Efficacy of Smoking Cessation Intervention for Expectant Fathers

Background: Pregnancy and impending parenthood are life-changing experiences that can alter beliefs about the cancer risks associated with smoking and thus, lead to smoking cessation. The perinatal time frame evokes strong affective and emotional responses, increases perceptions of personal risk, and redefines one's self-concept or social role in a manner that motivates a person to change health-risk behavior. Clinicians and health care providers have capitalized on the perinatal period to promote smoking cessation and health behavior changes in pregnant women. Limited data shows some men also quit smoking and make behavior changes during this time frame. However, systematic evaluation of smoking cessation interventions for expectant fathers has not been studied during the "teachable moment" of pregnancy.

Objective: This project's objective is to study the efficacy of smoking cessation intervention for expectant fathers during pregnancy and early postpartum.

Specific Aims: This project specifically aims to

1. examine expectant father's perspectives and experiences about smoking, pregnancy, and behavior change;
2. compare the effect of two different interventions on smoking cessation rates of expectant fathers;
3. evaluate the effect of smoking cessation by expectant fathers on the smoking behavior of the pregnant partners.

Study Design: A multi-method approach will be used to examine a proposed "teachable moment" model and improve smoking cessation in expectant fathers. Initially, 30 young men identified as smokers at the time of their partners' pregnancy will be interviewed about smoking, pregnancy, and behavior change. Audio taped interview transcripts will undergo qualitative content analysis. Early interviews will inform later interviews, an iterative process that will help to verify, refute, or modify our conceptualization of smoking cessation during pregnancy. These findings will contribute to the design and implementation of an experimental study. A two-factor experimental design, with time as a repeated measure, will compare two treatment conditions: a minimal contact, self-help treatment, and an enhanced contact, motivational support treatment. Two hundred seventy expectant fathers living with their pregnant partners will be randomly assigned to a treatment. The minimal contact self-help treatment includes a self-help treatment guide and a monthly smoking cessation advice call. The motivational support treatment includes a self-help treatment guide and bi-weekly calls from a research nurse using motivational interviewing principles. Smoking status, measured by saliva cotinine and self-report, is the dependent measure collected at baseline/enrollment, eight-month mark of the pregnancy, one month post-delivery, and six months post-treatment follow-up. Additional analyses focus on important predictors and mediators of smoking cessation, such as nicotine dependence, partner smoking status, cancer and parenting attitudes, self-efficacy for change, social support, and self-esteem.

Cancer Relevance: Our project will recruit and study expectant fathers of lower income and education levels, a population with high rates of tobacco use. The expected benefit of our study is to decrease smoking rates of young men and their partners and therefore reduce cancer risk. If a smoking cessation intervention is feasible and efficacious for men during their partner's pregnancy, and has a beneficial effect on cessation efforts of the pregnant partner, then the treatment approach of this project can be incorporated into prenatal care. There are vital health implications for paternal, maternal and family health if our treatment approach is effective in getting new parents to stop smoking.

For more information, contact:
Kevin D. Everett, PhD

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