Smoke-free Parents: Providing a smoke-free future for parents and their children

Abstract

The present thesis contributes to the research field focusing on helping (expecting) parents to quit smoking. This thesis presents the results of a Dutch cross-sectional study with a large nationally representative sample of 1,858 mothers of young children. The results revealed a strong association between the partner’s smoking status and the smoking status of women before, during, and after pregnancy (e.g., women who relapsed postpartum (vs. did not) were almost twice as likely to have a partner who continued smoking postpartum). Therefore, healthcare professionals should address partners’ smoking at all time points around pregnancy and provide them with evidence-based cessation support. Furthermore, the results of a meta-analysis in this thesis reveal that parent-tailored smoking cessation interventions are modestly effective. Parents in the intervention conditions were 1.62 times more likely to quit smoking than parents in the control conditions (13.1% vs. 8.4%; 95%CI = 1.38–1.90; p< .00001). These findings emphasize the need to improve these interventions.

The present thesis confirms the effectiveness of the Dutch proactive parent-tailored telephone smoking cessation counseling program Smoke-free Parents (SFP) when tested under more real-world conditions. Parents who received SFP were more than seven times more likely to quit smoking at three months follow-up than parents in the control condition (95%CI = 2.49–22.84). Furthermore, cost-effectiveness analyses revealed that SFP resulted in higher costs (€1,275.99) and a higher percentage of parents that quit smoking (53.3%) than the control condition (€280.03; 13.2%). From a societal perspective, this means that SFP is cost-effective if society is willing to pay €2,491 for each additional parent who quits smoking. The present thesis also presents the results of an implementation study in which parents were recruited via healthcare settings (e.g., pediatricians) and mass media (e.g., social media) for the SFP program. This study shows that 26.4% of the recruited parents participated in SFP. The main reasons for parents not participating in SFP were the high expenses of SFP and the difficulty of the smoking cessation counselors to reach parents after they had been recruited. The results showed that parents could be recruited for the SFP program via both recruitment approaches, since the proportion of parents who participated in SFP was slightly, but not significantly, higher for mass media than for healthcare settings (27.3% vs. 26.8%), and the recruitment cost-per-participant for both approaches were relatively low. Yet, to increase the impact of SFP in terms of controlling tobacco use among parents, future research should examine how the number of participating parents could be increased by addressing the barriers that parents prevented from participating. The final study presented in this thesis concerns an implementation study in which the barriers and facilitators of the SFP referral tool in healthcare settings were investigated. The results show that healthcare professionals found the tool convenient to use, but experienced several barriers that limited the use of the tool (e.g., the costs of SFP). To improve the implementation of the tool in healthcare settings, it is essential to overcome these barriers.