Perceptions of Smoking-Related Risk and Worry Among Dual-Smoker Couples

Relationship partners often engage in similar health behaviors such as dietary intake, exercise habits, and substance use, including smoking (Meyler, Stimpson, & Peek, 2007). Estimates of married smokers who have a smoking partner (i.e., dual-smoker couples) range from about one third in a sample of newly married couples (Homish & Leonard, 2005) to two thirds in a sample of low-income pregnant women (Kendrick et al., 1995). Persons’ health risks are amplified due to exposure to both their own and partner’s smoking (Reardon, 2007; U.S. Department of Health and Human Services, 2006). Coupled with the fact that quit rates are lower and relapse rates are higher among dual-smoker couples (Ferguson, Bauld, Chesterman, & Judge, 2005; Garvey, Bliss, Hitchcock, Heinold, & Rosner, 1992), intervention is needed. A review by Palmer, Baucom, and McBride (2000) concludes that having a smoking partner is a significant threat to abstinence. Achieving cessation in this group is a major public health challenge as most interventions that have focused on couples and attempted to leverage spousal influence and support to enhance quitting have met with negative results (Cohen, Gottleib, & Underwood, 2000; McBride et al., 2004). We are unaware of an intervention developed specifically for dual-smoker couples. New insights on couple-based strategies that enhance quitting are needed to meet this public health challenge. Most models of health behavior describe perceptions of one’s own health risks as a major factor underlying motivation to change behavior (Aiken, Gerend, Jackson, & Ranby, 2012). This is especially true in the smoking literature in which strong positive associations exist between risk perceptions and desire to quit among current smokers (Dillard, McCaul, & Klein, 2006; Norman, Conner, & Bell, 1999). Smoking, however, has direct health risks not only for the individual but also for the partner. Hence, beliefs about how smoking affects one’s partner are important to consider in motivating desire to quit and in understanding maintenance of cessation. This study examined associations between desire to quit, expressed by partners in dual-smoker relationships, and respondents’ perceptions of own and partner’s risk of disease, beliefs about damage to health from smoking, and worry about negative health outcomes. Distinct from a belief or judgment about risk for disease, worry captures a more affective aspect of possible future negative health consequences. Indeed, worry about developing a smoking-related disease may be an even more important predictor of contemplation to quit smoking than perceived risk (Magnan, Koblitz, Zielke, & McCaul, 2009). We examined concordance of beliefs, attitudes, and desires within couples to understand associations between relationship partners. We hypothesized that beliefs about harm to self and harm to one’s partner would be related to one’s own desire to quit (McCaul et al., 2006). We also hypothesized that desire for the partner to quit would be related to beliefs about harm to both the self and partner. We expected that partners would exhibit some degree of similarity related to smoking beliefs as they were both current smokers and had been in a relationship for an extended period of time.