The School of Nursing and School of Public Health of LKS Faculty of Medicine, The University of Hong Kong (HKUMed), in collaboration with the Department of Obstetrics and Gynaecology across seven public hospitals in Hong Kong, found that a quick intervention during regular prenatal visits, which combines brief advice with nicotine replacement therapy sampling and referral to a cessation service, could increase the chance of smoking cessation among expectant fathers by 90% and promote family harmony. The result has been published in JAMA Internal Medicine [link to the publication].
Non-smoking women exposed to second-hand smoke during pregnancy have higher risk of stillbirth, birth defects and developmental delay. The World Health Organization strongly recommends helping the partners of pregnant women quit smoking, but evidence on effective interventions has remained scarce.
Research methods and findings
Between October 2018 to February 2020, the HKUMed-led study team enrolled 1,053 expectant fathers in seven prenatal clinics in Kwong Wah Hospital (KWH), Queen Elizabeth Hospital (QEH), Queen Mary Hospital (QMH), United Christian Hospital (UCH), Tuen Mun Hospital (TMH), Pamela Youde Nethersole Eastern Hospital (PYNEH) and Princess Margaret Hospital (PMH). All participants were adult male daily smokers, with a mean age of 33.8 years, whose pregnant partners were non-smokers.
The participants were randomised to the intervention group or control group. The intervention group received brief advice with a one-week sample of nicotine replacement therapy and referral to a local cessation service. The control group received brief advice only. The brief advice included warning about the hazards of passive smoking towards pregnant women and infants.
The study team followed the participants for six months after recruitment and invited those who reported having quit smoking to do a carbon monoxide breath test for verification. After the six-month follow-up, it was found that the chance of verified quitting was 90% higher in the intervention group than the control group (6.8% vs 3.6%). The study team reckoned that the effect would likely to be even greater in real-world settings because expectant fathers rarely receive any smoking cessation advice during prenatal visits.
In addition to the physical benefits of smoking cessation, the study also found a greater improvement in family harmony in the intervention group than control group (0.5 vs 0.2 on a scale of 0 to 10). This indicates that smoking cessation of the expectant fathers could improve relationship among family members, which would eventually have a positive impact on the mental health of children.
Significance of the study
‘Becoming a father is a life-changing event that can enhance expectant fathers’ awareness of the health hazards of smoking to themselves as well as their beloved ones,’ remarked Dr Kelvin Wang Man-ping, Associate Professor of the School of Nursing, HKUMed, who led the research. ‘This study captured a long-missed opportunity to protect pregnant women and their children from the health hazards of tobacco exposure.’
‘Quitting smoking is the best first gift a father could give to his child. As the research results have shown, clinicians can help them achieve this simply by providing advice and referral at regular prenatal visits,’ said Dr Kevin Luk Tzu-tsun, Research Assistant Professor of the School of Nursing, HKUMed, who coordinated the study.
In view of the benefits of such intervention, the research team advocates a brief cessation intervention to all smoking expectant fathers as a routine practice in prenatal care.
About the research team
The study was led by Dr Kelvin Wang Man-ping, Associate Professor, and coordinated by Dr Kevin Luk Tzu-tsun, Research Assistant Professor of the School of Nursing, HKUMed. Other members of the study team included Professor Lam Tai-hing, Sir Robert Kotewall Professor in Public Health and Chair Professor of Community Medicine of the School of Public Health, and Dr William Li Ho-cheung, former Associate Professor of the School of Nursing, HKUMed. Clinical collaborators from the Department of Obstetrics and Gynaecology of the respective hospitals included Dr Leung Wing-cheong from KWH; Dr Leung Kwok-yin from QEH, Dr Cheung Ka-wang from QMH; Dr Carina Kwa from UCH; Dr Siong Kar-hung from TMH; Dr Tang Kwok-keung from PYNEH; and Dr Lee Kai-wan from PMH.
This study was funded by Health and Medical Research Fund (No. 15162691), Food and Health Bureau, Government of the Hong Kong Special Administrative Region.