges as the most protective factor over physical inactivity, unhealthy diet, smoking and alcohol, whereas the prevention focus is associated mainly with smoking and alcohol reduction. Results are consistent across genders and US subgroup-Italian samples. The HRBI is a valid instrument for assessing the big four health risk behaviours in clinic and research contexts, and among self-regulatory measures, the promotion and prevention foci have the greatest efficacy in eliciting positive health behaviours.

Sexual goals and perceptions of goal congruence in individuals' PrEP adoption decisions: A mixed-methods study of gay and bisexual men who are in primary relationships

BACKGROUND

Although health goals are recognized as a central feature of health behavior theories, the relational context through which goals are conceptualized is often overlooked. Interdependence theory represents a valuable framework for understanding goals in the adoption of health behaviors, such as pre-exposure prophylaxis (PrEP), among gay and bisexual men in primary relationships.

PURPOSE

We examined the content and focus of men's sexual health goals, as well as whether goal content, goal focus, or perceptions of goal congruence with a primary partner were related to PrEP adoption among gay and bisexual men in primary relationships.

METHODS

Mixed-methods data were collected from a PrEP demonstration project from 145 HIV-negative gay and bisexual men in primary relationships. Participants reported their sexual health goals and completed measures of perceptions of goal congruence, relationship factors, and sociodemographic factors.

RESULTS

Three main goal content categories were identified: prevention, satisfaction, and intimacy. In expressing these goals, participants framed them with either a self-focus or a relationship-focus. Men in serodiscordant relationships reported more intimacy goals and greater perceptions of goal congruence. There were no differences in goal content or focus by sexual agreement. In the multivariable logistic regression model, perceived goal congruence was associated with PrEP adoption, over and above covariates.

CONCLUSIONS

Intimate relationships play a significant role in the formation of health-related goals. Goal content, focus, and perceived congruence with partners may represent important targets for HIV prevention interventions for gay and bisexual men in primary relationships, especially in the context of PrEP.

The Interaction of Smoking Cessation Norms and Nicotine Dependence on Quit Attempts: Gender-Stratified Results for Low-Income Smokers in Baltimore, MD

Background: Declines in smoking prevalence among low-income adults lag behind national samples. Understanding the influence of social context factors such as gender, and normative influence on smoking attitudes and behaviors, can inform smoking cessation interventions. Objective: This study explored how gender, smoking dependence, and cessation norms influenced the likelihood of current quit attempts among urban-dwelling, predominately African American adults. Methods: Participants answered questions about their current quit attempts, smoking dependence (heaviness of smoking index [HSI]), and cessation norms (descriptive: having friends who quit smoking; injunctive: friends disapproving of smoking) as a part of a parent study exploring social and environmental factors in tobacco use. Logistic regression stratifying by gender and adjusting for demographics examined main and interaction effects of norms and HSI on odds of having a current quit attempt. Results: Among men, having a higher smoking dependence was associated with a reduced likelihood of trying to quit (AOR = 0.30 [0.15-0.59]), but this effect was moderated by having friends who had quit smoking (AOR = 2.40 [1.20-4.78]). When accounting for the effect of friends quitting smoking, men were not influenced by friends disapproving of smoking. Among women, currently attempting to quit was predicted by neither smoking dependence nor norms. Conclusions/Importance: Cessation norms and smoking dependence influenced the likelihood of quit attempts for men, but not women, in this study. This highlights the importance of conducting gender stratification in smoking cessation research so as to better understand how social and environmental factors differently impact cessation outcomes for men and women.

Linked Lives: Dyadic Associations of Mastery Beliefs With Health (Behavior) and Health (Behavior) Change Among Older Partners

Objectives

Mastery beliefs are known to contribute to healthy aging. However, it is an open question whether individual mastery-health associations impact the health of close long-term partners.

Method

We applied actor-partner interdependence models to 4-wave, 6-year longitudinal dyadic data from married and cohabitating partners in the Health and Retirement Study (N = 1,981 partners; age at baseline: M = 67 years, SD = 8.93, range 50-94 years).

Results

Higher individual mastery beliefs were associated with better individual physical health and health behaviors. Higher mastery beliefs were associated with subsequent increases in light physical activity. Having a partner with higher levels of mastery was uniquely associated with fewer functional limitations, better self-rated health, and more physical activity. Actor × Partner interaction effects for functional limitations indicated multiplicative associations of actor and partner mastery with health. Of note, mastery-health associations for individuals and their partners were invariant across age, gender, education, employment status, perceived stress over one's own and partner's health, and cognition.

Discussion

Findings suggest that partner mastery beliefs matter for the health (behaviors) of older adults. We discuss possible mechanisms underlying partner interrelations in mastery and health, their age invariance, and consider implications arising from our results.

"Don't Drink Too Much!" Reactance Among Young Men Following Health-Related Social Control

This study investigated conditions under which young men responded with reactance to the suggestion to reduce their alcohol consumption. In an experimental study, 84 young men (university students, mean age: 24 years) listened to a recorded telephone call and were asked to imagine that they themselves were the recipients of this call. In this call, either a girlfriend or a male friend suggested that the recipient of the call should reduce his alcohol intake that evening. In one condition, the suggestion was highly restrictive; in the other condition, the suggestion was framed in a nonrestrictive way. Perceived threat, negative thoughts, and feelings of anger after listening to the call were assessed. Further outcome variables were intention and perceived probability of complying with the suggestion. Participants felt more anger after hearing the highly restrictive suggestion and more threatened by the suggestion made by the girlfriend. Interaction effects emerged. Participants reported more negative thoughts and lower intention and perceived probability to comply when a highly restrictive suggestion was made by the girlfriend. The male friend’s highly restrictive suggestion resulted in a perceived probability of complying (54%) that was similar to the probability of the girlfriend’s nonrestrictive suggestion (55%). Women’s efforts to reduce their male partners’ alcohol consumption can result in boomerang effects. Male peers might be more effective in motivating other men to behave in a healthier way. These results support recent findings with regard to the potential of peer positive social control.

Fruit and Vegetable Intake: the Interplay of Planning, Social Support, and Sex

PURPOSE

Intention and planning are important predictors of dietary change. However, little attention has been given yet to the relationship between them as a function of other social-cognitive factors and their interplay with socio-demographics such as sex.

METHODS

In an observational study (1520 women, 430 men) with two measurement points in time, intention (predictor), planning (mediator), social support (first moderator), and sex (second moderator) were assessed to predict changes in diet separately for fruit and vegetable intake.

RESULTS

All predictors had a main effect on fruit intake but no interactions emerged. For vegetable intake, the mediation-chain was qualified by a three-way interaction: for women, the lower the perceived social support, the more the translation of planning into behavior; for men, the higher the perceived social support, the more the translation of planning into behavior.

CONCLUSIONS

Even though intention and planning are predictors of dietary change, they operate differently under specific conditions (level of social support), for specific subgroups (men vs. women), and for different target behaviors (fruit vs. vegetable intake). These results suggest to further examine the mechanisms by which intentions are translated into behavior via planning.

"I should have …":A Photovoice Study With Women Who Have Lost a Man to Suicide

While the gendered nature of suicide has received increased research attention, the experiences of women who have lost a man to suicide are poorly understood. Drawing on qualitative photovoice interviews with 29 women who lost a man to suicide, we completed a narrative analysis, focused on describing the ways that women constructed and accounted for their experiences. We found that women's narratives drew upon feminine ideals of caring for men's health, which in turn gave rise to feelings of guilt over the man's suicide. The women resisted holding men responsible for the suicide and tended to blame themselves, especially when they perceived their efforts to support the man as inadequate. Even when women acknowledged their guilt as illogical, they were seemingly unable to entirely escape regret and self-blame. In order to reformulate and avoid reifying feminine ideals synonymous with selflessly caring for others regardless of the costs to their own well-being, women's postsuicide bereavement support programs should integrate a critical gender approach.

Enhancing partner support to improve smoking cessation

BACKGROUND

While many cessation programmes are available to assist smokers in quitting, research suggests that support from individual partners, family members, or 'buddies' may encourage abstinence.

OBJECTIVES

To determine if an intervention to enhance one-to-one partner support for smokers attempting to quit improves smoking cessation outcomes, compared with cessation interventions lacking a partner-support component.

SEARCH METHODS

We limited the search to the Cochrane Tobacco Addiction Group Specialised Register, which was updated in April 2018. This includes the results of searches of the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (via OVID); Embase (via OVID); and PsycINFO (via OVID). The search terms used were smoking (prevention, control, therapy), smoking cessation and support (family, marriage, spouse, partner, sexual partner, buddy, friend, cohabitant and co-worker). We also reviewed the bibliographies of all included articles for additional trials.

SELECTION CRITERIA

We included randomised controlled trials recruiting people who smoked. Trials were eligible if they had at least one treatment arm that included a smoking cessation intervention with a partner-support component, compared to a control condition providing behavioural support of similar intensity, without a partner-support component. Trials were also required to report smoking cessation at six months follow-up or more.

DATA COLLECTION AND ANALYSIS

Two review authors independently identified the included studies from the search results, and extracted data using a structured form. A third review author helped resolve discrepancies, in line with standard methodological procedures expected by Cochrane. Smoking abstinence, biochemically verified where possible, was the primary outcome measure and was extracted at two post-treatment intervals where possible: at six to nine months and at 12 months or longer. We used a random-effects model to pool risk ratios from each study and estimate a summary effect.

MAIN RESULTS

Our update search identified 465 citations, which we assessed for eligibility. Three new studies met the criteria for inclusion, giving a total of 14 included studies (n = 3370). The definition of partner varied among the studies. We compared partner support versus control interventions at six- to nine-month follow-up and at 12 or more months follow-up. We also examined outcomes among three subgroups: interventions targeting relatives, friends or coworkers; interventions targeting spouses or cohabiting partners; and interventions targeting fellow cessation programme participants. All studies gave self-reported smoking cessation rates, with limited biochemical verification of abstinence. The pooled risk ratio (RR) for abstinence was 0.97 (95% confidence interval (CI) 0.83 to 1.14; 12 studies; 2818 participants) at six to nine months, and 1.04 (95% CI 0.88 to 1.22; 7 studies; 2573 participants) at 12 months or more post-treatment. Of the 11 studies that measured partner support at follow-up, only two reported a significant increase in partner support in the intervention groups. One of these studies reported a significant increase in partner support in the intervention group, but smokers' reports of partner support received did not differ significantly. We judged one of the included studies to be at high risk of selection bias, but a sensitivity analysis suggests that this did not have an impact on the results. There were also potential issues with detection bias due to a lack of validation of abstinence in five of the 14 studies; however, this is not apparent in the statistically homogeneous results across studies. Using the GRADE system we rated the overall quality of the evidence for the two primary outcomes as low. We downgraded due to the risk of bias, as we judged studies with a high weighting in analyses to be at a high risk of detection bias. In addition, a study in both analyses was insufficiently randomised. We also downgraded the quality of the evidence for indirectness, as very few studies provided any evidence that the interventions tested actually increased the amount of partner support received by participants in the relevant intervention group.

AUTHORS' CONCLUSIONS

Interventions that aim to enhance partner support appear to have no impact on increasing long-term abstinence from smoking. However, most interventions that assessed partner support showed no evidence that the interventions actually achieved their aim and increased support from partners for smoking cessation. Future research should therefore focus on developing behavioural interventions that actually increase partner support, and test this in small-scale studies, before large trials assessing the impact on smoking cessation can be justified.

Contribution of smoking-attributable mortality to life expectancy differences by marital status among Finnish men and women, 1971-2010

BACKGROUND

Smoking is known to vary by marital status, but little is known about its contribution to marital status differences in longevity. We examined the changing contribution of smoking to mortality differences between married and never married, divorced or widowed Finnish men and women aged 50 years and above in 1971-2010.

DATA AND METHODS

The data sets cover all persons permanently living in Finland in the census years 1970, 1975 through 2000 and 2005 with a five-year mortality follow-up. Smoking-attributable mortality was estimated using an indirect method that uses lung cancer mortality as an indicator for the impact of smoking on mortality from all other causes.

RESULTS

Life expectancy differences between the married and the other marital status groups increased rapidly over the 40-year study period because of the particularly rapid decline in mortality among married individuals. In 1971-1975 37-48% of life expectancy differences between married and divorced or widowed men were attributable to smoking, and this contribution declined to 11-18% by 2006-2010. Among women, in 1971-1975 up to 16% of life expectancy differences by marital status were due to smoking, and the contribution of smoking increased over time to 10-29% in 2006-2010.

CONCLUSIONS

In recent decades smoking has left large but decreasing imprints on marital status differences in longevity between married and previously married men, and small but increasing imprints on these differences among women. Over time the contribution of other factors, such as increasing material disadvantage or alcohol use, may have increased.

Self-Care Adherence and Psychological Functioning of Older Patients with Type 2 Diabetes: Effects of Persuasion, Social Pressure, and Self-Efficacy

This cross-sectional study examined the role of family members' use of persuasion versus pressure as distinct forms of social control by which family members attempt to encourage better diabetes management among older adults with type 2 diabetes mellitus (T2DM). The study also examined how self-efficacy might moderate the relationship between persuasion/pressure, psychological functioning, and self-care adherence. Participants were 96 men and 103 women with T2DM, with a mean age of 63.3 years. Regression results show that neither persuasion nor pressure was significantly related to self-care adherence, but persuasion and pressure were associated in complex ways with diabetes-related emotional distress and depressive symptoms for which significant interaction effects were found. Patients with lower self-efficacy benefited from persuasion, but were adversely affected by pressure. In contrast, patients with higher self-efficacy were adversely affected by persuasion, but were less negatively affected by pressure. Findings highlight the importance of reducing pressure-based social control, considering patients' self-efficacy when family members seek to influence patients' self-care behaviors, and targeting patient-family interactions in future interventions.

Sexual orientation disparities in smoking vary by sex and household smoking among US adults: Findings from the 2003-2012 National Health and Nutrition Examination Surveys

OBJECTIVE

This study examined whether sexual orientation-related smoking disparities in males and females varied by household smoking behaviors in a nationally representative sample of American adults.

METHODS

Data were drawn from the 2003-2012 National Health and Nutrition Examination Surveys, which assessed 14,972 individuals ages 20 to 59years for sexual orientation, current smoking status, and household smoking. Weighted multivariable logistic models were fit to examine whether differences in current smoking status among sexual minority adults compared to heterosexuals was moderated by household smoking and sex, adjusting for covariates.

RESULTS

The main effects of identifying as a sexual minority, being male, and living with a household smoker were all associated with a significantly higher odds of being a current smoker. However, there also was a significant three-way interaction among these variables (adjusted odds ratio=3.75, 95% confidence interval: 1.33, 10.54). Follow-up analyses by sex indicated that the interaction between sexual identity and household smoking was significant for both males (AOR=6.40, 95% confidence interval: 1.27, 32.28) and females (AOR=0.43, 95% confidence interval: 0.23, 0.81) but was in the opposite direction. Among males, living with a smoker was associated more strongly with greater odds of smoking among gay and bisexual males, compared to heterosexual males. In contrast, among females, living with a smoker was more strongly associated with greater odds of smoking for heterosexuals compared to lesbians and bisexuals.

CONCLUSIONS

Future research is warranted to examine characteristics of households, including smoking behaviors and composition, to guide more effective and tailored smoking cessation interventions for males and females by sexual orientation.

Smoking cessation behavioural therapy in disadvantaged neighbourhoods: an explorative analysis of recruitment channels

BACKGROUND

The optimum channel(s) used to recruit smokers living in disadvantaged neighbourhoods for smoking cessation behavioural therapy (SCBT) is unknown. This paper examines the channels through which smokers participating in a free, multi-session SCBT programme heard about and were referred to this service in a disadvantaged neighbourhood, and compares participants' characteristics and attendance between channels.

METHODS

109 participants, recruited from free SCBT courses in disadvantaged areas of two cities in the Netherlands, underwent repeated surveys. Participants were asked how they heard about the SCBT and who referred them. Participant characteristics were compared between five channels, including the General Practitioner (GP), a community organisation, word of mouth, another health professional, and media or self-referred. Whether the channels through which people heard about or were referred to the service predicted attendance of ≥4 sessions was investigated with logistic regression analysis.

RESULTS

Over a quarter of the participants had no or primary education only, and more than half belonged to ethnic minority populations. Most participants heard through a single channel. More participants heard about (49%) and were referred to (60%) the SCBT by the (GP) than by any other channel. Factors influencing quit success, including psychosocial factors and nicotine dependence, did not differ significantly between channel through which participants heard about the SCBT. No channel significantly predicted attendance.

CONCLUSION

The GP was the single most important source to both hear about and be referred to smoking cessation behavioural therapy in a disadvantaged neighbourhood. A majority of participants of low socioeconomic or ethnic minority status heard about the programme through this channel. Neither the channel through which participants heard about or were referred to the therapy influenced attendance. As such, concentrating on the channel which makes use of the existing infrastructure and which is highest yielding, the GP, would be an appropriate strategy if recruitment resources were scarce.

Cigarette smoking and alcohol consumption among Chinese older adults: do living arrangements matter?

This study used five waves of the Chinese Longitudinal Healthy Longevity Survey to examine the relationship between living arrangements, smoking, and drinking among older adults in China from 1998–2008. We found that living arrangements had strong implications for cigarette smoking and alcohol consumption among the elderly. First, the likelihood of smoking was lower among older men living with children, and older women living either with a spouse, or with both a spouse and children; and the likelihood of drinking was lower among both older men, and women living with both a spouse and children, compared with those living alone. Second, among dual consumers (i.e., being a drinker and a smoker), the amount of alcohol consumption was lower among male dual consumers living with children, while the number of cigarettes smoked was higher among female dual consumers living with others, compared with those living alone. Third, among non-smoking drinkers, the alcohol consumption was lower among non-smoking male drinkers in all types of co-residential arrangements (i.e., living with a spouse, living with children, living with both a spouse and children, or living with others), and non-smoking female drinkers living with others, compared with those living alone. Results highlighted the importance of living arrangements to cigarette smoking and alcohol consumption among Chinese elderly. Co-residential arrangements provided constraints on Chinese older adults’ health-risk behaviors, and had differential effects for men and women.

Heterosexual gender relations and masculinity in fathers who smoke

The purpose of this research was to explore the role of masculinity and heterosexual gender relations in new and expectant fathers’ explanations of their continued smoking. We conducted a secondary analysis of in-depth interviews with 20 fathers. Two themes were identified: (1) reconciling with partners to maintain a smoke-free family home; and (2) smoking to self-regulate emotions and maintain relationships. Fathers’ decisions to smoke and changes in smoking behavior were shaped by ideals of masculinity and by partner relationships and family and social contexts, including division of domestic duties and childcare. Recognizing the influence of both masculinity and gender relations could provide new directions for supporting men’s smoking cessation efforts during early parenthood. © 2014 The Authors. Research in Nursing & Health Published by Wiley Periodicals, Inc.

"Their depression is something different . . . it would have to be": findings from a qualitative study of black women's perceptions of depression in black men

This study reports findings from the Black Women's Perceptions of Black Men's Depression (BWP) study, which included eight focus groups with Black women (N = 46) from southeastern Michigan. Four themes illustrated the impressions of Black women from different socioeconomic backgrounds: Black men's depression is a cultured and gendered phenomenon, the role of Black women in Black men's depression, intergenerational differences with how depression is handled by Black men, and the need (and ways) to reach Black men with depression resources. Results underscore not only the importance of understanding the kind of depression in Black men that meets criteria described by the Diagnostic and Statistical Manual of Mental Disorders (DSM) but also the psychological distress that may coexist with (or be separate from) DSM depression. Implications for interventions that educate, diagnose, and treat depression in Black men are discussed.

A pilot evaluation of the efficacy of a couple-tailored print intervention on colorectal cancer screening practices among non-adherent couples

The objective of this study was to evaluate the efficacy of a couple-tailored print (CTP) intervention on colorectal cancer screening (CRCS), CRCS intentions, and on knowledge and attitudes among couples in which neither partner is on schedule with regard to CRCS. A total of 168 married couples with both members non-adherent with CRCS were randomly assigned to receive either a CTP pamphlet accompanied by a generic print (GP) pamphlet or a GP pamphlet only. Couples completed measures of CRCS, intentions, relational perspective on CRCS, discussions about CRCS, spouse support for CRCS, spouse influence strategies, CRC knowledge, perceived CRC risk, and CRCS benefits and barriers. Results indicated there was no significant benefit of CTP vs. GP on CRCS, but there was a significant increase in CRCS intentions in CTP compared with GP. There was also a significant increase in relationship perspective on CRCS, a significant increase in husbands' support of their wives' CRCS, and a significant increase in CRCS benefits in CTP. In summary, CTP did not increase CRCS practices but increased intentions and perceived benefits of CRCS as well as improving couples' ability to view CRCS as having benefit for the marital relationship.

Will mothers of sick children help their husbands to stop smoking after receiving a brief intervention from nurses? Secondary analysis of a randomised controlled trial

Background

Second-hand smoke is a severe health hazard for children. Clinical guidelines suggest that nurses advise smoking parents to quit when they accompany their sick children to paediatric settings, but the guidelines did not mention what nurses can do if the parents are not with the children. This study examines the effectiveness of a low-intensity, nurse-led health instructional initiative for non-smoking mothers, to motivate them to take action to help their husbands stop smoking.

Methods

This was a randomised controlled trial and 1,483 non-smoking women, who were living with husbands who do smoke, were recruited when they accompanied with their sick children on hospital admission in general paediatic wards/outpatient departments of four hospitals in Hong Kong. The women were randomly allocated into intervention and control groups. The former received brief health education counselling from nurses, a purpose-designed health education booklet, a “no smoking” sticker, and a telephone reminder one week later; the control group received usual care. The primary outcome was the women”s action to help their smoking husbands stop smoking at 3-, 6- and 12-month follow-ups.

Results

A higher proportion of women in the intervention than the control group had taken action to help their husbands stop smoking at the 3-month (76% vs. 65%, P < .001), 6-month (66% vs. 49%, P < .001) and 12-month (52% vs. 40%, P < .001) follow-ups. Women who had received the intervention, had better knowledge of the health hazards of smoking, higher intention to take action, perceived their husbands’ willingness to stop/reduce smoking, had previously advised their husbands to give up smoking, were aware of their husbands’ history of smoking and, were aware that their husbands had made an earlier quit attempt and intended to help them stop smoking at the follow-ups.

Conclusions

A brief health education intervention by nurses in paediatric settings can be effective in motivating the mothers of sick children to take action to help their husbands quit smoking. We recommend adding the following to the clinical practice guidelines on treating tobacco use and dependence: ‘Nurses should offer every non-smoking mother of a sick child brief advice to encourage their husbands to stop smoking’.

Trial registration

Current Controlled Trials ISRCTN72290421.

Health-Related Social Control over Physical Activity: Interactions with Age and Sex

Despite the disease prevention benefits of engaging in life-long regular physical activity, many adults remain sedentary. The social environment provides an important context for health and health behavior across the lifespan, as well as a potential point of intervention for increasing physical activity. Self-reports of perceived social support, social strain, positive social control, and negative social control were examined for their cross-sectional relationships to physical activity frequency in purposive samples of younger and older adults (N = 371, ages from 18 to 97, 68% women). Hierarchical regression analyses revealed that perceived support and perceived strain were not correlated with physical activity. However, age and sex interacted with social control, such that more positive social control was associated with more frequent physical activity for younger men. Furthermore, more positive and negative social control were significantly associated with less frequent physical activity for older men, while social control was not associated with physical activity among women. While younger men may be encouraged toward healthier behaviors by positive social control messages, social control attempts may backfire when targeting older men. Implications for physical activity promotion are discussed.

Spousal involvement in CPAP: does pressure help?

STUDY OBJECTIVES

Continuous positive airway pressure (CPAP) improves sleep and quality of life for both patients with obstructive sleep apnea (OSA) and their spouses. However, few studies have investigated spousal involvement in treatment adherence. Aims of this observational study were to assess perceptions of spousal involvement and evaluate associations between involvement and adherence.

METHODS

Spousal involvement in CPAP adherence was assessed in 23 married male OSA patients after the first week of treatment. At 3 months, 16 participants completed a second assessment of spousal involvement. Types of involvement assessed included positive (e.g., encouraging), negative (e.g., blaming), collaboration (e.g., working together), and one-sided (e.g., asking). An interpersonal measure of supportive behaviors was also administered at 3 months to evaluate the interpersonal qualities of spousal involvement types. Objective CPAP adherence data were available for 14 participants.

RESULTS

Average frequency of spousal involvement ratings were low for each involvement type and only negative spousal involvement frequency decreased at 3 month follow-up (p = 0.003). Perceptions of collaborative spousal involvement were associated with higher CPAP adherence at 3 months (r = 0.75, p = 0.002). Positive, negative and one-sided involvement were not associated with adherence. Collaborative spousal involvement was associated with moderately warm and controlling interpersonal behaviors (affiliation, r = 0.55, p = 0.03, dominance r = 0.47, p = 0.07).

CONCLUSIONS

Patients reported low frequency but consistent and diverse perceptions of spousal involvement in CPAP over the first 3 months of treatment. Perceptions of collaborative spousal involvement were the only type associated with adherence and represent moderately warm and controlling interpersonal behavior. Interventions to increase spousal collaboration in CPAP may improve adherence.

Spousal involvement in CPAP adherence among patients with obstructive sleep apnea

PURPOSE

To determine the effects of spousal involvement on continuous positive airway pressure (CPAP) adherence and response to CPAP problems in male patients with obstructive sleep apnea (OSA).

METHODS

Wives' involvement (pressure, support, and collaboration), CPAP adherence and CPAP problems (e.g., mask leaks) were assessed for 10 days in 31 male OSA patients. Disease severity and pre-treatment ratings of relationship quality were tested as moderators of daily associations in multilevel models. Effects of wives' involvement were tested as predictors of day-to-day adherence and average nightly adherence at 3 months.

RESULTS

Perception of wives' support predicted increased adherence only in patients with high disease severity. Collaboration increased following nights with lower adherence and greater CPAP problems. Patients with lower conflict in the relationship reported a greater increase in collaboration associated with CPAP problems. Patients with lower support in the relationship reported increased next-day support following nights with CPAP problems. Perceived pressure from the wife was not associated with increased adherence in day-to-day analyses and associated with poorer adherence at 3 months.

CONCLUSIONS

The relationship between wives' involvement and adherence was bidirectional and influenced by disease and relationship context. The majority of findings demonstrated increased positive wife involvement as a reaction to adherence and problems with CPAP. Supportive and collaborative interventions have the potential to improve CPAP adherence and response to CPAP-related problems, particularly in patients with high disease severity. Pressure to use CPAP from the wife was not beneficial for adherence that day and predicted poorer adherence at 3 months. Further research is needed to test supportive spousal involvement as an adherence intervention.

Dating and changes in adolescent cigarette smoking: does partner smoking behavior matter?

INTRODUCTION

Adolescents' relationships can play an influential role in adopting, maintaining, or changing health behaviors. Previous research has suggested that adolescent dating is a risk factor for both concurrent and prospective tobacco use. This study extends previous research by examining whether a partner's smoking status moderated the relationship between dating and adolescent smoking.

METHODS

Participants were 1,263 9th and 10th grade students who took part in a longitudinal study investigating the social and emotional contexts of adolescent smoking patterns. Adolescents were recruited into the longitudinal study based on prior smoking history. The presence of a romantic partner, the partner's smoking status, and the adolescents' smoking behavior were assessed at baseline and at 15 months.

RESULTS

Our findings indicated that a change in dating status from not dating to having a partner significantly increased the odds of the adolescent smoking at 15 months but significantly only for those who dated a smoker. This effect was especially pronounced among boys. All boys who dated a smoker smoked themselves. Among adolescents who smoked at 15 months, there was also a strong protective effect among boys for dating a nonsmoker, compared with either those who did not have partners or those with smoking partners; boys with nonsmoking partners smoked significantly less than those with partners who smoked or those without partners.

DISCUSSION

These results highlight the importance of considering the smoking status of the romantic partner in the smoking-dating relationship in adolescents.

Gender Differences in Quit Support by Partners of Health-Compromised Smokers

In a study of spousal support for smoking cessation, 34 couples in which one partner continued to smoke despite having a heart or lung problem used an adaptation of Cohen & Lichtenstein's (1990) Partner Interaction Questionnaire to describe the spouse's attempts to help the primary (ill) smoker quit. Female smokers received less support for quitting from their spouse or partner than male smokers did, regardless of whether the support was positive or negative, whether the partner also smoked, or whether the smoker or partner rated the partner's support behavior Female patients in a treatment sub-sample were also less likely than men to achieve stable 1-year cessation if the couple had rated partner support at baseline as coercive or unhelpful. Given known gender differences in relapse risk, cessation interventions for health-compromised female smokers might profitably include partners in addition to the smokers themselves.

Reactions to health-related social control in young adults with type 1 diabetes

Health-related social control refers to individuals' attempts to influence another's health behavior. We describe social control experienced by 109 adults aged 18-35 with Type 1 diabetes, and examine the influence of different types of social control on behavioral and psychological outcomes. Using a self-administered questionnaire, telephone interview, and chart review, we assessed individuals' social control experiences, behavioral and psychological reactions, psychological adjustment, metabolic control, socio-demographics, and clinical factors at baseline, and psychological adjustment and metabolic control at 6-months follow-up. Most participants (85%) reported experiencing social control. Regression analyses revealed that more frequent negative control predicted less behavior change and more negative cognitive reactions concurrently, and decreases in psychological adjustment over time. More frequent reinforcement/modeling and structural changes predicted more positive emotional reactions, but were not associated with behavior change, psychological adjustment, or metabolic control. Use of direct persuasion was associated with more pretending of behavior change. These results suggest that negative social control attempts by social network members may be counter-productive.

A family consultation intervention for health-compromised smokers

Although spousal support predicts the success of a smoker's cessation efforts, "social-support" interventions based on teaching partners better support skills have had consistently disappointing results. We examined the potential utility of a family consultation (FAMCON) intervention based on family-systems principles in a treatment-development project involving 20 couples in which one partner (the primary smoker) continued to smoke despite having or being at significant risk for heart or lung disease. The 50% rate of stable abstinence achieved by primary smokers over at least 6 months exceeds benchmark success rates reported in the literature for other comparably intensive interventions, suggesting that a couple-focused intervention different in concept and format from social-support interventions tested in the past may hold promise for health-compromised smokers. The FAMCON approach appeared particularly well suited to female smokers and smokers whose partner also smoked--two subgroups at high risk for relapse.