Can A Relationship Change After I Quit Smoking

• Research article
• Open Access
• Published: xix November 2014

Differences in spousal influence on smoking cessation by gender and education amid Japanese couples

BMC Public Wellness volume xiv, Article number:1184 (2014) Cite this commodity

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Abstruse

Background

Previous studies have reported that spousal not-smoking has a spillover effect on the partner's cessation. Withal, word is lacking on the factors modifying that association. Nosotros examined whether the spillover effect of spousal not-smoking was associated with the couple'due south educational attainment.

Methods

We used paired marital data from the Japanese Study on Stratification, Wellness, Income, and Neighborhood (J-Smooth), which targeted residents aged 25–50 years in 4 Japanese municipalities. We selected a spouse smoker at the time of wedlock (target respondent), and set his/her smoking status change (continued or quit smoking later on marriage) as an event, regressed on the analogue'due south smoking status (continued smoking or non-smoking) and combinations of each couple's educational attainment as explanatory variables using log-binomial regression models (north =1001 targets; 708 men and 293 women).

Results

Regression results showed that a counterpart who previously quit smoking or was a never-smoker was associated with the target male spouse'southward subsequent cessation. However, for women, the association between husband'southward non-smoking and their own cessation was significant only for couples in which both spouses were highly educated.

Conclusions

Our findings suggest that a spouse's smoking status is of import for smoking cessation interventions in men. For women, however, a couple's combined educational attainment may matter in the interventions.

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Groundwork

Smoking is a risk gene associated with the incidence of various not-communicable diseases. Attributable to secondhand smoke, smoking is harmful even to non-smokers, making it a major target of public wellness intervention, not but for smokers only too their families and neighbors.

In common with adult Western countries, the smoking rate in Nippon has declined markedly since the 1950s. However, the male smoking charge per unit in Nippon is the sixth highest amid OECD (Organization for Economic Cooperation and Evolution) countries [1], and tobacco remains the largest contributor to the nation's burden of diseases [2]. There is a notable tendency in the prevalence of smoking amid women with respect to age: although the female smoking charge per unit in Japan is relatively low compared with Western countries, the charge per unit amid young women is increasing [three].

Amid individual characteristics affecting smoking initiation and cessation, researchers take focused on age [iv], gender [5], educational groundwork [half dozen, 7], and other sociodemographic factors [8]. In parallel with the studies of individual factors, many researchers have also studied the influence of family unit, specially a spouse, on smoking abeyance among married people [ix–12]. Spousal smoking status is regarded equally a meaning factor affecting a partner'south smoking cessation. A longitudinal study by Falba and Sindelar [13] found that, if a spouse quit smoking, the odds of the partner'southward cessation showed an increase of up to 7.5-fold among men and 8.v-fold among women. Using self-reported life histories of smoking beliefs, Monden et al. [ten] plant that respondents living with an ex-smoker or never-smoker spouse were more than likely to quit smoking than respondents living with a electric current smoker.

Despite a number of publications linking a spouse'southward smoking cessation to that of their partner, discussion of the factors modifying these associations is lacking. As Ross et al. [fourteen] discussed in their review paper, a couple'due south cardinal characteristic in affecting the concordance of health-related behaviors is educational background. Many studies suggested that an private'due south education affects their own health through cloth circumstances, behavioral factors (east.1000., lifestyle), and psychosocial factors (e.one thousand., social support) [14–16]. A spouse's educational activity may also bear on their partner'due south health by the aforementioned mechanisms as the individual'southward own education [17]. Therefore, taking a spouse's didactics into account may well explain the health of married people. For example, using cross-exclusive data, Bloch et al. [eighteen] found that highly educated couples showed a high concordance rate with respect to absence of smoking behavior. Monden et al. [17] also examined the effect of a participant'due south own and their spouse'southward educational attainment on smoking behavior using information from about 40,000 Dutch people. Although the results suggested that a spouse's education was significantly associated with their partner's smoking behavior, the effect was weaker than that of the participant's own educational level. However, because these studies did not examine when the couples started and stopped smoking, they could not conclude whether the observed association was the consequence of a existent spillover effect of the partner's beliefs change or just the reflection of assortative mating. Based on social commutation theory, assortative mating proposes that mate selection is not random and that individuals are likely to choose a partner who is similar in personality, behavior, physical features, and health [xix–22].

To find a leverage bespeak of behavioral intervention to reduce smoking, it would be benign for public health practitioners to know whether couples' behavioral interactions and their educational backgrounds affect the likelihood of smoking cessation. If the spillover effect exists and the result is influenced by the couple's educational backgrounds, we tin more effectively modify smoking abeyance interventions according to their own and their partners' educational statuses whereas if the assortative mating caption is a ascendant factor for the couple'south concordance in smoking behavior, approaches relevant to the target'south educational background would not work. Thus, this paper examined how an private'southward smoking cessation is affected by a spouse'south prior smoking beliefs status, and how these associations are altered past the couple'south educational attainment combinations.

Methods

Data

Data from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-Shine) project were used for this study, details of which are described elsewhere [23]. The wave ane survey was conducted from July 2010 to Feb 2011 in iv municipalities in Japan (two in the Tokyo metropolitan area and two in a nearby prefecture), with a probabilistic sample of customs-domicile men and women aged 25–50 years. The sample size of the wave one survey was 8,408, and 4,357 respondents replied (response charge per unit was 51.8%). Among them, 3,027 with a spouse or partner were invited to take part in a spouse/partner survey from August to December 2011; this involved asking similar questions as in the wave ane survey questionnaire to brand a pair-wise comparison. The questionnaire was filled out past the spouses themselves. Data from the spouse/partner survey were merged into the wave 1 information, and the paired data of 1,500 couples were available for the analysis. All couples were asked when they married, and when each member of the couple initiated/quit smoking. Thirty-two couples in which spouses were living together but were non legally married were not included in our analyses considering there was no question identifying the starting date of their partner relationship. Additionally, 545 couples in which both spouses were non-smokers at the time of marriage were also omitted from our analyses. The present study analyzed 839 eligible couples who had no missing values in the measurement variables (as described below, the number of individual "targets" included in our analyses was 1001).

The study protocol and informed consent were approved past the ethics committees of the Graduate School of Medicine of The University of Tokyo.

Measurements

Smoking status

Respondents were asked to identify their smoking status from iii categories (1 = electric current smoker, two = ex-smoker, iii = never-smoker). Respondents who were categorized every bit current smokers or ex-smokers were then asked when they initiated smoking co-ordinate to a year-calendar month format. Ex-smokers were additionally asked when they quit smoking. In the spouse/partner survey, spouses were asked nearly their smoking status and the date of smoking initiation and cessation.

We extracted information about both spouses' smoking status at matrimony and their change in smoking status after matrimony, based on wave one and spouse survey information. Then, we included all subjects who were smokers at the time of marriage as the targets. In couples who both smoked at the time of union, each person in the couple was counted in the assay as a target, and their analogue's status at the fourth dimension of behavioral change as an exposure. Every bit a result, the number of individual targets in our analyses was 1001 (708 men and 293 women). Our principal exposure variable was dichotomous, indicating whether the analogue continued smoking later marriage or was a not-smoker (a never or ex-smoker at union, or quit after marriage). The outcome variable was also dichotomous, indicating whether the target respondent continued smoking after marriage or quit smoking during marital life (Table 1).

Table 1 Combinations of outcomes and main exposure

Full size table

Demographic variables

Educational attainment of high school graduation or lower was coded as 0 and that of college graduation or higher as i. Educational attainment was measured as completion of the level of schooling at the fourth dimension of the survey. In the analyses, combinations of the couple'due south educational attainment were used as explanatory variables, i.e., we used four dummy variables indicating couples with a low-educated target and low-educated counterpart (LOW-low couple), a low-educated target and high-educated analogue (Low-high couple), a high-educated target and low-educated counterpart (HIGH-depression couple), and a high-educated target and loftier-educated counterpart (HIGH-high couple). Additionally, the target respondent's age and gender and household's presence of children were likewise used as sociodemographic covariates.

Statistical assay

We adopted log-binominal regression models rather than logistic regression models as the prevalence of event events (change in smoking behavior after matrimony) was relatively big [24, 25]. We set the target respondent'south change in smoking beliefs as an outcome, and their counterpart's non-smoking status every bit a main exposure.

First, nosotros analyzed a model that included the main outcome of analogue's non-smoking condition and its interaction result with the target's sex activity to bank check whether in that location was a gender difference in the effect of counterpart'south smoking status. Because this analysis included some couples twice, the independence assumption of regression was violated. To account for potential underestimation of errors, we adopted robust error interpretation to take within-couple clustering into consideration [26]. Because the interaction was significant, nosotros farther conducted analyses stratified by gender, by regressing the primary effects of the analogue's non-smoking status and the couple's educational attainment combinations on the target's behavioral change in smoking after marriage (Model i). In subsequent analyses, we added to Model 1 interaction terms betwixt analogue'southward non-smoking status and couple's educational attainment combinations to determine whether the spillover event of counterpart's non-smoking varied according to the couple'southward educational levels (Model 2).

Results

Table ii presents descriptive statistics of the targets in the analysis.

Tabular array 2 Descriptive statistics of the target respondents

Full size table

Near half of the target respondents were in their 40s, and about lxxx% had children; 31.2% of men and 47.4% of women achieved high school graduation or less. The percent of the couples matched in terms of counterpart'south educational attainment ("Depression-low" or "Loftier-high" couples) were 75.2% among men and 66.9% among women. Whereas 42.five% of male person targets continued smoking after matrimony despite having a non-smoking counterpart, only x.half dozen% of female targets did so. Just 4.1% of males quit smoking despite their wife's continuing smoking, whereas 37.2% of females did then. The proportion of couples in which both target and counterpart continued smoking after marriage was 16.0% amongst men and 38.2% among women.

Next, we examined whether the interaction term between the target'southward sex activity and counterpart's non-smoking was associated with the target'southward cessation after marriage to bank check for a gender difference in the spillover effect (data not shown). The results showed that, in contrast to the non-significant main effect of counterpart's non-smoking on the target'due south postmarital cessation (gamble ratio (RR) =one.xx, 95% CI: 0.94–i.52), the interaction term was significant (RR =1.84, 95% CI: 1.22–2.76). A log-likelihood ratio (LR) test between the model with and without the interaction term showed that inclusion of the term was significant (LR chi²(i) =9.96, p < .01). Because these results indicated that in that location was a pregnant gender departure in the effect of counterpart's not-smoking on the target's cessation after matrimony, the following analyses were stratified by gender.

Model 1 in Table iii shows the log-binomial regression estimates for the effects of the analogue's not-smoking status and the couple'southward educational attainment combinations on the target'south smoking cessation after union. Model i indicates that counterpart'south not-smoking was associated with the target'southward smoking cessation subsequently marriage among men (RR =2.27, 95% CI: i.61–3.18), but not among women (RR =i.16, 95% CI: 0.90–i.49). The couple'south educational attainment combinations did not have significant main effects on smoking cessation in either men or women. As an additional assay, nosotros recategorized the counterpart's not-smoking status into "never-smoker" and "ex-smoker" and examined whether these not-smoking categories showed different associations with the target'southward abeyance. The RRs of never-smoker counterparts were 2.04 for men and i.02 for women whereas those of ex-smoker counterparts were iii.28 for men and 1.33 for women (continuing smoker as a reference, data not shown).

Table three Log-binomial regression estimates of factors associated with target smoking abeyance

Total size table

Model 2 in Table 3 examined whether the association between a analogue'south non-smoking and a target's abeyance varied depending on the couple's educational combination. Targets in couples where both spouses had low levels of pedagogy (i.eastward., Depression-depression couples) and the counterpart was a non-smoker were ready to the reference category to examine whether the result of a counterpart'south not-smoking depended on the couple's educational combination. For men, whatsoever combination of educational attainment did non testify meaning interaction with counterpart'due south non-smoking. Nonetheless, for women, the interaction of loftier educational attainment in both spouses and their hubby's non-smoking showed a significant association with their own smoking abeyance afterwards marriage (RR =i.48, 95% CI: 1.05–two.08). This outcome suggested that women in couples where both spouses were highly educated and the husband was a non-smoker were one.48 times more than likely to end smoking than women in couples where both had lower educational levels and the husband was a non-smoker. LR tests between models 1 and ii demonstrated that interaction terms betwixt educational pairs and spousal not-smoking as a whole were not significant either for men (LR chi² = 1.39, n.s.) or for women (LR chi² = 1.03, northward.s.).

Discussion

This study indicated that counterpart's not-smoking had a major association with a target's subsequent cessation in men, i.due east., at that place was a spillover effect of the wife's not-smoking only among men. Nevertheless, married man'due south non-smoking was non associated with female person target's cessation. In women, a significant association between analogue's non-smoking and the target'south ain cessation was just observed in couples in which both spouses were highly educated. The results suggested that the spillover effect from highly educated husbands quitting tobacco utilize was effective only for highly educated wives. Still, amongst men, the combinations of the couples' educational levels had no influence on the spillover upshot. The force of the present written report is that the possibility of assortative mating was excluded to some extent by analyzing the target respondents' postmarital behavioral changes in smoking.

Intrinsically, one person in a partnership may regulate the partner's wellness behaviors through direct physical intervention in an effort to improve the wellness of their partner [27]. Although many spouses generally monitor and attempt to control their partner'south health behaviors, women are more than probable to attempt to control their spouse'southward health than men [xvi]. Our finding that men benefit from their female counterpart's not-smoking, regardless of her educational background could be explained by the general influence of women on the daily habits of their husbands by monitoring health and social behavior, and/or providing back up for behavioral change. Meanwhile, our analyses suggested that a husband's non-smoking was significant only for women in highly educated couples, suggesting that a couple's educational level may change the impact of a married man's non-smoking on women. One plausible reason is that the corporeality of social influence and/or back up that husbands exert on their wives depends on their educational backgrounds. A woman who marries a husband of depression educational attainment may receive relatively little social support from him to stop smoking (e.g., emotional encouragement), or may have a negative influence from him (e.chiliad., emotional pressure to smoke) [28]. Likewise, a woman'south tendency to accept a hubby'southward influence may also depend on her own educational level. For example, a high education increases knowledge about health and helps people accept the positive influences from family health behaviors.

The analyses that separate never-smoker and ex-smoker counterparts into independent categories indicated that the spillover effect for a male person target from his analogue may depend on whether the analogue was a never-smoker or ex-smoker, and this was consequent with the findings of Monden et al. [10]. Ex-smoker counterparts may exist more likely to dislike their spouse smoking and to arbitrate in their spouse'southward abeyance than never-smoker counterparts, or ex-smoker counterparts may be able to provide more appropriate support for their smoking spouse because they know the difficulty of quitting smoking.

One possible reason that the main effect of a couple's educational level was not significant in this study may be attributed to the failure of previous studies to exclude the possibility of assortative mating [17, 18]. That is, there is a possibility that a highly educated person marries a highly educated partner and, in such couples, the probability of being a non-smoker is loftier because of their loftier educational level. In fact, when examining the cross-sectional smoking condition in our data, it was shown that the target'due south ain and the counterpart's educational levels were associated with the target's smoking status. In this paper, nosotros focused on smoking abeyance subsequently marriage and treated the respondent who was a smoker at the start of their marital life as the target, thus it is reasonable to believe that the primary outcome of educational attainment is weakened in our analyses, with a reduced influence of assortative mating.

Several limitations should be noted in this study. First, nosotros measured the respondents' self-reported engagement of smoking abeyance, which may be susceptible to measurement errors. 2nd, although partners who were living with, merely were not legally married to the respondents in the wave i survey (e.g., common-law husband/married woman) were also invited to participate in the spouse/partner survey, they were omitted from our analyses because of the lack of a defined starting date of the partner relationship. Still, an single partner tin also be seen as influential in the issue of the spillover outcome from intimate others. Future research should include unmarried couples and examine the outcome of the intimate partner'south smoking behavior. Tertiary, the sample was derived from four municipalities in the Greater Tokyo metropolitan area, which may bear upon the generalizability of our findings. Finally, we simply assumed in our analysis that the initial abeyance of a spouse affected the subsequent cessation of the partner; all the same, temporal initiation does not necessarily signify a causal association between the behaviors, and our estimates of the spillover consequence may have been exaggerated.

The implications of our results for public health do are that smoking cessation programs targeting both spouses may be more constructive than those targeting individuals in some couples. For case, for couples who both smoke, if either one can successfully quit smoking, the eventual likelihood of success of both spouses quitting tin be increased. Or, if a practitioner finds that 1 spouse's likelihood of cessation is higher than that of the other spouses', initial intervention for the sometime spouse tin can increase the probability of cessation in both spouses. Thus, both spouses should exist involved in the intervention. This is especially the case for men. However, for women, the husband's smoking status may not enhance the effectiveness of the intervention if the educational attainment of both spouses is not high; our consequence implied that the spillover effect between spouses may not be potent in such couples.

Conclusion

Our findings propose that a spouse'south smoking condition is associated with men's smoking cessation. For women, even so, a couple'due south combined educational attainment may matter in that association. The present paper implies that abeyance programs should involve both members of a couple, and such programs should take into business relationship the educational backgrounds of the couple in the instance of women smokers.

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Acknowledgments

This research was supported past a Grant-in-Aid for Scientific Research on Innovative Areas (No. 21119002) from the Ministry of Education, Culture, Sports, Scientific discipline and Engineering, Nihon.

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Affiliations

1. Section of Health and Social Behavior, The University of Tokyo, 7-three-i Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

   Daisuke Takagi, Naoki Kondo, Misato Takada & Hideki Hashimoto

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Correspondence to Daisuke Takagi.

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The authors declare that they have no competing interests.

Authors' contributions

DT performed the statistical analysis and drafted the manuscript. NK provided advice regarding critically important intellectual content and critically revised the manuscript. MT made substantial contributions to blueprint and editing of data. HH revised the drafted manuscript critically and contributed to revising the manuscript through the review process for important intellectual content. All authors read and approved the final manuscript.

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Takagi, D., Kondo, Due north., Takada, M. et al. Differences in spousal influence on smoking abeyance by gender and education among Japanese couples. BMC Public Health 14, 1184 (2014). https://doi.org/10.1186/1471-2458-xiv-1184

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• Received: 30 January 2014

• Accepted: 07 November 2014

• Published: xix Nov 2014

• DOI : https://doi.org/10.1186/1471-2458-14-1184

Keywords

• Japan
• Smoking abeyance
• Spousal influence
• Teaching

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