Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, 1300 2nd St, Ste 200, Minneapolis, MN 55454, USA.
Int J Environ Res Public Health. 2020 Dec 12;17(24):9302. doi: 10.3390/ijerph17249302.
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, = 8 villages) or usual care plus a community-level intervention delivered by local AN "Native Sisters" ( = 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, = 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.
在针对土著妇女的产前烟草使用干预措施的证据基础方面仍存在很大差距。使用整群随机对照试验（RCT），“健康妊娠项目”评估了阿拉斯加农村地区的阿拉斯加原住民（AN）妇女的社区一级干预措施。16 个村庄被随机分配到常规护理（对照组， = 8 个村庄）或常规护理加由当地 AN“原住民姐妹”提供的社区一级干预（ = 8 个村庄）。结果是分娩时以及产后 2 个月和 6 个月的烟草使用率，并在 6 个月时进行生物化学确认。该方案的覆盖面很广，招募了所有筛查合格的妇女的 73%。在 352 名参与者中，67%的人在基线时使用烟草。在随访期间，两组在烟草使用率上没有出现显著差异。与对照组相比，更多的干预组参与者在产后 2 个月时尝试戒烟（分别为 70%和 51%， = 0.012）。两组参与者均报告该方案有助于提高研究村庄对健康妊娠的认识。这项试验支持了社区一级干预措施的覆盖面，但不能证明其在减少怀孕期间或产后吸烟方面的有效性。努力维持早期戒烟尝试似乎是合理的。社区参与以及报告对提高对健康妊娠重要性的认识的影响，支持了该社区研究计划的价值。
