Background on Supportive Relationships
What are supportive relationship strategies?
- Programs or activities designed to increase social support to decrease tobacco use initiation (i.e., avoid tobacco use), reduce exposure to environmental tobacco smoke, and increase tobacco use cessation (i.e., quitting tobacco use). This support may be provided through involvement from families, organizations, and communities.
- These interventions may focus on increasing the information individuals have about: their risk of using tobacco, getting exposed to second-hand smoke and the benefits of cessation (informational support); the skills, abilities and resources they have to avoid or quit using tobacco (tangible support); or a sense of acceptance and belonging as they make choices to live tobacco free (emotional and appraisal support).
- In addition, such interventions provide opportunities to identify and address challenges collectively rather than individually (e.g., collective problem solving or advocacy). This support may be provided through involvement from a variety of individuals or individuals as part of groups, organizations, or communities.
How do supportive relationships impact tobacco related behaviors?
- Supportive relationships interventions are successful for many reasons, such as: individuals can ask questions or clarify what they have been told, those providing support can also provide referrals and resources to assist the individual, and longer-term relationships can help to sustain behavior change over time, among others.
How can I use supportive relationship strategies in a tobacco intervention?
- Supportive relationships interventions may help to reduce initiation of tobacco use in order to prevent a disease or health condition from occurring (primary prevention) or work with those who have already developed a health condition and acting to decrease the negative effects of that condition through reducing or eliminating tobacco use or exposure to tobacco smoke (secondary prevention). These interventions may include specific information as part of each session, or may be more open-ended and responsive to the specific needs of the individual.
Why is it important to considering tailoring in supportive relationship strategies?
- Supportive relationships interventions can be very successful when the support is tailored to the individual’s or group’s readiness to change as well as other important characteristics.
- Supportive relationships interventions may include an assessment of the individual’s health and tobacco use as well as a discussion of challenges, benefits and advice for maintaining cessation or prevention over time.
- Supportive relationship interventions work best when the advice also takes into account the person’s gender, age, language, race or ethnicity, and other cultural factors.
What is “readiness to change” and how does it relate to supportive relationships?
- The concept of readiness to change (drawn from the Transtheoretical Model or Stages of Change) suggests that individuals may need different kinds of interventions to help them avoid or quit using tobacco depending on how ready they are to change their behavior. For example, individuals who are not really thinking about quitting smoking may need information on the harmful effects of smoking whereas individuals who are ready to quit smoking may need training on how to quit. Supportive relationships may be particularly important when people are ready to change their tobacco use behaviors.
How do supportive relationship strategies deal with relapse?
- Because many tobacco users quit and then relapse, or go back to using tobacco, support often includes information to help individuals to recognize that this is not unusual and to work with individuals to develop strategies to help prevent relapse during future quit attempts (drawn from Relapse Prevention Theory).
- It can be helpful to recognize that changes in behaviors may happen in small steps. Every individual will have preferences for what steps may be the easiest to take first, and these preferences may depend to a large extent on the support of others for these changes (e.g., family, roommate, friends, co-workers).
How have supportive relationships been used in past tobacco interventions?
- Increase health care provider support for avoiding or quitting tobacco use, or staying away from environmental tobacco smoke. For example, a health care provider may provide support to a pregnant woman to reduce her exposure to tobacco smoke during and after pregnancy to improve the health of her baby, a school nurse can provide support to teenager to quit chewing tobacco to improve his/her performance in school or a dentist can ask a patient to quit smoking improve the appearance of his/her teeth. Health care provider support may be offered through face-to-face interactions, letters, or telephone calls. These support efforts may be initiated by the health care provider or the patient/client (e.g., counseling during an office visit, a “quit line” set up by telephone that allows anyone who is interested to call for support when needed).
- Increase school-based support for avoiding or quitting tobacco use, or staying away from environmental tobacco smoke. For example, peer educators can be trained to provide support through school based activities such as athletic programs; teachers, school nurses and coaches can be trained to provide formal structured support (e.g., class sessions covering these topics) or less formal support (e.g., advice or encouragement) and family members can be encouraged to provide support through letters, newsletters or videos sent home with the students. These cues to action (drawn from the Health Belief Model) can describe or illustrate the challenges in avoiding or quitting tobacco use (e.g., showing peer models making decisions not to smoke) and instigate discussion between school representatives, family members and students about these struggles.
- Increase worksite support for avoiding or quitting tobacco use, or staying away from environmental tobacco smoke. For example, worksites can be considered a mini-community with interventions that provide tangible support (e.g., policies for no smoking areas), informational support (e.g., tobacco use cessation classes, distribution of pamphlets, newsletters, posters and other media) and emotional and appraisal support (e.g., buddy systems, lay health advisors or team contests). Some worksite interventions have been offered by management, while others have been developed jointly through labor and management negotiations.
- Increase support from faith-based organizations for avoiding or quitting tobacco use, or staying away from environmental tobacco smoke. In general, faith-based organizations have attempted to help people recognize that tobacco use cessation is part of the faith message. For example, through health ministry and being part of the faith community, these organizations can increase knowledge and skills about the health risks of tobacco use and the benefits of cessation, offer cessation classes, include health messages as part of sermons and share testimonials from congregation members. Ministers, faith community nurses (e.g., parish nurses) and members have prayed with fellow members, found resources for them, comforted them, and helped to nurture them.
- Increase community support for avoiding or quitting tobacco use, or staying away from environmental tobacco smoke. For example, informational, emotional and appraisal support can be provided through telephone quit lines (e.g., program initiated calls to individuals, a call line or “quit line” that is made available for people to call). Individuals staffing these lines may be medical personnel, health educators or trained lay health advisors. Other examples of community support include the use of community role models who can speak to community members about the risks of tobacco use and the benefits of cessation (i.e., Olympic champions, sports players, and local celebrities who have experienced the negative effects of tobacco use).