Enhanced Therapy Helps Expectant Fathers Quit Smoking

Investigators assessed the effectiveness of a combined smoking cessation intervention involving expectant fathers.

Expectant fathers who received a short sample of nicotine replacement therapy plus referral to a smoking cessation program stopped smoking at twice the rate of expectant fathers who received only brief advice and a smoking-cessation pamphlet, according to the results of a study published in JAMA Internal Medicine.

Researchers reported the results of a pragmatic randomized clinical trial in prenatal clinics in 7 public hospitals in Hong Kong. They focused their research on expectant fathers who smoked and had nonsmoking pregnant partners. The researchers noted 35% or more of pregnant women are exposed to secondhand smoke, which is unhealthy for both the woman and the child.

From October 2018 to February 2020, research nurses or assistants approached and screened expectant fathers. Included participants smoked daily in the past 3 months. Their partners had not smoked for the past 30 days. Of 1904 cigarette-smoking fathers assessed for eligibility, 1053 were randomly assigned to either an intervention group (n=527) or a control group (n=526).

The intervention group received a smoking cessation intervention involving brief advice, a 1-week sample of nicotine replacement therapy in the form of a nicotine patch or gum, and active referral to a smoking cessation program that is free to Hong Kong residents. The control group received only brief advice and a brochure on the dangers of prenatal smoke exposure that included the toll-free number for a hotline. Data were collected at 3 and 6 months.

The researchers found abstinence at 6-month follow-up was 6.8% (36 of 527 participants) in the intervention group and 3.6% (19 of 526) in the control group (OR, 1.96; 95% CI, 1.11-3.46%; P =.02).

Of expectant fathers in both groups who continued to smoke, 200 (24.3%) were found to have reduced cigarette consumption by 50% or greater at 6-month follow-up.

Recruitment was terminated early as a result of the COVID-19 pandemic, and this resulted in decreased statistical power of the study. Bias from incomplete follow-up was also a factor despite an 80.7% retention rate. Participation in biochemical validation was low but similar in the intervention and control groups.

“Pregnancy can motivate quitting in expectant fathers to protect pregnant women and children from passive smoking,” the researchers concluded. “It also presents an opportunity to help expectant fathers quit smoking when they are still relatively young and healthy, a period in which they are less likely to consult a doctor and to benefit from opportunistic cessation intervention in primary care. Smoking cessation by the age of 40 years could avert the risk of smoking-related death by nearly 90%, compared with continued smoking. Providing brief cessation intervention to expectant fathers should be a part of routine practice in prenatal care.”


Luk TT, Lam TH, Leung WC, et al. Brief advice, nicotine replacement therapy sampling, and active referral for expectant fathers who smoke cigarettes: a randomized clinical trial. JAMA Intern Med. 2021;181(8):1081-1089. doi:10.1001/jamainternmed.2021.2757