Short communicationSpousal concordance in the use of alternative tobacco products: A multi-country investigation
Introduction
Married couples often share similar health-related characteristics and behaviors, including cigarette smoking status (Sutton, 1993, Venters et al., 1984). For example, in one study with 5459 spousal pairs, there was 79.7% agreement within couples for current-smoking status and 65.3% agreement for ever-smoking status (Treur et al., 2015). This spousal concordance (SC) in cigarette smoking is likely due to several factors. Assortative mating theory suggests that people tend to marry those with similar traits as them (Agrawal et al., 2006, Kuo et al., 2007). Further, once they are married, a smoking spouse can instigate his/her partner’s initiation (Daly et al., 1993) or reduce the likelihood that his/her partner can quit successfully (Homish and Leonard, 2005, Severson et al., 1995).
The SC in cigarette smoking has been identified across the globe (Bloch et al., 2003, Jurj et al., 2006, Kuo et al., 2007) although there are cultural differences in the strength of the association. For example, compared to 79.7% agreement in a large Dutch sample (Treur et al., 2015), a large study in China found only 39.2% agreement (Jurj et al., 2006). Although many factors likely account for these differences, it is worth noting that for the Chinese sample, 52.6% of the husbands but only 2% of the wives were current smokers (compared to 23.3% and 20.0%, respectively, in the Dutch sample). SC also appears to be stronger among younger vs. older cohorts: the Dutch sample found the odds of a couple being in agreement (vs. not in agreement) for current smoking status was 1.85 more for a recent cohort, compared to cohorts sampled in the previous eight years.
In contrast to the decades of research on SC for cigarette smoking, there has been very little focus on SC for use of alternative tobacco products (ATPs). Many of these products, such as e-cigarettes, hookah, and snus have only risen in popularity in the U.S. in recent years, especially among young people (Delnevo et al., 2014, Singh et al., 2016). Other products, such as smokeless tobacco, pipes, and cigars, have remained popular for many years, especially among men (SAMHSA, 2013). Although other countries show similar trends for the use of some of these ATPs (e.g., hookah; Maziak et al., 2014), the patterns are not universal. For example, stricter regulation of e-cigarettes has kept prevalence low in countries such as Australia (Yong et al., 2015).
The SC for ATPs could have important public health implications. A strong SC would suggest that spouses may be influencing their partners’ initiation and inhibiting their cession. Thus, one could anticipate a faster spread in use for popular products with a strong SC. Conversely, a weak SC could forecast a slower rise in prevalence, but also hidden health costs for the non-using spouses. For example, a smoking spouse exposes his/her non-using partner to the dangerous effects of secondhand smoke.
The purpose of this study was to examine the patterns of SC for ATPs. Beyond determining whether there was SC for these products, we sought to elucidate the factors associated with a strong vs. weak concordance. In particular, we noted the importance of age, gender, and culture for product use and anticipated that these factors would also be related to SC. Our foremost hypothesis was that there would be SC for most ATPs. There were two corollary hypotheses to this: (1) SC would be stronger among younger individuals; (2) SC would be stronger for products where prevalence rates were more equal across genders. Finally, an exploratory hypothesis posited that, across different countries, we would find similar patterns for SC – both in terms of strong vs. weak effects, and also in terms of the relation between SCs, age, and gender.
Section snippets
Participants
Our primary sample of interest was recruited from Columbus, Ohio, and surrounding areas. Potentially eligible individuals were approached by research staff in public areas (e.g., barber shops, community centers) and asked to take part in a research study on marriage. To be eligible to participate, an individual needed to be English-speaking, aged 18 years or older, and currently married. Eligible participants completed a paper-and-pencil survey, and received $10.00 in compensation for their
U.S. sample
As shown in Table 1, SC was negative and/or not significant for chewing tobacco, snus, cigars, and pipes (−0.13 to −0.01), low for clove cigars (0.14), moderate for flavored little cigars and roll-your-own cigarettes (0.24 and 0.22) and robust for e-cigarettes, flavored e-cigarettes, flavored cigarettes, and hookah (0.48–0.61).
The average age of ever-users of products varied from as low as 36.1 for hookah, to as high as 43.8 for pipes (see Table S2 in Supplementary material). Using the product
Conflict of interest
None.
Role of funding source
This study was funded by grant BA 1603/4-1 from The German Research Foundation (DFG).
Contributors
All authors participated in the design of the study. MR, RB, and CE participated in the coordination of the study. MR conducted the statistical analyses and drafted the manuscript. AF helped to draft the manuscript. All authors read and approved the final manuscript.
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