Effectiveness of a video-based smoking cessation intervention focusing on maternal and child health in promoting quitting among expectant fathers in China: A randomized controlled trial

Autoři: Wei Xia aff001;  Ho Cheung William Li aff001;  Wenzhi Cai aff002;  Peige Song aff003;  Xiaoyu Zhou aff005;  Ka Wai Katherine Lam aff006;  Laurie Long Kwan Ho aff001;  Ankie Tan Cheung aff001;  Yuanhui Luo aff001;  Chunxian Zeng aff007;  Ka Yan Ho aff006
Působiště autorů: School of Nursing, University of Hong Kong, Hong Kong, China aff001;  Shenzhen hospital, Southern Medical University, Shenzhen, China aff002;  School of Public Health, Zhejiang University School of Medicine, Hangzhou, China aff003;  Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, United Kingdom aff004;  Department of gynaecology and obstetrics, Nanhai Hospital Affiliated to Southern Medical University, Foshan, China aff005;  School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China aff006;  Clinical Innovation & Research Center (CIRC), Shenzhen Hospital, Southern Medical University, Shenzhen, China aff007
Vyšlo v časopise: Effectiveness of a video-based smoking cessation intervention focusing on maternal and child health in promoting quitting among expectant fathers in China: A randomized controlled trial. PLoS Med 17(9): e32767. doi:10.1371/journal.pmed.1003355
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1003355



Secondhand smoke can cause adverse pregnancy outcomes, yet there is a lack of effective smoking cessation interventions targeted at expectant fathers. We examined the effectiveness of a video-based smoking cessation intervention focusing on maternal and child health in promoting quitting among expectant fathers.

Methods and findings

A single-blind, 3-arm, randomized controlled trial was conducted at the obstetrics registration centers of 3 tertiary public hospitals in 3 major cities (Guangzhou, Shenzhen, and Foshan) in China. Smoking expectant fathers who registered with their pregnant partners were invited to participate in this study. Between 14 August 2017 to 28 February 2018, 1,023 participants were randomized to a video (n = 333), text (n = 322), or control (n = 368) group. The video and text groups received videos or text messages on the risks of smoking for maternal and child health via instant messaging. The control group received a leaflet with information on smoking cessation. Follow-up visits were conducted at 1 week and at 1, 3, and 6 months. The primary outcome, by intention to treat (ITT), was validated abstinence from smoking at the 6-month follow-up. The secondary outcomes included 7-day point prevalence of abstinence (PPA) and level of readiness to quit at each follow-up. The mean age of participants was 32 years, and about half of them were first-time expectant fathers. About two-thirds of participants had completed tertiary education. The response rate was 79.7% (815 of 1,023) at 6 months. The video and text groups had higher rates of validated abstinence than the control group (video group: 22.5% [75 of 333], P < 0.001; text group: 14.9% [48 of 322], P = 0.02; control group: 9.2% [34 of 368]) with adjusted odds ratios (ORs) of 2.80 (95% confidence interval [CI]: 1.79–4.37, P < 0.001) in the video group and 1.70 (95% CI: 1.06–2.74, P = 0.03) in the text group. The video and text groups differed in the rates of validated abstinence (22.5% versus 14.9%, P = 0.008; adjusted OR: 1.64, 95% CI: 1.10–2.46, P = 0.02). The video and text groups had higher rates of 7-day PPA than the control group at 6 months (video group: 24.6% [82 of 333] versus 11.4% [42 of 368], P < 0.001; text group: 17.4% [56 of 333] versus 11.4% [42 of 368], P = 0.02). The video and text groups also differed in the rates of 7-day PPA (24.6% versus 17.4%, P = 0.02). Excluding the quitters, the video and text groups had higher levels of readiness to quit than the control group at 6 months (video group: 43.5% [109 of 251] versus 31.6% [103 of 326], P = 0.002; text group: 40.6% [108 of 266] versus 31.6% [103 of 326], P = 0.01), No such difference was detected between the video and text groups (43.5% versus 40.6%, P = 0.29). The study was limited in that the long-term effectiveness of the intervention is uncertain.


This smoking cessation intervention for expectant fathers that focused on explaining the ramifications of smoking on maternal and child health was effective and feasible in promoting quitting, and video messages were more effective than texts in delivering the information.

Trial registration

ClinicalTrials.gov: NCT03236025.

Klíčová slova:

Adverse events – Alcoholism – Child health – Nicotine – Nurses – Obstetrics and gynecology – Pregnancy – Smoking habits


1. WHO Guidelines Approved by the Guidelines Review Committee. WHO Recommendations for the Prevention and Management of Tobacco Use and Second-Hand Smoke Exposure in Pregnancy. Geneva: World Health Organization; 2013. https://apps.who.int/iris/bitstream/handle/10665/94555/9789241506076_eng.pdf?sequence=1

2. Wipfli H, Avila-Tang E, Navas-Acien A, et al. Secondhand smoke exposure among women and children: evidence from 31 countries. Am J Public Health. 2008;98(4):672–679. doi: 10.2105/AJPH.2007.126631 18309121

3. US Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention (US) [Internet]. 2006 [cited 2019 Dec 12]. https://www.cdc.gov/tobacco/data_statistics/sgr/2006/index.htm

4. Matt GE, Quintana PJ, Hovell MF, et al. Households contaminated by environmental tobacco smoke: sources of infant exposures. Tob Control. 2004;13(1):29‐37. doi: 10.1136/tc.2003.003889 14985592

5. Xu X, Rao Y, Wang L, et al. Smoking in pregnancy: a cross-sectional study in China. Tob Induc Dis. 2017;15:35. doi: 10.1186/s12971-017-0140-0 28747859

6. Yang L, Tong EK, Mao Z, et al. Exposure to secondhand smoke and associated factors among non-smoking pregnant women with smoking husbands in Sichuan province, China. Acta Obstet Gynecol Scand. 2010;89:549–557. doi: 10.3109/00016341003713851 20367430

7. Kayser JW, Semenic S. Smoking motives, quitting motives, and opinions about smoking cessation support among expectant or new fathers. J Addict Nurs. 2013;24(3), 149–157. doi: 10.1097/JAN.0b013e3182a4caf1 24621544

8. Kwon JY, Oliffe JL, Bottorff JL, Kelly MT. Masculinity and Fatherhood: New Fathers' Perceptions of Their Female Partners' Efforts to Assist Them to Reduce or Quit Smoking. Am J Mens Health. 2015;9(4):332–339. doi: 10.1177/1557988314545627 25106653

9. Pollak KI, Lyna P, Bilheimer AK, et al. Efficacy of a couple-based randomized controlled trial to help Latino fathers quit smoking during pregnancy and postpartum: the Parejas trial. Cancer Epidemiol Biomarkers Prev. 2015;24:379–385. doi: 10.1158/1055-9965.EPI-14-0841 25406226

10. Winickoff JP, Healey EA, Regan S, et al. Using the postpartum hospital stay to address mothers' and fathers' smoking: the NEWS study. Pediatrics. 2010;125:518–525. doi: 10.1542/peds.2009-0356 20123776

11. Flemming K, Graham H, McCaughan D, et al. The barriers and facilitators to smoking cessation experienced by women's partners during pregnancy and the post-partum period: a systematic review of qualitative research. BMC Public Health. 2015;15:849. doi: 10.1186/s12889-015-2163-x 26335935

12. Grudniewicz A, Kealy R, Rodseth RN, et al. What is the effectiveness of printed educational materials on primary care physician knowledge, behaviour, and patient outcomes: a systematic review and meta-analyses. Implement Sci. 2015;10:164. doi: 10.1186/s13012-015-0347-5 26626547

13. Zhuang RS, Han TG, Wu L. Establishment and operation of smoking cessation clinics in public hospitals in Shenzhen city. Chinese Journal of Public Health. 2017;33:720–724.

14. Tuong W, Larsen ER, Armstrong AW. Videos to influence: a systematic review of effectiveness of video-based education in modifying health behaviors. J Behav Med. 2014;37:218–233. doi: 10.1007/s10865-012-9480-7 23188480

15. Fiore MC, Wetter DW, Bailey WC, et al. The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline. JAMA. 1996;275:1270–1280. 8601960

16. Brame CJ. Effective Educational Videos: Principles and Guidelines for Maximizing Student Learning from Video Content. CBE Life Sci Educ. 2016;15:es6. doi: 10.1187/cbe.16-03-0125 27789532

17. Dror I, Schmidt P, O'Connor L. A cognitive perspective on technology enhanced learning in medical training: great opportunities, pitfalls and challenges. Med Teach. 2011;33:291–296. doi: 10.3109/0142159X.2011.550970 21456986

18. Tzelepis F, Paul CL, Williams CM, et al. Real-time video counselling for smoking cessation. Cochrane Database Syst Rev. 2019;2019(10):CD012659. doi: 10.1002/14651858.CD012659.pub2 31684699

19. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211.

20. Li WHC, Ho KY, Wang MP, et al. Effectiveness of a Brief Self-determination Theory–Based Smoking Cessation Intervention for Smokers at Emergency Departments in Hong Kong: A Randomized Clinical Trial. JAMA Intern. Med. 2020;180(2), 206–214. doi: 10.1001/jamainternmed.2019.5176 31790546

21. Li WHC, Wang MP, Ho KY, et al. Helping cancer patients quit smoking using brief advice based on risk communication: a randomized controlled trial. Sci Rep. 2018;8(1):2712. doi: 10.1038/s41598-018-21207-1 29426956

22. Benowitz NL, Jacob P, Ahijevych K, et al. SRNT Subcommittee on Biochemical Verification. Biochemical verification of tobacco use and cessation. Nicotine Tob Res. 2002;4:149–159. doi: 10.1080/14622200210123581 12028847

23. Cha S, Ganz O, Cohn AM, et al. Feasibility of biochemical verification in a web-based smoking cessation study. Addict Behav. 2017;73:204–208. doi: 10.1016/j.addbeh.2017.05.020 28551588

24. Shou J, Ren L, Wang H, et al. Reliability and validity of 12-item Short-Form health survey (SF-12) for the health status of Chinese community elderly population in Xujiahui district of Shanghai. Aging Clin Exp Res. 2016;28:339–46. doi: 10.1007/s40520-015-0401-9 26142623

25. Huang CL, Lin HH, Wang HH. The psychometric properties of the Chinese version of the Fagerstrom Test for Nicotine Dependence. Addict Behav. 2006;31(12):2324‐2327. doi: 10.1016/j.addbeh.2006.02.024 16567055

26. Etter JF, Bergman MM, Humair JP, et al. Development and validation of a scale measuring self-efficacy of current and former smokers. Addiction. 2000;95:901–913. doi: 10.1046/j.1360-0443.2000.9569017.x 10946439

27. Free C, Knight R, Robertson S, et al. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 2011;378: 49–55. doi: 10.1016/S0140-6736(11)60701-0 21722952

28. Kim HY. Analysis of variance (ANOVA) comparing means of more than two groups. Restor Dent Endod. 2014;39:74–77. doi: 10.5395/rde.2014.39.1.74 24516834

29. Jakobsen JC, Gluud C, Wetterslev J, et al. When and how should multiple imputation be used for handling missing data in randomised clinical trials—a practical guide with flowcharts. BMC Med Res Methodol 2017;17: 162. doi: 10.1186/s12874-017-0442-1 29207961

30. Brame CJ. Effective educational videos: Principles and guidelines for maximizing student learning from video content. CBE Life Sci Educ. 2016;15(4): es6. doi: 10.1187/cbe.16-03-0125 27789532

31. Stanczyk NE, de Vries H, Candel MJ, Muris JW, Bolman CA. Effectiveness of video- versus text-based computer-tailored smoking cessation interventions among smokers after one year. Prev Med. 2016;82:42–50. doi: 10.1016/j.ypmed.2015.11.002 26577867

32. West R, Hajek P, Stead L, Stapleton J. Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction. 2005;100(3):299–303. doi: 10.1111/j.1360-0443.2004.00995.x 15733243

33. Herd N, Borland R, Hyland A. Predictors of smoking relapse by duration of abstinence: findings from the International Tobacco Control (ITC) Four Country Survey. Addiction. 2009;104:2088–99. doi: 10.1111/j.1360-0443.2009.02732.x 19922574

34. Ho KY, Li WHC, Wang MP, et al. Comparison of two approaches in achieving smoking abstinence among patients in an outpatient clinic: A Phase 2 randomized controlled trial. Patient Educ Couns. 2018;101:885–93. doi: 10.1016/j.pec.2018.02.003 29439844

35. Nguyen TQ, Ebnesajjad C, Cole SR, Stuart EA. Sensitivity analysis for an unobserved moderator in RCT-to-target-population generalization of treatment effects. The Ann Appl Stat 2017;11(1):225–247.

36. World Health Organization (WHO). WHO Tobacco Free Initiative. The Role of Health Professionals in Tobacco Control. Geneva, Switzerland: WHO; 2005 [cited August 20, 2019]. http://www.who.int/tobacco/resources/publications/wntd/2005/bookletfinal_20april.pdf

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