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Summer 2010 | Vol 13 No 4

Q&A

The “baby patch”: Smoking cessation interventions embrace new fathers

By Avril Roberts

Fathers who smoke don’t generate as much attention as pregnant women or mothers who smoke. Now, Dr. Joan Bottorff, director of the Institute for Healthy Living and Chronic Disease Prevention at the University of British Columbia, is leading groundbreaking research showing how new fatherhood may be an opportune time to encourage and help men stop smoking.

Why focus on new fathers for smoking reduction or cessation?
First, it would go a long way towards supporting women’s tobacco reduction. Second, it would protect infants from second-hand smoke and create more smoke-free homes. Third, it would enhance men’s health. Men typically don’t think about stopping smoking until they have their first heart attack, but here we can intervene with men at a younger age. The men we interviewed talked about wanting to be able to run and play soccer and keep up with their kids, so they were already thinking about their own health as it relates to their role as fathers.

What have you learned about why expectant and new fathers continue to smoke?
Smoking is tied to men’s identity; many men find it difficult to imagine life without cigarettes. Men also tell us that becoming a new father is stressful; there is added pressure to provide for their families. Because men say smoking helps to manage that stress, some believe they would be better partners and fathers if they continued to smoke. They worry that if they stop smoking they would become irritable, which might influence their ability to be good partners and fathers.

How does new fatherhood affect men’s smoking?
Before men actually held their babies or the babies became real to them, they thought: “I can continue to smoke. It’s not going to interfere with my partner or my baby. I’m going to smoke outside. I can keep it totally separate.” However, we found that as men began to connect with their infants, they became more uncomfortable with smoking. They began to realize that the ideal of a good father is not a smoking father; so they sensed a contradiction as they began to change their identity from a man who smokes to a father who smokes. Taking on the identity of a father created tension and began to motivate some men. The more engaged men were in fathering, the more they reduced their smoking, simply because there was less time to smoke.

There were also fewer places to smoke – they can’t smoke in the house any more. Some men became sensitive to the stigma attached to smoking – they got looks if they were smoking while pushing a stroller, for example. Others worried that while smoking outdoors they were missing important activities relating to the baby and said they wanted to be inside with their families.

What smoking cessation/reduction strategies do new fathers use?
Few men used smoking cessation aids. Most thought that if they decided to quit and had enough willpower, they could just do it. We need to reinforce the message that it sometimes takes many attempts to quit. Some men made detailed plans about how they would reduce their smoking by eliminating one cigarette a day for the first two weeks, then another cigarette a day for another two weeks and so on. It wasn’t entirely clear when they would get to zero cigarettes. However, the fact that they were reducing is a step toward giving up smoking. One man told us that he had tried quitting smoking many times, but that once he became a father, it was easier – the baby was the “patch.” This shows how strong a motivator the baby can be.

Speaking of the patch, many of the men see it as a sign of weakness. Some said they carried the patch just in case they needed it. A few spoke of being teased in the gym when other men noticed they were wearing it. The men who did use the patch were doing it mostly on their own and having trouble determining the right amount to use. Providing support around the best way to use the patch could go a long way to making the cessation process more comfortable and successful. We also have to figure out how to make the patch a masculine symbol of strength, not weakness.

How will you incorporate your findings into new smoking reduction/cessation interventions?
Based on consultations with men, their partners and health care professionals, we are developing three resources:

We have just launched a booklet featuring men talking with men. It integrates quotes from our interviews and focuses on fathering and the identify shift to get men thinking about their smoking. It presents possibilities for men to choose from to make their own way, instead of stepwise instructions about how to quit smoking.

To our surprise, some men wanted a group. We have designed a 10-week program that includes support for tobacco reduction and cessation; a strong fathering theme to help men become comfortable with fathering; and a healthy living component for stress reduction. We hope to provide child care to give partners a break while fathers attend the program. We anticipate a pilot launch this fall.

For spring 2011, we plan to integrate what we have learned about women and smoking into a better smoking cessation support for women during pregnancy and pair that with a piece that targets the smoking partner in the woman’s life. A lot of tension and sometimes conflict occur in pregnant couples around smoking, so we have to address that separately with women and their partners.

For more information about tobacco reduction for new fathers, visit the Families Controlling and Eliminating Tobacco website.