Unintended Effects of a Smoking Cessation Intervention on Latino Fathers’ Binge Drinking In Early Postpartum

Abstract

The co-occurrence of substance use, including tobacco and alcohol use, are common among Latino men. Roughly 70 % report alcohol use in the past year, and 45 % reporting binge drinking [1, 2]. Alcohol-related social risks (i.e., family strain and violence) and related health risks (i.e., cancer and liver disease) also remain high [3]. With alcohol use comes smoking among many, among Latino men that are current drinkers, 25 % of them use tobacco on a daily basis, and this number increases to 37 % among those men classified as heavy drinkers [1]. The co-occurrence of smoking and alcohol use is multifaceted and may be due to genetic, environmental, behavioral, and psychosocial mechanisms [4]. Due to the clustering of these behaviors, reductions in one of the behaviors can lead to reductions in the other [1, 5]. While not straightforward [6], smoking cessation has been linked to a decrease in alcohol consumption [5]. The majority of studies available in the literature have been conducted among treatment-seeking alcohol users rather than those not seeking treatment or those seeking treatment for smoking [5]. However, a recent study among non-treatment-seeking binge drinkers showed that those who quit smoking reported a decrease in binge drinking [7]. Reductions in co-occurring risk behaviors take multiple pathways. Smoking and alcohol use share similar behavior change pathways (i.e., mutual cravings and behavioral triggers); when these cravings and triggers are diminished, this may lead to reductions in both behaviors [4]. Increased confidence from changing one behavior, such as smoking, may also transfer to other behaviors like alcohol use and lead to reductions [8]. Unique to this study, there also may be naturally occurring times, like pregnancy or the birth of a child, when reductions of these behaviors also co-occur. Because pregnancy is a teachable moment when Latino fathers may be more inclined to quit smoking [9], they also may be more motivated to reduce their alcohol consumption. Factors related to becoming a parent can serve as motivators to engage in healthy behaviors, yet they are rarely examined among male partners [10]. To our knowledge, the effects of a smoking cessation intervention on binge drinking behavior among new Latino fathers have not been examined. We expected that the smoking cessation intervention might affect alcohol use for three reasons. First, smoking and alcohol use share common behavioral pathways. Second, new fatherhood may bring increased motivation to engage in healthy behaviors. Third, that the provided intervention had a significant effect on couple relationship satisfaction [11], which may have decreased stress (a common behavioral trigger of both smoking and alcohol use). Therefore, the purpose of this study was to examine whether arm effects exist for a cessation intervention on the unintended outcome of binge drinking. We also examine the effects of smoking cessation (regardless of arm allocation) on binge drinking in Latino fathers using data from a smoking cessation randomized controlled trial called the Parejas Trial [12]. This is a secondary analysis of data from the Parejas Trial, a randomized controlled trial to compare a culturally tailored couples-based intervention plus written materials and free nicotine replacement therapy (NRT) to a minimal intervention (self-help smoking guides and NRT only) in promoting smoking cessation among Latino fathers during pregnancy and postpartum from 2010 to 2013 (see Pollak et al., 2015 for full study details) [12]. This study was approved by the Duke University School of Medicine Institutional Review Board. Pregnant Latinas and their male partners were recruited from 10 clinics in North Carolina. Eligibility criteria for Latina women included being at least 16 years of age, between 13 and 29 weeks gestation, and not smoking. Eligibility criteria for their male partners included being at least 16 years of age, having smoked at least 100 cigarettes in their lifetime, and having smoked in the last 30 days. Data was collected at baseline, 3-month postpartum, and 12-month post-randomization. All 348 Latino fathers randomized into the trial were used in the current analyses. Men were randomized to the minimal intervention arm or the couples-based intervention. Those randomized to the minimal intervention arm received a booklet, No lo deje para mañana, deje de fumar hoy: Guía para Dejar de Fumar (Don’t leave it for tomorrow, quit today: Guide to quitting smoking), and were offered free NRT for a period of 6 weeks. Men randomized to the couples-based intervention arm also received the booklet, free NRT for 6 weeks, three counseling sessions during pregnancy, and three sessions postpartum (one face-to-face and two over the phone). The face-to-face counseling sessions occurred in the client's home and lasted 2 h. The first part of the session consisted of a PowerPoint slide show that focused on the emotions surrounding the family (includ