Prospective predictors of long-term abstinence versus relapse among smokers who quit as young adults

A non-smoking spouse and smoke-free workplace play key roles in long-term success for young adults who quit smoking, according to Indiana University research, which found environmental factors to be more influential than individual behaviors and beliefs when it comes to kicking the habit.

Smoking has been on the rise for young adults in recent years, adding urgency to research efforts to identify ways to help these 18- to 25-year-olds successfully quit a habit that typically takes multiple attempts to break.

"Most smokers cycle through multiple periods of relapse and remission," said Jon Macy, project director of the IU Smoking Survey, a 27-year longitudinal study of the natural history of cigarette smoking. The survey is housed in IU Bloomington's Department of Psychological and Brain Sciences. "In that sense, tobacco dependence is like a chronic disease and should be treated as such."

Smoking cessation attempts often are thought of as solitary endeavors, Macy said, but their findings point to possible benefits in cessation programs that involve couples, because marriage to a non-smoker was such a strong predictor of long-term smoking abstinence. The findings also underscore the benefits of smoke-free workplaces, which Macy says are on the increase.

These new findings will be published online on Thursday (June 28) at 4 p.m. under the American Journal of Public Health 's "First Look," http://www.ajph.org/first_look.shtml. Co-authors of the study include Dong-Chul Seo, assistant professor in the IUB Department of Applied Health Science; Laurie Chassin and Clark C. Presson, professors of psychology at Arizona State University; and Steven J. Sherman, professor in the IUB Department of Psychological and Brain Sciences. The findings also will appear in the journal's August issue, which is devoted to research that examines smoking cessation among young adults.

The IU study involved 327 participants from its Smoking Survey who had quit smoking as young adults. Of these, 219 remained abstinent for at least five years, making the study unique because of its ability to examine the demographic and behavioral predictors of long-term success of quitting during young adulthood.

The researchers looked at factors in four areas: smoking-related beliefs, such as the belief that smoking helps people relax or an understanding of personal health consequences of smoking; smoking-related behaviors, such as the number of quit attempts or age when one began smoking; acquisition of adult roles, such as having children; and smoking in the social environment, such as a spouse's smoking status and extent of access to smoking in the workplace.

"We found that two-thirds of the people who quit between the ages of 18-24 were able to stay quit," Macy said. "Of all the factors we examined, the external environment had the largest independent effect, specifically being married to a non-smoker, and second, working in a completely smoke-free environment."

The study was supported by the National Institutes of Health, which has funded the IU Smoking Survey since it began in 1980. The Smoking Survey initially involved 8,556 sixth- through twelfth-grade students in a Midwestern county school system. Seventy-one to 73 percent of the cohort participates in follow up surveys that occur every five to six years and the Smoking Survey has begun involving the children of the original cohort.

The American Journal of Public Health is the monthly journal of the American Public Health Association, the oldest organization of public health professionals in the world. For more information about the IU Smoking Survey, visit http://www.indiana.edu/~smokesvy/.

"Prospective Predictors of Long-term Abstinence versus Relapse among Smokers Who Quit as Young Adults," American Journal of Public Health , vol. 97, no. 8.