The effectiveness of a video-based smoking cessation intervention focusing on maternal and child health to help Chinese expectant fathers quit smoking: an open-label, single-blind, three-arm, randomised controlled trial

Abstract

Background: More than a third of Chinese expectant fathers are smokers. Secondhand smoke can cause adverse pregnancy outcomes. The implementation of interventions to help expectant fathers quit smoking is crucial. Video-based intervention has been increasingly used in health promotion. We examined the effectiveness of a video-based smoking cessation intervention focusing on maternal and child health in helping expectant fathers quit smoking. Methods: We did an open-label, investigator-blind, multicentre, three-arm, randomised controlled trial at the obstetrics and gynaecology registration centres of three Chinese tertiary public hospitals. Expectant fathers (≥18 years) were eligible for this study if they had smoked at least one cigarette per day in the past 30 days and had a carbon monoxide concentration in expired air of four parts per million or higher, had smartphones, and were able to read Chinese and communicate in Mandarin. We excluded those who were unable to provide informed consent or receive counselling because of impaired mental status, cognitive impairment, or communication barriers identified from their medical records, or if they had participated in other smoking cessation programmes or services. After providing written informed consent, eligible participants were randomly (1:1:1) allocated using random-number tables into a video-based group, a text message-based group, or a control group. The participants received four 1-min videos (video-based group) or four text messages (text message-based group) on the risks of smoking for maternal and child health via instant messaging every 2 weeks, or a smoking cessation leaflet only (control group). Follow-up visits were done at 1 week and at 1 month, 3 months, and 6 months. The primary outcome, assessed by intention-to-treat, was biochemically validated abstinence at 6 months. This trial was approved by the Institutional Review Board of the University of Hong Kong and Hospital Authority Hong Kong West Cluster (UW 17-269) and Institutional Review Board of the Shenzhen Hospital, and registered with ClinicalTrials.gov (trial number NCT03236025). Findings: From Aug 14, 2017, to Feb 28, 2018, 1023 eligible expectant fathers were randomly assigned to a video-based (n=333), text message-based (n=322), or control (n=368) group. At 6 months, we found the video-based group had a significantly higher prevalence of validated abstinence than the text message-based group (75 [22·5%] of 333 participants vs 48 [14·9%] of 322, p=0·013) and control group (75 [22·5%] of 333 vs 34 [9·2%] of 368; p<0·0001), with adjusted odds ratios of 1·64 (95% CI 1·10–2·46, p=0·018, vs text message-based group) and 2·80 (1·79–4·37, p<0·0001, vs control group). Interpretation: The video-based smoking cessation intervention focusing on maternal and child health was effective and feasible in helping expectant fathers quit smoking. The findings could guide health-care professionals to incorporate this simple and effective innovation to promote smoking cessation and other lifestyle habits in clinical practice.