Problem/Objective: To examine the prevalence of prenatal cigarette smoking and smokeless tobacco use in Alaska Native (AN) and white women.

Methods: Using 1996-2003 data from the Pregnancy Risk Assessment Monitoring System, the authors describe trends in prenatal tobacco use. Multiple variable logistic regression analysis was used to identify maternal factors independently associated with prenatal tobacco use.

Results: From 1996 through 2003, 46.6% (SE 0.7) of AN women and 15.1% (0.5) of white women reported using some form of tobacco during pregnancy. Among AN women, 20.2% (0.5) reported using smokeless tobacco and 29.4% (0.6) reported smoking cigarettes during pregnancy. In contrast, 0.7% (0.1) of white women reported using smokeless tobacco and 14.5% (0.5) reported smoking cigarettes during pregnancy. Over the study period, prevalence of tobacco use during pregnancy declined by approximately 27% for both AN and white women. In 2003, reported smokeless tobacco use during pregnancy was 42-fold higher for AN women compared with white women and cigarette smoking was 1.7-fold higher. The great majority of reported prenatal AN smokeless tobacco use occurred among residents of small rural villages in Southwest Alaska. Maternal factors associated with tobacco use were less education, higher parity, and lower income for both AN and white women.

Conclusions: Tobacco use decreased among both AN and white women. However, striking disparities persist, especially for smokeless tobacco. Effects of smokeless tobacco on pregnancy outcomes are unknown and merit further research. Tobacco cessation efforts targeting pregnant AN women, especially those residing in Southwest Alaska, should be intensified.