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标题：Effect of Network Social Capital on the Chances of Smoking Relapse: A Two-Year Follow-up Study of Urban-Dwelling Adults
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作者：Spencer Moore ; Ana Teixeira ; Steven Stewart 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：12
页码：e72-e76
DOI：10.2105/AJPH.2014.302239
语种：English
出版社：American Public Health Association
摘要：Objectives. We sought to examine the prospective influence of social capital and social network ties on smoking relapse among adults. Methods. In 2010, a 2-year follow-up study was conducted with the 2008 Montreal Neighborhood Networks and Healthy Aging Study (MoNNET-HA) participants. We asked participants in 2008 and 2010 whether they had smoked in the past 30 days. Position and name generators were used to collect data on social capital and social connections. We used multilevel logistic analysis adjusting for demographic and socioeconomic factors to predict smoking relapse in 2010. Results. Of the 1400 MoNNET-HA follow-up participants, 1087 were nonsmokers in 2008. Among nonsmokers, 42 were smokers in 2010. Results revealed that participants with higher network social capital were less likely (odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.47, 0.96), whereas socially isolated participants (OR = 3.69; 95% CI = 1.36, 10.01) or those who had ties to smokers within the household (OR = 4.22; 95% CI = 1.52, 11.73) were more likely to report smoking in 2010. Conclusions. Social network capital reduced the chances of smoking relapse. Smoking cessation programs might aim to increase network diversity so as to prevent relapse. Tobacco smoking is a risk factor for a range of ill health conditions, including lung cancer, stroke, heart disease, and chronic respiratory disease. 1 In 2010, worldwide tobacco smoking, including secondhand smoking, was ranked as the second highest risk factor contributing to the overall global burden of disease with estimates placing global smoking prevalence at 23.7%. 1,2 Researchers have suggested that cessation by current smokers offers the only practical way to avoid a substantial proportion of global tobacco-related deaths in the coming decades. 3 Relapse is common during smoking cessation attempts. 4,5 Social support interventions, which involve a person’s close social relationships, have been shown to be important in preventing relapse. 5 Developing effective network interventions to reduce smoking requires a greater understanding of the range of social network influences beyond social support that might be leveraged to encourage cessation and prevent relapse. Research on social influences and smoking have highlighted the importance of social networks on a range of smoking behaviors, including initiation, cessation, and relapse. 6–8 Network influences on smoking might operate in a positive or negative fashion: being connected to others who smoke might lead to an increased risk of smoking, whereas being connected to people who do not smoke might reduce the risk. 9 Although much research has focused on youth smoking, studies have also shown the importance of social networks and support for adult smoking. 10,11 For example, using data from the Framingham Heart Study, Christakis and Fowler reported that smoking cessation clustered among more connected groups of people, suggesting the diffusion of cessation behavior within social networks. 7 Research has also shown the importance of social support in smoking cessation and relapse. 10,12 For example, Holahan et al. showed that general social support reduced the chances of smoking relapse among adult women. 10 Social support resources might emerge from formal (e.g., clinics or support groups) or informal sources; when informal, support for smoking cessation tends to come from a person’s close friends or family members (e.g., spouse or partner). 13 Although the importance of support and close ties in smoking behaviors is thus recognized, less is known about the influence of network social capital on smoking. In this study, we examined 3 social network influences on smoking relapse: social capital, social isolation, and having strong ties to other smokers (i.e., smoking alters). First, social capital refers to the resources to which individuals and possibly groups have access through their social networks. In contrast to social support, which tends to emerge from a person’s strong, core social connections, social capital often emerges from a person’s weaker and more heterogeneous social connections. 14,15 Most studies on social capital and smoking have applied proxy measures of social capital such as generalized trust and social participation to examine its link to smoking behavior. These studies have shown that those persons with higher levels of social participation or generalized trust are less likely to smoke 16,17 and more likely to cease smoking. 11 Few studies have examined network social capital and smoking prospectively, and, therefore, less is known about the potential influence of network capital on smoking behavior. Second, social isolation (i.e., not having social connections) can also impact smoking behavior. 18 Choi and Smith, for example, showed that social isolation can lead to smoking as a means of managing negative moods that might emerge from the lack of social connections and support. 19 Finally, being socially isolated might increase smoking risk but having social connections can also increase risk, if those connections tend to be to smokers. Strong ties to smokers might lead to smoking initiation or relapse through various mechanisms, including normative or social learning mechanisms. 20 For example, Homish and Leonard showed that spouses actually exercised a stronger influence on a partner’s chances of relapse than cessation. 21 Living with smokers regardless of relationship status has also been shown associated with smoking. 22 Despite such findings, little is known on whether the influence of having strong ties to smokers on adult smoking relapse is similar across different spatial units (e.g., sharing a household compared with residing in the same neighborhood). In this study, we examined the importance of 3 social network influences on smoking relapse and whether there are protective effects of network social capital on relapse. Based on previous research, we expected network social capital, social isolation, and having strong ties to smokers to have independent and different relationships to smoking relapse. Four hypotheses on the relationship between adult social network characteristics and smoking relapse guided the study: (1) the higher a person’s network social capital, the lower that person’s chances of smoking relapse; (2) adults who are socially isolated have increased chances of smoking relapse; (3) the greater the number of strong ties to smokers that a person has, the greater their chances of smoking relapse; and (4) the more spatially proximate smoking alters are to participants, the more likely they are to relapse. To test these hypotheses, we examined prospectively the influence of baseline levels of network social capital and social network characteristics on adult smoking behavior 2 years later.