BETHEL -- Jennifer Wilson, a dentist here, thought she knew chew. Growing up in tobacco-loving Kentucky, it was common to see men loading up on Copenhagen or Skoal. Women too.
What she found while treating patients in Western Alaska's largest city and the surrounding villages was something different: People of all ages, sometimes entire families, chewing an earthy, super-charged variety of smokeless tobacco.
It's called iqmik, or blackbull, and it makes a mule kick of a first impression. Like all smokeless tobacco it can lead to a lifelong nicotine addiction, receding gums and low-birth weight for babies of mothers who chew. It may enter the bloodstream even faster than over-the-counter chew. A University of Alaska Anchorage researcher is studying potential links between the homemade mixture of fungus ashes and tobacco leaves to oral cancer in Alaskans.
Like salmon fishing or steam houses, some Yukon-Kuskokwim Delta residents who chew iqmik consider the habit to be part of living a Yup'ik lifestyle, a separate study found. Prying the fungus from birch trees and selling the resulting ash for $25 a bag is a rare source of cash for villagers.
What shocked Wilson, the dentist, was the widespread use.
As many as three of 10 children she treats under the age of 18 chew blackbull, with the highest use in villages outside Bethel, she said. Health aides use it. So do pregnant mothers believing it to be a safer alternative to smoking. Some elders prescribe it to children to soothe toothaches.
"I've seen more than one family where the kid, maybe between 5 and 10, they're chewing iqmik," said Wilson, who spends 50 days a year visiting patients in Lower Kuskokwim River villages. "I ask them where they get it, and they say either the parents or the grandparents."
The flat, river-fed Y-K Delta is home to roughly 25,000 people spread across about 50 villages and the Bethel hub. It's the size of Oregon and the only area in Alaska where residents report widespread iqmik use. Between 15 percent and 20 percent of Alaska Native adults here chew, according to state Division of Public Health surveys.
Look for the evidence just outside many village schools, said Yukon-Kuskokwim Health Corp. president Gene Peltola. "The closer you get to the front door in the winter, the more brown snow you see."
Peltola said he sent a letter to the Bethel mayor last month calling for a new tax on tobacco products, saying the added cost would discourage kids from chewing and smoking. But some iqmik users and sellers say raising the price won't necessarily quash the habit.
Sharing the mixture among friends and family is a Delta tradition.
'THING TO PUT IN THE MOUTH'
In Bethel, there is a story that many women of a certain age tell about their childhood. It goes something like this:
When I was young, someone gave me a pinch of iqmik to chew. It made me miryaq -- throw up. I felt dizzy and went to sleep for hours.
They are describing the symptoms of nicotine poisoning. Some never used iqmik again. Some never quit.
"I tried it but I passed out," said Carrie Anvil, 87. That was in 1935.
The eighth of 11 children, Anvil grew up in a village that later moved to nearby Kasigiluk when, she said, the slough grew shallow and the river slowed. Her father was a preacher. Her mother chewed.
"When we go around the wilderness, you know, when we saw a punk (the fungus iqmik is made from), we give it to Mom," Anvil said.
The use of iqmik, which means "thing to put in the mouth," began after the mid-1700s when Alaska Natives began to trade tobacco with Russian and European explorers, according to a 2007 state Health Department report. Often prepared by women and girls, iqmik is sometimes made from willow ash when the more desirable punk -- a loaf or clam-shaped fungus called Phellinus igniarius -- isn't available.
As a sixth-grader in the Nelson Island village of Toksook Bay, Caroline Nevak remembers chewing iqmik before school and sneaking a second pinch at recess.
"I would get nauseated. I would feel sick, but I would still continue using it," said Nevak, who later studied iqmik habits for the regional health corporation. She now works for the Alaska Native Tribal Health Consortium in Anchorage, where she's met many people who chew iqmik in the city.
Nevak said her mother still chews. Her mom gained weight when she tried to quit. Nevak, too, craved iqmik after meals or when it was time to go berry picking but stopped cold turkey about 14 years ago.
Her gums were beginning to look strange, she said, turning from pink to purple.
Along the Kuskokwim River, the raw ingredients for iqmik are as easy to buy as paper towels and cola.
In the village of Kwethluk, fresh milk is hard to find but the tribe-owned grocery store sells "punk" fungus for $2.75 a pound. A half-hour boat ride down river, in Bethel, the ash is advertised on store bulletin boards beside used snowmachines and heaters.
Call one of the numbers and you meet George Philbrick and Alice Noah, a couple making extra cash selling aqaq (ash) by the bag.
Philbrick collects the fungus, kumakaq, from decaying birch trees upriver of Bethel, gathering as much as 80 pounds in an hour and a half, he said. Sometimes he uses a hammer to break the fungus free. It's then dried, cleaned of wood and bark and burned to a fine white ash in a can or trash barrel.
In late September the couple was selling 10 bags of fungus ash that Alice's nephew brought downriver from Tuluksak. Retail value: $250.
Villagers often try to save money by buying from sellers here in the city where ash prices are lower, Philbrick said. "We had this little old lady from Kipnuk yesterday, and she bought the majority of it."
Cured tobacco leaves complete the recipe. At least two local stores sell them. Some people make iqmik by chewing the ash and tobacco together, then storing the mix in tins or boxes for later. Others mix it by hand in a bowl, adding water or tea. Some people mix it up with a coffee grinder, which is known as electric iqmik.
'100 TIMES MORE POTENT'
Originally from Massachusetts, Philbrick met Noah 17 years ago in Anchorage. They quit drinking together and moved to Bethel about three years ago. On a recent weekday, the couple sat looking after an elderly relative at a quiet row of senior housing apartments. A cop drama played on the small flat-screen TV.
Noah produced a can of iqmik, which looks a little like store-bought tobacco and smells like someone poured water on a campfire. Noah is originally from Tuluksak, she said, and started chewing when she was maybe 11. She remembers throwing up and her mother giving her an aspirin.
Her grandmother chewed too and once said that girls in the village would iqmik -- people use the word as a verb and as well as noun -- before it was time to "story knife," a tradition of sketching pictures in the ground or snow.
"My mom started when she was 9 years old. She's now 84," Noah said, touching her cheek. Nobody knew it might be bad for you back then, she said.
She's seen kids as young as 4, 5 and 6 years old chew the mixture and cry if they're denied it.
"They used to think tobacco was for everybody to have if they want," Noah said.
Today, the Swanson's grocery store in Bethel sells the ash in cigar-sized plastic baggies labeled "www.iqmik.com."
"I don't think it's any cheaper (than regular chew)," said Brady Sigmon, an 18-year-old employee at the store. "Most of the leaves and punk ash go for a pretty high price."
A redhead from Arkansas, Sigmon first tried iqmik when a friend offered him a pinch at the Bethel skate park. Sigmon was used to chewing tobacco, he said, but this was different. He grew dizzy and sat down. He threw up.
You know the buzz you get the first time you chew tobacco or smoke a cigarette? he asked. "It's like that, but 100 times more potent."
The blackbull mix tastes chalky, like chewing soil, he said. On the side of his mouth where he tucks his iqmik, Sigmon's gum has receded to reveal an alarming length of tooth.
"It'll start peeling the skin on your lip. Burns it off," he said.
Still, some users say they prefer iqmik to regular chew or cigarettes because it seems more natural.
Adam Turrentine, a 24-year-old wearing a red hoodie outside the Bethel bingo hall, described iqmik as almost nourishing.
"When I chew snuff I taste all these chemicals and I have no idea what chemical they are," he said. "Iqmik, it has more of a wholesome flavor."
CURBING USE WILL BE HARD
Statewide, Alaskans are only slightly more likely to smoke or chew tobacco than the average American. But tobacco use rates are far higher for Alaska Natives, particular in the western and northern corners of the state, said Jay Butler, senior director for community health services at the Alaska Native Tribal Health Consortium.
One 2002 University of Minnesota study found that more than 80 percent of women receiving prenatal care at the Bethel-based health corporation used tobacco during their pregnancy, with the majority using iqmik or store-bought smokeless tobacco. That number has likely declined in the past decade, said Cindy Knall, a researcher at the University of Alaska Anchorage studying iqmik use.
Whether iqmik is more or less harmful than mass-produced smokeless tobacco is unclear.
"There's not a lot of data to answer that question," Butler said. "Part of the appeal of iqmik is it's a higher pH, as I understand the science."
What he means is that potassium, calcium and magnesium in the fungus ash may allow nicotine to enter the bloodstream more quickly than other smokeless tobacco.
Anti-tobacco groups say raising prices is one surefire way to reduce usage, especially among young people. But Bethel City Clerk Lori Strickler said it's unclear if a city tobacco tax would apply to iqmik ingredients. Efforts to curb use among older generations, meanwhile, are made more complicated by the habit's roots in Yup'ik culture over the past 150 years.
A study published in 2009 looked at tobacco use in eight Yup'ik villages, asking people not only if they smoked or chewed iqmik, but also how often they ate traditional foods and used traditional medicine and herbal teas.
The Center for Alaska Native Health Research study found people who chewed smokeless tobacco identified more with a Yup'ik way of life by speaking Yup'ik and eating traditional foods than those who smoked or did not use tobacco at all. They were also less likely to turn to drugs or alcohol to cope with stress than smokers.
Wilson, the Bethel-based dentist, said she doesn't command patients to quit but talks to younger iqmik users about the risk of addiction. Potential tooth loss, for one.
"It's going to increase your chance of oral cancer. If you're prone to periodontal disease, it can definitely accelerate the symptoms," Wilson said.
Noah, who earns extra money selling punk ash with her partner, chews a pinch of iqmik three times or so a day, she said. Doctors tell her it would be a good idea to stop but the habit is too addictive, she said. "We're too deep into it."
As she talked, Noah occasionally disappeared into a nearby bedroom to check on her aunt, Catherine Lott. Lott chewed iqmik for more than 70 years before quitting to ease the strain on her heart. "She still asks for it though," Noah said.
This month Noah and Philbrick plan to boat upriver to Tuluksak, where Philbrick hopes to spend a few days collecting punk and replenishing the couple's stock of ash. Noah will once again post hand-written ads at local stores.
"This is actually the best time," Philbrick said. "The spring and the fall when there's no leaves on the trees you can see the kumakaq."