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Smokers Quit in Droves, Not Isolation

Healthy behavior has cascade effect, but trend marginalizes those who keep smoking

WEDNESDAY, May 21, 2008 (HealthDay News) -- When one person quits smoking, that health triumph doesn't occur in isolation, new research shows.

Instead, it appears that one person quitting can cause a ripple effect, making others more likely to kick the habit.

If your spouse stops smoking, you're 67 percent less likely to continue smoking. If your friend kicks the habit, it's about 36 percent less likely that you'll be smoking. When a sibling gives up cigarettes, your risk of smoking decreases by 25 percent, and it drops by 34 percent if a co-worker in a small office quits smoking, according to the study in the May 22 issue of the New England Journal of Medicine.

"It's sort of like watching dominoes. If one falls, it very quickly causes others to fall," said study co-author James Fowler, an associate professor of political science at the University of California at San Diego. "People are not quitting on their own; they're quitting in droves."

The problem then becomes how to reach increasingly smaller groups of smokers who may feel marginalized by society.

"In 1962, it didn't matter if you smoked or not. But beginning around the mid-1980s, we saw increasing polarization, and smokers were pushed to the outside of community circles. Smokers are no longer at the center of the circles and tend to have fewer friends and tend to be connected to fewer people," explained Fowler. "While we've been remarkably successful in getting people to quit, in part by using social networks, the downside is that for some of the people we're trying to help, we've unintentionally wreaked havoc on their social lives."

And, Fowler said, as smokers cling together to their smaller groups, their bad health behavior is being reinforced and becomes harder to change.

"We have to treat people in groups, rather than as individuals. Friends and family need to be involved. If you want to quit, try to get close friends and family to quit as well," Fowler suggested.

Using information from the large Framingham Heart Study that began in 1948, Fowler and his colleague Nicholas Christakis of Harvard Medical School identified social connections for 5,124 people involved in the study. They found an average of 10.4 social ties per subject to someone else in the study network.

The average age of those included in the study was 38, and 53 percent were female. The average education level was 1.6 years of college. The number of people smoking mirrored national trends, with an all-time high of nearly 66 percent to a low of 22.3 percent. Smoking behavior was collected for 1971 through 2003.

During that time period, the researchers found that smokers and nonsmokers began to form separate social networks.

"People used to have the idea of smokers being the bad boy who'd be popular, but now smoking isn't only bad for your physical health, but for your social health as well," said Fowler.

The researchers also found that the more educated people were, the more likely they were to influence smoking behavior.

That's one of the findings that most concern editorial author, Dr. Steven Schroeder, who said, "Smoking is increasingly concentrated in the lower classes, and in people with mental illness, and the risk is one of stigma." That may make it even harder for them to get the help they need, added Schroeder, who is a distinguished professor of health and health care, and director of the smoking cessation leadership center at the University of California, San Francisco.

But, said Schroeder, "Don't think it's a lost cause," if all of your friends and family smoke. Other factors, such as your own desire to stop smoking, your health, the price of cigarettes, smoke-free indoor areas, health information on how harmful smoking is, and counter-marketing can all help reinforce your decision to quit.

"The tide is definitely running out. There's more and more social pressure to quit, and it's harder to find socially acceptable places to smoke. The science keeps accumulating, and the pressure's not going to let up," Schroeder said.

Fowler pointed out that these findings also suggest that quitting smoking may have the side benefit of improving social well-being, just as it improves physical health.

More information

For advice on quitting, visit the U.S. government's Web site, or call 1-800-QUITNOW for more information on stopping smoking.

SOURCES: James Fowler, Ph.D., associate professor, political science, University of California, San Diego; Steven Schroeder, M.D., distinguished professor, health and health care, and director, smoking cessation leadership center, University of California, San Francisco; May 22, 2008, New England Journal of Medicine
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