Randomized controlled trial of a social support (‘buddy’) intervention for smoking cessation

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Abstract

Objective

To assess the effectiveness of including a social support intervention (‘buddy system’) in a group treatment programme to aid smoking cessation.

Methods

Five hundred and sixty-three smokers attended groups at a smokers’ clinic. These groups were randomized either to be (a) groups in which smokers were paired with another person to provide mutual support (buddy condition: n = 237 in 14 groups) or (b) to receive the same treatment without the buddy component (control: n = 326 in 20 groups). Participants were seen weekly for the first 4 weeks after stopping then followed up again after 26 weeks.

Results

Smokers in the buddy condition were no more likely than smokers in the control condition to stay abstinent at 1, 4 or 26 weeks. The effect was in the right direction at week one post-quit but after controlling for potential confounders the difference was not significant (odds ratio = 1.45 (95% CI; 0.92–2.29), p = 0.06).

Conclusions

We were unable to show that a buddy system improved abstinence rates of group treatment programmes. This might be due to the high level of social support already achieved through the groups.

Practice implications

The buddy system is a simple and very low cost addition to a group treatment programme; but the results from this study suggest that the kind of buddy system tested may not add substantially to the success rates. However there may be merits in a more intensive or protracted form of buddying.

Introduction

Social support has been identified as important in the maintenance of several health behaviours [1]. This study examined whether adding a specific type of social support intervention (a ‘buddy system’) can improve the effectiveness of a group support programme helping smokers to stop.

An individual's social environment is important in their smoking behaviour. Hence for example population surveys find that people who are married have higher rates of smoking cessation than people who are divorced, separated or widowed [2], [3], [4]. Recent evidence suggests that being married may not predict cessation among smokers approaching services for help however [5], [6]. Researchers in Sweden using large samples of the population found that a high level of social participation was associated with smoking cessation and maintenance [7]. It is also apparent that having smokers in one's social environment increases the chances of becoming a smoker and reduces the chances of stopping [4], [8], [9], [10]. These findings may be attributed to cues or other social factors such as social support. Chandola et al. [4] found that general measures of social support were predictive of non-smoking status at follow-up in a general population survey. Other researchers have found that the existence of a partner [11], [12], [13] or a friend [14] who is specifically supportive of an attempt to stop smoking predicts success. However this is not consistently the case [15], [16].

Harnessing the benefits of support into a successful intervention has proved difficult (see May and West [17] for a more complete discussion). These interventions have typically focussed on the support of an individual or ‘buddy’ given special responsibility to help a smoker stop. In the field of smoking cessation the majority of studies have focused on attempts to improve the quality of pre-existing supportive relationships with, for example, a friend or partner [18], [19]. These studies have typically involved only small samples and results have been largely negative [17], [20]. Other studies have looked at smokers trying to stop being paired with another smoker previously unknown to them who is also trying to stop [21], [22], [23]. Again there are methodological problems, e.g. small sample sizes and no biochemical validation [21], [22]. More recently West et al. [23] used a similar intervention in a randomized controlled trial involving 172 smokers in a nurse-led smokers clinic in general practice. In this study smokers trying to stop were paired up 1 week before their quit dates. The two quitters were seen together at all subsequent appointments and were encouraged to phone each other up every day for at least the first week. They were also encouraged to deposit a sum of money (the amount to be decided by the smokers) to be returned the following week contingent on both smokers remaining abstinent. This was compared with a control group of smokers quitting with only the nurse's support. The percentage of smokers abstinent after 4 weeks was higher in the buddy than in the control condition (27% versus 12%; p < 0.01).

May and West [17] in their review of the literature included studies with any length of follow-up and concluded that there may be some benefit of ‘buddy’ support interventions in a clinic context. Park et al. [20] in their Cochrane review concluded that partner support interventions did not increase quit rates in the longer term (6 months or more), although they commented that the interventions might have a short-term benefit. Both reviewers point out that the scarcity of positive findings may be due to methodological problems, e.g. inadequate power or the diversity between studies making comparisons difficult. These findings led both reviewers to conclude that there is a need for good quality, large-scale research examining support interventions for smoking cessation.

Many smokers in the UK and elsewhere are treated in groups using an approach that aims to foster group communication and mutual support [24]. This approach is highly cost effective because groups of 20 or more smokers can be treated together and success rates are at least as high as those found in individual treatment [25]. This group approach routinely involves the use of a buddy system similar to that evaluated by West et al. [23]. Anecdotal reports suggest that many quitters find the buddy procedure beneficial, but as groups can generate high levels of group support in any case, the question arises whether this particular intervention makes an independent contribution over and above the other more traditional group support mechanisms. This paper reports the results of a large randomized controlled trial testing the hypothesis that the use of a buddy system in a group treatment setting increases abstinence rates.

Section snippets

Design

Smokers attending a group-based treatment programme to help them stop were randomly assigned to receive additional social support from another member of the group (the buddy condition) or an additional educational intervention (the control). Assignment was by group rather than individual to avoid contamination across conditions. The participants were a subset of those also taking part in a randomized controlled trial of glucose as an aid to cessation. This meant that all participants received

Results

Table 1 gives the baseline characteristics of the two study groups. A series of t-tests and chi-squared analyses were performed to compare them on a number of variables. By chance the buddy sample rated their chances of stopping more highly at visit one (i.e. prior to exposure to the intervention). All other differences were not significant. A chi-squared analysis of intervention by site also showed that the number of participants in each condition was not equally distributed between sites (χ2 = 

Discussion

There was no significant benefit of the buddy system to smokers trying to stop at 1, 4 and 26 weeks following their quit date. This suggests that the buddy system did not represent a significant addition to group smoking cessation treatment; although these results cannot be generalised to include smokers in other situations such as individual treatment or self-help programmes. It is possible that the level of social support already provided by the groups may have limited the scope for any

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