Tobacco Cessation Intervention During Pregnancy Among Alaska Native Women

Abstract

This paper describes a community-based participatory research program with Alaska Native people addressing a community need to reduce tobacco use among pregnant women and children. Tobacco use during pregnancy among Alaska Native women is described along with development of a community partnership, findings from a pilot tobacco cessation intervention, current work, and future directions. Among Alaska Native women residing in the Yukon Kuskokwim Delta region of western Alaska, the prevalence of tobacco use (cigarette smoking and/or use of smokeless tobacco) during pregnancy is 79%. Results from a pilot intervention study targeting pregnant women indicated low rates of participation and less than optimal tobacco abstinence outcomes. Developing alternative strategies to reach pregnant women and to enhance the efficacy of interventions is a community priority, and future directions are offered.

Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature

“… 134 However, it is important to note that smoking cessation programmes have been shown to be effective within Indigenous groups. 113 135 Culturally appropriate interventions tailored to the needs of Indigenous smokers should continue to be developed, implemented and evaluated. These programmes should acknowledge the cultural significance of tobacco use, and the important historical and social factors associated with Indigenous groups and smoking.…”

Smoking in Pregnancy Among Indigenous Women in High-Income Countries: A Narrative Review

“…62 The potential normative influences of tobacco use in pregnancy, or other cultural or psychosocial reasons to use tobacco, have not been reported for AI women. 3,87,88 Likewise, studies have shown that many Australian Aboriginal and Torres Strait Islander pregnant smokers are motivated to quit smoking or cut down their consumption of cigarettes to protect their baby as a natural response to becoming pregnant. 24,25,77 Moreover, potent individual and cultural facilitators for quitting include the protective attitudes of Aboriginal and Torres Strait Islander women, guilt about smoking, and their esteem of positive role models who have quit tobacco.…”

“…62 To address this need, a successful tobacco control community-academic research partnership was developed and has been sustained over the past 15 years. 62,88 However aside from one pilot study, 19 prenatal cessation interventions have not been otherwise evaluated for AI or AN women. 87,90 In the one pilot study conducted among AN women, an individual-based intervention delivered at the first prenatal visit based on the USPHS guidelines 90,95 was culturally adapted through qualitative work.…”

“…An ongoing project in a rural region of Western Alaska (Y-K Delta region) has developed a social marketing campaign targeting the entire community, not just pregnant women. 88 Local female elders will deliver the intervention. This approach has been found to be effective for cancer prevention and control efforts among AI/AN women.…”

Prevention and Treatment of Smoking and Tobacco Use During Pregnancy in Selected Indigenous Communities in High-Income Countries of the United States, Canada, Australia, and New Zealand

“…83,84 Approaches in the latter context include a social marketing campaign targeting the entire community in western Alaska (Yukon-Kuskokwim Delta region). 85 Another current project in Anchorage, Alaska uses urine cotinine testing to provide feedback to women about their infant's likely exposure to a tobaccospecific nitrosamine and carcinogen, NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) as a motivator to stop tobacco use in pregnancy. 86 No interventions address concurrent use of cannabis and tobacco among Indigenous pregnant women as far as we are aware.…”