FATHERS AND SMOKING IN THE PERINATAL PERIOD

Messages from Research

Parental smoking is a significant issue. In a study of smoking households in the Midlands containing infants under three months old, two-thirds contained a smoking father (many more than contained a smoking mother). Tobacco consumption was higher where both parents smoked or where only the father smoked (Blackburn et al, 2005a). Many of these new fathers wanted to stop smoking: more than 50%f had tried to cut down; 20% had tried to quit; and more than 75% had tried not to smoke in the house. However, less than 5% had succeeded in quitting; and only 60% had achieved not smoking at home (Blackburn et al, 2005b).

Astonishingly, most of the fathers were not asked about their smoking habits by health professionals, either during the pregnancy or after the birth, let alone given even the most basic information to encourage them to quit (Blackburn et al, 2005b).

Impact of fathers’ smoking on children

• Smoking by fathers causes sperm damage, reduces semen quality and reduces responsiveness to fertility treatment (British Medical Association, 2004).

• Heavy smoking by fathers is associated with increased risk of early pregnancy loss (Venners et al, 2004), respiratory disease in infants and low birth-weight (Health Education Authority, 1999).

• Fathers’ smoking is directly linked with SIDS – and also indirectly, via low birth-weight (Health Education Authority, 1999). And where both parents smoke, the baby is eight times more likely to die of SIDS (Health Education Authority, 1999).

• A substantial study in New Zealand identified father’s smoking as a risk factor for breastfeeding cessation at four months postpartum, independently of mother’s smoking and other factors (McLeod et al, 2002).

• Heavy smoking by either father or mother is associated with fussiness/colic in newborns. In a Dutch national sample, excessive infant crying (which has a deleterious effect in parent infant boding and couple satisfaction, and perceptions of which are the number one trigger for Shaken Baby Syndrome – Barr, 2006) was found to occur more frequently among infants whose fathers (but not mothers) smoked 15+ cigarettes daily (Reijneveld et al, 2005).

• A high quality case control study in Northern California found that exposure to paternal preconception smoking alone (as well as in combination with postnatal passive smoking) is highly likely to be important in the risk of childhood leukemia (Chang et al, 2006).

Fathers have, at best, incomplete knowledge of the effects of passive smoking on infants: only 33% are aware that it contributes to SIDS; 24% that it contributes to ear infections; 65% that it is related to babies’ developing asthma, bronchitis and pneumonia; and 75% that it contributes to coughing/sore throats in babies (Moffat & Stanton, 2005).

In the US, paediatricians are being urged to address fathers’ smoking, not only because of the impact on their health but because of productivity issues: children from smoking households miss an extra six days of school a year (Dake et al, 2006).

Links between mothers’ and fathers’ smoking behaviour

• An expectant father’s continuing to smoke is associated with his partner’s continuing smoking (for review, see Bottorff et al, 2006).

• A longitudinal UK survey found that smoking by a pregnant woman’s partner was by far the biggest predictor of her current smoking status (Penn & Owen, 2002).

• A review of nine cohort studies published in international peer-reviewed journals found ‘partner’s smoking habit’ to be one of the key determinants of a pregnant woman’s smoking. Most of the other determinants of pregnant women’s smoking were SES related (Lu et al, 2004).

• An expectant mother’s quitting is consistently associated with her partner’s provision of support for her quitting – and by his quitting himself (for review, see McBride et al, 2004).

• Similarly, an expectant father’s quitting is strongly associated with his partner’s quitting (Lu et al, 2004),

• Although mothers’ influence on fathers’ quitting is small (for review, see Bottorf et al, 2006), mothers who have quit themselves have the strongest influence (Ratner et al, 2001).

For many fathers, not smoking in the home may be a more achievable target than smoking cessation (Blackburn et al, 2005b). So how effective are mothers in protecting their infants from the father’s smoking? Results are mixed. A Dutch study found that among the 65% of mothers who prevented passive smoking to some extent, success was linked with the mother’s self-efficacy in asking others not to smoke (Crone et al, 2001). This suggests that the most vulnerable women are likely to be the least efficacious in protecting their infants from passive smoking.

Fatherhood as a motivator for smoking cessation/reduction

What indicators are there, that fatherhood may prove an incentive for men to reduce their smoking, smoke outside the house – or even quit? Most men, and in particular healthy men from lower socioeconomic classes, are poorly motivated by existing smoking cessation programmes. However, ‘significant life events’ are a time of increased receptiveness to smoking cessation influences (Stanton et al, 2004). Fatherhood seems to be one of these:

• Expectant and new fathers experience discomfort with their smoking (Bottorff et al, 2006)

• The desire to be a caring, participative father increases men’s ambivalence about smoking and precipitates changes in smoking (Westmaas et al, 2002)

• Men who become fathers are more likely than other men to have quit in the two years preceding childbirth, and to be still abstinent one year thereafter (Brenner & Mielck, 1993).

• Becoming a father and preparing to become a father are associated with spontaneous quitting (Brenner & Mielck, 1993); and multiple quit attempts are common prior to smoking cessation (Prochaska & Goldstein, 1991).

• The discontinuities in everyday life associated with the postnatal period provide opportunities for establishing new routines (Bottorff et al, 2006)

Impact of smoking interventions with expectant and new fathers

• A randomized controlled trial of a multi component intervention with expectant fathers in the US found that, at six months post partum, almost twice as many in the intervention group compared with the controls (16.5% v. 9.3%) had stopped smoking. However, the number needed to be treated to get one male smoker to quit was 13 to 14 (Stanton et al, 2004).

• Almost exactly the same treatment/quit ratio was found in a Hong Kong study, with – again – almost double the quit rate in the intervention group. The intervention group, in that case, had received three-session telephone-based smoking cessation counseling (Abdullah et al, 2005).

• In another randomized controlled study of an intervention designed to reduce smoking in expectant fathers, addressing the mothers alone resulted in 5% of the fathers’ quitting, while addressing the father directly resulted in a 15% quit rate (McBride et al, 2004).

The barriers to fathers’ quitting/smoking reduction, and the factors that may encourage it, are beginning to be understood:

• An Australian focus group identified a belief among expectant, smoker, fathers that the stress caused in their family through smoking withdrawal/quitting would be more detrimental to the unborn baby than continued smoking (Wakefield et al, 1998).

• In another Australian study, in multivariate logistic regression analyses ‘feeling close to the unborn baby’ and a ‘high level of knowledge about the effects of passive smoking on baby’ were associated with early quit attempts by fathers Moffatt & Stanton (2005).

• Moffatt & Stanton (2005) also found ‘high level of knowledge about the effects of passive smoking on baby’ and ‘confidence in ability to quit’ associated with smoking cessation.

• Fathers’ not smoking in the home is linked to both their caring and their economic circumstances, so other interventions (e.g. supporting them into further education, training or employment) may have spinoffs in reducing fathers’ smoking in the home (Blackburn et al, 2005b).

• Masculinity Issues may need to be addressed: identification of smoking with masculinity precludes some fathers from viewing partner’s tobacco reduction or cessation as an opportunity for their own cessation (Bottorff et al, 2006).

It seems possible that social and cultural shifts that redefine masculinity and male roles in relation to childcare and family life may support positive changes in health behaviour among fathers, including their smoking practices (Bottorff et al, 2006).

REFERENCES

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Blackburn, C.M., Bonas, S., Spencer, N.J., Coe, C.J., Dolan, A., & Moy, R., (2005a). Parental smoking and passive smoking in infants: fathers matter too. Health Education Research, 20(2), 185-194.

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