Alaska Comes Up for Fresh Air

The Alaska clean air movement was born in an unlikely setting—an Alaska Native community of 6,000, where -60° F is coupled with a 52 percent smoking rate. The winds of the open tundra of rural Alaska could not protect smokers from the facts: safe air means "take it outside"—even if that means wear a fur hat and coat to do so.

In 1997 a band of fifth-grade Bethel youth partnered with the local Native Health Corporation to carry out a health education campaign that included debates, radio ads, a community parade, print media, and public speaking pointing out the dangers of exposure to secondhand smoke. The youth, many of whom were Alaska Natives, created ads specific to the region using the hypothetical exposure of the local salmon run to ammonia as an analogy to their own exposure to the known 3,000 chemicals in secondhand smoke. In their ads they pointed out how concerned people would be if the river had been contaminated, but that no one was doing anything about the youth exposure to secondhand smoke.

The results were overwhelming. Physicians from the local health corporation came to city council meetings to support the youth's claims that exposure to secondhand smoke could harm health. Alaska Native elders named a spokeswoman who said she represented "ninety-nine percent of the elders" in supporting the ordinance banning smoking in all public places and enclosed public spaces. In 1998, after a year of community education, the first clean indoor air ordinance in Alaska was passed unanimously by the Bethel city council.

Since passage of the ordinance, continued community support for anti-tobacco efforts has led to creation of a nicotine dependence treatment program at the Yukon-Kuskokwim Delta Regional Hospital in Bethel, which treats the 25,000 Yup'ik and Athabascan Alaska Natives from the Yukon-Kuskokwim Delta. The entire staff of counselors is Alaska Native and has received training at the Mayo Clinic in nicotine dependence treatment counseling. Counseling is often carried out in Yup'ik. More than 600 patients have been treated in the program, which boasts a 27.6 percent "quit rate at 12 weeks" for smokers and chewers.

This August the clean indoor air ordinance will be four years old. Since its passage, both Anchorage and Juneau have passed similar ordinances, citing Bethel as the example. The coalition that helped get the ordinance passed received a citation from the Alaska State legislature for their work in public health.

Caroline Cremo Renner, MPH, is the director of Nicotine Research and Control at the Yukon-Kuskokwim Health Corporation in Bethel, Alaska. She was the chair of the Bethel Tobacco Control Alliance when the ordinance was passed, and founded the Nicotine Dependence Treatment Program at the Bethel hospital.