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Evid Based Nurs 9:60 doi:10.1136/ebn.9.2.60
  • Qualitative

Patterns of tobacco use became an integral component of intimate partner relationships


 
 Q Before pregnancy, what are the couple routines that accommodate tobacco use in intimate relationships? How do the dynamics within couples influence tobacco use, and how are these dynamics influenced by tobacco use?

DESIGN

A qualitative study using grounded theory.

SETTING

A large urban community in western Canada.

PARTICIPANTS

28 women (and their partners) who had reduced or stopped smoking during their most recent pregnancy.

METHODS

Data were collected using indepth interviews with each partner. Similar questions were presented to both women and their partners and addressed tobacco related interaction patterns (TRIPs). Each couple’s transcripts were reviewed as a set and summarised as a dyad. Emergent themes were developed from these case summaries.

MAIN FINDINGS

2 major groups of interactions were discerned. (1) Couple specific tobacco related routines. (a)Regulation of smoking. Over time, couples established routine smoking patterns that fit with their daily activities, individual tolerances for smoking, and need to smoke. For couples who regularly smoked together, smoking not only helped to order couple life but also foster perceived couple unity, intimacy, and companionship. In couples where smoking was not a shared activity (eg, the woman’s partner did not smoke), smokers tried to find regular times to fit smoking into daily activities and to minimise conflict related to tobacco use. (b)Practices related to procurement and handling of tobacco supplies. Whether one or both partners smoked, there were references to normalised practices related to the purchase of cigarettes, storage of tobacco supplies, and disposal of butts, ashes, and empty packages. (c)Communication about tobacco use. Couples’ routines related to smoking included well established ways of communicating about tobacco. These routinised communications reinforced expected levels of disclosure and debate about each other’s tobacco use history and day to day experiences and feelings related to smoking. (d)Responding to slips and relapse. Because slips and relapses to smoking were part of couple life, responses to these transgressions also became part of couples’ tobacco related routines. For example, a few ex-smokers who smoked “once in a while” with their partners could routinely do so without having to acknowledge they had resumed smoking. In the context of repeated quit attempts, responses to slips and relapses also became expected patterns and, at times, functioned to preserve the stability of relationships.

(2) Pre-pregnancy TRIPs. (a)Disengaged interactions. The disengaged TRIP was reflected in accounts provided primarily by dual smoking couples and couples who perceived and valued smoking as an individual activity. These couples tended to link tobacco use to work and to gendered roles. For example, it was acceptable for both men and women to smoke when they were at work. By reinforcing distinctions, smoking was individualised and not handled as a joint issue. As a result, couple interactions directly related to tobacco use were minimal, and their TRIPs were described as disengaged. (b)Conflictual interactions. This TRIP was characterised by conflict within dyads in which women were smokers and their partners were non-smokers or ex-smokers. Conflictual TRIPs were characterised by tobacco related routines that maximised opportunities for smoking that avoided conflict and ridicule from non-smoking partners, including efforts to purchase and store cigarettes in ways that did not draw the attention of non-smoking partners, and, in the context of a quit attempt, reflected a low degree of tolerance for slips and relapse by non-smoking partners. (c)Accommodating interactions. Accommodating TRIPs were characterised by tobacco related routines that intentionally made room for smoking in the couple’s daily activities, involved sharing responsibilities for purchasing and storing cigarettes, normalised open and non-confrontational discussion about tobacco, and, in the context of a quit attempt, included empathetic responses to slips and relapses by non-smoking partners.

CONCLUSIONS

Among couples in which one or both partners smoked, tobacco was an important mediator in their interaction patterns and potentially affected power relationships within the dyad. When confronted with the index pregnancy, tobacco related interactions were characterised by disengagement, conflict, or accommodation.

Commentary

  1. Nancy Edwards, RN, PhD1,
  2. Sonia Semenic, RN, PhD2
  1. 1School of Nursing and Department of Epidemiology and Community Medicine
  2. 2School of Nursing, University of Ottawa, Ottawa, Ontario, Canada

      Interventions to reduce maternal smoking have largely focused on individual behaviour change, with poor success. Although a partner’s smoking status has been identified as an important predictor of smoking cessation,1 few studies have addressed the complexity of interpersonal processes associated with tobacco use. Bottorff et al’s fine grained and rigorous analysis of couple interactions and dynamics showed how tobacco use becomes routinised and reinforced in intimate relationships. The findings provide unique insights into why people who smoke may resist behavioural change and offer a novel framework for understanding the role of partners in women’s tobacco use.

      Study participants were predominantly Caucasian, well educated, and motivated to reduce smoking. However, couple dynamics may be influenced by gendered roles and thus may differ across cultures and socioeconomic classes. Future research should address interaction patterns with friends and extended family, given their influence on smoking.2 More indepth work is also needed to examine how couple interactions around tobacco use change during the critical transition periods of pregnancy and postpartum.3

      The study by Bottorff et al underscores the importance of recognising how health compromising behaviours such as tobacco use may be deeply embedded within women’s social contexts. For example, nurses need to recognise that the process of quitting smoking may require substantial alterations in couple relationship dynamics. The tobacco related routines and interaction patterns summarised by the authors are useful for raising awareness of couple interactions that may impede or support cessation attempts and providing new insights into ways to manage tobacco. However, research is required to assess the effectiveness of interventions tailored to interaction patterns among couples.

      References

      Footnotes

      • For correspondence: Dr J L Bottorff, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. joan.bottorff{at}ubc.ca

      • Sources of funding: Canadian Institutes of Health Research.

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