Tobacco cessation interventions target pregnant Alaska Native women

In the United States, Alaska Native women have higher rates of tobacco use before, during and after pregnancy than any other racial or ethnic group. The overall prevalence of prenatal cigarette smoking in the U.S. is 11 percent; among Alaska Natives, it's more than twice that.

Alaska Native women also report exceptionally high rates of smokeless tobacco use. Although less than 1 percent of U.S. women report using smokeless tobacco, use among pregnant women in the remote Yukon-Kuskokwim Delta (Y-K Delta) in western Alaska approaches 79 percent.

Christi A. Patten, Ph.D., a tobacco cessation researcher at Mayo Clinic's campus in Minnesota who has worked with this population for nearly 15 years, says all forms of tobacco use are an accepted cultural norm in some rural Alaska Native communities.

"Tobacco use is socially acceptable, even among children of kindergarten age," she says. "Furthermore, smokeless tobacco is perceived as safer to use during pregnancy than cigarettes, and there is little knowledge about its adverse effects, which may include an increased risk of preterm birth, stillbirth and low birth weight infants."

In the Y-K Delta region, the most common form of smokeless tobacco is Iqmik — a homemade mixture of tobacco leaves and fungus ash. The combination causes rapid absorption of nicotine, making the product highly addictive — "similar to cocaine," Dr. Patten says.

In a 2005 study published in The Journal of Maternal-Fetal & Neonatal Medicine, Dr. Patten and colleagues found significantly higher concentrations of cotinine in maternal blood and infant cord blood among women using Iqmik in the week before delivery compared with women who used other forms of tobacco or didn't smoke.

Tobacco cessation interventions, past and present

The health and well-being of children are of paramount importance to the Alaska Native community and a national public health priority. So nearly 15 years ago, Mayo Clinic partnered with community health organizations to try to reduce tobacco use among children and pregnant women in the Y-K Delta. Although the partnership has been highly successful, tobacco cessation interventions have not; results of a pilot study of a culturally appropriate intervention delivered at the first prenatal visit were disappointing. The study, published in 2010 in Nicotine & Tobacco Research, found that the intervention produced no change in tobacco abstinence.

"We thought delivering cessation counseling within the health care system would be successful, but we found that we missed a large number of women because many don't come to the hospital until late in their pregnancy," Dr. Patten explains. "For the few who did participate, there was little social support — they had to return to homes where everyone was using tobacco."

That experience led Dr. Patten and her colleagues in a new direction. They are now developing a communitywide marketing campaign that will not only target pregnant women but also every Alaska Native in the eight villages selected for the study. Eight other villages will serve as controls. Because traditional media is limited — the region has one radio station and little access to television — the campaign will rely on posters, fliers and the efforts of female elders who will give presentations and provide individual counseling. The researchers hope to enroll pregnant women in all 16 villages in the study.

"It takes time to develop trust," Dr. Patten says. "But now we have established solid relationships, and we hope our studies will yield findings that will reduce health disparities in these traditionally underserved communities."

For more information

Hurt RD, et al. Iqmik — A form of smokeless tobacco used by pregnant Alaska natives: Nicotine exposure in their neonates. The Journal of Maternal-Fetal & Neonatal Medicine. 2005;17:281.

Patten CA, et al. Feasibility of a tobacco cessation intervention for pregnant Alaska Native women. Nicotine & Tobacco Research. 2010;12:79.