Healthy pregnancies project: Cluster randomized controlled trial of a community intervention to reduce tobacco use among alaska native women

Christi A. Patten, Harry A. Lando, Chris A. Desnoyers, Martha J. Bock, Lucinda Alexie, Paul A. Decker, Christine A. Hughes, Kenneth Resnicow, Linda Burhansstipanov, Rahnia Boyer, Joseph Klejka

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Substantial gaps remain in the evidence base for prenatal tobacco use interventions among Indigenous women. Using a cluster randomized controlled trial (RCT), the Healthy Pregnancies Project evaluated a community-level intervention for Alaska Native (AN) women in rural western Alaska. Sixteen villages were randomly assigned to usual care (control, n = 8 villages) or usual care plus a community-level intervention delivered by local AN “Native Sisters” (n = 8 villages). Outcomes were tobacco use rate at delivery and at 2 and 6 months postpartum, with biochemical confirmation obtained at 6 months. The program had high reach, enrolling 73% of all eligible women screened. Of the 352 participants, 67% used tobacco at baseline. No significant differences emerged between study groups on follow-up in tobacco use rates. More intervention than control participants made a quit attempt at 2 months postpartum (70% vs. 51%, respectively, p = 0.012). Participants in both study groups reported the program helped to raise awareness of healthy pregnancies in the study villages. This trial supports the reach of a community-level intervention, but not its efficacy for reducing tobacco use during pregnancy or postpartum. Efforts to sustain early quit attempts appear warranted. The community involvement, and reported impact on raising awareness of the importance of healthy pregnancies, supports the value of the research program in this community.

Original languageEnglish (US)
Article number9302
Pages (from-to)1-14
Number of pages14
JournalInternational journal of environmental research and public health
Issue number24
StatePublished - Dec 2 2020

Bibliographical note

Funding Information:
Funding: This work was funded by the National Cancer Institute, grant number R01 CA164533. The funding source had no role in the design and conduct of this study or the drafting of this manuscript.

Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.


  • Alaska Native
  • Community
  • Intervention
  • Pregnancy
  • Tobacco
  • Women


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