The rate of cigarette smokers in rural northwest Alaska topped the charts when compared to all other counties around the United States for 2012, according to a recent study from the University of Washington.
Researchers from the university's Institute for Health Metrics and Evaluation dissected data from the annual telephone health survey conducted by the U.S. Centers for Disease Control and Prevention and stratified it based on county and sex for 17 years from 1996 to 2012.
"When you look at it county by county you see the disparities," said Ali Mokdad, a researcher and professor of global health at the university.
Mokdad and his team found that the Northwest Arctic Borough had the highest rate of smokers in the United States, estimating that about 41 percent of males and females regularly used cigarettes in 2012, double the percentage in Anchorage and Fairbanks. The North Slope Borough, Wade Hampton census area and Nome census area did not fare much better -- between 35 and 41 percent of the populations identified as smokers.
Michelle Woods, district coordinator with the Northwest Arctic Borough School District, said she's not surprised. In Kotzebue, she smells stale smoke when standing in line at the post office, walking to the grocery store and working in the classroom.
"It's just horrific out here. It seems like everyone and their brother is doing it," she said. "There's just so much smoking, and it's so gross."
Nearly 7,800 people live in the Northwest Arctic Borough, an area slightly smaller than the size of Indiana that sits along the Kotzebue Sound.
An annual grant from the state Department of Health and Social Services of about $375,000 funds the borough's tobacco prevention program run by the tribe-operated Maniilaq Association, said Elmer Howarth Jr., the association's tobacco prevention manager.
About 912 people have joined the association's cessation program since 2009, Howarth said.
He and Don Fancher Jr., tobacco prevention coordinator, said that in Kotzebue and surrounding villages, many people still consider smoking cigarettes "the norm" and that's something they're trying to change.
They have posted metal signs around the borough that read: "Help protect the air out of respect for elders and love for children and nature."
"We hold on to our culture a lot, " Howarth said. "So it's kind of weird because our culture didn't include tobacco."
About one in three Alaska Native adults smokes, compared to one in five non-Native adults, according to Alaska Tobacco Facts 2014, a statewide report from the state health department.
In Alaska, the Legislature has not enacted a statewide smoking ban, although local smoke-free workplace laws cover about 50 percent of the population. Since 2012, 11 of the 12 tribal communities served by the Maniilaq Association passed workplace smoking bans, Fancher said.
That doesn't mean people have put out their cigarettes.
"Cigarette smoking in Kotzebue is pretty high. It's sad to say," Fancher said. "For males, you see a lot of men smoking. I would probably see seven out of 10, or maybe six out of 10 or so men walking down the road or driving with a cigarette. For women, it's a little less."
In Alaska, adult cigarette consumption declined by 57 percent between 1996 and 2012 with 453 million fewer cigarettes sold, said the state report.
Still, the report said more Alaskans die annually from the direct effects of tobacco use than from suicide, motor vehicle crashes, chronic liver disease, cirrhosis, homicide, HIV/AIDS and influenza combined.
Beside smoking, health officials also link the deaths to chewing tobacco and iqmik -- a mix of punk ash and tobacco used like chew and popular in the Yukon-Kuskokwim Delta. While the university research only charts cigarette smoking, state data shows that the rate of smokeless tobacco is highest in Southwest Alaska, where about 21 percent of people say they use it.
To combat tobacco use, the Legislature funnels money into the state health department's Alaska Tobacco Prevention and Control Program. The budget signed by Gov. Sean Parnell in March includes nearly $10.4 million for the program, about $750,000 less than last year. That funding comes from the Centers for Disease Control and Prevention, tobacco taxes, the state's general fund and the Tobacco Master Settlement Agreement, a Medicaid payment lawsuit involving 46 states and the big four tobacco companies. The companies agreed to curb deceptive marketing and pay, in perpetuity, billions of dollars to the states.
The Tobacco Prevention and Control Program disperses about half of its budget to 28 agencies across the state in 15 grants, said Alison Kulas, program manager.
The Nome Community Center received $375,000 for fiscal year 2014. Nearly 36 percent of women and 38 percent of men smoked in the city of about 3,600 in 2012 , said the University of Washington research published in March.
Amber Otton, a tobacco prevention and control specialist with the community center, said what she finds most troubling in Nome is the number of young people smoking cigarettes or chewing tobacco.
She recently spoke at a village high school to a group of about 50 students.
"I asked them, 'How many of you guys smoke or chew?' " she said. "Only three kids didn't raise their hands."
Reach Tegan Hanlon at firstname.lastname@example.org  or 257-4589.
By TEGAN HANLON