Fatherhood as Motivator for Smoking Behaviour Change Jeffrey Gage RN, MPH, PhD Christchurch Polytechnic Institute of Technology Research supported by the Robert Wood Johnson Foundation

Background A supportive male partner is the most significant influencing factor on the success of smoking cessation during pregnancy A supportive male partner is the most significant influencing factor on the success of smoking cessation during pregnancy (McBride et al., 1998; Nafstad, Botten, & Hagen, 1996) The influence of the male partner is also the strongest predictor for maternal quitting and relapse post-delivery The influence of the male partner is also the strongest predictor for maternal quitting and relapse post-delivery (Mermelstein, Cohen, Lichtenstein, Baer, & Karmarck, 1986; Severson, Andrews, Lichtenstein, Wall, & Akers, 1997) (Mermelstein, Cohen, Lichtenstein, Baer, & Karmarck, 1986; Severson, Andrews, Lichtenstein, Wall, & Akers, 1997)

The state of Missouri was ranked 48 th out of 50 in all state health rankings for cigarette smoking The state of Missouri was ranked 48 th out of 50 in all state health rankings for cigarette smoking (United Health Foundation, 2004) (United Health Foundation, 2004)

Purpose To develop a mid-range theory to describe and explain male partner participation in smoking cessation during pregnancy To develop a mid-range theory to describe and explain male partner participation in smoking cessation during pregnancy

Grounded Theory Design Constant comparison – data are collected and analysed simultaneously Constant comparison – data are collected and analysed simultaneously Theoretical sampling – decisions about which data are collected next are determined by the theory that is being constructed Theoretical sampling – decisions about which data are collected next are determined by the theory that is being constructed

Sample ► Individual interviews with 23 men from 15 towns in Mid-Missouri ► Average age 22 years ► 19 White, 2 African American, 1 Bi-Racial, 1 Hispanic ► Education: 36% grades % grade 12 or GED 9% 1-3 years college ► Employment: 19% employed full-time, 19% employed full-time, 2 unemployed 2 unemployed 1 student 1 student 1 unable to work 1 unable to work

Smoking Behaviours ► 77% were current smokers ► Average length of smoking 9.5 years; 19 cigarettes per day ► Four participants had quit smoking ► Two participants were non-smokers ► Saliva cotinine analysis verified smoking and non- smoking self reports

Findings Fatherhood as Motivator for Smoking Behaviour Change

Findings ► Pregnancy and preparation for fatherhood provided motivation for smoking behaviour change ► First-time fathers described themselves as being more motivated to change their smoking behaviours than other fathers ► Protecting the baby was the primary aim of first-time fathers during pregnancy and post-delivery ► Protection motivation, smoking goals and smoking behaviours were interpreted and reinterpreted during pregnancy and the transition to fatherhood

Baby’s Safe Arrival Fathers Smoke Outside Time Periods Motivation for Smoking Behavior Change Fathers’ Smoking Goal Fathers’ Smoking Behavior Post- Delivery Protection of Baby Cut-down Smoking Outcome Fathers Smoke Outside Attempt to Quit Independently or Together Quit Smoking Continue Smoking The Reality of Fatherhood (First-Time Fathers) Pregnancy: Preparation for Fatherhood Beginning & Early Pregnancy Mid to Late Pregnancy Protection of Baby Protection of Baby

Smoking Goals Smoking Goals Beginning and Early Pregnancy: “Within the week after having the baby, after we calm down, we are just quitting.” Mid-to-Late Pregnancy: “Well I mean I figure if I just cut down I will probably be able to stop smoking… I mean a pack lasts me two days, almost two and a half days. So I figure get it up to three days, something like that would be alright.” Post-Delivery: “We still smoke, but we smoke outside because the baby’s here”

Conclusions  The transition to fatherhood may be viewed as timeframe during which first-time fathers are motivated to change smoking behaviour  Smoking cessation motivation, goals, and behaviors of first-time fathers, are likely to change during the course of their transition to fatherhood  Fatherhood is perceived by some fathers as a socially constructed role in the context of relationship with their partners

 Promotion of smoking cessation for first-time fathers is potentially most effective during beginning and early pregnancy  Strategies to encourage smoking behaviour change may be more efficacious if they are focused on the theme of protection of baby from the effects of cigarette smoke  During mid-to-late pregnancy and post-delivery it may be more prudent to emphasize harm reduction strategies with first-time fathers rather than smoking cessation

Fatherhood as Motivator for Smoking Behaviour Change Jeffrey Gage RN, MPH, PhD Christchurch Polytechnic Institute of Technology Research supported by the Robert Wood Johnson Foundation