Exploring men’s alcohol consumption in the context of becoming a father: a scoping review

Figures & data

Figure 1. PRISMA flowchart.

Table 1. Studies on new fathers’ experiences of alcohol consumption.

Study information	Aim	Methods	Population	Recruitment	Key findings (in relation to fathers)
Benoit and Magnus (2017). Canada	Explores how parents fit fathers into discourses about problematic substance use during the perinatal period	Qualitative study, part of a mixed-methods study. Interviews in family-friendly locations, including the parents' homes. Open-ended questions about participants’ living situation, experiences with healthcare services, opinions about how Her Way Home (HWH) services (a new harm reduction program for new and expectant mothers) could be most helpful, and about a personal definition of problematic substance use during pregnancy and early parenting.	Eight expectant or new fathers Age: Median = 26 Relationship status: 8 in a committed relationship with the mother of their youngest (or unborn) child. Ethnicity: 6 Indigenous (First Nations, Métis or Inuit). Employment: 2 employed; 4 in receipt of income assistance. Housing status: 1 homeless.	Via posters in health and social service sites and community centres frequented by families; and snowball sampling.	Fathers saw themselves as role models for their children. Modelling virtuous behaviour was framed as necessary for breaking the cycle of socioeconomic disadvantage, including criminality. Some men believed fathers’ substance use became problematic when it compromised emotional and physical support for the mother. The majority of participants believed safety was a prerequisite for the inclusion of fathers in family life or in family social programs. Men believed fathers’ problematic substance use can be as harmful to the baby as that of the mother. Agreement to abstain was more often represented as the mother’s decision, rather than a mutual negotiation.
Crawford-Williams et al. (2015). Australia	To identify gaps in knowledge about the effects of alcohol use in pregnancy among pregnant women, newly delivered and their partners.	Qualitative study, using focus groups. Focus group guide focused on the adverse consequences of drinking during pregnancy, the partner’s role in health decisions, the sources of information about alcohol use in pregnancy, and the availability of reliable health information.	Four expectant or new fathers Age range: 23 to 40 years. Ethnicity: Caucasian, either from Australia or New Zealand. Demographic information on male partners is not reported separately.	Flyers at a Women’s and Children’s Hospital and at a University.	Most women and their partners recognised that alcohol has the potential to cause harm to the unborn baby. However, the quantity of alcohol required to cause harm, and the impact of the timing of the exposure were not as well known. Knowledge of FASD: Belief that alcohol consumption in the first trimester would cause the most harm, but small amounts of alcohol, such as one or two glasses throughout the whole of pregnancy would not be harmful to the foetus. Men’s role in pregnancy: Some men showed support by cutting back their own drinking, while others continued to drink.
Van der Wulp et al. (2013). The Netherlands	To explore what information Dutch pregnant women and partners receive about alcohol in pregnancy.	Qualitative study, using interviews and focus groups. Questions related to men in the sample included: Has your partner used alcohol in her pregnancy?; Have you discussed antenatal alcohol use with your partner?; What did you discuss specifically?; Did you receive or search for information about alcohol consumption during pregnancy?; and discussion around the content of the information and thoughts on how information can be improved.	9 expectant fathers Age: Mean= 34 years. Place of residence: 56% lived in cities, 44% lived in village/ rural locations. Education: 78% had higher vocational school/ college degree/ university degree, 22% had secondary vocational/ high school degree. Antenatal alcohol use: 33% of men in the sample Percentage first pregnancy: 78%	Through midwife practices, pregnancy courses, antenatal childbearing classes, pregnancy yoga classes. Midwives distributed recruitment flyers. Pregnant women and partners in pregnancy classes were recruited at class meetings.	Many partners reduced their alcohol use around their spouse to support her to refrain from alcohol and because they missed their spouse as a drinking companion. Partners reported that websites about pregnancy seemed largely designed for women, as they were published in pink and contained pictures of happy pregnant women.

Table 2. Studies on interventions to reduce alcohol consumption in new fathers.

Study information	Aim	Methods	Population	Recruitment	Intervention information	Alcohol measures and outcomes
Fletcher et al. (2018). Australia	To conduct the first randomized controlled trial of a text-based intervention, SMS4dads, which targets fathers’ mental health during the perinatal period.	Randomized Controlled Trial	800 fathers-to-be or new fathers will be recruited.	Through the SMS4dads website; social media, flyers distributed by health staff in contact with parents, and mainstream media outlets. Eligibility criteria: having a partner who is more than 16 weeks pregnant or their infant is less than 12 weeks of age, have a mobile phone capable of receiving text messages, and they can read and understand English.	A 77-week program, including 294 text messages, limited to 160 characters. Messages will provide new fathers with information, support them in caring for their own physical and mental health, nurturing strong relationships with their child, and developing strong parenting partnerships with their partner. Messages are timed according to the baby's expected or actual date of birth. Messages aim to engage with fathers through humor, by use of the baby’s voice, and through an encouraging, non-judgmental tone. Some messages address particular issues such as alcohol consumption (n = 25).	Measures: The Alcohol Use Disorders Identification Test (AUDIT C, 3 items). Outcomes: It is predicted that use of alcohol will be lower among those receiving SMS4dads than among those receiving SMS4health.
Robinson et al. (2018). Australia	To develop 30 text messages to inform men about the benefits of reducing risky drinking during the transition to fatherhood.	A developmental study in addition to a qualitative study of participants experiences of the intervention.	51 expectant or current fathers Parenting experience: 2 (3.9%) expectant fathers, 49 (96.1%) current father Living arrangements: 44 (86.3%) married/de facto, 7 (13.7%) separated Age group: 13 (25.5%) between 25 and 35 years, 38 (74.5%) between 36 and 50 years Education level: 2 (3.9%) year 10 or below, 10 (27.4%) years 11 or 12,39 (76.5%) university under/postgraduate Employment: 50 (98.0%) full-time/part-time, 1 (2.0%) unemployed.	Via social media. Eligibility criteria: being a current or expectant Australian father, having ever consumed alcohol and having access to the Internet.	Thirty short messages, limited to 160 characters. The messages were informed by Motivational Interviewing and the Stages of Change model. They addressed alcohol-related harms in relation to infant health, the spousal relationship, father-infant relationship and the father's health. Messages were based on national alcohol guidelines regarding alcohol consumption. The text messages were presented using two types of message voice: a child’s voice, as if the father’s own child were addressing him.	Measures: Importance and difficulty of drinking alcohol as per Australian alcohol guidelines (Using 10-point Likert scales); AUDIT C. Outcomes: Most fathers’ (65%) current alcohol levels were considered risky according to the Australian Alcohol Guidelines. Messages in a child’s voice were given a higher importance rating, compared to those in a second person voice. Most interview participants found the messages to be non-judgmental in style. Messages that directly connected the father’s behavior with their child’s health and emotional wellbeing had greater impact than the messages about men’s own health. Messages using the child’s voice made men aware of their paternal responsibilities and how their drinking behavior may impact upon their child, but some men believed messages in a child’s voice to be manipulative. Ex-drinkers and risky drinkers indicated a preference for the strongly worded alcohol messages.
Noonan et al. (2016). USA	To examine whether arm effects exist for a cessation intervention on the unintended outcome of binge drinking	Secondary analysis of data from the Parejas Trial, a randomized controlled trial to compare a culturally tailored smoking cessation intervention among Latino fathers during pregnancy and postpartum.	348 men. Age: Mean = 30 years. Race: 49 white, 46 more than one race, 5 other, 6 missing data. Monthly income: 22 <$500, 32 between $501 and $1000, 25 between $1001 and $1500, 21 > $1501. Perceived financial burden: 5 had enough money for special things, 42 had enough money to pay the bills but little spare money, 15 had money to pay the bills but cut back on things, 38 had difficulty paying the bills. Education: 66 < 9th Grade. Alcohol use in the past 30 days: 17 none, 26 <once a week, 36 one day a week, 12 two days a week, 10 three or more days a week; 51 binge drinkers	Through antenatal clinics. Eligibility criteria: at least 16 years of age, having smoked at least 100 cigarettes in their lifetime, and having smoked in the last 30 days, pregnant partner between 13 and 29-week gestation	Intervention: a smoking cessation booklet, free nicotine replacement therapy 6 weeks, three 2-hour face-to-face counselling sessions at the couple’s home during pregnancy, and three sessions postpartum (one face-to-face and two over the phone). Face-to-face sessions included: a PowerPoint slide show on the emotions surrounding the family (including pride, protectiveness; and responsibility), discussion about the health effects of smoking; goal setting (male counsellor helped the man to build motivation and set goals around quitting smoking; female counsellor worked with the woman to promote healthy eating and activity goals); promotion of effective communication skills. Phone sessions with men lasted approximately 15 min and focused on reviewing progress towards smoking cessation and practicing couple’s communication skills. Comparison intervention: a smoking cessation booklet and free nicotine replacement therapy 6 weeks.	Measures: Binge drinking in the past 30 days, measured in two stages: 1) asking men: “During the past 30 days, on or about how many days a week did you drink alcoholic beverages?” 2) Those men that drank one or more days a week were then asked, “Consider a drink to be a can or bottle of beer, a 4-oz glass of wine, or one cocktail containing 1-oz of liquor. On average, when you drink alcoholic beverages how many drinks do you have each day?” Those men who answered 5 or more drinks a day were considered to be binge drinkers. Outcomes: Men who received the couples-based intervention were less likely to report binge drinking at 12 months compared to those in the control arm, and men who quit smoking reported less binge drinking at 12-month follow-up compared to non-quitters.

Benoit, C., & Magnus, S. (2017). Depends on the father: Defining problematic substance use during pregnancy and early parenthood. Canadian Journal of Sociology, 42(4), 379–402.

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Crawford-Williams, F., Steen, M., Esterman, A., Fielder, A., & Mikocka-Walus, A. (2015). “My midwife said that having a glass of red wine was actually better for the baby”: A focus group study of women and their partner's knowledge and experiences relating to alcohol consumption in pregnancy”: BMC Pregnancy and Childbirth, 15, 79. https://doi.org/10.1186/s12884-015-0506-3

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Van der Wulp, N. Y., Hoving, C., & Vries, H. (2013). A qualitative investigation of alcohol use advice during pregnancy: Experiences of Dutch midwives, pregnant women and their partners. Midwifery, 29(11), e89–e98. https://doi.org/10.1016/j.midw.2012.11.014

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Fletcher, R., May, C., Attia, J., Garfield, C. F., & Skinner, G. (2018). Text-based program addressing the mental health of soon-to-be and new fathers (SMS4dads): Protocol for a randomized controlled trial. JMIR Research Protocols, 7(2), e37. https://doi.org/10.2196/resprot.8368

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Robinson, M., Wilkinson, R. B., Fletcher, R., Bruno, R., Baker, A. L., Maher, L., Wroe, J., & Dunlop, A. J. (2018). Alcohol text messages: A developmental study. International Journal of Mental Health and Addiction, 16(5), 1125–1139. https://doi.org/10.1007/s11469-017-9835-y

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Noonan, D., Lyna, P., Fish, L. J., Bilheimer, A. K., Gordon, K. C., Roberson, P., Gonzalez, A., & Pollak, K. I. (2016). Unintended effects of a smoking cessation intervention on Latino fathers’ binge drinking in early postpartum. Annals of Behavioral Medicine, 50(4), 622–627. https://doi.org/10.1007/s12160-016-9781-0

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