Nicotine replacement therapy for expectant fathers

1. A combined smoking cessation intervention almost doubled the odds of expectant fathers achieving remission, compared to cessation advice alone.

2. Expectant fathers in the intervention group reported greater family harmony than the control group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Expectant fathers, or those who are expecting a child in the near future, have the opportunity to begin the process of achieving abstinence during pregnancy. Given the known teratogenicity of cigarette smoke on children, as well as the expecting mother, this is an important step in preparing a healthy environment for the child’s growth. Smoking cessation has been studied, but less studied is the combination of intervention with cessation programs on future abstinence in this population.

This randomized clinical trial from public hospitals in China recruited adult males who were expecting children with pregnant mothers who were nonsmokers. The participants must have smoked daily over the previous three months. They received cessation advice, one week of nicotine replacement therapy (NRT), and referrals to cessation programs while the control group received only cessation advice. The intervention group was almost two times more likely to achieve abstinence than the controls with the combination of treatments.

Overall, this study found that a proactive, combined intervention strategy for smoking cessation was significantly more effective among expectant fathers than brief cessation advice alone. This provides direction for prenatal clinics to offer suggestions to expecting parents regarding how to approach smoking cessation prior to the births of their children.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Current Pharmacologic Treatments for Smoking Cessation and New Agents Undergoing Clinical Trials

In-Depth [ case-control study]:

Adequate child development can be promoted through developing a healthy and safe environment prior to birth. For expecting parents who smoke cigarettes, specifically fathers, pregnancy is the time during which they may try to begin the process of abstaining from smoking to ensure that their child can be born without risk of teratogen exposure. This study sought to investigate the effectiveness of a combined intervention for smoking cessation among expectant fathers.

A total of 1,053 expectant fathers were enrolled across seven prenatal clinics in Hong Kong, China between October 2018 and February 2020 (M [SD] age = 33.8 [6.9] years). All participants were adults (>18 years) expecting a child with a nonsmoker, expectant mother and had smoked cigarettes daily for the past three months. The intervention group received one week of free NRT, brief cessation advice, and referrals to community cessation programs. The control group received only brief cessation advice. The primary outcome was biochemically validated tobacco abstinence at six-month follow-up. Approximately 80.7% of participants were retained through six months. At this time, those in the intervention group demonstrated almost two times the odds of achieving abstinence, compared to those in the control group (difference 3.2%, OR = 1.96, 95% CI 1.11 to 3.46, p = 0.02). The intervention group also showed greater odds of self-reported 24-week abstinence (OR = 1.87, 95% CI 1.08 to 3.23, p = 0.03) and seven-day point prevalence abstinence at both three months (OR = 1.48, 95% CI 1.05 to 2.09, p = 0.03) and six months (OR = 1.74, 95% CI 1.29 to 2.34, p<0.001). Lastly, greater family harmony was reported by the intervention group, compared to the controls, across the six months (B = 0.28, 95% CI 0.063 to 0.50, p = 0.01).

Image: PD

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