To our knowledge, this is the first study to examine the smoking behaviors of Chinese expectant fathers and the association with smoking abstinence after their partner becomes pregnant. Our study results showed that more than half (69.3%) of smoking expectant fathers continued to use tobacco after their partner had become pregnant. In addition, among all smoking expectant fathers, 47.1% made no attempt to quit smoking since their partner was pregnant, and 67.5% had no intention to quit within the following 30 days. These findings show that it is crucial for health care professionals to develop and evaluate interventions that can first promote smokers’ intention to quit and then to help them quit smoking step by step.28,29
Our study showed that smoking expectant fathers had insufficient knowledge about the relationships between smoking and health hazards of tobacco use to smokers, pregnant women, fetuses, and newborns. Consistent with previous studies,30,31 the findings of this study provide further support that knowledge among expectant fathers about the health hazards of smoking and SHS to smokers, pregnant women, fetuses, and newborns are a main factor that is associated with smoking abstinence after their partner becomes pregnant. Insufficient smoking-related knowledge, especially regarding hazards to the health of pregnant women, the fetus, and newborns, may result in low motivation and unwillingness to quit smoking among expectant fathers, even after their partner becomes pregnant. It is therefore crucial that health care organizations operationalize greater efforts and resources, so as to implement effective health education and interventions directed toward expectant fathers when they accompany their pregnant partner to an obstetrics and gynecology clinic. Specifically, health care professionals should provide education, to clarify misconceptions among expectant fathers about their smoking habits and reinforce their knowledge about the relationship between smoking and health hazards to their pregnant partner, the fetus, and the newborn.
The results of multivariable regression showed that expectant fathers who only smoked outside the home were less likely to abstain from smoking. A previous study showed that many people misunderstand that if they smoke outside of the home or not in front of others, this will protect non-smokers from the potential harms of SHS.32 Therefore, smoking expectant fathers might wrongly believe that smoking outside the home is sufficient to prevent their pregnant partner and baby from being exposed to SHS; consequently, these expectant father did not have the intention to quit even after their partner became pregnant. Evidence shows that harmful chemicals on smokers’ clothing and hair, which is called thirdhand smoke, can produce long-term harmful effects to the health of pregnant women and newborns.33 Thus, information about thirdhand smoke should be provided to smoking expectant fathers in future practice, with the aim to increase their awareness about such long-term health impacts on their pregnant partner and baby, thereby motivating them to abstain from tobacco use.
The results of regression analyses revealed that males who were the first-time to be expectant fathers were more likely to quit smoking after their partner got pregnant. This might be due to the shifts in masculinity associated with impending fatherhood. The transition to fatherhood involved feelings of anticipation about their new paternal role before birth, which increased the eagerness of expectant or new fathers to make positive behavior changes to their smoking behaviors.6 However, such feeling may be weakened in the subsequent pregnancies.34 In addition, their previous experience of healthy babies born with paternal smoking during pregnancy and postpartum was at odds with the advice given by health professionals, which may increase their suspicions about the risks of smoking, and consequently weaken their motivation to quit smoking.11,33,35 Health care professionals should therefore pay more attention to men who are not the first-time expectant fathers by assessing their intention to quit smoking so as to develop effective interventions to motivate them to quit smoking.
The results of multivariable regression indicated that severe dysfunctionality in terms of family support was a factor that was negatively associated with smoking abstinence among expectant fathers. There is some evidence that support and encouragement from the partner can motivate expectant fathers to quit smoking and increase the probability of successful abstinence.7 However, poor family relationships and a lack of the partners’ support might result in less concern among expectant fathers about the relationship between SHS and pregnancy complications or adverse birth outcomes. Consequently, such expectant fathers might have greater reservations about quitting smoking. Thus, apart from offering smoking cessation interventions, it is crucial to refer smokers with severely dysfunctional levels of family support to appropriate organizations for counseling and support, to increase the probability of achieving successful smoking abstinence.
Limitations of the study
There were several limitations to this study. First, we relied mainly on self-reported smoking status, which is less desirable than biologically-confirmed smoking status. Second, although we encouraged all pregnant women to invite their smoking husband to participate in this study even if they did not accompany them to a prenatal visit, some expectant fathers were reluctant to join the study. Further study may consider to explore whether male partners who attend prenatal visits are more likely to engage with educational interventions than those who do not. Third, the gestation age of the pregnant women at the time of recruitment varied. As this is a cross-sectional study, some fathers may have relapsed and recommenced smoking after data collection. Researchers may consider conducting a longitudinal study in future to monitor the expectant fathers’ smoking status throughout the gestation period of their partners.
Implications for clinical practice and research
Despite the above limitations, the present findings have important implications for clinical practice and research. Expectant fathers may increase their understanding of their own vulnerability to health risks, emotional responses, and changes in their self-image, which may lead them to be motivated to bring about substantial changes in their health behavior, particularly in terms of taking greater responsibility for their own actions. As the tobacco use rate among expectant fathers in China remains very high, further smoking cessation interventions should be developed, implemented, and evaluated to help this population to quit smoking, especially during the teachable period while their partner is pregnant.
Our results provide useful recommendations for health care professionals in guiding the development of smoking cessation interventions. The findings of this study reveal that knowledge among smoking expectant fathers about the risks of SHS to the health of pregnant women, fetuses, and newborns can serve as powerful motivation for their abstinence from tobacco use. This suggests that educational interventions addressing smoking-related hazards, with a particular focus on maternal and neonatal health, are potentially effective and feasible to motivate smoking expectant fathers to quit smoking.