Enhancing partner support to improve smoking cessation

Abstract

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 rep...

Peer effects in smoking cessation: An instrumental variables analysis of a worksite intervention in Thailand

“…However, little evidence exists on the extent to which friends influence each other during tobacco cessation interventions, and even less is known about the effect of these approaches in LMICs. A meta-analysis of 14 high-quality randomized controlled trials leveraging peer or social support as the key intervention component included only one trial in a low-income setting (Indonesia) and rated the overall quality of the evidence across all studies as low ( Faseru et al, 2018 ). In their review, Faseru and colleagues attribute an overall lack of effectiveness in peer support interventions to the difficulty in successfully increasing the support that smokers receive from peers.…”

“…Several mechanisms may underlie the effects of peers on smoking behavior in our context, including social learning, changes in perceived smoking norms, direct support or encouragement from peers, and other pathways rooted in the structure and characteristics of social networks (see Hunter et al, 2019 for a review of social networks in the context of health). Team- or partner-based approaches, which draw on existing social ties to encourage peer-to-peer support or information spillovers, are often a key component of adult smoking cessation interventions ( Faseru et al, 2018 ). In theory, such interventions may encourage individuals to modify their behavior by eliciting emotional or material support from friends, family members or co-workers, or by appealing to accountability, fear of social punishment, or shame.…”

“…These intervention approaches may take a variety of forms, ranging from group therapy, to one-on-one cessation support, to team-based incentive designs in which rewards or penalties are contingent upon the behaviors of a group of smokers ( Faseru et al, 2018 ; Stead et al, 2017 ; White et al, 2013 ). These team-based incentive designs may be particularly successful by leveraging peer pressure or peer support ( Haisley et al, 2012 ; Kullgren et al, 2013 ; Patel et al, 2016 ) or by encouraging social interactions between teammates that result in individuals exerting more effort to achieve their goals ( Babcock 2019 ).…”

“…These team-based incentive designs may be particularly successful by leveraging peer pressure or peer support ( Haisley et al, 2012 ; Kullgren et al, 2013 ; Patel et al, 2016 ) or by encouraging social interactions between teammates that result in individuals exerting more effort to achieve their goals ( Babcock 2019 ). To date, however, the evidence is limited on the extent to which friends influence each other in the context of such interventions ( Faseru et al, 2018 ; May & West, 2000 ; Westmaas et al, 2010 ), and even less is known about peer influence in workplaces, where adults spend a large amount of their time.…”

Incentive programmes for smoking cessation: cluster randomized trial in workplaces in Thailand

“… 11 Group 6, which consisted of teammates and deposits but no other team based incentives, allows for identification of the independent effect of buddy based peer support, for which the evidence is mixed. 29 30 Groups 7 and 8 combine deposits with an individual bonus for abstaining, similar to the individual deposit based intervention in a prominent trial led by Halpern. 6 Finally, group 9 combines a deposit contract with the same $40 team bonus in group 4, which replicates the intervention used in our pilot study.…”