New Treatment for Change-Resistant Smokers--Couples Find Habit Hard to Break

In the early days of Hollywood, the movies portrayed it seductively: the couple smoking together, enjoying a romantic interlude. Today, some couples find it extremely difficult to break that bond, despite overwhelming medical evidence that smoking kills.

The lure of couples smoking is so strong that an anti-smoking campaign in Oregon actually uses a similar Hollywood scene to encourage quitting. In a black-and-white photo mimicking a movie scene, he says "Mind if I smoke?" She replies "Care if I die?"

Cigarette smoking continues to be a major factor in deaths due to cardiac failure and lung disease. Despite an array of products designed to help them, such as patches, gum and hypnosis, programs designed to help smokers quit just don't work says Michael Rohrbaugh, a professor in the Division of Family Studies and Human Development, and the psychology department at the University of Arizona in Tucson.

"Although effective cessation treatments exist, their overall effect is modest, and they rarely reach the high-risk, health-compromised smokers who need them most," Rohrbaugh says.

After smoking for years together, many couples have woven the smoking regime into an integral part of their relationship. When one person seeks to quit, the dynamics of their relationship can change. A preliminary study led by Rohrbaugh found that family and relationship patterns contribute to the persistence of high-risk smoking.

Funded by the UA College of Agriculture and Life Sciences, the Couples and Smoking Assessment Project assessed physician-referred couples who had at least one partner continuing to smoke cigarettes despite multiple personal risk factors for heart disease. To identify behavior patterns that appeared to encourage smoking, Rohrbaugh and his colleagues conducted personal interviews and read three weeks of the smokers' daily diaries. Through one-way glass in the laboratory, the researchers observed the couples while they smoked and also while they did not.

Rohrbaugh and his team noted the various "functions" smoking served in the couple's relationship (e.g., drawing the partners together or keeping them apart), and sometimes in their interactions with other people. The team found that the effects varied depending on whether both partners smoked, or only one. Smoking couples noted such things as "it's the only time we talk" and "it's our forbidden pleasure together." In the couples with one smoker only, patterns emerged in the ways they tried to influence each other. Some commented, "The more she complains the more I smoke."

Based on these findings and their previous work with alcohol-involved couples, Rohrbaugh, Varda Shoham, director of clinical training in the psychology department, and their colleagues have developed a family-focused intervention program for high-risk smokers and their spouses. The Family Consultation (FAMCON) Project, begun in January 2000, is funded by the National Institute on Drug Abuse, and includes nicotine replacement therapy.

"We hope to encourage high-risk, change-resistant smokers to give up smoking for health reasons, and to set the framework for their family and friends to encourage them," Rohrbaugh says.