Community-Based Intervention to Reduce Tobacco Use Among Pregnant Alaska Native Women

Among Alaska Native women residing in Western Alaska, about 75% use tobacco during pregnancy, greatly exceeding the national rates of prenatal tobacco use.  Interventions to reduce tobacco use among AN pregnant women are limited. This study builds on our successful 13 year partnership with the AN community.  Our pilot study suggested an individual-based intervention delivered at the first prenatal visit had low reach to pregnant women and poor tobacco abstinence rates.  Interventions targeting the entire community, not just pregnant women, to address social norms about tobacco use might be more effective.  Thus, in this study, we will develop and evaluate the efficacy of a novel, multi-component intervention for reducing tobacco use in pregnancy, incorporating both individually targeted and community level (social marketing campaign) components to be delivered by female elders “Native Sisters.” To reach pregnant women, enrollment will occur at the time of a positive pregnancy test done by village-based health aides.  Both tobacco users and non-users will be enrolled because many start to use during pregnancy.   In Phase 1 of the project we will develop the social marketing campaign messages and delivery channels through focus groups and individual interviews with pregnant women, family members and elders.  In Phase 2 we will evaluate the efficacy of the intervention compared with a control condition using a group-randomized design with village as the unit of assignment.  The primary outcomes are the biochemically confirmed 7-day point prevalence tobacco use rate at week 36 gestation and at 6 months post-partum.  The process of intervention development will be presented including feedback from a Community Advisory Committee that was formed for this project.