Background
Methods
Search strategy
# | Searches | Results | Search type |
---|---|---|---|
1 | exp Smoking/or exp Smoking Cessation/ | 129169 | Advanced |
2 | exp "Tobacco Use"/or "Tobacco Use Cessation"/or exp Tobacco/or exp Tobacco Products/or exp "Tobacco Use Cessation Products"/ | 148028 | Advanced |
3 | 1 or 2 | 149967 | Advanced |
4 | exp family/ | 234438 | Advanced |
5 | (grandparent: or grand-parent: or grandfather: or grand-father: or grandmother: or grand-mother:).af. | 4543 | Advanced |
6 | (partner: or husband: or wif: or wiv: or sibling: or brother: or sister: or mother: or father: or son: or daughter:).af. | 659383 | Advanced |
7 | (cousin: or uncle: or aunt:).af. | 162264 | Advanced |
8 | exp caregivers/ | 21234 | Advanced |
9 | (caregiver: or care giver:).af. | 39284 | Advanced |
10 | 4 or 5 or 6 or 7 or 8 or 9 | 986779 | Advanced |
11 | 3 and 10 | 13147 | Advanced |
12 | limit 11 to english language | 12148 | Advanced |
13 | limit 12 to randomized controlled trial | 446 | Advanced |
14 | (rct: or random: trial: or random: control: trial: or random: stud: or random: control: stud:).af. | 509205 | Advanced |
15 | exp Randomized Controlled Trials as Topic/ | 93713 | Advanced |
16 | (non random: stud: or nonrandom: stud: or non random: control: stud: or nonrandom: control: stud:).af. | 3632 | Advanced |
17 | (non random: trial: or nonrandom: trial: or non random: control: trial: or nonrandom: control: trial:).af. | 1615 | Advanced |
18 | (controlled before and after stud:).af. | 368 | Advanced |
19 | (controlled before and after trial:).af. | 1176 | Advanced |
20 | (quaziexper: or quazi-exper:).af. | 2 | Advanced |
21 | (quasi exper: or quasiexper:).af. | 5403 | Advanced |
22 | or/14-21 | 516489 | Advanced |
23 | 12 and 22 | 609 | Advanced |
24 | 13 or 23 | 609 | Advanced |
25 | from 24 keep 1-609 | 609 | Advanced |
Eligibility criteria and selection process
1. Not in English language | We excluded all papers not in English because of lack of translation facilities. |
2. Type of study | Randomised controlled trials (RCTs), controlled non-randomised studies and controlled before and after studies. Comparison groups of the family intervention could be usual care, no intervention or another smoking cessation intervention. Feasibility and pilot studies were included if effects of the intervention were reported. |
3. Type of intervention | Interventions promoting changes in adult tobacco use or prevention. Interventions involving at least one family member. Interventions that gave the option of including a family member or close friend/significant other were excluded. Interventions where the primary aim was to reduce exposure to secondhand smoke and place of smoking were excluded. Interventions delivered to whole-community or whole-population level interventions such as media campaigns or changes in the local environment, which included a discrete family-based intervention, were included. |
4. Type of participants | The target of the intervention was an adult of any gender who smoked (18 years and over). One or more of the adult smoker’s family had to be involved in the intervention. Pregnant and non-pregnant and married and unmarried smokers were included. Interventions that targeted adults and children who smoked were included but only if outcomes of adults were reported separately and only if the intervention specifically targeted adult smoking behaviour. Interventions that only targeted children’s smoking behaviour were excluded. |
5. Type of outcomes | Outcomes were the change in number of cigarettes smoked/smoking cessation of adults. Behaviours could be measured objectively (e.g., saliva) or by self-report questionnaire. If it was a multi-component intervention (e.g., family-based programme administered as part of a school-based programme to prevent smoking up-take in young people) then the effects of the family-based programme of the intervention must have been reported separately. Studies that aimed to shift location of smoking behaviour and reduce Environmental Tobacco Smoke as opposed to smoking cessation were excluded. |
Data extraction processes
Risk of bias
Methods
Intervention description
Intervention function
Theory coding scheme
Narrative synthesis of results
Results
Risk of bias
Design and description of comparison groups | Selection bias | Performance bias | Detection bias | Attrition bias | Reporting bias | |||
---|---|---|---|---|---|---|---|---|
Authors | Random sequence generation | Allocation concealment | Blinding participants/personnel | Blinding outcome assessment | Incomplete outcome data | Selective reporting | Other bias | |
Hjermann et al. [38] | RCT – lifestyle intervention; anti-smoking advice given individually to all smokers vs. usual care | Unclear | Low risk | High risk | Unclear | Low risk | Unclear | Unclear |
McBride et al. [34] | 3-group randomised controlled intervention; pregnant women; – Usual care (advice to quit and self-help guide), woman only group (usual care plus late-pregnancy relapse prevention kit and 6 counselling calls), Partner-assisted group (woman only group intervention plus their partners received telephone counselling and a support guide) | Unclear | Unclear | High risk | Unclear | Low risk | Unclear | Unclear |
McIntyre-Kingsolver et al. [39] | RCT - a multi-component cognitive-behavioral smoking program vs. the same program with spouses attending and receiving training designed to increase spouse social support | High risk | Unclear | High risk | Unclear | High risk | Unclear | High risk |
Nyborg and Nevid [41] | 3-group, randomly assigned; effort only control (written materials), therapist administered treatment (couples received weekly counselling sessions), self-administered/minimal contact control (behavioural treatment manual and weekly telephone contact) | Unclear | Unclear | High risk | Unclear | Unclear | Unclear | Unclear |
Øien et al. [36] | Controlled, prospective, intervention study of two cohorts - a prenatal, structured, multi-disciplinary smoking cessation programme vs. common, nationwide recommended, advice on lifestyle, including smoking behaviour | N/A – not RCT | N/A | High risk | Unclear | Unclear | Unclear | High risk |
Patten et al. [40] | Pilot, feasibility RCT - a web-based support skills training vs. health education | Unclear | Unclear | High risk | Unclear | Low risk | Low risk | Unclear |
de Vries et al. [35] | Cluster RCT - Midwives in the experimental group provided brief health counseling, self-help materials on smoking cessation during pregnancy and early postpartum, and a partner booklet. Controls received routine care | Low risk | Unclear | High risk | Unclear | Low risk | Unclear | High risk |
Wood et al. [37] | Cluster RCT – a nurse-coordinated multidisciplinary, family-based preventive cardiology programme vs. usual care | Unclear | Unclear | High risk | Unclear | High risk | Low risk | Low risk |
Primary outcome and target group
Author | Country | Main target group for smoking cessation | Family member involved in intervention | Smoking behaviour of main target group and family member | Sample* | Reason for involving family | Smoking outcome measure/length follow up | Comparison groups (interventions described fully in Table 5) | Results: Are family-based interventions more effective? |
---|---|---|---|---|---|---|---|---|---|
Hjermann et al. [38] | Norway | Men at risk of coronary heart disease and aged 20-49 years with no evidence of diseases of the cardiovascular system, diabetes psychopathological disease or alcoholism | Wives | Smoking behaviour of the main target group (men at risk of coronary heart disease) and family members was not an eligibility criteria | 1232 healthy, normotensive men at high risk of coronary heart disease; 604 intervention and 628 control group respectively. Number of family members not given | None given | Self-reported smoking habits; 5 years | Lifestyle intervention involving wives vs. control group (not described) | It is unclear if the ‘active ingredient’ of the wives’ involvement influenced effectiveness because this was not tested The intervention was effective for men. Tobacco consumption (expressed as number of cigarettes per man per day; pipe smoking is included taking one pack of pipe tobacco weekly to equal 7 cigarettes daily) fell about 45 % more in the intervention group than in the controls |
McBride et al. [34] | North America | Pregnant women (current or recent quitters) living intimately with their partners | Partners | The main target group was a current smoker or recent quitter; smoking behaviour of partner was not included in eligibility criteria | 583 pregnant women and 583 partners. 198 pregnant women in usual care group, 192 pregnant women in women only group and 193 pregnant women in the partner assisted group | Marital theory and empirical research show how marital relationships might affect provision of support for smoking cessation | Self-reported smoking status baseline (about 11 weeks of pregnancy), at 28 weeks of pregnancy, and at 2-, 6-, and 12-months postpartum. Saliva samples were collected by mail at 28 weeks of pregnancy and at 12 months postpartum from women and partners who reported not smoking | 3 groups: Women in the usual care group received advice to quit and a self-help guide vs. women in the women only group also receiving a late-pregnancy relapse prevention kit (booklet and gift items) and six counseling calls vs. women in the partner-assisted group also having their partners receiving telephone counseling and a support guide emphasizing skills to help the woman build and maintain her confidence to quit smoking | No for pregnant women. Intent-to-treat analyses showed no significant differences by group in women’s reports of abstinence at any follow-up Yes for partners. In late pregnancy, more partners were abstinent in the partner assisted group (15 %) than in the usual care group (5 %), p = 0.02 |
McIntyre-Kingsolver et al. [39] | North America | Adult smoker in a committed live-in relationship with a spouse or spouse-equivalent | Spouse or partners | The main target group was a smoker; smoking behaviour of partner was not included in eligibility criteria | 64 couples. Subjects were required to be in a committed, live-in relationship with a spouse or spouse-equivalent who was willing to attend the treatment sessions | Perceived helpfulness from a spouse and verbal encouragement and cooperative participation may be an asset to cessation and maintenance | Self-report smoking status and abstinence and reports of significant others; saliva thiocyanate (SCN) and/or level of alveolar carbon monoxide (CO); 1 and 6 months follow up | Spouse training vs. usual treatment to aid a smoking cessation | No. There was a consistent trend in favour of the partner training treatment, but even the largest difference (72.7 % vs. 48.4 % abstinent), at the end of treatment, was not significant. |
Nyborg and Nevid [41] | North America | Couples who both smoke and live together and both seeking to quit or reduce smoking and both smoking > 20 cigarettes a day | Spouse or partner who also smoked | To be eligible both individuals that comprised the couple had to smoke | 40 couples living together randomly assigned to 1 of 5 treatment groups | Social support | Self-reported abstinence post-treatment and 3 and 6 months | 5 different types of smoking cessation interventions compared: 2 couple-based and 2 individual-based therapy groups and a group just given written materials | No. Abstinence rates for couples were not significantly different across groups at follow-up intervals, |
Øien et al. [36] | Norway | Pregnant women | Spouse or partners | The smoking behaviour of the main target group (pregnant women) and the family member (partner) was not included in the eligibility criteria | Pregnant women and partners: intervention cohort (N = 2051) and the control cohort (N = 1788). Number of partners not given | None given | Self-reported smoking behaviour; 9-12 weeks gestation, and at 6 weeks after delivery | A cohort given smoking cessation intervention vs. a cohort not given the intervention | It is unclear if the ‘active ingredient’ of partner spouses’/partners’ involvement influenced effectiveness because this was not tested The intervention was not effective for pregnant women. Data stratified according to smoking behaviour at the beginning of pregnancy demonstrated that in the intervention cohort only one in four of the smoking women continued to smoke from the beginning of pregnancy until inclusion, with no significant difference between the cohorts. Yes for partners. In contrast, most men continued to smoke in the same period, but significantly fewer in the intervention cohort |
Patten et al. [40] | North America | Parent (biological, adopted, step parent or adult guardian) who currently smoked ≥5 cigarettes per day | Child aged 13-19 years, never smoked or if a former smoker had not smoked during past 6 months, and interested in helping parent quit | The main target group (parent) was a current smoker and the family member (child) either never smoked or had quit | 40 non-smoking adolescents (13–19 years) interested in helping a parent (biological, adopted, step parent or adult guardian) to quit who currently a) smoked >=5 cigarettes per day | Adolescents are concerned about parents who smoke and wish to help them quit | At each follow-up point prevalence of abstinence defined as no cigarettes smoked (not even a puff) for previous 7 days. Confirmed at 6 months by salivary cotinine concentration of <15 ng/ml. Quit attempts since time of enrolment assessed at each follow-up; 6 and 12 weeks and 6 months | 2 smoking cessation interventions compared: Health education vs. support training | It is unclear if the ‘active ingredient’ of child involvement influenced effectiveness because this was not tested. The study included two different family-based interventions and about half of parents in each group reported a quit attempt since study enrolment |
de Vries et al. [35] | Netherlands | Pregnant women who had been pregnant more than twice (because assumed that these women would be very unlikely to change their smoking behaviour) and smoked at least 1 cigarette a day | Partners who smoked were involved, otherwise partners not involved | The main target group (pregnant women) was a current smoker. If their partner also smoked then they were included in the intervention | 141 and 177 pregnant women in intervention and control groups completed first questionnaires, respectively. Number of partners not given | None given | Self-reported: 7-day abstinence, Continuous abstinence (6 weeks postpartum), Partner smoking; Measures at pre-test and 6 weeks post-intervention and 6 weeks postpartum. Urine-cotinine levels measured by gas chromatography/mass spectrometry in sub-sample | Brief health counseling, self-help materials on smoking cessation during pregnancy and early postpartum, and a partner booklet vs. usual care and a general folder from the Dutch Smoking and Health Foundation | It is unclear if the ‘active ingredient’ of partner spouses’/partners’ involvement influenced effectiveness because this was not tested The intervention was effective for pregnant women. Significant differences were found between the two groups. Nineteen percent of the experimental group reported 7-day abstinence compared to 7 % of the control group at first follow up, and 21 and 12 %, respectively, at second follow up. For continuous abstinence these percentages were 12 % in the experimental group and 3 % in the control group The intervention was not effective for partners. No significant differences between the two groups were found for partners |
Wood et al. [37] | European countries: France, Italy, Poland, Spain, Sweden, UK, Denmark, Italy,Poland, Spain, the Netherlands | Patients at least 50 years of age and less than 80 years old, with no history of cardiovascular disease but at risk of coronary heart disease with no history of severe heart failure, severe physical disability, or dementia and their partners | Spouse or partners | Smoking behaviour of the main target group (men at risk of coronary heart disease) and family members was not an eligibility criteria | 1589 and 1499 patients with coronary heart disease in hospitals and 1189 and 1128 at high risk were assigned to intervention and usual care groups. 860 patients and 410 partners participated in hospital intervention programme; 947 high-risk patients and 204 partners participated in general practice intervention programme | Provide support | Self-reported cessation of smoking, validated by a breath carbon monoxide concentration of less than 6 parts per million; 12 months follow up | 2 lifestyle intervention groups (hospital and general practice groups) vs. usual care (not described) | It is unclear if the ‘active ingredient’ of partner spouses’/partners’ involvement influenced effectiveness because this was not tested The intervention was effective for patients Among patients with coronary heart disease who reported smoking in the month before their cardiac event, a higher proportion in the intervention group were not smokers at 1 year compared with the usual-care group (for example, hospital intervention vs. usual care was 58 % vs. 47 % p=0.06) The intervention was not effective for partners. Non-smoking at 1 year was greater, although not significantly so, in the partners of patients in the intervention groups than in usual-care groups |
Intervention description
Author | Behaviours | Materials and procedures | Intervention function(s) | Deliverers | Duration | Tailoring | Family involvement |
---|---|---|---|---|---|---|---|
Hjermann et al. [38] | Smoking, diet | The wives of the subjects were invited in groups of 30-40 together with their husbands for diet and smoking information. | Education | Not described | Not described | No | Not measured |
McBride et al. [34] | Smoking | 6 counseling telephone calls (three in pregnancy and three in postpartum) using motivational interviewing techniques. An “It Takes Two” booklet and companion video were developed to guide couples in discussing support behaviors related to the woman’s smoking. | Education and training | Health advisor | Not described | No | Not measured |
McIntyre-Kingsolver et al. [39] | Smoking | Spouse training Common examples of helpful or unhelpful behaviors were pointed out and the group was also asked to contribute examples from their own experience. Guided group discussions and direct instruction were used to try and increase positive or decrease negative spouse behaviors. Spouses were encouraged at all stages to help problem solve difficult situations (e.g., quit day) and to reward subjects for making small steps in changing their habit. It was emphasized that the posttreatment support and assistance that spouses provided was crucial to the success of the subject. Subjects were also encouraged to reward their spouses for participating in the program and for helping them. | Education and training | Counsellors were two clinical psychology graduate students with experience of conducting smoking cessation groups. | Six weekly two-hour groups sessions | No | Not measured |
Nyborg and Nevid [41] | Smoking | Couples received additional written materials which provided instructions in providing mutual support for smoking reduction and cessation) The techniques included mutual modeling of appropriate nonsmoking behavior in smoking-related contexts (e.g., talking on the telephone without smoking), mutual monitoring (systematically counting each other's cigarettes), partner reinforcement for habit change, and couple reinforcement contingent upon achievement of mutual goals in changing smoking habits (e.g., the couple selects a shared reward for mutual abstinence during a predetermined period of time). Couples receiving therapist-administered treatment reviewed their progress in implementing these mutual support strategies and received therapist feedback in their treatment sessions. Weekly telephone contact was maintained with minimal contact couples during which partners reported on each other's progress and received therapist feedback. | Education and training | Behaviour therapists | 8 weeks | No | Not reported |
Øien et al. [36] | Smoking | Women were invited to bring their partners to the individual consultations, and if he was a smoker they were encouraged to make a smoking cessation effort together | Enablement | Primary care professionals: GPs and midwives, public health nurses. Offered a 3 h course to improve smoking cessation counselling skills | 8 to 10 prenatal consultations in primary care | No | Not measured |
Patten et al. [40] | Smoking | Health education control group 11 page booklet: (1) education on the health effects of smoking, (2) nicotine dependence and withdrawal symptoms, (3) readiness to quit, (4) basic communication skills between the adolescent and parent, (5) strategies on how to approach the parent about their smoking and quitting, (6) strategies on how to elicit from the parent the pros and cons of continued smoking and quitting, (7) triggers for relapse. 5 web-based group sessions for Support Skills Training: (1) rationale for treatment (i.e., Raise awareness of possible personal benefits of treatment) (e.g., dealing with anger or distress regarding parent's smoking behavior) – “You can't control your parent, only yourself. It is important to focus on what you can do as a support person”, setting S.M.A.R.T. goals and use of self-rewards and education on nicotine dependence; (2) provide education on motivation and readiness to quit; (3) using positive behaviors and statements to encourage their parent to move forward in the quitting process; (4) provide education on how smokers quit (i.e., setting a quit date, nicotine dependence treatments, coping with triggers, and social support); (5) provide education on lapse, relapse and how to reinforce (shape) progress made by the smoker and goal setting after the program ends.Web-based message board to post questions | Education and training and persuasion | 6 research counsellors with Masters or Bachelors degree in behavioural health or social science. Training provided to deliver the intervention | 5 weeks × 1 session × 30 min | No | 95 % (19/20) adolescents completed all sessions and 79 % read the booklet |
de Vries et al. [35] | Smoking | Because pregnant women motivated to quit smoking encounter difficulties to quit in the presence of a smoking partner a booklet was made for partners who also smoked | Education | Midwife | Not described | No | Not measured |
Wood et al. [37] | Smoking, diet, exercise | Couples attended lifestyle assessment and group workshop about lifestyle risk factors for coronary heart disease and cardiovascular risks. Patients were provided with a personal record card for lifestyle and risk factor targets and their families with family support packs. | Education | Nurse | 8 weekly sessions in hospital or general practice | No | Not measured |
Intervention function
Theoretical models
Study | Is theory/model mentioned? | Are the relevant theoretical constructs targeted? | Is theory used to select recipients or tailored interventions? | Are the relevant theoretical constructs measured? | Is family-related theory tested? | Is theory refined? |
---|---|---|---|---|---|---|
Hjermann et al. [38] | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
McBride et al. [34] | Social support and marital theory is referred to. | Yes. Intervention objectives were to (1) encourage couple communication about helpful and unhelpful support behaviors, (2) assist partners in developing alternatives to negative behaviors, (3) prompt couples to make plans for handling high-risk situations, and (4) when appropriate, encourage and assist partner smoking cessation.An “It Takes Two” booklet and companion video were developed to guide couples in discussing support behaviors related to the woman’s smoking. | No | Yes. Partner Interaction Questionnaire to assess positive and negative perceived and provided support for cessation. | Intervention impact on support was measured. Women in all 3 groups consistently reported a decline in positive partner support from baseline to 12-month Postpartum, negative support decreased through pregnancy, but increased postpartum. Partners reported little change in positive and negative smoking-specific support that they gave in the same time frame. | Not reported |
McIntyre-Kingsolver et al. [39] | Social support is cited as the driving theory, referring to a previous study which found that perceived helpfulness from a spouse during treatment was significantly related to smokers achieving and maintaining abstinence. | Yes. Common examples of helpful or unhelpful behaviors were discussed. Guided group discussions and direct instruction were used to try and increase positive or decrease negative spouse behaviors. Spouses were encouraged at all stages to help problem solve difficult situations (e.g., quit day) and to reward subjects for making small steps in changing their habit. It was emphasized that the post-treatment support and assistance that spouses provided was crucial to the success of the subject. Subjects were also encouraged to reward their spouses for participating in the program and for helping them. | Relatives are guided on how to be more/less supportive. | Partner Interaction Questionnaire measured the impact of the spouse-training treatment component. This 61-item tool taps into a variety of smoking-related spousal interactions. | Influence of social support is measured and found to not be related to self-reported smoking status at follow-up. | Not reported |
Nyborg and Nevid [41] | Social support | Yes. Couples received additional written materials which provided instructions in providing mutual support for smoking reduction and cessation) The techniques included mutual modeling of appropriate nonsmoking behavior in smoking-related contexts (e.g., talking on the telephone without smoking), mutual monitoring (systematically counting each other's cigarettes), partner reinforcement for habit change, and couple reinforcement contingent upon achievement of mutual goals in changing smoking habits (e.g., the couple selects a shared reward for mutual abstinence during a predetermined period of time). Couples receiving therapist-administered treatment reviewed their progress in implementing these mutual support strategies and received therapist feedback in their treatment sessions. Weekly telephone contact was maintained with minimal contact couples during which partners reported on each other's progress and received therapist feedback. | No | Not reported | Not reported | Not reported |
Øien et al. [36] | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
Patten et al. [40] | No explicit theory provided, but the link between adolescents influencing parental smoking is proposed as promoting health and reducing second-hand smoke exposure. | Not reported | Not reported | Not reported | Not reported | Not reported |
de Vries et al. [35] | Theory of behaviour change, based on communication techniques, and the “health communication persuasion matrix”, based on social influence theory and self-efficacy. The authors note that reviews on smoking and pregnant women suggest to include partner smoking in programs since smoking status of the partner is a chief predictor of postpartum relapse | The intervention was focused on pregnant women. A booklet was provided to smoking fathers, encouraging cessation and support to their partner. | The booklet was given to women with smoking partners. | No, but partner smoking was measured. | Not reported | Not reported |
Wood et al. [37] | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |