Persistent Smoking after Stroke Among Cohabitating Dual-Smoker Couples

Background and Purpose: Approximately 6.6 million adults in the United States (U.S.) have had a stroke. Population-based studies suggest that approximately 30% of stroke survivors smoked cigarettes prior to their stroke and while quitting smoking is critical for survivor health (i.e., persistent smoking for this population has been associated with an 83% increased risk for subsequent stroke and a 70% increased risk for early mortality), over 75% of these individuals continue to smoke afterwards. It is well known that the health behaviors of cohabitating individuals are closely linked. Thus, it is likely that for stroke survivors with caregivers who also smoke, quitting smoking can be especially challenging. The purpose of this study is to present findings from a pilot study investigating how cohabitating dual-smoker stroke survivor-caregiver dyads view the issue of smoking in their relationship, how they can influence one another’s smoking attitudes and behaviors in positive and negative ways, and how this these influences then translate to each partners’ readiness to quit.

Methods: In-depth interviews were conducted with 11 dual-smoker cohabitating stroke survivor-caregiver dyads recruited from a large metropolitan area. A semi-structured interview schedule was used, based loosely on Proschaka’s (1982) transtheoretical model and studies about the role of relationship dynamics in couples’ health behaviors. Interviews were professionally transcribed and major themes were distilled using constant comparative methods. Quantitative data on participant demographics, mood, smoking history and quantity, smoking behaviors, and readiness to quit were also obtained.

Results: Survivors and caregivers were on average, approximately 53 years old and relatively well educated, although the majority were unemployed and living in poverty. Most participants were long-term heavy smokers. Five major themes emerged from the qualitative data: 1) Conflicting feelings about whether smoking was an individual versus a mutual concern; 2) Paradoxical views about which member of the couple should stop smoking first; 3) Future versus past orientation with respect to the link between smoking and stroke; 4) Barriers to and facilitators of cessation for survivors and caregivers; and 5) Lack of awareness, knowledge, and experience with couples-oriented smoking cessation programs.   

Conclusions and Implications: The current pilot study is the first known effort to collect in-depth qualitative data from dual-smoker cohabitating stroke survivor-caregiver dyads, a particularly vulnerable and difficult-to-reach population. Findings suggest that practitioners should work to facilitate better communication in couples about the importance of cessation, educate couples about the health implications of persistent smoking after stroke, reduce both individual and relational barriers to quitting, and assist couples with formulating and implementing a plan to quit smoking together.