Smoking and smoking cessation among men whose partners are pregnant: a qualitative study

Abstract

Smoking among partners of non-smoking pregnant women has been linked to adverse pregnancy outcome, including low birthweight. Paternal smoking also increases the risk of infant respiratory infections and sudden infant death syndrome, irrespective of maternal smoking status. Furthermore, men's smoking habits are probably one of the strongest influences on the extent to which women are able to quit smoking in pregnancy and maintain cessation post birth. In four focus group discussions, male smokers whose partners were pregnant discussed their beliefs about passive smoking in pregnancy, the barriers they perceived to quitting in pregnancy and their preparedness to support maternal cessation. Men were largely unaware that their own smoking could pose a specific risk to the fetus, but when pregnant women are smokers, men believed their own smoking habits were unimportant. For men, barriers to quitting during their partners' pregnancy were: lack of understanding as to how passive smoking can affect the fetus, including a belief that the fetus is “protected” inside its mother; lack of motivation to quit early in pregnancy due to the baby not being “real”; and concern about stress-induced marital discord associated with cigarette withdrawal. These findings are discussed with regard to messages and strategies which may influence men to quit during their partners' pregnancy.

Introduction

It is well known that maternal smoking in pregnancy is associated with an increased risk of low birthweight. In recent years, there has been strong evidence that the father's smoking may make a contribution to reduced birthweight, through the mother being exposed to the father's cigarette smoke (Martin and Bracken, 1986; Rubin et al., 1986; Chen et al., 1989; Lazzaroni et al., 1990). A study by Haddow and colleagues found serum cotinine levels (a metabolite of nicotine) of non-smoking women during the second half of their pregnancy to be significantly associated with birthweight, after adjustment for other birthweight determinants (Haddow et al., 1988). Babies born to non-smoking mothers considered passively exposed to tobacco smoke were an average of 108 g lighter than babies of unexposed women. More recent studies using cotinine as the marker of exposure have since confirmed these findings (Martinez et al., 1994; Eskenazi et al., 1995).

Apart from the direct effects on pregnancy outcome, research suggests that partner's smoking status is associated with cessation among pregnant women. For example, a Swedish study found exposure to daily passive smoke at home (usually from a partner) to be an independent risk factor for continued smoking during pregnancy (Cnattingius et al., 1992). Another study of over 5000 Danish women who reported cessation in late pregnancy, found that partner's smoking status was independently related to quitting (Olsen, 1993). Positive attitudes to quitting smoking, and reduction in the use of cigarettes in early pregnancy, were significantly more likely among women in Norway who reported that they had been encouraged to stop smoking by their partners, and among those who expected support from their partners through reduced consumption (Haug et al., 1992). Among working class women in England, having a non-smoking partner was independently associated with cessation in pregnancy maintained to six months post-partum (Wakefield et al., 1993).

Work by Graham has drawn attention to the need to consider the wider social and economic context in which smoking takes place (Graham, 1976, Graham, 1987). An understanding of the way in which economic circumstances and close social ties shape and limit the scope for behaviour change is important for those who plan and implement smoking cessation programs and services. With respect to social environment in particular, support from partners and friends is an important factor in achieving long-term cessation in the wider smoking cessation literature (Coppotelli and Orleans, 1985; Mermelstein et al., 1986). In studies examining the determinants of situations in which people relapse back to smoking, social pressure to smoke, either direct coercion to smoke or simply being in the company of smokers, has been found to account for between 30 and 50% of all relapse situations (Shiffman, 1982). The presence of another smoker automatically provides for the availability of cigarettes and therefore the opportunity, as well as the temptation, to smoke.

In addition, pregnant women acknowledge their partners as having an important influence on their own smoking behaviour. In this respect, a study in Queensland, Australia, reported that approximately half of all pregnant smokers identified their partners as the people whose view about smoking during pregnancy mattered most and who would be most helpful in assisting them to quit (Muller, 1987). Partners of pregnant women in a South Australian study were identified as the people who most often had advised women to quit, despite the fact that 75% of the partners were themselves smokers (Wakefield and Jones, 1991). Continuation of smoking by a partner provided a constant source of temptation for women who had quit or were trying to limit their consumption.

Smoking cessation programs in pregnancy need to be informed by a better understanding of the role of partner support in achieving smoking cessation (Graham, 1976; Muller, 1987). Apart from the direct effects this might provide to fetal well-being, a focus on the importance of partners' smoking cessation in pregnancy and post-partum may encourage partners to be more supportive of women's cessation attempts, thereby increasing the likely success of maternal attempts to quit. Although partner support seems to play an important role in the likelihood of achieving and maintaining cessation, relatively little is known regarding partner's views about the health effects of passive smoking in pregnancy and post-birth, the barriers they perceive to quitting smoking during pregnancy and their preparedness to support maternal cessation. The aim of the present study was to explore these issues, in order to assist the development of messages and strategies that might influence change in paternal smoking habits during pregnancy.