Using data from a longitudinal study of smoking cessation among blue-collar apprentices, our study found that partner smoking characteristics at baseline were highly associated with smoking and smoking cessation among blue-collar apprentices. Apprentices whose partners requested that they stop smoking had more than three and half times the odds of smoking cessation regardless of intervention status. Many of them maintained this smoking cessation six months later. They had almost twice the odds of maintaining smoking cessation for six months compared to those who reported that their partner had not asked them to stop smoking. In fact, partner request to quit smoking had a stronger and longer lasting effect than intervention group. Those whose partners smoked were less likely to achieve smoking cessation immediately after the intervention; however, the effect of partner smoking was not significantly related to prolonged smoking cessation for six months. Our results, which indicate that partner smoking status potentially has an effect on smoking cessation, is supported by findings from other studies [Dollar, et al. 2009
, Osler and Prescott 1998
In addition to a high prevalence of smoking among the blue-collar apprentices, there was a high prevalence of smoking among those in their work and home social context. The high prevalence of smoking in the work setting of blue-collar apprentices has been reported by other studies [Leigh 1996
, Sorensen 2001
, Sorensen, et al. 1996
]. This study shows that there is also a high prevalence among the partners of blue-collar workers. Blue-collar apprentices who smoke had 13 times higher odds of having partners who smoke. This result does not necessarily imply a causal relationship between partner smoking status and smoking behavior of blue-collar workers because we know that smokers usually associate with friends and partners who smoke [de Leeuw, et al. 2009
, Homish and Leonard 2005
, Macken, et al. 2000
]. However, our results contextualize the social situations in which blue-collar workers are trying to quit smoking.
Prior to discussing possible implications of our results, it is necessary to examine the limitations and strengths of the study. The study utilized self reported measures for both the predictors and outcomes in the study. We made sure that all variables were collected using the same method at all study periods and we used validated scales where available. We could not implement biochemical or respiratory verification of smoking status in this study. Drug testing is routine at the workplaces. As a result, our collaborators advised us that any biological tests would likely lead to deep mistrust of study staff because they would likely be misinterpreted by workers as a drug test. To ensure that the apprentices reported accurate smoking status, the survey assistants stressed that the study needed truthful reporting of smoking status in order to develop effective smoking cessation interventions for the apprentices. They also reminded participants that confidentiality of results would be maintained. Besides, the need for such validation of smoking cessation in population based studies has been questioned [Murray, et al. 2002
, Velicer, et al. 1995
The strengths of our study include our prospective longitudinal design, which allowed us to establish temporal precedence. We were able to gather information on the exposures at baseline and then match it with follow up information from the apprentices. In addition, we used data from an intervention that did not focus on partner support; as a result, there is little risk that the study influenced the answers that we got regarding partner smoking characteristics. The partner questions were included in a multitude of other questions related to work and home environment that were contained in the study survey.
Our study found that there was high amount of smoking in the work and social context of the blue collar workers in the study. Evidence suggests that the disparity in smoking cessation between occupational groups has widened over the years [Barbeau, et al. 2004
, Brackbill, et al. 1988
, Giovino, et al. 2000
, Leigh 1996
, Nelson, et al. 1994
]. In concert with this disturbing trend, smoking cessation interventions targeting blue-collar workers have not yielded promising results in achieving prolonged smoking cessation [Campbell, et al. 2002
, Moher, et al. 2005
, Willemsen, et al. 1998
]. This study suggests that incorporating intervention strategies that address partner smoking into smoking cessation interventions might potentially resonate with this group of smokers. Partner requests to stop smoking and partner smoking had stronger effects on smoking cessation than the smoking cessation intervention.
Our study implies that partner smoking characteristics has a strong relationship with both smoking and smoking cessation among blue-collar workers. However, we recognize that addressing partner smoking characteristics is not necessarily a magic bullet for addressing smoking cessation in this group of workers. We also recognize that partner request to stop smoking as operationalized in our study could be a proxy for social support for smoking cessation, which in some cases has been shown to increase smoking cessation [Park, et al. 2002
, Roski, et al. 1996
]. Further studies are needed to understand the best way to operationalize the findings from this study in smoking cessation interventions. A meta-analysis of randomized control trials of interventions aimed at improving partner support among smokers found that the evidence does not suggest a significant improvement in cessation rates though live-in partners may have some influence [Park, et al. 2004
While partner smoking characteristics might not be the remedy for combating smoking among blue-collar workers, our results show that partner smoking characteristics warrant closer examination. Currently, partners of blue-collar workers who smoke have not been a target of smoking cessation studies targeting this population. In fact, the smoking cessation intervention whose data was used for this study collected but did not report data on partner smoking characteristics [Okechukwu, et al. 2009
]. The workers in the study had the option of taking home literature on how partners/friends could help workers who were trying to quit but the partners were not explicitly targeted for smoking cessation. The intervention succeeded in getting more workers in the intervention group to quit; however, there was significant relapse so that there were no differences between the intervention and control groups in maintenance of smoking cessation for six months. It is possible that addressing partner smoking could have decreased the high relapse rate that occurred among these workers given that partner smoking characteristics had a stronger effect than intervention group.