In a recent study published in BMC Public Health, researchers performed a systematic-type review to evaluate the efficacy of behavior change interventions (BCIs) for smoking cessation in pregnant couples and new parents using a gendered lens.

Smoking cessation is a crucial strategy for expecting males, offering significant health benefits. However, partners are less likely to seek cessation treatments compared to pregnant or postpartum females.

Personalized programs are increasingly recognized for new and expecting fathers. BCIs are a promising strategy; however, research on efficacy in this group is fragmented, limiting clear conclusions.

About the study

In the present systematic review, researchers investigated the types of effects that can be expected from behavior-change-focused smoking cessation couple- or individual-based interventions personalized to male partners of pregnant as well as postpartum females.

The major goal was to investigate the efficacy of behavior change interventions for quitting smoking when administered to pregnant females and the husbands of new mothers (new and expectant fathers).

The study’s secondary goal was to investigate different BCI methods to address the smoking behavior of expecting and newly-turned fathers. Fathers were included in the new father group until their children were aged one year.

In November 2021, peer-reviewed publications were found in eight databases [EMBASE, PubMed, Web of Science, JSTOR, Wiley Online Library, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and APA PsycINFO], with no language, location, or date restrictions.

Furthermore, reference lists from identified studies were cross-checked to find further relevant studies that were not picked up in the original search.

Only randomized controlled trials (RCTs) examining the impact of behavior change interventions to quit smoking for new and expectant fathers, as well as RCTs evaluating interventions on expecting females and new mothers (infants aged less than one year) with assistance to quit smoking for their partners, were considered.

New and expectant fathers who engaged in smoking during the interventions were included in the studies, regardless of the extent of their nicotine dependency, intention to stop, or preset mental and physical circumstances.

There were no constraints on the mode, duration, or setting of the intervention. Two reviewers examined the papers and disagreements were addressed by discussion or consulting another reviewer.

The included studies' quality was assessed using Cochrane's revised risk-of-bias (RoB2) technique. The study eliminated RCTs that solely reported substitutes or alternatives to smoking cigarettes [such as electronic nicotine delivery systems (ENDS), electronic cigarettes, and cannabis]. Review articles were also omitted. Michie and Johnston's definition was used to characterize BCIs.

Results

In total, 1,222 studies were initially identified, of which 213 duplicate records were eliminated. Further, 970 records were excluded after title and abstract screening, and the remaining 39 records underwent full-text screening.

Eight records were identified by reviewing the references of articles identified in the original database search. As a result, nine RCTs were considered for review, of which one and six records had high and low bias risks, respectively, and two had minor concerns.

Six of the nine records concentrated on males, two on couples, and one on women. All studies were generally done in healthcare settings such as maternal-neonatal wellness centers, antenatal or prenatal health clinics, pediatric clinics, and urban county and rural medical departments. The studies included a total of 6,231 couples, including 2,663 new parents and 3,568 pregnant couples.

The definitions of BCI, intervention components, controls, and outcome measures varied throughout the included research. Booklets and self-help materials, telephone counseling, face-to-face therapy, and online or telephonic video or text-based counseling were among the intervention delivery options. The length of the interventions ranged from one month to eight years.

The transtheoretical model of behavior change and the social cognitive theory were the most frequently referred-to theories. The research interventions were informed by the AWARD (Ask, Warn, Advise, Refer, and Do It Again) paradigm, the health belief model, and the teachable moment model.

In the studies, one to seven BCTs were utilized, with health-related data being the most prevalent element, followed by social support and goal-setting outcomes.

All participating males smoked in current times, whereas participating mothers included non-smokers, former smokers, and current smokers. The most prevalent primary outcome was the one-week point prevalence (PP) of not smoking. While male follow-up data differed between trials, the majority reported biochemically validated quit rates at six months.

Most therapies had a beneficial impact on cessation results. Specifically, five of the six records reporting one-week PP as the research endpoint revealed favorable effects in abstinence rates compared to control groups, while one reported a small change. According to the data, sex-targeted therapies had a higher possibility of producing favorable smoking cessation outcomes.

Conclusions

Overall, the study findings showed that BCI interventions have shown promising results in improving smoking cessation outcomes in expecting males. However, more research is needed to understand the sex-based requirements during pregnancy and the impact of gender on health-related behavior.

A holistic strategy should be implemented to provide gender-equitable services, considering both same- and different-sex partnerships. Engaging expecting fathers in health behavior interventions can provide a foundation for gender-specific tobacco control policies and practices. Taking gender variations into account can lead to favorable cessation results.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.