1. 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, RN Muscogee (Creek) Nation Catherine Rohweder, DrPH Smoke-Free Families National Dissemination Office BlueEye Consulting

2. Outline Background Sacred use of tobacco Tobacco use among pregnant Native Americans Methods –qualitative & quantitative Results Conclusions

3. 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

4. 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

5. 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

7. Prevalence Rates

8. 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

9. Qualitative Methods Focus groups & individual interviews –Transcribed, coded, qualitative software Participants –Pregnant Native Americans –Health care providers in Native American communities

10. 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

11. 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

14. 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

15. Contact Information LaDonna BlueEye BlueEye Consulting 405.650.2817 blueeyeconsulting@sbcglobal.net Sarah Jane Carlson Ernestine Jennings Smoke-Free Beginnings Oklahoma State Medical Association 405.843.9571 ext.117 carlson@osmaonline.org jennings@osmaonline.org Cynthia Coachman Muscogee (Creek) Nation 918.756.6231 Cynthia.Coachman@mail.ihs.gov Catherine Rohweder Smoke-Free Families National Dissemination Office 919.966.6879 rohweder@mail.schsr.unc.edu