Second Wind, First Breath: Educational Materials for Pregnant Native Americans

LaDonna BlueEye, MPH BlueEye Consulting

Sarah Jane Carlson, MBA Ernestine Jennings, MS

Smoke-Free Beginnings Oklahoma State Medical Association

Cynthia Coachman, RNMuscogee (Creek) Nation

Catherine Rohweder, DrPHSmoke-Free Families National Dissemination Office

BlueEye Consulting

Outline

• Background

• Sacred use of tobacco

• Tobacco use among pregnant Native Americans

• Methods– qualitative & quantitative

• Results

• Conclusions

Smoke-Free Beginnings

• Demonstration grant from Smoke-Free Families (SFF) to Oklahoma State Medical Association (OSMA)

• Grant objectives– Increase use of the 5 A’s by prenatal care

providers– Develop sustainable framework for ongoing

dissemination of 5 A’s among prenatal care providers

Smoke-Free Beginnings• Through SFB work determined great need

for culturally relevant materials in Native American clinics

• Began coordination with SFF and National Partnership– Needs assessment survey– Recognized Oklahoma needs similar to

national

• SFB awarded additional monies to begin work with Native American communities

Second Wind Tobacco Cessation Program

• Background– Created to address culturally specific needs within

Native American communities– Modified from ACS Fresh Start

• Used in Native American Communities – OK, CA, OR, CT, UT, AK, AZ

• Evaluation– 3 months = 67% success at MCN– TIHRC = Increase in retention rate of Native

Americans compared to ACS Fresh Start & Freedom from Smoking

H O W T O B A C C O IS U S E DIN A S A C R E D W A Y

U sed inP raye r

U sed toH e a l

P eop le

E sp ec ia llyfo r

som e th ingspec ific

T oba ccoS oc ie ties

K now thepow er o ftobacco

K now there a l

tobaccos to ries

G en de r-spec ific

S how ed N a tiveA m ericans h owto u se toba cco

T h is is h ow N a tiveA m erican peop le canlea rn abou t to bacco

S m ok in gC ig a re ttesvs . U s ingfo r P raye r

U sed inP raye r

H e a ls o rp ro te c ts

m om andbab y

U se aL ittle

B it

N o t, like ,fou r pa cks a

day

Jus t a littlew h en w e

p ray

Prevalence Rates

Percentage of Women Who Smoke During Pregnancy By Ethnic Group

0 5 10 15 20 25

American Indian & Alaska Native

Hawaiian

White

Black

Japanese

Filipino

Other

Chinese

Percentage

National Vital Statistics Report, Vol 50, No 5, Feb 12, 2002: Table 24

Quantitative Methods• 283 needs assessments

– IRB-approved, self-administered surveys

• Participants– Tribal Support Centers & Indian Health

Service facilities– Physicians, nurses, health educators,

and other health care practitioners across North America

Qualitative Methods

• Focus groups & individual interviews– Transcribed, coded, qualitative software

• Participants – Pregnant Native Americans – Health care providers in Native American

communities

Survey Results

• Nearly 72% of respondents provide self-help materials • Few were pregnancy-specific

• Participants reported educational materials are culturally-relevant• Generally only minor changes were made

Survey Results

• Participants stated culturally-relevant materials are available • Systematic review revealed that many

materials are:- no longer in print- have ownership or publication restrictions- too regionally-specific- not relevant outside of small region

H e a lth B e lie fs S p e c ific toIn d ig e n o u s

N a tive A m e rica nW o m e n

B e lie veD o n ’t

B e lie ve

N a tive A m e rica nW o m e n a re m o re

p ro n e to g e t d ise a se

D ia b e te s

S m o k in g ca u se slo w e r b irth w e ig h t

A lw a ys try to sh o wth a t th e b a b y w ill b e

sm a ll

B a b y w a s1 1 .6 lb s

Y o u h e a r th a ts ta tis tic b u t it

“d o e sn ’t so u n d tru e ”

5 0 /5 0 ch a n ceb a b y w ill b e b ig o r

sm a ll

IM A G E S INE D U C A T IO N A L

M A T E R IA L S

U se o fc rad leboa rds

U se h is to rica l im ages

H a s b a b y o nh e r b a ck

S acagaw eaP roduce coun te r-ads toadd ress use o f N a tive

A m erican to se ll tobacco

S ugges tions

P ic tu re o f p re g n a n tw o m a n g iv in g

to b a ccoa s a n o ffe rin g

U se lo o se to b a ccoo r to b a cco tie

T obaccoeduca tion

spec ific p ic tu res

“M a te ria ls tha ton ly change o radd the w o rd

Ind ian isno t enough ”

“N a tive p e o p le a re d iffe re n t. Id o n ’t ca re a ll a b o u t ‘w e a re

o n e ’, w e a re n ’t! o u r h is to ry a n de ve n h o w w e live to d a y is w h a tm a ke s u s su rv ive fo r to m o rro w .A n d th e m e ssa g e s h a ve to b e

fo r u s , o r th e N a tive p e o p led o n ’t g e t it!”

N eed au then ticim ages

D on ’t ju s t usep ic tu res o f

a rrow s o r fea the rs

P regnan t w om anbe ing b lessed w ith

tobacco sm oke

“M ake it rea l”

P regnan t w om andanc ing a t pow w ow

G ood im agebecause they

con tinue to dance

P regnancy takes a to ll on the body and if the m omdoesn ’t take ca re o f he rse lf, she can ’t dance

S how he rw ith E lde rs

Conclusions• Important for health care providers to

recognize and honor traditional use of tobacco• Capitalize on function of tribal relationships

• incorporating social support • Incorporate appropriate images

• more modest, reflect the population• Culturally-relevant tobacco educational

materials:• must include input from population to be served• need to address specific health beliefs of

population

Contact Information

LaDonna BlueEyeBlueEye Consulting405.650.2817 blueeyeconsulting@sbcglobal.net

Sarah Jane CarlsonErnestine JenningsSmoke-Free BeginningsOklahoma State Medical Association405.843.9571 ext.117carlson@osmaonline.orgjennings@osmaonline.org

Cynthia CoachmanMuscogee (Creek) Nation 918.756.6231Cynthia.Coachman@mail.ihs.gov

Catherine RohwederSmoke-Free Families National Dissemination Office919.966.6879 rohweder@mail.schsr.unc.edu