Second-hand smoke exposure—it’s time to move beyond the pregnant woman herself

Second-hand smoke (SHS) exposure causes approximately 1.2 million deaths globally each year. Exposure to SHS during pregnancy has negative health effects both for the mother and for her baby, including preterm delivery, low birth weight, and congenital malformations. Most of the exposure to smoking during pregnancy occurs at home, mainly from the pregnant woman’s partner and/or other household members who smoke.

Studies have shown that SHS is more prevalent among disadvantaged populations such those from a low socio-economic background and ethnic minorities. Consequently, SHS exposure might be more prevalent among pregnant women who live in more ‘traditional’ or patriarchal families. A recent study in which we interviewed 68 pregnant and postpartum Israeli Jewish and Arab women regarding their experiences of SHS exposure during pregnancy, showed that many felt helpless in their ability to change their exposure. These feelings of helplessness were also evident in a similar study among Arab Israeli women regarding SHS exposure at home (not specifically during pregnancy), mentioning that cultural norms, such as the man owning the house and the woman’s social status, contribute to women’s lack of ability to prevent their SHS exposure.

Many of the interventions to date have been directed at the pregnant woman herself, meaning that the pregnant woman is expected to influence her partner to change his behavior. However, this does not take into account the familial and social context and the woman’s ability to influence her partner’s behavior. Social circumstances may preclude women from feeling it is safe or that they are able to confront their partner and ask him to avoid smoking at home and in the car. The few interventions that did include the partner focused on getting him to quit smoking, which has a low success rate even when one is highly motivated.

A recent qualitative study we conducted among 24 Israeli expectant fathers revealed that many of them wanted to protect their spouse and their baby to the best of their ability, but felt that the addiction was too strong, coupled with many other stressors that were considered as significant barriers to quitting smoking. More importantly, expectant fathers explicitly spoke about wanting it to be their “own” decision, without being told what they “have” to do. Therefore, providing options that can support expectant fathers to reduce their spouse and baby’s exposure, such as through a gradual implementation of a smoke free home and car, might show promise as a future direction for interventions. A study among fathers in Scotland found similar results, highlighting how fathers perceive themselves in the ‘father-protective’ role, and their need to also be a positive role model for their children.

Furthermore, a few recent studies have shown promise for a new strategy of using Nicotine Replacement Therapies (NRT) as an aid to creating a smoke-free home (without quitting). NRT are currently used as a smoking cessation pharmacotherapy, sold over the counter, available in different forms such as gum and lozenges, and can be used sporadically as needed. Therefore, NRT might be an acceptable strategy for expectant fathers to overcome some of the barriers they have, using them within the home/car to deal with craving when unable to go outside to smoke.

In conclusion, future interventions to reduce SHS exposure during pregnancy should move beyond the pregnant woman, and be inclusive of the partner and all family members who smoke. Findings from recent studies mentioned above and published in Nicotine and Tobacco Research, have highlighted several strategies that might improve future interventions directed explicitly at expectant fathers, including a focus on their autonomy using a more masculine lens, highlighting shifting views on their role as fathers, and using NRT as an aid to creating a smoke free home and car.

_{Featured image by Cparks via Pixabay.}