Public Health Nurs. 2020;37:161–168. wileyonlinelibrary.com/journal/phn | 161 © 2019 Wiley Periodicals, Inc. 1 | INTRODUCTION Over the past 50 years, smoking prevalence in the United States (US) has dropped from 42% to 15% (CDC, n.d.). Interestingly, the number of clusters of smokers connected in social contexts, such as family members, co-workers and friends has decreased, yet the size of clus- ters (number of smokers within the clusters) has remained relatively unchanged (Christakis & Fowler, 2008). Such a pattern suggests that a group of smokers—dual-smoker couples—quit together, and one quitter can motivate the others to quit (Boyd, Ranby, MacKillop, & Lipkus, 2016). The most fundamental group of smokers connected in social contexts is married couples, dual-smoker couples. Spousal concordance in smoking behavior has been observed in large-scale studies (Falba & Sindelar, 2008; Jackson, Steptoe, & Wardle, 2015; Venters, Jacobs, Luepker, Maiman, & Gillum, 1984). In the US, although there are wide variations in previous studies, Received: 6 July 2019 | Revised: 25 October 2019 | Accepted: 26 October 2019 DOI: 10.1111/phn.12686 POPULATIONS AT RISK ACROSS THE LIFESPAN–POPULATION STUDIES Smoking behavior and social contexts associated with smoking among dual-smoker couples Seung Hee Choi PhD RN, Assistant Professor 1 | Jiying Ling PhD, Assistant Professor 2 | Devon Noonan PhD, Associate Professor 3 | Woojong Kim PhD, Assistant Professor 4 1 College of Nursing, Wayne State University, Detroit, MI, USA 2 College of Nursing, Michigan State University, East Lansing, MI, USA 3 Duke University School of Nursing, Durham, NC, USA 4 Department of Social Work, University of Michigan, Flint, MI, USA Correspondence Seung Hee Choi, College of Nursing, Wayne State University, 5557 Cass Ave #350, Detroit, MI 48202, USA. Email: hc0054@wayne.edu Abstract Objectives: To examine smoking behavior and social contexts related to smoking among dual-smoker couples. Design: Cross-sectional online survey study. Sample: A convenience sample of 183 dual-smoker couples. Measurements: Investigator-developed survey on smoking and related social contexts. Results: Participants smoked 16.0 cigarettes daily for 14.2 years; 48.4% shared more than half of their smoking time with their spouse. More than half made quit attempts in the past year individually (M = 5.3) and jointly (M = 2.5). Couples sharing more smoking time were more likely to be motivated to quit ( p = .002), make quit attempts ( p < .0001), and be interested in cessation interventions ( p = .002); but less likely to implement home smoking bans ( p < .001). Among those who reported quit attempts, 41% quit by themselves and 15.3% sought professional assistance. Most common reasons for relapse were chronic stress and crisis, 63.6%, however, were interested in smoking cessation services, preferably technology-based interventions. Conclusions: We found smoking interdependence within dual-smoker couples. Despite high levels of motivation to quit, most did not utilize professional help, lead- ing to low successful quit rates. Technology-based smoking cessation interventions incorporating spousal support and addressing stress/crisis may best assist dual- smoker couples. KEYWORDS dual-smoker couples, smoking, tobacco