Smoking behaviour change among fathers of new infants
Introduction
Concern about the negative effects of environmental tobacco smoke on the health of infants and young children has resulted in campaigns and programmes worldwide to promote smoking cessation and change smoking habits among parents and carers. Although mothers’ smoking is thought to be the most harmful to the health of the young child, fathers’ smoking has also been linked to adverse health outcomes in children, including an increased risk of sudden infant death syndrome, asthma and other respiratory conditions (Strachan & Cook, 1997; Cook & Strachan, 1999). Estimating the proportion of children living with fathers who smoke is difficult because studies of smoking patterns in infant households, while recording mothers’ smoking habits in some detail, often subsume fathers’ habits within the category of other household smokers. Although smoking rates vary internationally, a small number of studies from North America, United Kingdom, Italy and Scandinavia that have recorded fathers’ smoking status indicate that 50–80% of children in smoking households lived with a father who smokes (Berman et al., 2003; Erikson & Bruusgaard, 1995; Dell’Orco et al., 1995). Protecting infants from fathers’ as well as mothers’ tobacco smoke is likely to be key to promoting child health and may bring about further reductions in SIDS-related mortality in infants.
Apart from the direct contribution that fathers’ smoking makes to infants’ exposure to tobacco smoke, research suggests that mothers’ smoking status and smoking cessation attempts are linked to fathers’ smoking status and knowledge and beliefs about the effects of smoking on health. First, pregnant mothers and mothers with young children who have smoking partners are more likely to be smokers themselves and less likely to quit smoking than other mothers (Health Education Authority, 1997; Olsen, 1993; Wakefield, Gillies, Graham, Madeley, & Symonds,1993). Second, fathers’ beliefs, knowledge and attitudes to maternal smoking are linked to mothers’ quitting (Wakefield, Reid, Roberts, Mullins, & Gillies, 1998; Olsen, 1993). These studies highlight that mothers’ and fathers’ smoking behaviour is inter-related. Tackling mothers’ smoking is likely to depend, at least in part, on tackling fathers’ smoking. Taken together, this suggests that a greater understanding of fathers’ smoking is key to reducing smoking in households with young infants.
Fathers, however, are a neglected target group for health promotion smoking programmes and campaigns. To date, the thrust of health promotion strategies and programmes has been aimed at expectant and new mothers, with the specific objective of reducing mothers’ smoking in pregnancy and in the early years of their children's lives. Fathers as smokers are neither targeted directly, nor to any great extent indirectly, through their partners.
Although men's smoking has received some research attention, this has generally focused on risk taking behaviour and has examined smoking patterns in the context of men's leisure and work lives (Mullen, 1993; Mort, 1996). Smoking among men has been linked to what has been termed ‘masculine-sanctioned’ strategies (Eisler & Blalock, 1991) which men adopt as a means of coping with the stresses that result from masculine norms and the material realities of their lives. Commodities such as cigarettes have also been associated with aspects of masculinity in more symbolic ways, as symbols of attraction and satisfaction that are clearly gendered (Crawford, 1984; Wright, 1993).
Fathers’ smoking has received far less research attention. The few studies that have discussed fathers’ smoking have focused on the influence of fathers’ smoking status and habits on those of their partner during pregnancy and after childbirth. An Australian study of smoking and smoking cessation among men whose partners were pregnant highlighted that expectant fathers were largely unaware that their own smoking could pose a risk to the unborn child and that they lacked motivation to quit smoking during their partner's pregnancy (Wakefield et al., 1998). This study suggested that fathers might experience particular difficulties quitting post-partum, especially if the mother relapses back to smoking at this time.
To our knowledge, there has been only one attempt to report on the smoking behaviour of men in relation to the birth of their children. This study (Brenner & Mielck, 1993) examined one aspect of smoking behaviour, smoking cessation, and found that although childbirth was associated with increased smoking cessation among better educated men, men's smoking behaviour was much less influenced by the birth of their children than women's. Moreover, childbirth led to long-term cessation for only a small minority of fathers. There have been no attempts to examine other aspects of smoking behaviour change among fathers such as quit attempts or the use of harm reduction strategies such as not smoking in the house, nor to understand how, if at all, the experience of fatherhood impacts on men's smoking behaviour.
Among mothers, a number of factors appear to be associated with smoking patterns and habits. Pregnancy and motherhood, as life transitions and events, appear to act as important motivators for smoking behaviour change and triggers for smoking cessation among women. Pregnancy has a marked cessation effect (Graham & Der, 1999; Brenner & Mielck, 1993). Although there are high rates of postpartum relapse, higher rates of quitting are found among pregnant women than among women in the general population. Social and material circumstances are also associated with mothers’ smoking patterns. There are sharp socio-economic gradients in cigarette consumption and smoking cessation patterns, with heavy smokers experiencing poorer material circumstances than light smokers, ex-smokers or never smokers (Graham & Der, 1999; Jarvis & Wardle, 1999). Mothers’ and women's smoking patterns and rates of quitting are also associated with their domestic circumstances, including lone parenthood, number of dependent children and cohabitation status (Jarvis, 1997; Graham, 1993). Own tobacco consumption level and that of a partner have also been shown to be associated with smoking habits and quit attempts among mothers and the wider population (Nafstad, Bottem, & Hagen, 1996).
Whether similar social, domestic and material factors are associated with patterns of smoking and smoking behaviour change among fathers is unknown. For many men, the economic and social pressures of work, unemployment and providing for a family are likely to be particularly acute after the birth of an infant (Hobson & Morgan, 2002). An exploration of the factors linked to smoking habits within fathers’ home and work lives is likely to provide valuable background information for programmes to promote smoking cessation and smoke exposure harm-reduction strategies.
This paper reports on data from a study of the smoking habits among fathers of new infants. It examines two smoking behaviours shown to be positively associated with infant health, quitting smoking and not smoking in the infant's home, and the factors associated with attempting and successfully achieving these behaviours. These smoking behaviours reflect the two broad approaches currently promoted in developed countries to protecting infants and children from tobacco smoke. The first approach, harm elimination, aims to protect infants through the promotion of smoking cessation among parents and the wider community. The second approach, harm reduction, focuses on reducing harm to infants by promoting the modification of smoking habits, such as reducing cigarette consumption, banning smoking in the infant's home and avoiding smoking environments outside of the home. While it is widely acknowledged that the greatest benefits to children arise if parents stop smoking, there is a small, but growing body of evidence that shows that not smoking in the infant's home also reduces infant exposure to environmental tobacco smoke (Blackburn et al., 2003; Wakefield et al., 2000; Bakoula, Kafristias, & Kavadias, 1997; Hovell, Meltzer, & Zakarian, 1994). This paper examines the extent to which fathers attempt and successfully achieve smoking cessation and not smoking in the infant's home and the predictors of these behavioural outcomes. These data were collected as part of a study of fathers’ smoking behaviour, knowledge about passive smoking and the factors that promote smoking and inhibit smoking cessation among fathers of young infants.
Section snippets
Participants and methods
A cross-sectional survey design was used to collect data from fathers of infants’ age 8–14 weeks. The population from which the sample was recruited was fathers with infants born in four maternity units in the English Midlands during a 9-month period. The maternity units served socially and ethnically mixed populations. The study aimed to recruit smokers and non-smokers with smoking and non-smoking partners so that differences in smoking knowledge, beliefs and behaviours, and the influences on
Findings
The sample generated 286 fathers, of whom 275 were current smokers and 11 had stopped smoking since the birth of their baby. In total, 128 smokers who initially gave consent to participate later withdrew or could not be contacted despite several attempts to contact, reflecting a response rate of 55%. Fathers willing to give information on why they no longer wished to participate gave a variety of reasons, including work commitments, busy life with new baby and no longer having contact with
Discussion
Before conclusions are drawn it is important to note several features of the study design. The study relied on self-report measures of tobacco consumption and attempts to change smoking behaviour. Some commentators have noted that tobacco consumption can be misreported either intentionally or unintentionally (Ford, Tappin, Schluter, & Wild, 1997; Cook et al., 1994). Despite this, studies have found good agreement between parent reporting of smoking habits and biochemical measures of tobacco
Acknowledgements
We wish to acknowledge the support of the Foundation for the Study of Infant Deaths who funded the study, the fathers who participated, Clare Jackson and Alison Trout who carried out the fieldwork and the staff of the four maternity units where recruitment took place.
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