Background The prevalence of smoking has decreased substantiallyin the United States over the past 30 years. We examined theextent of the person-to-person spread of smoking behavior andthe extent to which groups of widely connected people quit together.
Methods We studied a densely interconnected social network of12,067 people assessed repeatedly from 1971 to 2003 as partof the Framingham Heart Study. We used network analytic methodsand longitudinal statistical models.
Results Discernible clusters of smokers and nonsmokers werepresent in the network, and the clusters extended to three degreesof separation. Despite the decrease in smoking in the overallpopulation, the size of the clusters of smokers remained thesame across time, suggesting that whole groups of people werequitting in concert. Smokers were also progressively found inthe periphery of the social network. Smoking cessation by aspouse decreased a person's chances of smoking by 67% (95% confidenceinterval [CI], 59 to 73). Smoking cessation by a sibling decreasedthe chances by 25% (95% CI, 14 to 35). Smoking cessation bya friend decreased the chances by 36% (95% CI, 12 to 55 ). Amongpersons working in small firms, smoking cessation by a coworkerdecreased the chances by 34% (95% CI, 5 to 56). Friends withmore education influenced one another more than those with lesseducation. These effects were not seen among neighbors in theimmediate geographic area.
Conclusions Network phenomena appear to be relevant to smokingcessation. Smoking behavior spreads through close and distantsocial ties, groups of interconnected people stop smoking inconcert, and smokers are increasingly marginalized socially.These findings have implications for clinical and public healthinterventions to reduce and prevent smoking.
Source Information
From the Department of Health Care Policy, Harvard Medical School, Boston (N.A.C.); the Department of Medicine, Mt. Auburn Hospital, and the Department of Sociology, Harvard University — both in Cambridge, MA (N.A.C.); and the Department of Political Science, University of California, San Diego, San Diego (J.H.F.).
Address reprint requests to Dr. Christakis at the Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, or at christakis{at}hcp.med.harvard.edu.
Kairouz, S, O'Loughlin, J, Lague, J
(2009). Adverse effects of a social contract smoking prevention program among children in Quebec, Canada. Tobacco Control
18: 474-478
[Abstract][Full Text]
Drum, M. L., Shiovitz-Ezra, S., Gaumer, E., Lindau, S. T.
(2009). Assessment of Smoking Behaviors and Alcohol Use in the National Social Life, Health, and Aging Project. J Gerontol B Psychol Sci Soc Sci
64B: i119-i130
[Abstract][Full Text]
Mermelstein, R. J., Colvin, P. J., Klingemann, S. D.
(2009). Dating and changes in adolescent cigarette smoking: Does partner smoking behavior matter?. Nicotine Tob Res
11: 1226-1230
[Abstract][Full Text]
Schroeder, S. A.
(2009). Public smoking bans are good for the heart.. J Am Coll Cardiol
54: 1256-1257
[Full Text]
Stefanek, M. E., Andrykowski, M. A., Lerman, C., Manne, S., Glanz, K., on behalf of the AACR Behavioral Science Task Forc,
(2009). Behavioral Oncology and the War on Cancer: Partnering with Biomedicine. Cancer Res.
69: 7151-7156
[Abstract][Full Text]
McCubbins, M. D., Paturi, R., Weller, N.
(2009). Connected Coordination: Network Structure and Group Coordination. American Politics Research
37: 899-920
[Abstract]
Frishman, W. H.
(2009). Smoking cessation pharmacotherapy. Ther Adv Cardiovasc Dis
3: 287-308
[Abstract]
Sharp, D. L., Blaakman, S. W., Cole, R. E., Evinger, J. S.
(2009). Report From a National Tobacco Dependence Survey of Psychiatric Nurses. J Am Psychiatr Nurses Assoc
15: 172-181
[Abstract]
Stapleton, J. A., Keaney, F., Sutherland, G.
(2009). Illicit drug use as a predictor of smoking cessation treatment outcome. Nicotine Tob Res
11: 685-689
[Abstract][Full Text]
Nguyen, Q. B., Zhu, S.-H.
(2009). Intermittent smokers who used to smoke daily: A preliminary study on smoking situations. Nicotine Tob Res
0: ntp012v1-ntp012
[Abstract][Full Text]
Fowler, J. H., Dawes, C. T., Christakis, N. A.
(2009). From the Cover: Model of genetic variation in human social networks. Proc. Natl. Acad. Sci. USA
106: 1720-1724
[Abstract][Full Text]
Schroeder, S. A.
(2009). A 51-Year-Old Woman With Bipolar Disorder Who Wants to Quit Smoking. JAMA
301: 522-531
[Abstract][Full Text]
Schroeder, S. A.
(2009). Moving Forward in Smoking Cessation: Issues for Psychiatric Nurses. J Am Psychiatr Nurses Assoc
15: 68-72
Houle, B, Siegel, M
(2009). Smoker-free workplace policies: developing a model of public health consequences of workplace policies barring employment to smokers. Tobacco Control
18: 64-69
[Abstract][Full Text]
Rosengren, A., Perk, J., Dallongeville, J.
(2009). CHAPTER 12 Prevention of Cardiovascular Disease. ESC Textbook of Cardiovascular Medicine
2: med-9780199566990-chapter-med-9780199566990-chapter
[Abstract][Full Text]
Fowler, J. H, Christakis, N. A
(2008). Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. BMJ
337: a2338-a2338
[Abstract][Full Text]
Katz, M. H.
(2008). Banning Tobacco Sales in Pharmacies: The Right Prescription. JAMA
300: 1451-1453
[Full Text]
(2008). All you need to read in the other general journals. BMJ
336: 1212-1212
[Full Text]
Schroeder, S.
(2008). Stranded in the Periphery -- The Increasing Marginalization of Smokers. NEJM
358: 2284-2286
[Full Text]
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