Does Enhancing Partner Support and Interaction Improve Smoking Cessation? A Meta-Analysis

Abstract

BACKGROUND We wanted to determine whether an intervention to enhance partner support helps as an adjunct to a smoking cessation program. METHODSWe undertook a meta-analysis of English-language, randomized controlled trials of smoking cessation interventions through July 2002 using the following data sources: Cochrane Tobacco Addiction Group specialized register, Cochrane controlled trials register, CDC Tobacco Information and Prevention Database, MEDLINE, Cancer Lit, EMBASE, CINAHL, PsycINFO, ERIC, PsycLIT, Dissertation Abstracts, SSCI and HealthSTAR, with reviews of bibliographies of included articles. Included were trials that assessed a partner support component with a minimum follow-up of 6 months. The outcomes measured were abstinence and biochemical assessment at 6 to 9 months and more than 12 months after treatment. Partner Interaction Questionnaire scores were primary and secondary outcomes.RESULTS Nine studies (31 articles) met inclusion criteria. Partner defi nition varied among studies. All studies included self-reported smoking cessation rates, but there was limited biochemical validation of abstinence. For self-reported abstinence at 6 to 9 months after treatment, the Peto odds ratio (OR) = 1.08 (95% confi dence interval [CI], 0.81-1.44) and at 12 months Peto OR = 1.0 (95% CI, 0.75-1.34). Sensitivity analysis of studies using live-in, married, and equivalentto-married partners found a higher odds ratio at 6 to 9 months after treatment, Peto OR = 1.64 (95% CI, 0.5-4.64). Sensitivity analysis of studies reporting signifi cant increases in partner support found at 6 to 9 months after treatment Peto OR = 1.83 (95% CI, 0.9-3.47); and at 12 months Peto OR =1.22 (95% CI, 0.67-2.23). CONCLUSIONSInterventions to enhance partner support showed the most promise for clinical practice when implemented with live-in, married, and equivalentto-married partners. Such interventions should focus on enhancing supportive behaviors, while minimizing behaviors critical of smoking. INTRODUCTIONS moking remains the leading cause of preventable disease and death in the United States, causing more than 400,000 deaths annually. 1Smoking cessation is an important behavior change that can have considerable effects on health outcomes. The initiation, maintenance, and cessation of smoking are strongly infl uenced by other family members. Smokers are more likely to marry smokers, to smoke the same number of cigarettes as their spouse, and to quit at the same time.2 In addition, married smokers have higher quit rates than those who are divorced, widowed, or have never married.3 Several studies have shown that support from the spouse is highly predictive of successful smoking cessation. [4][5][6][7] Family interventions have become a standard part of most substance abuse programs. Initial trials of partner support for smoking cessation, however, have been disappointing. In reviewing their own studies of social support interventions for smoking cessation, Lichtenstein and colleagues 11 stated that their interventions did not...

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