Developing health communication messaging for a social marketing campaign to reduce tobacco use in pregnancy among Alaska native women

ABSTRACT

Background: Despite the high prevalence of tobacco use during pregnancy among Alaska Native and American Indian (AI/AN) women, few efforts have focused on developing tobacco cessation interventions for this group. This paper describes development of messaging for a social media campaign targeting the entire community to reduce tobacco use in pregnancy (cigarette smoking and smokeless tobacco use including a homemade product known as Iqmik) among AN women, as part of a multi-component intervention.

Method: The study (clinical trial registration #NCT02083081) used mixed methods with two rounds of assessments to develop and refine culturally relevant message appeals. Round 1 used qualitative focus groups and individual interviews (n = 60), and Round 2 used quantitative survey interviews (n = 52). Each round purposively sampled adult AN pregnant women, family/friends, and Elders in Western Alaska, and included tobacco users and non-users. Round 1 also assessed reasons for tobacco use in pregnancy.

Results: Qualitative findings generally converged with quantitative results to indicate that many participants preferred factual, loss-framed, visual concepts on how maternal tobacco use harms the fetus, newborn, and child in contrast to spiritual or emotional appeals, or gain-framed messaging. Stress was indicated as a major reason for tobacco use in pregnancy and strategies to manage stress along with other health pregnancy targets (e.g. prenatal care) were suggested.

Conclusions: This preliminary study suggests campaign messages targeting the entire community to reduce tobacco use in pregnancy among rural AN women should include factual messaging for being tobacco-free as well as focus on reducing stress and other healthy pregnancy targets.

KEYWORDS:

• Tobacco
• health messaging
• healthcare
• communication
• behavior change
• Alaska natives
• pregnancy
• social marketing campaign

Disclosure statement

No potential conflict of interest was reported by the authors.

Acknowledgements

We wish to acknowledge the contributions of the following people for assisting with the implementation of the study: Christine Hughes, Tabetha Brockman, and Carrie Bronars from Mayo Clinic, Rochester, MN, and Rahnia Boyer from the Yukon-Kuskokwim Health Corporation, Bethel, AK. We also want to thank our Community Advisory Board members. We appreciate the contributions of Tiffany Tutuliak and Bailey Beaty at Northwest Strategies, Inc., and Brenda Manuelito and Carmelita Rodriguez at nDigiDreams, Inc. for developing the media produced in this study. We appreciate the assistance of Dr. Pamela Sinicrope (Mayo Clinic) with manuscript editing. Finally, we thank the people of the Y-K Delta region who participated in this research.

Copies of the media developed for this study are available by contacting the first author.

Notes on contributors

Christi Patten is a Professor of Psychology and has conducted research on tobacco use among Alaska Native pregnant women and children for the past 17 years.

Harry Lando is a Professor of Epidemiology and his research focuses on global tobacco issues.

Kenneth Resnicow is a Professor of Public Health and his work focuses on health communications and cultural messaging.

Paul Decker has worked with the study team as a biostatistician, including analysis of multiple clinical trials conducted in Alaska.

Christina Smith has worked on coordinating studies in Alaska for over decade.

Marcelo Hanza also coordinated multiple studies in Alaska and previously lived and worked in Bethel, Alaska.

Professor Linda Burhansstipanov’s work focuses on engaging female lay community role models ‘Native Sisters’ to enhance cancer screening in Native communities. Her work also focuses on community-based participatory research approaches.

Matthew Scott directs the Community Health and Wellness Program and he leads and contributes to several wellness initiatives among Alaska Native people.

ORCID

Christi A. Patten http://orcid.org/0000-0002-7194-8160

Additional information

Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA164533. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.