Social influences on smoking in middle-aged and older women

Development and psychometric assessment of Health Action Process Approach (HAPA) in terms of smoking cessation among Chinese smokers

The Health Action Process Approach (HAPA) is a two-stage (pre-intentional and post-intentional) behavioral change model that distinguishes between motivation and volition in behavior change process. This study aims to develop HAPA-based assessments for smoking cessation among current smokers. The HAPA-based measures were developed and the draft measures included nine constructs, namely, risk perception in smoking-induced cancer, risk perception in smoking-induced systemic disease, positive outcome expectancy, negative outcome expectancy, self-efficacy in quitting smoking, self-efficacy in maintaining, self-efficacy in re-initiating, quitting planning and coping planning in smoking cessation, with a total of 26 items. A cross-sectional survey was conducted in China in 2022. Principal Component Analysis was used for Exploratory Factor Analysis (EFA). Cronbach's α coefficient was calculated to evaluate the internal consistency. Variables such as severity of smoking addiction were selected to evaluate the correlation between the HAPA scale and these variables. Of the 928 participants, 76.4% (709/928) were male and the median age was 35 years. Five factors were extracted by EFA. The factor loadings of each item were all greater than 0.60, and the cumulative variance contribution rate was 90.15%. The Cronbach's α coefficient of each HAPA-based subscales was 0.929-0.986. The HAPA-based measurements are comprehensive, reliable and valid in the assessment of smokers' smoking cessation cognition, which can be used to guide the design and implementation of intervention and the development of theory.

Examining the Association of Social Isolation and Smoking in Older Adults

Background: Tobacco use remains a leading cause of preventable death among older adults, but few studies have examined social isolation as a risk factor for smoking in US. older adults. Methods: Using National Health and Aging Trends Study (NHATS) data, we conducted multivariate analyses of smoking in a sample of 8136 adults ages 65 and older. Results: Social isolation and severe isolation were associated with higher odds of smoking (OR: 2.48 and 5.48, p = 0.002 and p < 0.001). Individuals with mild (OR: 1.46, p = 0.006), moderate (OR: 1.80, p = 0.001), or severe (OR: 3.05, p = 0.001) symptoms of depression/anxiety also had higher odds of smoking. Conclusions: Social isolation is a significant risk factor for smoking in US older adults. Further research is needed to support the development of interventions to reduce social isolation and smoking behavior in older adults.

Social isolation and loneliness: Undervalued risk factors for disease states and mortality

Social isolation and loneliness are two common but undervalued conditions associated with a poor quality of life, decreased overall health and mortality. In this review, we aim to discuss the health consequences of social isolation and loneliness. We first provide the potential causes of these two conditions. Then, we explain the pathophysiological processes underlying the effects of social isolation and loneliness in disease states. Afterwards, we explain the important associations between these conditions and different non-communicable diseases, as well as the impact of social isolation and loneliness on health-related behaviours. Finally, we discuss the current and novel potential management strategies for these conditions. Healthcare professionals who attend to socially isolated and/or lonely patients should be fully competent in these conditions and assess their patients thoroughly to detect and properly understand the effects of isolation and loneliness. Patients should be offered education and treatment alternatives through shared decision-making. Future studies are needed to understand the underlying mechanisms better and to improve the treatment strategies for both social isolation and loneliness.

Social Support among Older Persons and Its Association with Smoking: Findings from the National Health and Morbidity Survey 2018

BACKGROUND

Globally, the average age of the world's population of older people continues to rise and having a good social support network becomes increasingly relevant with the aging populace. Overall, in Malaysia, social support prevalence was low among older persons. This study was conducted to determine the association between social support and smoking status among the older Malaysian population.

METHODS

Data were obtained from the National Health and Morbidity (NHMS) 2018 survey on the health of older Malaysian adults and analyzed. This cross-sectional population-based study used a two-stage stratified random sampling design. Sociodemographic characteristics, smoking status, and social support data were collected from respondents aged 60 years and more. A validated Malay language interviewer-administered questionnaire of 11-items, the Duke Social Support Index, was utilized to assess the social support status. A multivariable logistic regression analysis was used to assess the association of social support and smoking status among the respondents.

RESULTS

The prevalence of good social support was significantly higher among the 60-69 years old (73.1%) compared to the ≥80 years old respondents (50%). Multivariate logistic regression analysis showed that respondents aged ≥80 years old were 1.7 times more likely to have poor social support compared to those aged 60-69 years. Respondents with no formal education were 1.93 times more likely to have poor social support compared to respondents who had tertiary education. Respondents with an income of MYR 3000. Former smokers had good social support compared to current smokers (73.6% vs. 78.7%). For current smokers, they had poor social support, which is almost 1.42 times higher than that for non-smokers.

CONCLUSION

There was poor social support among older people who were current smokers, had an increased age, had no formal education and had a low income. The findings obtained from this study could assist policymakers to develop relevant strategies at the national level to enhance the social support status among older smokers and aid in their smoking cessation efforts.

Couples-based behaviour change interventions to reduce metabolic syndrome risk. A systematic review

BACKGROUND AND AIMS

Metabolic Syndrome (MetS), is a major risk factor for non-communicable diseases including type 2 diabetes mellitus, cardiovascular disease, and cancer. Although MetS risk is transferred via the epigenome from both biological parents, periconceptional lifestyle interventions are generally directed towards mothers. There is a need for interventions to reflect the shared nature of epigenetic MetS risk between both biological parents. Couples-based lifestyle interventions have previously been used to improve adherence to behaviour change in conditions with shared risk responsibility such as sexually transmitted diseases. This systematic literature review sought to answer the research question: Are couples-based interventions more effective than individual interventions to address overweight and obesity as the primary modifiable risk for MetS in addition to other associated factors.

METHODS

Couples-based studies involving randomised controlled trials, published between 01/01/1990-31/12/2021, were identified in Medline, CINAHL, PsycINFO, Psychology and Behavioural Sciences Collection, Cochrane, and Scopus.

RESULTS

After screening 4742 articles, only five eligible trials remained. Statistically significant post-intervention maintenance of low glycaemic levels was observed in one study. Otherwise, no statistically significant group differences between couples' groups and control groups were observed in any of the five included studies.

CONCLUSIONS

The included studies concluded that couple-based interventions can lead to weight reduction, maintenance, and adherence to modified health behaviours similar to interventions that target individuals. Overall, the findings indicate that, notwithstanding the paucity of authentic couples-based interventions, there is potential for such approaches to moderate MetS risk factors likely to flow onto epigenetic transmission of risk.

Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older adults in England

BACKGROUND

Smoking is often colloquially considered "social". However, the actual relationship of smoking with current and future social isolation and loneliness is unclear. We therefore examined these relationships over a 12-year follow-up.

METHODS

In this cohort study, we used a nationally representative sample of community dwelling adults aged 50 years and over from the English Longitudinal Study of Ageing (N=8780) (45% male, mean(SD) age 67(10) years. We examined associations of self-reported smoking status at baseline assessment, with social isolation (low social contact, social disengagement, domestic isolation), and loneliness (3-item UCLA loneliness scale), measured at baseline, and follow-up at 4, 8 and 12 years, using ordinary least squares regression models.

FINDINGS

At baseline, smokers were more likely to be lonely (coef.=0·111, 95% CI 0·025 - 0·196) and socially isolated than non-smokers, having less frequent social interactions with family and friends (coef.= 0·297, 95%CI 0·148 - 0·446), less frequent engagement with community and cultural activities (coef.= 0·534, 95%CI 0·421 - 0·654), and being more likely to live alone (Odds Ratio =1·400, 95%CI 1·209 - 1·618). Smoking at baseline was associated with larger reductions in social contact (coef.=0·205, 95%CI 0·053 - 0·356, to 0·297, 95%CI 0·140 - 0·455), increases in social disengagement (coef.=0·168, 95%CI 0·066 - 0·270, to coef.=0·197, 95%CI 0·087 - 0·307), and increases in loneliness (coef.=0·105, 95%CI 0·003 - 0·207), at 4-year follow-up) over time. No association was found between smoking and changes in cohabitation status. Findings were independent of all identified confounders, including age, sex, social class and the presence of physical and mental health diagnoses.

INTERPRETATION

Smoking is associated with the development of increasing social isolation and loneliness in older adults, suggesting smoking is detrimental to aspects of psychosocial health. The idea that smoking might be prosocial appears a misconception.

FUNDING

UK Economic and Social Research Council & Imperial College London.

Social influences on smoking cessation in mid-life: Prospective cohort of UK women

INTRODUCTION

Decisions to quit smoking are thought to be influenced by social factors such as friends, family and social groups, but there have been few attempts to examine comprehensively the influence of a range of social factors on smoking cessation. In the largest study to date, we examined whether smoking cessation was associated with marital status and the smoking habits of a partner, socio-economic status and social participation.

METHODS

In the prospective Million Women Study, 53,650 current smokers in 2001 (mean age 58.3, SD 4.4) reported their smoking status 4 years later; and reported on social factors on both occasions. Logistic regression yielded odds ratios (ORs) and 99% confidence intervals (CIs) for stopping smoking in the next 4 years by marital status, whether their partner smoked, deprivation, education, and participation in social activities.

RESULTS

31% (16,692) of the current smokers at baseline had stopped after 4 years. Smokers who were partnered at baseline were more likely to quit than those who were not partnered (OR 1.13, 99% CI 1.06-1.19). Compared to having a partner who smoked throughout, those who had a non-smoking partner throughout were more likely to quit (OR 2.01, 99% CI 1.86-2.17), and those who had a partner who smoked at baseline but stopped smoking in the next 4 years were even more likely to quit (OR 6.00, 5.41-6.67). There was no association with cessation for education or deprivation. The association with social participation varied by type of activity but was null overall.

CONCLUSION

Women who were partnered were most likely to stop smoking if their partner also stopped smoking. There was little evidence of a strong influence of either socio-economic status or social participation on smoking cessation. These results emphasise the importance of a spouse's smoking habits on the likelihood of a smoker successfully quitting smoking.

Comparisons Between Smoking Patterns Among Sexual Minority Females and Males in Romantic Relationships

PURPOSE

Several studies have noted sexual minority disparities in tobacco smoking; however, few studies have examined the role of intimate partners in these different smoking behaviors among sexual minority men and women. Furthermore, few studies distinguish between intermittent and daily smokers. Thus, this study sought to examine whether perceptions of their partner's smoking behaviors were associated with their own smoking behaviors in a sample of sexual minority adults in romantic relationships.

METHOD

In total, 898 participants (413 sexual minority females and 485 sexual minority males) completed a one-time online anonymous survey.

RESULTS

Approximately one third of the sample reported smoking, with 21.2% daily smokers and 9.8% intermittent smokers. Multinomial regression results revealed that for both sexual minority females and males having a partner who was a daily or intermittent smoker was associated with an increased odds of being a daily smoker, whereas having a partner who was an intermittent smoker was associated with an increased odds of being an intermittent smoker.

CONCLUSIONS

These findings provide valuable information on the need to attend to romantic partners and consider tailored programming to account for different smoking patterns and partners' potential role in reinforcing smoking.

Perceived partner responsiveness predicts smoking cessation in single-smoker couples

INTRODUCTION

Romantic partners are crucial to successful smoking cessation, but the mechanisms by which partners influence cessation is unclear. Research in this area has focused heavily on partner smoking status and support for quitting, but partner influence may not be limited to these two constructs. The current study examines the perceived responsiveness of the partner (i.e., the perception that the partner understands, approves of, and supports the self) as a predictor of smoking cessation in unassisted quitters, independent of smoking-specific support for quitting and more general relationship satisfaction.

METHODS

Data were taken from a sample of smokers (N = 62) in relationships with never/former smokers (i.e., members of single-smoker couples) who completed a 21-day ecological momentary assessment study during an unassisted quit attempt. Measures of perceived responsiveness, support for quitting, and relationship satisfaction obtained at baseline were used to predict smoking outcomes over the course of the study.

RESULTS

Consistent with our predictions, perceived responsiveness emerged as a significant predictor of smoking cessation over and above the effects of support for quitting and relationship satisfaction. Support for quitting only predicted self-reported relapse. Unexpectedly, once perceived responsiveness was considered, greater relationship satisfaction was associated with poorer smoking outcomes.

CONCLUSIONS

The current research suggests that perceived responsiveness is a more effective resource for smoking cessation than support specifically for quitting. These findings extend previous research by demonstrating that perceived responsiveness represents a distinct construct from smoking-specific support or relationship satisfaction, and that it is important for smokers during a quit attempt.

Are Optimism and Cynical Hostility Associated with Smoking Cessation in Older Women?

BACKGROUND

Optimism and cynical hostility independently predict morbidity and mortality in Women's Health Initiative (WHI) participants and are associated with current smoking. However, their association with smoking cessation in older women is unknown.

PURPOSE

The purpose of this study is to test whether optimism (positive future expectations) or cynical hostility (mistrust of others) predicts smoking cessation in older women.

METHODS

Self-reported smoking status was assessed at years 1, 3, and 6 after study entry for WHI baseline smokers who were not missing optimism or cynical hostility scores (n = 10,242). Questionnaires at study entry assessed optimism (Life Orientation Test-Revised) and cynical hostility (Cook-Medley, cynical hostility subscale). Generalized linear mixed models adjusted for sociodemographics, lifestyle factors, and medical and psychosocial characteristics including depressive symptoms.

RESULTS

After full covariate adjustment, optimism was not related to smoking cessation. Each 1-point increase in baseline cynical hostility score was associated with 5% lower odds of cessation over 6 years (OR = 0.95, CI = 0.92-0.98, p = 0.0017).

CONCLUSIONS

In aging postmenopausal women, greater cynical hostility predicts lower smoking cessation over time. Future studies should examine whether individuals with this trait may benefit from more intensive cessation resources or whether attempting to mitigate cynical hostility itself may aid smoking cessation.

The role of smoking in social networks on smoking cessation and relapse among adults: A longitudinal study

Understanding the spread of smoking cessation and relapse within social networks may offer new approaches to further curb the smoking epidemic. Whether smoking behavior among social network members determines smoking cessation and relapse of adults however, is less known. For this study, longitudinal data of 4623 adults participating in the Dutch Longitudinal Internet Studies for the Social sciences (LISS) panel were collected in March 2013 with a follow-up in 2014. Logistic regression was used to examine the association between the proportion of smokers in social networks, and (1) smoking cessation (n=762) and (2) smoking relapse (n=1905). Analyses were adjusted for the size of the network, age, sex, and education. Respondents with the largest proportion of smokers in their social network were less likely to quit smoking (OR=0.25; 95% CI=0.11-0.66) and more likely to experience a relapse (6.08; 3.01-12.00). Smoking cessation and relapse were most strongly associated with the proportion of smokers among household members and friends. The proportion of smokers in family outside the household was not related to smoking cessation and smoking relapse. In conclusion, smoking behavior in social networks, especially among household members and friends, is strongly associated with smoking cessation and relapse. These findings further support the spread of smoking within social networks, and provide evidence for network-based interventions, particularly including household members and friends.

A longitudinal study of persistent smoking among HIV-positive gay and bisexual men in primary relationships

INTRODUCTION

We examined the stability of smoking behaviors, and factors associated with persistent smoking in a longitudinal study of HIV-positive gay and bisexual men in primary relationships.

METHODS

A sample of 377 HIV-positive men on antiretroviral therapy and their same-sex partners completed five assessments over two years. Participants completed semi-structured interviews which assessed smoking status, sociodemographic factors, relationship dynamics, and HIV-related disease characteristics. Latent transition analysis estimated the amount of transition in smoking over time. Latent class analysis examined factors associated with smoking status across the study period.

RESULTS

At baseline, 28.1% (n=106) of participants reported current smoking. Over 90% of the HIV-positive men remained in the same smoking category over time (68.4% persistent non-smokers; 24.1% persistent smokers). Men whose partners smoked and men with lower income had higher odds of being persistent smokers, whereas older men and men who identified as Latino race/ethnicity had lower odds of being persistent smokers compared to non-smokers.

CONCLUSIONS

Despite efforts to reduce smoking among people living with HIV (PLWH), a substantial subset of men continued to smoke during their two years in the study. Findings suggest that primary partners who also smoke and low income were the strongest predictors of sustained smoking behaviors among HIV-positive men. Additional research is needed to better understand how to increase motivation and support for smoking cessation among PLWH and their primary partners, while attending to how socioeconomic status may inhibit access to and the sustained impact of existing smoking cessation programs.

Stress is a principal factor that promotes tobacco use in females

Tobacco use is a major economic and health problem. It is particularly concerning that women consume more tobacco products, have a more difficult time quitting smoking, and are less likely to benefit from smoking cessation therapy than men. As a result, women are at higher risk of developing tobacco-related diseases. Clinical evidence suggests that women are more susceptible to anxiety disorders, and are more likely to smoke in order to cope with stress than men. During smoking abstinence, women experience more intense anxiety than men and report that the anxiety-reducing effects of smoking are the main reason for their continued tobacco use and relapse. Consistent with this, pre-clinical studies using rodent models suggest that females display more intense stress during nicotine withdrawal than males. This review posits that in women, stress is a principal factor that promotes the initiation of tobacco use and relapse behavior during abstinence. Studies are reviewed at both the clinical and pre-clinical levels to provide support for our hypothesis that stress plays a central role in promoting tobacco use vulnerability in females. The clinical implications of this work are also considered with regard to treatment approaches and the need for more research to help reduce health disparities produced by tobacco use in women.

Social engagement and chronic disease risk behaviors: the Multi-Ethnic Study of Atherosclerosis

OBJECTIVE

Although engagement in social networks is important to health, multiple different dimensions exist. This study identifies which dimensions are associated with chronic disease risk behaviors.

METHODS

Cross-sectional data on social support, loneliness, and neighborhood social cohesion from 5381 participants, aged 45-84 from the Multi-Ethnic Study of Atherosclerosis was used.

RESULTS

After adjusting for individual characteristics and all social engagement variables, social support was associated with lower smoking prevalence (PR=0.88, 95% CI: 0.82, 0.94), higher probability of having quit (PR=1.03, 95% CI: 1.01, 1.06) and a slightly higher probability of achieving physical activity recommendations (PR=1.03, 95% CI: 1.01, 1.06). Neighborhood social cohesion was associated with very slightly higher probability of achieving recommended (PR=1.03, 95% CI: 1.01, 1.05) or any regular (PR=1.0, 95% CI: 1.01, 1.04) physical activity, and a higher probability of consuming at least five daily fruit and vegetable servings (PR=1.05, 95% CI: 1.01, 1.09).

CONCLUSIONS

Both social support and neighborhood social cohesion, a less commonly considered aspect of social engagement, appear to be important for chronic disease prevention interventions and likely act via separate pathways.

Structural and Functional Support in the Prediction of Smoking Cessation in Caregivers of Children with Asthma

Caregivers of children with asthma smoke at rates similar to the general population. Research on the relative importance of structural or functional social support in smoking cessation has been mixed. Participants were smokers (N = 154) who were caregivers of children with asthma. Both functional (Interpersonal Support Evaluation List) and structural social support (living with another smoker, partner status, and the proportion of smoking friends) were measured at baseline. Participants received an asthma-education and smoking cessation intervention based on Motivational Interviewing. Biochemically-verified abstinence was assessed at six months post treatment. Results indicated that functional support predicted smoking abstinence even when controlling for relevant covariates and structural support (OR = .896, p = .025). Exploratory analyses revealed that this effect was driven primarily by the self-esteem ISEL subscale. Smoking cessation that focuses on building general functional support, particularly self-esteem support, may be beneficial for smoking cessation in caregivers of children with asthma.

Effect of network social capital on the chances of smoking relapse: a two-year follow-up study of urban-dwelling adults

OBJECTIVES

We sought to examine the prospective influence of social capital and social network ties on smoking relapse among adults.

METHODS

In 2010, a 2-year follow-up study was conducted with the 2008 Montreal Neighborhood Networks and Healthy Aging Study (MoNNET-HA) participants. We asked participants in 2008 and 2010 whether they had smoked in the past 30 days. Position and name generators were used to collect data on social capital and social connections. We used multilevel logistic analysis adjusting for demographic and socioeconomic factors to predict smoking relapse in 2010.

RESULTS

Of the 1400 MoNNET-HA follow-up participants, 1087 were nonsmokers in 2008. Among nonsmokers, 42 were smokers in 2010. Results revealed that participants with higher network social capital were less likely (odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.47, 0.96), whereas socially isolated participants (OR = 3.69; 95% CI = 1.36, 10.01) or those who had ties to smokers within the household (OR = 4.22; 95% CI = 1.52, 11.73) were more likely to report smoking in 2010.

CONCLUSIONS

Social network capital reduced the chances of smoking relapse. Smoking cessation programs might aim to increase network diversity so as to prevent relapse.

Better late than never: the perceived benefits of smoking cessation among women in late midlife

The current study examined the association of smoking cessation (≥1 year without relapse) and self-reported psychosocial and physical outcomes among a community sample of women (N = 195; mean age = 63.7 years, SD = 5.7 years). Data were collected in 1985-1986 and 2009. Successful smoking cessation for ≥1 year was significantly associated with each of the outcome measures (e.g., less financial stress [adjusted odds ratio (AOR) = 0.50; 95% confidence interval (CI) = 0.25-1.00, P< 0.05), less life dissatisfaction (AOR = 0.51, 95% CI = 0.24-1.09, P< 0.05). Findings suggest that older women should be included in smoking cessation programs, and the important benefits of quitting should be used to encourage cessation.

Social influences on smoking in American workers: the role of the presence of smokers in the workplace and in the home

PURPOSE

To examine the relationship between the presence of smokers in the workplace and smokers in the home and current smoking status among employed men and women.

DESIGN

Analysis of data from the second wave of the nationally representative Survey of Midlife Development in the United States (2004-2006).

SUBJECTS

Sample of 627 currently employed men and women, aged 34 to 82 (M = 51), who had been regular cigarette smokers at some time.

MEASURES

Survey items indexing presence of smokers in the respondents' immediate work area and home and their current smoking status.

ANALYSIS

Multiple logistic regression analyses, controlling for age, gender, education, race, and job type.

RESULTS

Examined together, smokers in the workplace (OR = 2.83) and smokers in the home (OR = 6.09) were uniquely associated with current smoking status. Moreover, smokers in the home reduced the association between smokers in the workplace and current smoking. The presence of smokers in the workplace was associated with a more than fourfold increase in current smoking among respondents with no smokers in the home, but was unrelated to current smoking among respondents with smokers in the home.

CONCLUSIONS

Failure to consider the presence of smokers in the home significantly limits the potential impact of workplace smoking interventions.

Perceived partner responsiveness predicts decreases in smoking during the first nine years of marriage

INTRODUCTION

Support for quitting is associated with smoking cessation, but few studies have examined the influence of more general social support on smoking outcomes. The current research examines perceptions of the partner's willingness and ability to provide general social support (i.e., perceived partner responsiveness) as a longitudinal predictor of smoking trajectories.

METHODS

Data are from a sample of newlywed couples assessed at six timepoints over 9 years. The current analyses focus on both partners in 333 "ever-smoker" couples. Participants completed measures of partner responsiveness, smoking, and demographics through the mail at each timepoint.

RESULTS

Both husbands and wives who initially reported greater partner responsiveness showed a decrease over the following 9 years in the likelihood of being a smoker and in cigarette quantity. This decrease was not apparent for husbands and wives who initially reported lower partner responsiveness. These effects were mediated by several time-varying characteristics.

CONCLUSIONS

Previous research has shown that support for quitting is an important predictor of smoking cessation. The current research demonstrates that more general perceived social support, unrelated to smoking behavior, also predicts decreases in smoking over time in both men and women. In fact, reports of partner responsiveness at baseline predicted smoking over 9 years, demonstrating the potency of this particular relationship perception for smoking outcomes.