Cessation services in American Indian communities: Findings from the National Partnership to Help Pregnant Smokers Quit

Background: American Indian women have the highest rate of smoking during pregnancy (@18%), which disproportionately affects maternal and child health outcomes. Addressing commercial tobacco abuse by this population is complicated by the importance of traditional tobacco. Providers must deliver evidence-based cessation interventions, while also recognizing the cultural significance of tobacco for many Tribes. Because few cessation programs are tailored to American Indian pregnant women, The National Partnership to Help Pregnant Smokers Quit collaborated with community partners to 1) conduct focus groups and case studies; 2) create culturally appropriate tobacco treatment materials. Methods: Six focus groups were held in 2004/2005 and facilitated by an experienced American Indian researcher. Three groups included clinicians and educators, and two included pregnant or postpartum American Indian women. Participants discussed cultural beliefs around tobacco and pregnancy, how smoking affects pregnancy, access to cessation services, and barriers to quitting. In-depth interviews for case studies were conducted with five model tobacco treatment programs across the country. Results: Focus group and interview data were transcribed, coded, and analyzed. Themes included: secrecy around sacred tobacco use, dangers of second-hand smoke, negative perceptions of quitlines, and preferred images for educational materials. Recommendations were compiled into a Native American Action Plan, posters and other materials were created, and the Second Wind, First Breath support group curriculum was developed. Discussion: These products provide guidance for discussing tobacco addiction in a sensitive manner, attending to concerns of pregnant women, enhancing clients' problem solving skills, and increasing social support within an American Indian cultural context.