Smoking characteristics of non-participants in a pragmatic trial of brief interventions for smoking expectant fathers

Abstract

Significance: Pregnancy is a teachable moment to engage male partners of non-smoking pregnant women in smoking cessation, but evidence on how to best approach these smokers is scarce. We developed a proactive model to enroll smoking expectant fathers in a trial of brief cessation interventions and compared the smoking behaviors between participants and non-participants. Methods: We did a pragmatic randomized clinical trial in antenatal clinics in 7 public hospitals in Hong Kong (ClinicalTrials.gov: NCT03671707), in which researchers proactively approached and recruited male partners of pregnant women. Eligible subjects were daily cigarette smokers aged 18+ years living with their non-smoking pregnant partners. Descriptive statistics were used to compare the smoking characteristics between the trial participants and non-participants. Results: From Oct 2018 to Feb 2020, 1053 of 1415 (74.4%) eligible smokers consented to participate in the trial. 325 of 362 (89.8%) who declined to participate provided data on their smoking behaviors. Trial participants and non-participants had similar median [IQR] numbers of cigarette per day (10 [5-15] vs 10 [6-15], P=0.28), heaviness of smoking index (1 [0-3]vs 1 [0-3]; P=0.28) and exhaled carbon monoxide levels (14 [8-22] vs 15 [9-23] part per million, P=0.49). However, significantly greater proportions of trial participants than non-participants reported having reduced their smoking consumption (48.4% vs 44.5%) and made a quit attempt (3.4% vs 1.3%) since their partners become pregnant (P=0.037). The proportion of non-participants who reported smoking near their partners in the past 7 days was higher than that of trial participants (31.0% vs 22.0%; P=0.001). Conclusion: In this pragmatic smoking cessation trial for expectant fathers, non-participants appeared to be more reluctant to change their smoking behaviors in response to their partners’ pregnancy. Efforts to optimize the recruitment strategy, including health messaging on the hazards of maternal and child exposures to tobacco smoke, are needed to motivate these smokers in smoking cessation treatment and address the high prevalence of smoking near pregnant women.