Anchorage Daily News

Starting this morning, there will be no shivering smokers outside the Alaska Native Medical Center.

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James Ahkivgak

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The organizations that run the hospital and surrounding medical buildings have a new, super-strict tobacco ban: No one can smoke or chew on hospital property, including inside cars. It's likely the biggest employee health effort of its kind in Alaska.

The ban at two of the state's largest private employers, the Alaska Native Tribal Health Consortium and Southcentral Foundation, covers more than 3,300 employees at 22 buildings in Anchorage and across the state. The hospital and nearby clinics see some 600,000 patient visits a year. Patients often come from outside Anchorage and travel with family.

Other big employers are watching. Providence Alaska Medical Center and Alaska Regional Hospital are considering following suit, representatives said. The goal at the Native medical center isn't just to clear the air. It's to get employees and patients to quit smoking and chewing, said Don Kashevaroff, board chairman and president of the health consortium.

As at many other Anchorage workplaces, it's easy to find clusters of smokers outside the hospital in designated break areas, even when it's freezing. Some of them said the new rule is an incentive to quit. Others think it goes too far.

Research suggests that more than half of Alaska Native adults smoke or chew, according to Caroline Cremo Renner, nicotine research and control program manager with the health consortium. That's more than any other ethnic group in the country. In some places in the state, tobacco use is even more prevalent. For example, in Barrow, as many as 75 percent of adults use tobacco. Cancer is the leading cause of death among Alaska Natives. Lung cancer is the biggest killer, she said.

"We weren't having a problem with people smoking in the building," Kashevaroff said. "We were having a problem with people smoking in the first place and chewing."

Employees must follow a stricter code than patients. They can't come to work smelling like cigarettes or have tobacco products showing in pockets. Repeated violations could mean discipline or potential dismissal, officials said. Based on statewide trends, as many as a third of employees are tobacco users, Cremo Renner said.

The hospital plans to promote a quit-tobacco program aggressively for staff, patients and visiting family members, offering free education, counseling, follow-up and several types of nicotine replacement therapies, like the patch and gum, and the prescription medication Zyban.

Smoking is illegal in hospitals, schools, grocery stores and government offices under state law. In Anchorage, city ordinance prohibits smoking in most workplaces and enclosed spaces. New restrictions passed by the Assembly last summer will make smoking illegal in bars, bingo halls and within 50 feet of hospitals. Those go into effect next July.

Some smaller health-care facilities around the state have banned smoking on their property. But the new ban will be the most far-reaching, Cremo Renner said. Hospitals from Florida to Washington have instated similar policies in recent years.

"We want to change a mind-set," said Ileen Sylvester, Southcentral Foundation vice president of executive and tribal services. "It's going to change expectations."

About 140,000 Alaska Natives are eligible for care at the hospital. Kashevaroff hopes the ban will send a message to the Native community.

"They are going to know that when they go to Anchorage, they aren't going to be able to use tobacco when they are getting their health care," he said.

Health care costs were another reason for the ban, he said. Tobacco-related cancer and other health problems, like heart disease, are on the rise among Natives, many of whom receive free health care paid for by the federal government through the Indian Health Service. As the number of illnesses increase, so does the cost of treatment, Kashevaroff said.

"We have a fixed amount to serve everyone," he said. "Now more and more people are getting cancer."

Outside the building Wednesday, where smokers savored their cigarettes in a subzero wind, the ban did not enjoy much support. Many had doubts about how it would be enforced.

Marge Trigg and her daughter Debi Johnson of Nome smoked with Trigg's teenage granddaughter Deilah Johnson of Wasilla. Trigg expects to be in Anchorage for treatment until December. The ban is a violation of rights, especially the part about not smoking in the car, Trigg said.

"We don't smoke in the building; we go to the designated tobacco area," she said.

"If anything, it makes me want to smoke more," Debi Johnson said.

Jason Atuk, a hospital office specialist, took a more optimistic approach.

"I do plan to try to quit," he said. "In the end, it's a good thing and I shouldn't resent it."

Another smoker, Marcia Sundquist, an endoscopic technician, puffed in her scrubs and lab coat.

It is going to be hardest with elders, she said. Already, she'd heard one old woman talking about defying the ban.

"She said she was going to go to chew and do it in the room," Sundquist said.

Sundquist plans to quit, starting today. So does Selma Oskolkoff-Simon, another office specialist.

"I had a brother who passed away in 2002 of lung cancer right in here, in this hospital," she said, her eyes welling.

She told everyone she knows that she's quitting and hopes they'll help her stick with it.

"I do have a concern about not even smelling like smoke because in my home I live with three smokers," she said, echoing a common complaint in the smoking area. "I'm going to carry a bottle of Febreze everywhere."

Lakota Murray, the hospital's program manager for health promotion and disease prevention, said the process of weaning the community from tobacco wouldn't be an easy one.

The hospital will repeatedly remind patients who cause infractions and provide them with information, she said.

"Making a decision to create change is never easy; however, this is the right decision to make," Cremo Renner said. "People will eventually become used to this like they did on public transportation."

Daily News reporter Julia O'Malley can be reached at jomalley@adn.com or 257-4325.

THE ALASKA NATIVE MEDICAL CENTER BY THE NUMBERS

Number of buildings: 22

Number of employees: 3,368

Number of outpatient visits: 600,000

Number of Alaska Natives eligible for care: 140,000

Source: Gary Chythlook, public relations manager, Alaska Native Medical Center