Substance Abuse & Mental Health Services Administration

The Substance Abuse and Mental Health Services Administration (SAMHSA)

Palau Ministry of Health, Division of Behavioral Health: Prevention Unit/Tobacco Use Prevention and Control Program

Within Palau’s Ministry of Health, under the Division of Behavioral Health Prevention Unit, the Prevention Unit/Tobacco Use Prevention and Control Program strives to prevent tobacco use among pregnant women and nursing mothers in Palau through a national social marketing campaign. The program develops social marketing activities that influence behavioral change, improve women’s recognition of tobacco cessation services, reduce tobacco-related pregnancy complications, and reduce infant ailments due to breastfeeding while using tobacco.

In response to a study conducted in 2008, which revealed that 64.1% of respondents used tobacco during their most recent pregnancy, the program began to distribute anti-tobacco brochures to pregnant women and nursing mothers through a prenatal program. A later study revealed that in 2011, 12.2% of babies born in Palau were either premature or low birth-weight, although it was not known the degree to which tobacco use was a contributing factor. In response, the Ministry of Health launched a campaign targeting pregnant women and nursing mothers in early 2013, which included a new research-based poster depicting the effects of using tobacco during pregnancy or while breastfeeding, as well as a brochure for distribution to all public and private healthcare facilities.

In addition to preventing tobacco use, the program also improved cessation services by hiring a cessation worker, who receives referrals through the prenatal program and throughout the community. Despite these efforts, the number of referrals and readiness to quit remains low. Since April 2013, there have been 46 pregnant women screened and offered tobacco cessation services, but none of them have quit. The program is now focusing on making use of social marketing strategies to change social norms.

With funding from SAMHSA’s FY2014 Subcontracts to Build Evaluation Capacity for Evidence-Based Interventions, the Palau Ministry of Health will enhance the evaluation of the Tobacco Use Prevention and Control Program in order to produce the basis for the campaign’s future social marketing plans. Specific activities will include:

  • Obtaining qualitative and quantitative information from women of childbearing age
  • Recruiting and training surveyors to assist in administering surveys throughout Palau communities
  • Conducting a paper-based self-administered survey
  • Providing incentives to participants of the survey in order to encourage their participation
  • Conducting focus groups in order to evaluate the campaign’s current and potential promotional materials
  • Collecting and analyzing data to be subsequently presented to stakeholders, published in local media, and used to create an effective social-marketing plan
  • Recommending that the Family Health Unit incorporate survey questions into their Well-Baby and PRAMS surveillance systems about tobacco use during breastfeeding and exposure to secondhand smoke among pregnant women and nursing mothers


Candace Koshiba
Program Manager
Prevention Unit | Behavioral Health Division
Bureau of Public Health | Ministry of Health
P.O. Box 6027
Koror, Palau 96940
Phone: (680) 488-8118/9