World Journal of Pharmaceutical Research

Wejdan et al. World Journal of Pharmaceutical Research

SJIF Impact Factor 8.084

Volume 8, Issue 13, 1-11. Research Article ISSN 2277– 7105

ENHANCING PARTNER SUPPORT AND INTERACTION IN

IMPROVING SMOKING CESSATION: A META-ANALYSIS

Wejdan Abdullah Bamusa1*, Khulod M. Abdullah2, Fahad Solaiman Alanizy3, Ghaidaa

Zaki Arif4, Wejdan Abdulrahman Alghamdi5, Mohammed Helal Alanazi6, Ahmed
Abdullah Ojaem7 and Yusra Mohammed Alkhalifa8

1*
Medical Intern, Faculty of Medicine, King Abdul-Aziz University Hospital, Jeddah Saudi
Arabia.
2
Medical Intern, Faculty of Medicine, King Khalid University, Abha, Saudi Arabia.
3
Medical Intern, Faculty of Medicine, King Faisal University, Al-Ahsa Saudi Arabia.
4
Medical Intern, Faculty of Medicine, Umm Al-Qura University, Makkah Saudi Arabia.
5
Medical Intern, Faculty of Medicine, King Abdul-Aziz University Hospital, Jeddah Saudi
Arabia.
6
Medical Intern, Faculty of Medicine, Jordan University of Science and Technology, Riyadh,
Saudi Arabia
7
Medical Intern - King Khalid University, Aseer Hospital center
8
General Practioner, Imam Abdul Rahman Bin Faisal University, Saudi Arabia.

ABSTRACT
Article Received on
21 Sept. 2019, Background & Purpose: Smoking cessation is an important behavior
Revised on 11 Oct. 2019, change that can have considerable effects on health outcomes. The
Accepted on 01 Nov. 2019,
DOI: 10.20959/wjpr201913-16203
initiation and cessation of smoking are strongly stimulated with the aid
of different circle of relatives‟ members. The aim of this work is to
provide cumulative data about the effect of partner support and
*Corresponding Author
Wejdan Abdullah Bamusa interaction on improving smoking cessation. Methods: A systematic
Medical Intern, Faculty of search was performed of PubMed, Cochrane library Ovid, Scopus &
Medicine, King Abdul-Aziz Google scholar to identify family medicine RCTs, clinical trials, and
University Hospital, Jeddah
comparative studies, which studied the outcome of Interventional
Saudi Arabia.
group (with partner support) versus Control group. A meta-analysis
was done using fixed-effects methods. The primary outcome of interest was 3-months
cessation rate. Secondary outcome was 6-months or more “cessation rate”. Results: A total of
5 studies were identified involving 1850 participants, with 888 participants in Interventional

www.wjpr.net Vol 8, Issue 13, 2019. 1

Wejdan et al. World Journal of Pharmaceutical Research

group, and 962 participants in Control group. Regarding primary outcome measures, fixed-
effects model of the meta-analysis study showed highly significant increase in 3-month
cessation rate in Interventional group (p = 0.002). Regarding secondary outcome measure,
fixed- effects model of the meta-analysis study showed significant increase in 6-month
cessation rate in Interventional group (p = 0.028). Conclusion: To conclude, there may be a
strong evidence that interventions directed closer to individual smokers increase the
probability of quitting smoking. these include individual and group counselling,
pharmacological treatment to overcome nicotine addiction, and more than one intervention
targeting smoking cessation.

KEYWORDS: Partner Support, Smoking Cessation.

INTRODUCTION
Smoking cessation is a vital conduct exchange that can have giant outcomes on health
outcomes. The initiation, maintenance, and cessation of smoking are strongly stimulated
through other own family members.[1]

Most people of smokers try to cease smoking on their personal, but in any given year, only 5%
or much less are a hit. to enhance cessation rates, tapping social networks for social support
throughout quitting has been advocated or tested in some interventions.[2]

People who smoke are much more likely to cease while others of their social circle stop.
They're additionally much more likely to achieve success when they receive active support to
cease. life partners, family members, friends, and others are all viable resources of support.[3]

Social support is thought to be a vital determinant of achievement in smoking cessation

efforts. It is consequently reasonable to assume that an intervention designed to increase
support from a partner would possibly result in more rates of successful smoking cessation.[1]

Support for a partner can rise up both from a willingness to assist and promote the partner‟s
personal goals or a preference to change the partner or partner‟s behaviors. However, there are
many costs – specifically in highly interdependent relationships – that can accrue from
providing support. Offering support for another‟s goals may be effortful and useful resource-
consuming.[4]

www.wjpr.net Vol 8, Issue 13, 2019. 2

Wejdan et al. World Journal of Pharmaceutical Research

One issue shown to promote cessation is support from others; people who smoke who obtain
high quality support are much more likely to successfully cease. Even though consensus
exists that certainly going on support from close others helps quitting, little is known about
what activates near others to offer support. Beyond attempts at improving partner support via
interventions have yielded uninspiring results potentially due to the fact they did not focus on
elements that might maximum naturally encourage people to provide support.[5]

Social assist is an interactive manner between a provider and a receiver, and it refers to the
function and quality of social relationships. it may be differentiated into perceived and
received social support. Perceived social support accommodates the anticipated to be had help
from the social community if it is wished. This general expectation of support in the future
particularly resembles a personality disposition associated with optimism and is distinctly
stable. Received social support refers to retrospective reviews of actual support transactions
in the past.[6]

Aim of the study: The aim of this work is to provide cumulative data about the effect of
partner support and interaction on improving smoking cessation.

METHODS
This review was carried out using the standard methods mentioned within the Cochrane
handbook and in accordance with the (PRISMA) statement guidelines.[7]

Identification of studie
 An initial search carried out throughout the PubMed, Cochrane library Ovid, Scopus &
Google scholar using the following keywords: Partner Support, Smoking Cessation.
 We will consider published, full text studies in English only. Moreover, no attempts were
made to locate any unpublished studies nor non-English studies.

Criteria of accepted studies

 Types of studies
The review will be restricted to RCTs, clinical trials, and comparative studies, either
prospective or retrospective, which studied the outcome of Interventional group versus
Control group.

www.wjpr.net Vol 8, Issue 13, 2019. 3

Wejdan et al. World Journal of Pharmaceutical Research

 Types of participants
Participants reporting self-abstinence smoking.

 Types of outcome measures

1. Rate of self-reported abstinence (3-months) (1ry outcome)
2. Rate of self-reported abstinence (6-months or more) (2ry outcome)

Inclusion criteria
 English literature.
 Journal articles.
 Between 1991 until 2006.
 Describing partner support and its impact on smoking cessation.
 Human studies.

Exclusion criteria
 Articles describing other types of other types of interventions e.g. internet-based or other
smoking. Cessation methods.
 Irrelevance to our study.

Methods of the review

 Locating studies
Abstracts of articles identified using the above search strategy will be viewed, and articles that
appear of fulfill our inclusion criteria will be retrieved in full, when there is a doubt, a second
reviewer will assess the article and consensus will be reached.

 Data extraction
Using the following keywords: Partner Support, Smoking Cessation, data will be
independently extracted by two reviewers and cross-checked.

Statistical analysis
Statistical analysis done using MedCalc ver. 18.11.3 (MedCalc, Ostend, Belgium). Data were
pooled and odds ratios (ORs) as well as standard mean differences (SMD), were calculated
with their 95 per cent confidence intervals (CI). A meta-analysis was performed to calculate
direct estimates of each treatment, technique or outcome. According to heterogeneity across
trials using the I[2]-statistics; a fixed-effect model (P ≥ 0.1) or random-effects model (P< 0.1)

www.wjpr.net Vol 8, Issue 13, 2019. 4

 Wejdan et al. World Journal of Pharmaceutical Research

was used.

Study selection
We found 49 record; 30 were excluded based on title and abstract review; 19 articles are
searched for eligibility by full text review; 5 articles cannot be accessed or obtain full text; 6
studies were reviews and case reports; the desired intervention not used in 3 studies leaving 5
studies that met all inclusion criteria (Fig. 1).

Figure No 1: Flow chart for study selection.

RESULTS
Descriptive analysis of all studies included (Tables 1, 2)
Table No 1: Participants and study characteristics.
Number of participants
Highly
N Author Total Intervention Controlal Male gender
educated
group group
1 Orleans et al., 1991 938 471 467 --- ---
2 Ginsberg et al., 1992 64 31 33 --- ---
3 Gruder et al., 1993 197 100 97 --- ---
4 Wakefield et al., 2004 88 49 39 85 29
5 May et al., 2006 563 237 326 213 176
#Studies were arranged according to publication year.

www.wjpr.net Vol 8, Issue 13, 2019. 5

Wejdan et al. World Journal of Pharmaceutical Research

Table No 2: Summary of outcome measures in all studies.

Primary outcome Secondary outcome
N Author Cessation rate (3-month) Cessation rate (6-month)
Interventional group Control groupInterventional group Control group
1 Orleans et al., 1991 67 69 67 71
2 Ginsberg et al., 1992 13 15 8 11
3 Gruder et al., 1993 19 6 21 14
4 Wakefield et al., 2004 9 5 14 7
5 May et al., 2006 102 92 48 30

The included studies published between 1991 and 2006.

The total number of participants in all the included studies was 1850 participants, with 888
participants in Interventional group, and 962 participants in Control group.

Regarding general characteristics, gender and educational level was mentioned in 2 studies,
with 298 male participants, and 205 highly educated participants.

Meta-analysis of outcome measures (Figures 2 and 3)

Data were divided into two groups:
1) Interventional group
2) Control group

Meta-analysis study was done on 5 studies which described and compared the 2 different
groups of participants; with overall number of participants (N=1850).

Participants who achieved favorable outcomes were pooled:

Each outcome was measured by
 Odds Ratio (OR)
 For rate of self-reported abstinence (3-months) (1ry outcome)
 For rate of self-reported abstinence (6-months or more) (2ry outcome)

Regarding primary outcome measure,

We found all 5 studies reported 3-month cessation rate.
Fixed-effects model was carried out; with overall OR= 1.42 (95% CI 1.13 to 1.79).

The fixed-effects model of the meta-analysis study showed highly significant increase in 3-
month cessation rate in Interventional group compared to Control group (p = 0.002).

www.wjpr.net Vol 8, Issue 13, 2019. 6

Wejdan et al. World Journal of Pharmaceutical Research

Figure 2: Forest plot of (3-month cessation rate) on Interventional group vs Control group
– Odds ratio.

Regarding primary outcome measure,

We found all 5 studies reported 6-month cessation rate.
Fixed-effects model was carried out; with overall OR= 1.32 (95% CI 1.03 to 1.7).

The fixed-effects model of the meta-analysis study showed significant increase in 6-month
cessation rate in Interventional group compared to Control group (p = 0.028).

Figure 3: Forest plot of (6-month cessation rate) on Interventional group vs Control group
– Odds ratio.

www.wjpr.net Vol 8, Issue 13, 2019. 7

Wejdan et al. World Journal of Pharmaceutical Research

DISCUSSION
The aim of this work is to provide cumulative data about the effect of partner support and
interaction on improving smoking cessation.

Regarding general characteristics, gender and educational level was mentioned in 2 studies,
with 298 male participants, and 205 highly educated participants.

Data were divided into two groups: (Interventional group and Control group).

Regarding primary outcome measure, we found all 5 studies reported 3-month cessation rate.
The fixed-effects model of the meta-analysis study showed highly significant increase in 3-
month cessation rate in Interventional group compared to Control group (p = 0.002) which
came in agreement with Solomon et al. 2000[8] and disagreement with Hennrikus et al.
2010.[9]

Solomon et al. 2000 reported that at the 3-month observe-up, appreciably extra women in the
patch plus proactive smartphone support situation have been abstinent (42%) compared to the
patch simplest condition (28%) (P = 0.03).

Hennrikus et al. 2010 reported that compared with manage topics, intervention group subjects
stated that their supporters had supplied support behaviors more often and have been extra
committed to supporting them cease. There has been a non-significant fashion for more
validated quits in the intervention group on the cease of pregnancy: 13% vs. 3.6% a number of
the controls. Cease rates decreased to 9.3% inside the intervention group and 0% inside the
manipulate institution at 3 months postpartum.

Regarding primary outcome measure, we found all 5 studies reported 6-month cessation rate.
The fixed-effects model of the meta-analysis study showed significant increase in 6-month
cessation rate in Interventional group compared to Control group (p = 0.028) which came in
agreement with Whittaker et al. 2016[10] and disagreement with Whittaker et al. 2011.[11]

Whittaker et al. 2016 reported that primary outcome: 7-day point-occurrence abstinence using
a 2 (treatment groups) × 3(time points) repeated measures design throughout 3 time points:
8weeks, 3 months and6 months; confirmed a significant major effect for treatment group (P
value= 0.02) with higher odds of quitting in the intervention group in comparison with the
manipulate group (odds ratio 4.52).

www.wjpr.net Vol 8, Issue 13, 2019. 8

Wejdan et al. World Journal of Pharmaceutical Research

Whittaker et al. 2011 reported that, continuous cessation at 6 months was 26.4% in the
intervention group and 27.6% in the control group (P > 0.05).

As regard 3 month cessation rate and 6 month cessation rate results came in agreement with

Cahill and Lancaster 2014[12] reported that Group therapy programs (OR for cessation 1.71;
eight trials, 1309 participants), individual counselling (OR 1.96; eight trials, 3516
participants), pharmacotherapies (OR 1.98; five trials, 1092 participants), and multiple
intervention programs aimed mainly or solely at smoking cessation (OR 1.55; six trials, 5018
participants) all increased cessation rates in comparison to no treatment or minimal
intervention controls.

CONCLUSION
To conclude, there may be a strong evidence that interventions directed closer to individual
smokers increase the probability of quitting smoking. These include individual and group
counselling, pharmacological treatment to overcome nicotine addiction, and more than one
intervention targeting smoking cessation.

ACKNOWLEDGMENTS
Conflict of interest
None.

Authorship
All the listed authors contributed significantly to conception and design of study, acquisition,
analysis and interpretation of data and drafting of manuscript, to justify authorship.

Funding
Self-funding.

REFERENCES
1. Park, E.-W.; Tudiver, F.; Schultz, J. K.; Campbell, T. Does Enhancing Partner Support and
Interaction Improve Smoking Cessation? A Meta-Analysis. Ann Fam Med, 2004; 2(2):
170– 174. https://doi.org/10.1370/afm.64.
2. Westmaas, J. L.; Bontemps-Jones, J.; Bauer, J. E. Social Support in Smoking Cessation:
Reconciling Theory and Evidence. Nicotine & Tobacco Research, 2010; 12(7): 695–707.
https://doi.org/10.1093/ntr/ntq077.

www.wjpr.net Vol 8, Issue 13, 2019. 9

Wejdan et al. World Journal of Pharmaceutical Research

3. Faseru, B.; Richter, K. P.; Scheuermann, T. S.; Park, E. W. Enhancing Partner Support to
Improve Smoking Cessation. Cochrane Database of Systematic Reviews, 2018; 8.
https://doi.org/10.1002/14651858.CD002928.pub4.
4. Vandellen, M. R.; Boyd, S. M.; Ranby, K. W.; Beam, L. B. Successes and Failures in
Resisting Cigarettes Affect Partner Support for Smoking Cessation. Psychology &
Health, 2017; 32(2): 221–233. https://doi.org/10.1080/08870446.2016.1255945.
5. Van Dellen, M. R.; Boyd, S. M.; Ranby, K. W.; MacKillop, J.; Lipkus, I. M. Willingness
to Provide Support for a Quit Attempt: A Study of Partners of Smokers. J Health Psychol,
2016; 21(9): 1840–1849. https://doi.org/10.1177/1359105314567209.
6. Ochsner, S.; Luszczynska, A.; Stadler, G.; Knoll, N.; Hornung, R.; Scholz, U. The
Interplay of Received Social Support and Self-Regulatory Factors in Smoking Cessation.
Psychology & Health, 2014; 29(1): 16–31.
https://doi.org/10.1080/08870446.2013.818674.
7. Liberati, A.; Altman, D.; Tetzlaff, J.; Mulrow, C.; Gøtzsche, P.; Ioannidis, J.; Clarke, M.;
Devereaux, P.; Kleijnen, J.; Moher, D. The PRISMA Statement for Reporting Systematic
Reviews and Meta-Analyses of Studies That Evaluate Healthcare Interventions. Bmj,
2009; 339.
8. Solomon, L. J.; Scharoun, G. M.; Flynn, B. S.; Secker-Walker, R. H.; Sepinwall, D. Free
Nicotine Patches plus Proactive Telephone Peer Support to Help Low-Income Women
Stop Smoking. Preventive Medicine, 2000; 31(1): 68–74.
https://doi.org/10.1006/pmed.2000.0683.
9. Hennrikus, D.; Pirie, P.; Hellerstedt, W.; Lando, H. A.; Steele, J.; Dunn, C. Increasing
Support for Smoking Cessation during Pregnancy and Postpartum: Results of a
Randomized Controlled Pilot Study. Preventive Medicine, 2010; 50(3): 134–137.
https://doi.org/10.1016/j.ypmed.2010.01.003.
10. Whittaker, R.; Mc Robbie, H.; Bullen, C.; Rodgers, A.; Gu, Y. Mobile Phone-based
Interventions for Smoking Cessation. Cochrane Database of Systematic Reviews 2016; 4.
https://doi.org/10.1002/14651858.CD006611.pub4.
11. Whittaker, R.; Dorey, E.; Bramley, D.; Bullen, C.; Denny, S.; Elley, C. R.; Maddison, R.;
Mc Robbie, H.; Parag, V.; Rodgers, A.; et al. A Theory-Based Video Messaging Mobile
Phone Intervention for Smoking Cessation: Randomized Controlled Trial. Journal of
Medical Internet Research, 2011; 13(1): 10. https://doi.org/10.2196/jmir.1553.
12. Cahill, K.; Lancaster, T. Workplace Interventions for Smoking Cessation. Cochrane
Database of Systematic Reviews, 2014; 2.

www.wjpr.net Vol 8, Issue 13, 2019. 10

Wejdan et al. World Journal of Pharmaceutical Research

https://doi.org/10.1002/14651858.CD003440.pub4.
13. Orleans, C.T., Schoenbach, V. J., Wagner, E.H., Quade, D., Salmon, M.A., Pearson, D.C.,
Fiedler, J., Porter, C.Q. and Kaplan, B.H., Self-help quit smoking interventions: effects of
self- help materials, social support instructions, and telephone counseling. Journal of
consulting and clinical psychology, 1991; 59(3): 439.
14. Ginsberg, D., Hall, S.M. and Rosinski, M., Partner support, psychological treatment, and
nicotine gum in smoking treatment: an incremental study. International journal of the
addictions, 1992; 27(5): 503-514.
15. Gruder, C. L., Mermelstein, R.J., Kirkendol, S., Hedeker, D., Wong, S.C., Schreckengost,
J., Warnecke, R.B., Burzette, R. and Miller, T.Q., Effects of social support and relapse
prevention training as adjuncts to a televised smoking-cessation intervention. Journal of
consulting and clinical psychology, 1993; 61(1): 113.
16. Wakefield, M., Olver, I., Whitford, H. and Rosenfeld, E., Motivational interviewing as a
smoking cessation intervention for participants with cancer: randomized controlled trial.
Nursing research, 2004; 53(6): 396-405.
17. May, S., West, R., Hajek, P., McEwen, A. and Mc Robbie, H., Randomized controlled trial
of a social support („buddy‟) intervention for smoking cessation. Participant Education
and Counseling, 2006; 64(1-3): 235-241.

www.wjpr.net Vol 8, Issue 13, 2019. 11