Men's constructions of smoking in the context of women's tobacco reduction during pregnancy and postpartum

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Abstract

Men's smoking is largely under-examined despite research that has consistently linked partner smoking to pregnant women's smoking and smoking relapse in the postpartum. An on-going qualitative study involving 31 couples in Canada exploring the influence of couple interactions on women's tobacco reduction provided the opportunity to examine men's smoking in the context of women's tobacco reduction or cessation during pregnancy and postpartum. Individual open-ended interviews with 20 men who smoked were conducted at 0–6 weeks following the birth of their infants and again at 16–24 weeks postpartum. Constant comparative methods were used along with social constructivist perspectives of fatherhood and gender to guide data analysis and enhance theoretical sensitivity. Four themes emerged in men's accounts of their tobacco use: (1) expressing masculinity through smoking, (2) reconciling smoking as a family man, (3) losing the freedom to smoke, and (4) resisting a smoke-less life. Men's reliance on and commitment to dominant ideals of masculinity seemed to preclude them from viewing their partner's tobacco reduction or cessation for pregnancy as an opportunity for cessation. Expectant and new fathers who smoke, however, may be optimally targeted for cessation interventions because it is a time when men experience discomfort with their smoking and when discontinuities in everyday life associated with the transition to fatherhood and presence of a new baby provide opportunities for establishing new routines. Implications for gender-sensitive smoking cessation interventions are discussed.

Introduction

In the context of family health, men's smoking has serious repercussions for both their own health and for the health of co-habiting women and children. Smoking is associated with an increased risk of cardiovascular disease, cancer (lung, cervix, pancreas, kidney, bladder, esophagus, pharynx), pulmonary disorders, cerebrovascular disease, and many other health risks (Mallampalli & Guntupalli, 2004). Smoking also adversely affects fertility and reproductive outcomes. For men, smoking causes sperm damage, reduces semen quality, and reduces responsiveness to fertility treatment (British Medical Association, 2004). An increased risk of early pregnancy loss has also been reported among non-smoking women whose husbands smoke heavily (more than 20 cigarettes daily) (Venners et al., 2004). Moreover, men's smoking negatively influences women's tobacco reduction attempts and continued cessation during pregnancy and the postpartum period (Fingerhut, Kleinman, & Kendrick, 1990; Johnson, Ratner, Bottorff, Hall, & Dahinten, 2000; Klesges, Johnson, Ward, & Barnard, 2001; Mullen, Richardson, & Quinn, 1997; Ratner, Johnson, Bottorff, Dahinten, & Hall, 2000). Men's smoking, independent of mother's smoking, has also been associated with low birth weight, Sudden Infant Death syndrome, and respiratory and middle-ear diseases in both infants and young children (British Medical Association, 2004; Martinez, Wright, Taussig, & Group Health Medical Associates, 1994). Despite the significance of men's smoking, there is a dearth of information about expectant and new fathers’ smoking to guide the development of effective interventions.

Section snippets

Review of relevant literature

There have been relatively few attempts to describe smoking from the perspective of expectant fathers or to include male smokers in smoking cessation interventions for pregnant women. The findings of the few descriptive studies of men's smoking in relation to the birth of their children have been fairly consistent. Unlike women, few changes (Blackburn, Bonas, Spencer, Dolan et al., 2005; Brenner & Mielck, 1993; Everett et al., 2005) or only light reductions in the prevalence and level of men's

Methods

This analysis arose from a larger grounded theory study of the influence of couple interactions on women's tobacco reduction during pregnancy and postpartum. Although the primary analysis of these data was conducted from the standpoint of the women (Bottorff, Kalaw, Johnson, Stewart et al., 2006; Bottorff, Kalaw, Johnson, Greaves et al., 2005), in this secondary analysis we examined data from the perspective of smoking fathers. Additional exploration of qualitative data from different

Findings

The men's constructions of their smoking were captured in four major themes: (a) expressing masculinity through smoking, (b) reformulating smoking as a family man, (c) losing the freedom to smoke, and (d) resisting a smoke-less life.

Discussion

Juxtaposed with women's tobacco reduction or cessation during pregnancy and the postpartum period, the participants’ propensity to construct tobacco use in ways that defended and justified their continued smoking extends contextual understandings of men's health behaviors. Instead of examining men's smoking as an exclusive activity associated with masculinity and risk-taking (Mort, 1996; Vitz & Johnston, 1965), or as a determinant of women's cessation and smoking relapse (McBride et al., 1998;

Conclusion

Further research into the direct and indirect social influences on men's smoking behavior is necessary to enrich our understanding of men's smoking and provide a foundation for developing interventions. Our results support suggestions that to interpret men's smoking behavior in the context of a pregnancy or parenting, societal expectations, interpersonal constructions of fatherhood, and the economic responsibilities of fatherhood (Steinberg et al., 2000) must be examined. Moreover, men should

Acknowledgments

This research was supported by a grant from the Canadian Institutes of Health Research (CIHR) Investigator Award to Dr. Bottorff and a CIHR PORT Research Training Postdoctoral award to Dr. Oliffe. We would like to acknowledge the contribution of Drs. Joy Johnson, Lorraine Greaves, and Miriam Stewart.

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