Using the Postpartum Hospital Stay to Address Mothers' and Fathers' Smoking
While expectant women are generally made aware of the dangers of smoking during pregnancy, fewer parents are counseled on the harmfulness of secondhand smoke for babies.
This pilot trial program, known as Newborns Excel Without Secondhand Smoke (NEWS), is based on the premise that both mothers and fathers are very focused on their newborns’ well-being immediately postpartum and that parents are already not smoking while they are physically in the hospital. Thus, the postpartum hospital stay would seem to be a teachable moment to reach young, healthy adults about the dangers of tobacco use to their babies and themselves.
This trial of NEWS, piloted in Massachusetts General Hospital during a 14-month recruitment period in 2005-2006, was not designed to test the effectiveness of tobacco cessation programs, but only the feasibility and efficacy of identifying tobacco-using parents; enrolling them in the study; and linking them to tobacco cessation resources during the postpartum hospital stay.
- Parents who used tobacco or had recently quit were identified by adding a single question to the routine admission checklist administered by a nurse, asking if “either parent/guardian smoked a cigarette, even a puff, within the last 12 months.”
- The tobacco cessation information was generally welcome: 50 percent of eligible parents asked to participate did so, including 72 current smokers and 29 recent quitters (101 total participants).
- Fifty-three participants assigned to a control group had no contact between the baseline and follow-up surveys. Although the control group did receive a brochure about the Massachusetts statewide tobacco quitline, none of them followed up.
- By contrast, the 48 parents assigned to intervention were counseled in-person during the hospital stay; offered ongoing enrollment in the Massachusetts quitline; and supported through faxed letters to their family’s doctors which advised of the patient’s readiness to quit and recommended strategies for ongoing support.
- There was widespread acceptance of tobacco control services among the intervention group, with 75 percent accepting enrollment in the quitline and 92 percent of those making telephone contact with the quitline. The majority of the intervention group also agreed to have a fax sent to at least one of their doctors.
- Follow-up three months after enrollment did show that NEWS intervention seemed to stimulate quit attempts by parents.
- The ability to reach fathers is particularly striking. While more than 90 percent of expectant mothers had received advice to quit smoking from their obstetricians, only 15 percent of expectant fathers had. Consequently, fathers had low rates of previous quit attempts. But more than 75 percent of fathers in the intervention group here accepted enrollment in the quitline; and nearly 70 percent of those then made follow-up telephone contact (compared to just 41% of enrolled mothers).
Based on this study, postpartum hospitalization would seem to be a feasible and welcome moment in which to reach healthy young people about smoking. The efforts to link new parents to tobacco cessation support in this state with a quitline were easy to implement for the postpartum unit and well-received by parents, especially fathers. The NEWS program should be easily transportable to any state that has a fax to quit anti-smoking effort.