The goal of this report was to examine smoking patterns and influences in couples through the early years of marriage in a sample of individuals who were not involved in a smoking cessation program. We were interested in determining whether the smoking behaviors of one partner affect his or her partner’s smoking or nonsmoking status. Overall, there was some support that a partner who smokes did influence the other’s smoking. However, the findings were different for relapse and cessation, and for husband’s influence compared to wife’s influence.
Over the transition to marriage, the pattern of smoking among married couples was fairly stable. At the first assessment, about one-third of the sample reported that they were current smokers and more than half of the smokers in the sample had a partner who also smoked. These rates are slightly higher, but generally comparable, to the prevalence reported by the US Centers for Disease Control and Prevention (2004
) (29.2% for men, 24.1% for women). Quit rates and start rates were low for both the men and women in the sample. It is difficult to compare these rates to other samples, however, because most of the information about smoking quit rates is derived from samples of individuals involved in treatment to quit smoking (Green, 1995
). Studies that do consider spontaneous cessation of smoking are often samples of pregnant women (Ockene et al., 2002
The primary focus concerned whether spouses influenced each other’s smoking behavior. As previously discussed, the small number of true initiators at each time point necessitated combining these true initiators and those who relapsed into one group. There was evidence to suggest that in the early years of marriage, women who are married to smokers are more likely to resume smoking. Others have also found a significant relationship between smoking initiation in women and a partner who smokes (Daly et al., 1993
; Severson et al., 1995
). Spousal influence, however, did not work in the reverse. That is, men who were married to smokers, compared to those who were married to nonsmokers, were not more likely to initiate smoking or relapse. Similarly, others have not found a relation between a wife’s smoking status and her husband’s smoking (Hymowitz, Sexton, Ockene, & Grandits, 1991
). Wetter and colleagues (2004
) assessed predictors of changes in smoking behaviors among college students and found that a romantic partners’ smoking status did not predict nonsmokers becoming smokers. However, unlike our sample of newly married adults, their sample consisted of college students who were all under 24 years old and predominantly European American. Additionally, only two assessments were completed over a 4 year period, so it is possible that changes in smoking behaviors during the four years were not captured (i.e. participants could have quit and relapsed several times during the four years).
There are a number of possible reasons for finding an influence of husband’s smoking on his wife’s smoking but not the reverse. At each wave, more men reported smoking compared to women; therefore, it is possible that being male may be a sufficient risk factor for smoking and, therefore, husbands do not need an outside influence (i.e., his partner) to initiate or return to smoking. In a recent review of the development of adolescent smoking, male gender was significantly associated with several stages of smoking (trying cigarettes, experimenting, and regular smoking) (Mayhew, Flay, & Mott, 2000
). It is also possible that there are other, gender-specific risk factors involved in smoking relapse that make women more likely to return to smoking. In a study of risk factors and smoking, Soldz and Cui (2001
) found that the belief that smoking was a valid approach to control weight was a stronger predictor of heavy smoking among girls compared to boys. Also, sociability has been related to smoking among females, but not males (Killen et al., 1997
). Based on this notion, it is possible that women whose partners smoke are more likely to smoke in order to be more social and possibly more compatible with their partners.
We found an influence of husband’s smoking on his partner’s smoking; however, in other analyses of this sample, we have found different patterns of spousal influence for different substances. For instance, in a study of spousal influence and marijuana use in married couples (Leonard & Homish, in press), the opposite influence pattern was identified; that is, wives significantly influenced their husbands’ initiation of marijuana use, but husbands did not influence their wives’ initiation. Leonard and Mudar (2003
) found that husbands’ premarital drinking was predictive of wives’ drinking at the couples first anniversary and that wives’ drinking at the first anniversary predicted husbands’ drinking at the second anniversary. Although evidence suggests that the spousal influence may not be the same across substances, or at different stages of marriage, it is clear that spouses do influence their partner’s substance use. The reason for the differential influence patterns across different substances is not entirely clear. Because both marijuana use and heavy alcohol consumption may disrupt interpersonal functioning, wives may be more likely to set the standard for the use of these substances. Smoking does not have this same interpersonal impact. Wives may hold some expectations about smoking, but these may be restrictions regarding the time or place (e.g., not in the home) of use, rather than use per se. Alternatively, because both marijuana and alcohol are involved with socializing behaviors, wives may exert an influence through their impact on the couple’s pattern of socializing. In contrast, smoking may be less tied to socializing outside the couple, and less subject to these influences. Further research is needed to explicate the processes underlying these differential influence patterns.
Our findings provided some support that spouse’s may influence each other’s smoking cessation, although this evidence was not very strong. For instance, partner influence for smoking cessation at Wave 2 was suggested for both men and women in the bivariate analyses. Additionally, in the multivariate models, women’s smoking status at Wave 1 was associated with her husband’s cessation at Wave 2 (at a trend level). For those who did not quit, there was some evidence to suggest that spousal influence was involved in reducing the amount of smoking. From Wave 2 to Wave 3, women who smoked were more likely to reduce the amount they smoked when married to nonsmokers compared to women who were married to smokers. It is possible that with a longer follow-up assessment, these individuals who cut down on their smoking would eventually stop smoking.
It is not entirely surprising that partner influence was found to be a stronger influence in the relapse models compared to the cessation models. The addictive nature of tobacco makes cessation efforts difficult, while increasing the likelihood of relapse among those who do make a quit attempt. Using data from the National Comorbidity Survey, Anthony and colleagues (1994
) assessed the prevalence of dependence of alcohol, tobacco, controlled substances, and inhalants. Of the substances they considered, the rate of dependence among tobacco users was higher compared to the rate of dependence among other substance users. About one-third of smokers were dependant on tobacco, whereas 15% of drinkers were dependant on alcohol. Given the addictive qualities of tobacco, the behavior of one’s partner may not provide sufficient influence to lead to a complete cessation. Instead, it may prompt individuals to make a series of smaller steps in preparation for complete cessation. Consistent with the Transtheoretical Model of Changes in smoking behavior (Prochaska & DiClemente, 1983
; Prochaska, DiClemente, & Norcross, 1992
), the influence of one’s partner might be to move an individual from a pre-contemplative to contemplative or preparation stage in which the individuals are thinking about making a change and have made small attempts towards this change (e.g., reducing amount smoked) (Prochaska et al., 1992
). Further, although beliefs about the positive health effects of quitting smoking are related to smoking cessation (e.g., West, McEwen, Bolling, & Owen, 2001
), it is possible that changes in individuals’ beliefs about health and smoking take a longer period of time than the periods we observed here. In a large sample of smokers, it was found that over 6 months, behavior changes towards smoking cessation were not evident without intervention (Schumann, Meyer, Rumpf, Hapke, & John, 2002
In this report, we found support that one spouse’s smoking impacted his/her partner’s smoking. There are likely to be other factors that mediate or moderate this relation. Leonard and Mudar (2004
) investigated potential moderators of spousal influence and alcohol consumption. They found that, during the transition to marriage, several factors moderated the process of husband’s alcohol consumption influencing his wife’s alcohol consumption. Namely, interpersonal dependence, size of the peer network, and the belief that alcohol had a positive effect on the relationship were significance moderators of this influence processes. Future work will need to consider whether these moderators are substance specific, or related more generally to substance use.
In addition to partner influence, there are many other cognitive and behavioral processes that are involved in smoking cessation and relapse. For example, changes in one’s attitudes about smoking (Gibbons & Eggleston, 1996
), attitudes about smokers (Gibbons & Eggleston, 1996
), or overall health beliefs concerning smoking (Rose, Chassin, Presson, & Sherman, 1996
) may be related to changes in smoking. Additionally, the social environment could also affect change in current smoking through modeling (Grove, 1993
; Morgan, Ashenberg, & Fisher, 1988
), availability of cigarettes (Carter & Tiffany, 2001
; Juliano & Brandon, 1998
), negative social support (Glasgow, Klesges, & O’Neill, 1986
), or positive social support (Mermelstein et al., 1986
Several limitations to this report need to be considered. Smoking status was self-reported and we did not confirm this status using any biochemical methods. However, Wagenknecht and colleagues (1992
) compared self-report measures to biochemical results in sample of over 5000 young adults and found that self-report was an accurate estimate of smoking status. The rates of individuals who either started or stopped smoking during our time period were low. This could have affected our power to detect spousal influence patterns. Additionally, our assessments were one year apart so it is possible that individuals stopped smoking and relapsed several times throughout the year. Also, we do not have detailed pregnancy information and, therefore, cannot assess how factors such as pregnancy or breastfeeding may have affected smoking rates. We also did not differentiate between those who relapsed to smoking compared to those who initiated smoking for the first time. However, true initiation of smoking is less common in adults compared to adolescents, (Chassin, Presson, Rose, & Sherman, 1996
; Chen & Kandel, 1995
) and this was also true for our data with less than 3 individuals considered true initiators at any time point. Although we identified some spousal influence patterns, it is also possible that there was some influence occurring prior to marriage. However, Bachman and colleagues (1997
) considered the effects of engagement and marriage separately and found that, compared to marriage, the effects of engagement on smoking behaviors were quite modest and only significant among women.
Despite these limitations, this work used a longitudinal study of married adults in the general population to assess the influence one partner has on his or her spouses smoking behaviors. Importantly, we found that during the early years of marriage, partners do influence the resumption of smoking. This is especially true for the influence that a husband’s smoking status has on his wife. Although we did not find strong evidence for spousal influence of smoking cessation, there was some evidence that smokers married to nonsmokers are more likely to decrease their tobacco use, thus suggesting promise for intervention programs for married couples. Future work should determine whether spousal influence continues in the later years of marriage and whether subsequent transitions in family life, such as having children, has an impact on smoking and other substance use.