Women's perceived and partners' reported support for smoking cessation during pregnancy

Feasibility of Using Ecological Momentary Assessment to Study Unaided Smoking Cessation in Couples

Introduction

Ecological momentary assessment (EMA) is a valuable method for studying smoking cessation, but feasibility has not been examined in committed couples. The current study examines the feasibility of conducting an EMA study of unaided smoking cessation in single-smoker couples.

Methods

Participants were 62 single-smoker couples recruited to participate in a 21-day study of unaided smoking cessation. Quitters and Partners were given instructions to complete one morning report, three signaled reports, and one evening report per day, as well as lapse reports when necessary. They also completed a series of questionnaires at baseline and follow-up. This article examines predictors of compliance with the reporting instructions.

Results

Compliance with scheduled reporting was reasonable (Quitters: 76%, Partners: 79%). Compliance with "on-time" lapse reporting (vs. make-up reporting) was poor (Quitters: 62%, Partners: 43%). Quitters' compliance with lapse reporting was strongly associated with an orientation toward quitting. Partners' compliance with lapse reporting was associated with relationship motivation. Quitter compliance plummeted when Partners were noncompliant. Self-regulation and emotional instability were not associated with compliance but were associated with time to complete reports. Quitters' and Partners' experiences completing the study provide some insight into the dynamics of completing an EMA study as part of a dyad.

Conclusions

Overall, this study suggests it is feasible and effective to collect EMA data on smoking cessation from couples. However, compliance with lapse reporting was poor, especially for Partners. Researchers could provide remuneration on a different schedule, provide shorter lapse reports, or omit Partner lapse reports altogether.

Implications

This article examined compliance with scheduled and lapse reporting in single-smoker couples during an unaided quit attempt. Compliance with scheduled reporting was acceptable, but compliance with lapse reporting was poor, especially for Partners. Quitters' compliance with lapse reporting was heavily influenced by an orientation toward quitting, suggesting that improved screening for motivation to quit might improve compliance rates. Quitter compliance also plummeted when Partners were noncompliant. Partner demographics and relationship motivation were the best predictors of compliance. To enhance compliance, researchers might provide remuneration on a different scale, dramatically shorten lapse reports, or even omit Partner lapse reports.

A response surface analysis of expected and received support for smoking cessation: Expectancy violations predict greater relapse

People attempting to stop smoking cigarettes (quitters) hold expectations about the extent to which their partner will provide helpful support during a quit attempt. However, these expectations may not align with their perceptions of the helpfulness of the support they receive. We examine expected and received helpful support during a quit attempt. We hypothesized that receiving less helpful support than expected (i.e., creating an expectancy violation) would be associated with the greatest return to smoking. Sixty-two quitters completed a 21-day ecological momentary assessment (EMA) study. They reported expected support at baseline and support receipt and smoking during the EMA phase. At follow-up, they completed an expelled breath carbon monoxide test. Analyses using polynomial generalized linear models with response surface analysis indicated that smoking outcomes depended on the joint influence of expected and received helpful support. As hypothesized, when quitters expected more helpful support than they received, they were more likely to smoke in the first 24h and the last seven days of the EMA, and they provided higher carbon monoxide readings at follow-up. These results are consistent with an expectancy violation explanation: quitters are more likely to smoke when they perceive their partner has failed to provide support that is as helpful as expected. Given the importance of support for smoking cessation, many researchers have attempted to experimentally increase provision of support. The current findings suggest that partner support interventions might backfire if the quitter is led to expect more helpful support than the partner is able to provide.

Smoking concordance during pregnancy: Are there relationship benefits?

OBJECTIVE

Couples often engage in similar patterns of behavior, including substance use, and similarity may benefit relationship quality. Such relationship benefits may be especially salient for adolescent and young couples, whose relationships are often unstable and prone to breakups. This study examined the effect of mutual smoking during pregnancy on relationship quality in pregnant adolescent and young adult couples.

METHODS

Couples (N = 228; M_AgeFemale = 18.69; M_AgeMale = 21.12) were recruited from obstetrics/gynecology clinics in Connecticut from July 2007 to February 2011. Couples completed measures of recent smoking and relationship quality (i.e. satisfaction, affectional expression, cohesion, and consensus) during pregnancy and at six months postpartum. Data were analyzed using multilevel models to account for interdependence within dyads.

RESULTS

Discrepant smoking patterns were associated with a reduction in satisfaction and cohesion over time (B = -1.14, p = 0.03, and, B = -2.74, p = 0.03, respectively), and a reduction in consensus over time for female participants, B = -1.98, p = 0.07, but not for male participants, p = 0.51. Discrepant smoking was not related to affectional expression, p = 0.11.

CONCLUSIONS

Results suggest relationship benefits concordant smoking patterns during pregnancy. Interventions should consider potential unintended relationship consequences of changing individual health behavior and instead work to develop couple-level health interventions.

Psychosocial Factors Related to the Correspondence of Recipient and Provider Perceptions of Social Support among Patients Diagnosed with or at Risk for Malignant Melanoma

This study examined considered perceptions of social support and factors contributing to increased support among 18 patients diagnosed with or at risk for malignant melanoma and their partners. Partner support, perceived stress, emotional approach coping and partner empathy were evaluated. Results showed lack of correspondence between patient and partner reports of support. Greater correspondence between reports was associated with increased patient emotional approach coping. Partners reported increased empathy following the patients’ diagnoses and more perceived stress than patients. Patients indicated greater use of emotional approach coping than their partners. Male partners reported engaging in less emotional expression than female partners. Interventions might incorporate partner participation to resolve misperceptions of support and to foster factors that promote increased support.

Perceptions of Social Support Provided to Smokers

Introduction: Cessation efforts and maintained abstinence in smokers have been associated with social support from others (i.e., ‘support persons’). Characteristics of support persons appear to affect the amount and quality of support provided to adults who smoke. In the present investigation, the relationship between support person characteristics and perceived quality and quantity of smoking-specific support provided was examined. Method: College students (N = 244) were asked to identify an adult who smokes about whom they were concerned. Participants reported demographic and smoking-related information about themselves and their identified smoker and perceptions of positive and negative smoking-specific social support provided. Results: Results indicated significant differences in smoking status (p < .05), such that current and ex-smokers reported providing more negative support than never smokers. Additionally, participants romantically involved with their smokers reported providing more positive (p < .05) support than those in other relationships. Discussion: Findings suggest the importance of relationship in the perception of support provided during the cessation process and highlight the need for future research in this area.

Correlates of expected positive and negative support for smoking cessation among a sample of chronically ill veterans

OBJECTIVE

To examine demographic, relationship, and smoking history factors related to expected positive and negative support for quitting smoking among chronically ill veterans.

METHODS

Data for this report comes from baseline data from a randomized controlled trial of a support-based smoking cessation intervention for veterans with chronic diseases (cancer, cardiovascular disease, hypertension, diabetes, and chronic obstructive pulmonary disease). We used separate multiple linear regression models to analyze relationships between positive and negative support and variables selected for model entry.

RESULTS

Veterans in our sample expected high positive and negative support for quitting. Veterans who were married/living as married, had some college education, were female, or named a female support person expected higher levels of positive support. Veterans who named a female or a nonsmoker as a support person expected higher levels of negative support. Males and non-Caucasians also reported higher levels of expected negative support.

CONCLUSIONS

Individual differences that influence perceptions of expected support are likely to influence intervention participation and engagement. Thus, understanding factors associated with expected positive and negative support is necessary to optimize future implementation of support-based cessation interventions through better treatment matching.

Predictors of spontaneous smoking cessation among Chinese men whose wives are pregnant

This is an exploratory study to identify the predictors that Chinese men will spontaneously quit smoking during their wives' pregnancy. Smoking husbands who accompanied their non-smoking pregnant wives to an antenatal clinic were invited to complete a questionnaire soliciting information regarding their smoking behaviours, perceptions of support received from their wives, and motivating factors for quitting smoking. A total of 74 men were recruited. Two-thirds (67.6%) were daily smokers, had started smoking under the age of 18 (66.2%), and smoked 6-15 cigarettes (48.6%) a day. Nearly one-third of the smoking husbands (n = 50, 67.6%) reported that their wife was the person who provided them with the necessary main support in quitting. Nearly a quarter (18 out of 74, 24.3%) of the husbands indicated that they quit smoking during their wives' pregnancy. Those more likely to quit were the 'occasional smokers' (61.1% vs. 38.9%), those who craved cigarettes a few hours after getting up (0% vs. 100%), those who were confident in their ability to quit (77.8% vs. 22.2%), and those who had previously attempted to quit (88.9% vs. 11.1%). The level of negative support from wives to quit smoking was significantly related to men's quitting (55.6% vs. 44.4%). The results of this study identified the husbands most likely to spontaneously quit smoking during their wives' pregnancy as those who were occasional smokers, were confident about smoking cessation, and reported their wives as being bothered by smoke.

Socio-demographic factors and processes associated with stages of change for smoking cessation in pregnant versus non-pregnant women

Background

The tobacco control community assumes that the most effective interventions are personalized. Nevertheless, little attention is paid to understanding differences between pregnant and non-pregnant European women in terms of the social factors that influence tobacco use and the processes of change used to quit smoking.

Methods

The study consecutively enrolled 177 pregnant women who acknowledged smoking the year before pregnancy and 177 non-pregnant women who acknowledged smoking the year before their clinic visit for a Pap test.

Results

With respect to socio-demographic factors, the stages of change in pregnant women were associated with level of education, marital status, and the presence of roommates, partners and friends who smoke. In pregnant women, there was no statistically significant difference in the processes used to stop smoking among the stages of change. Furthermore, behavioral processes were higher in non-pregnant women than in pregnant women, and the difference was statistically significant in the advanced stages of behavioral change. Both pregnant and non-pregnant women showed higher levels of acceptance towards smoking in the earlier stages of change, but the acceptability of smoking in the pre-contemplative stage was higher in non-pregnant women. Greater craving was detected in non-pregnant vs. pregnant women at all stages and reached a statistically significant level at the pre-contemplative stage.

Conclusion

Pregnancy is a favorable time to stop smoking since pregnant women are more likely to be in an advanced stage of behavioral change. Pregnant and non-pregnant women are distinct populations in the types and processes of change involved in smoking cessation. The intervention programs to promote smoking cessation and prevent relapses will need to take these differences into account.

Validation of the support provided measure among spouses of smokers receiving a clinical smoking cessation intervention

Studies indicate a positive association between social support and smoking cessation. However, clinic-based interventions designed to increase social support have had limited success. Most studies have relied on only the smoker's perceptions of support received while few have assessed the support provider's report of support delivered. Understanding supportive interactions between support providers and recipients may assist in developing effective support interventions for cessation. The current investigation examined the perceptions of smoking-specific support provided by the spouse of a partner who smokes and was seen for a nicotine dependence consultation. Specifically, we examined spouse reported willingness to help their spouse quit, interest in learning ways to help their spouse quit, and characteristics associated with the provision of smoking-specific supportive behaviors (as assessed via the Support Provided Measure, SPM), in the 2-weeks prior to the consultation. The current investigation also examined the concurrent validity of the SPM with a validated measure of support provided to a smoker, the Partner Interaction Questionnaire (PIQ), accounting for social desirability bias and smoker readiness to change. The sample comprised 84 adult cigarette smokers seen for a clinical smoking cessation intervention and their spouses (N = 84). Results indicate that a high percentage of spouses are willing to help their partner who smokes and interested in learning way to help. As expected, spouses who were females and had never smoked had higher scores on the SPM than males or current smokers. The SPM was significantly correlated with the PIQ positive (r = 0.50, p < 0.01) and negative (r = 0.44, p <0.01) item scales overall and for spouses whose partners reported higher levels of readiness to quit smoking (r = 0.54, p < 0.01; r = 0.50, p < 0.01, respectively). Suggestions for future research are offered.

Perceived support to stay quit: what happens after delivery?

OBJECTIVE

To assess whether perceived changes in postpartum support were associated with postpartum return to smoking.

STUDY DESIGN

This is a prospective repeated measures, mixed methods observational study. Sixty-five women who smoked prior to pregnancy were recruited at delivery and surveyed at 2, 6, 12, and 24 weeks postpartum; in-depth interviews were conducted when participants reported smoking.

RESULTS

Fifty-two percent self identified as White, non-Hispanic. Forty-seven percent resumed smoking by 24 weeks postpartum. Women who had returned to smoking by 24 weeks had a significantly larger decrease in perceived smoking-specific support than women who remained abstinent (p<0.001). By 24-week postpartum follow-up, only 24% of women reported that an obstetric clinician had discussed how to quit/stay quit. When qualitatively interviewed, more than half of women reported having no one to support them to stay quit or quit smoking.

CONCLUSION

Following delivery, women lack needed smoking-specific support. Decline in perceived smoking-specific support from family and friends is associated with postpartum smoking resumption.

Baby BEEP: A randomized controlled trial of nurses' individualized social support for poor rural pregnant smokers

OBJECTIVES

We tested the effect of nurse-delivered telephone individualized social support ("Baby BEEP") and eight mailed prenatal smoking cessation booklets singly and in combination (2 x 2 factorial design) on smoking cessation in low-income rural pregnant women (N = 695; 75% participation).

METHODS

Participants randomized to Baby BEEP groups (n = 345) received weekly calls throughout pregnancy plus 24-7 beeper access. Saliva cotinine samples were collected monthly from all groups by other nurses at home visits up to 6 weeks post-delivery. Primary outcomes were point prevalence abstinence (cotinine < 30 ng/ml) in late pregnancy and post-delivery.

RESULTS

Only 47 women were lost to follow-up. Intent-to-treat analyses showed no difference across intervention groups (17-22%, late pregnancy; 11-13.5%, postpartum), and no difference from the controls (17%, late pregnancy; 13%, postpartum). Post hoc analyses of study completers suggested a four percentage-point advantage for the intervention groups over controls in producing early and mid-pregnancy continuous abstainers. Partner smoking had no effect on late pregnancy abstinence (OR = 1.7, 95% CI = 0.95, 3.2), but post-delivery, the effect was pronounced (OR = 3.2, 95% CI = 1.8, 5.9).

CONCLUSIONS

High abstinence rates in the controls indicate the power of biologic monitoring and home visits to assess stress, support, depression, and intimate partner violence; these elements plus booklets were as effective as more intensive interventions. Targeting partners who smoke is needed.

Health concordance within couples: A systematic review

Research has consistently linked marriage and positive health outcomes. In addition, many researchers have found that couples often have similar or concordant health statuses. However, concordance research has been conducted in many fields for decades without a concise review of the literature, nor has one theory of health concordance been established. A systematic review was performed implementing rigorous identification strategies, and 103 health concordance research articles were identified and reviewed to understand what research has been conducted in mental health, physical health, and health behavior concordance among couples. The research overwhelmingly suggests evidence for concordant mental and physical health, as well as health behaviors among couples. Each area of health concordance research offers room for greater research and deeper understanding for the causes of health concordance.

Examining smoking and cessation during pregnancy among an Appalachian sample: a preliminary view

BACKGROUND

Several transitions that a woman experiences prenatally may influence her desire or ability to discontinue smoking. This study explores the role of smoking for young, Appalachian, nulliparous pregnant women and their plans for smoking during their pregnancies.

RESULTS

The reports of women and their male partners were taken from baseline interviews conducted during the first trimester of pregnancy. Cigarette smoking appeared to be more than an isolated addictive activity; rather, smoking was interwoven in women's social and personal realms, often changing as their perceptions of self changed. Women and their partners who continued to smoke appeared to be depressed, reject authority, and perceived little control over issues related to being pregnant.

CONCLUSION

These findings support the argument that standard substance use treatments and polices based on stages-of-change theories may not be effective for all individuals particularly those experiencing significant developmental changes in their lives. Greater success might be obtained from treatment programs designed to recognize the impact of these transitions as it relates to the substance use. The changing experiences of pregnant women in terms of their identity development, views of others, and their relationships have not been adequately addressed in existing cessation programs. Empirically-based interventions targeting these lifestyle characteristics may lead to increased cessation success among pregnant women.

Couples' reports of support for smoking cessation predicting women's late pregnancy cessation

PURPOSE

Although social support has been linked to smoking cessation, no studies have examined whether social support predicts women's late pregnancy cessation. Further, few have included reports from both support recipients and providers.

DESIGN

Longitudinal.

SUBJECTS

Pregnant couples (n = 394) reported support for cessation in early (13-20 weeks) and late (28 weeks) pregnancy.

MEASURES

Different measures of couples' support were tested for predicting women's late pregnancy, cessation. Measures of couples' support that were calculated included: summative (added women's and male partners' support scores, possible range 2-10), difference (subtracted the lower score from the higher, possible range 0-4), strong link (used higher positive or lower negative score, possible range 1-5), weak link (lower positive or higher negative score, possible range 1-5), and female and male reports alone (possible ranges 1-5). Covariate-adjusted odds ratios for the association of these various measures of couples' support with women's late pregnancy cessation were calculated.

RESULTS

Of the 12 scores (6 positive, 6 negative), only summative (p = .03) and weak link (p = .05) for positive support predicted women's quitting.

CONCLUSION

Neither women's nor male partners' reports alone predicted women's cessation; only when both scores were considered, either by adding the scores or by taking the lower score, was the positive support score predictive. Future studies of social support should include support recipients' and providers' perspectives.

Characteristics of tobacco withdrawal in pregnant women

OBJECTIVE

To describe the management of tobacco withdrawal in pregnant women.

STUDY DESIGN

The questionnaire-based, descriptive survey included 979 post-partum women. The variables analysed included the characteristics of the mother and neonate at delivery, her smoking habits, her level of exposure to passive smoking, and the barriers to giving up smoking. The chi square test was used to analyse qualitative variables and the Students t-test for quantitative variables.

RESULTS

76% of women who smoked at the start of pregnancy said that they had been asked about their tobacco consumption. However, only 16% had been asked by a clinician or midwife about their attempts to stop smoking. Seven percent were offered a specialised consultation, but only one-third attended. Seventy-six percent of women who failed to stop smoking during pregnancy had a partner who smoked compared with 63% of women who gave up. Dependency and stress during pregnancy also were lower for women who stopped smoking.

CONCLUSIONS

Healthcare professionals seems to offer only rudimentary care. Simple strategies to help women give up smoking are required. The partner is an important target, especially if he can be persuaded to give up at the same time.

Development and preliminary evaluation of a measure of support provided to a smoker among young adults

Most studies indicate a positive association between social support and smoking cessation. However, clinic-based interventions to increase support for stopping smoking have had limited success. Prior research has emphasized the smoker's perceptions of support received for smoking cessation while less attention has focused on support persons' reports of supportive behaviors provided to a smoker. This study examined select psychometric properties of the Support Provided Measure (SPM), a self-report questionnaire designed by the investigative team to assess supportive behaviors provided to a smoker. The SPM was administered to a college sample (N=771; 67% female) of young adults, aged 18 to 24 years, who reported knowing a smoker whom they thought should quit smoking. Results indicate that, in this sample, the SPM has a two-factor structure with good internal consistency reliability (Cronbach's alpha=0.77) and appears to assess a wide range of individual differences in the provision of support. Demographic correlates associated with SPM scores are described and suggestions for future research are offered.

Smoking cessation strategy use among pregnant ex-smokers

There is strong evidence for the beneficial health effects associated with smoking cessation during pregnancy. Although many pregnant women spontaneously quit smoking during pregnancy, postpartum relapse is high. Evidence suggests that pregnant women do not use smoking cessation strategies as identified by the 40-item Processes of Change Scale as frequently as others who quit smoking. The purpose of this study is to identify factors associated with pregnant exsmokers' use of experiential and behavioral smoking cessation strategies. A cross-sectional survey design is used for the study. From a sample of 201 primarily low-income pregnant women recruited to participate in a larger study, 58 were biologically confirmed ex-smokers. Multiple regression analysis reveals that motivation to quit smoking is the only significant factor explaining the use of experiential and behavioral smoking cessation strategies, accounting for 44% of the variance in experiential processes and 31% of the variance in behavioral processes.

Tobacco use in intimate spaces: issues in the study of couple dynamics

Few guidelines exist for using qualitative research to examine couple dynamics in contexts complicated by strong social stigmas and wide-ranging patterns of interpersonal relationships. The purpose of this article is to describe the methodological and ethical issues that arose in an ongoing qualitative study focused on tobacco reduction in the context of couple relationships, and the strategies undertaken to deal with these challenges. The authors discuss their experiences with the following: recruitment in the context of social stigma and the potential for intracouple coercion, data collection and the implications of uncovering intimate dimensions of couples' lives, the impact of the research process on mothers' vulnerability, and the challenges of capturing shared, "dyad" experiences. These issues point to unique challenges in conducting qualitative research with couples and families and provide a useful base for similar studies.

Unraveling smoking ties: How tobacco use is embedded in couple interactions

The purpose of this research was to explore couple interactions related to tobacco use prior to pregnancy, as part of a larger grounded theory project focused on couple interactions related to tobacco use. Interviews with 28 women who quit or reduced smoking for pregnancy and their partners were conducted. Analysis of retrospective accounts of pre-index pregnancy interactions resulted in the identification of tobacco-related routines related to: (a) regulation of smoking; (b) practices related to the acquisition, use and handling of tobacco; (c) communication about tobacco use; and (d) responding to slips and lapses. Variations in the enactment of routines were captured in three tobacco-related interaction patterns: (a) disengaged; (b) conflictual; and (c) accommodating. Findings provide insights into the role tobacco plays in relationships and resistance to behavior change.

Factors associated with smoking cessation among U.S. pregnant women

OBJECTIVES

This study examines smoking and smoking cessation behaviors among U.S. pregnant women and seeks to identify the sociodemographic correlates of smoking cessation in pregnancy.

METHODS

The 1998 NHIS Pregnancy and Smoking supplement was analyzed, including 5288 U.S. women (weighted to represent 13,714,358 women) who gave birth to a liveborn infant in the past 5 years. Four categories of smoking behavior were analyzed: nonsmoking at last pregnancy, persistent smoking throughout pregnancy, attempting unsuccessfully to quit during pregnancy, and successfully quitting during pregnancy. Logistic regression was used to isolate risk factors for each of the smoking behaviors and to examine factors associated with attempted and successful cessation.

RESULTS

The women most likely to attempt to quit smoking in pregnancy were Hispanic women (OR = 3.09) and women who have smoked for less than 10 years (OR = 2.75 for women aged 18-24.) In general, for the groups at highest risk of smoking at the start of pregnancy, the odds of being a persistent smoker were higher than the odds of being an unsuccessful quitter, which in turn were higher than the odds of quitting successfully. The factors associated with attempts to quit included Hispanic ethnicity, higher education, above-poverty income, and shorter duration of smoking, while the combined effect of age and smoking duration was the only one significantly associated with successful quitting. In every age group, longer smoking duration was associated with lower likelihood of attempting to quit as well as successful quitting.

CONCLUSIONS

The factors most strongly associated with attempts to quit smoking were Hispanic ethnicity and the combined effect of age and smoking duration. Future smoking cessation and relapse prevention programs should be developed, taking into consideration the critical factors of age, ethnicity, income, geography, and addiction.