Exposure to secondhand smoke contributes to the deaths of 41,000 nonsmoking adults and 400 infants in the United States each year.1 Children exposed to secondhand smoke are at higher risk for serious health conditions, including Sudden Infant Death Syndrome (SIDS) and respiratory diseases. Smoke-free environments are vital to children's health and well-being, yet close to 40% of U.S. children ages 3 to 11 are exposed to secondhand smoke.2
The state of Alaska faces unique challenges in protecting children from the harmful effects of secondhand smoke. While the overall adult cigarette smoking rate in Alaska is 19%, the rate for Alaska Native adults is nearly 40%.3 This disparity puts children in many Alaska Native communities at higher risk for secondhand smoke exposure.
Since 1994, the Alaska Tobacco Prevention and Control Program (TPC) has worked to promote smoke-free environments and protect all children in Alaska from the negative health effects of secondhand smoke. Cheley Grigsby, TPC Program Manager, says the program takes a tailored approach to tobacco prevention in local communities. “One size doesn’t fit all here,” she explains. “Every community is different, and they all have different challenges.”
Reaching Rural Areas Through Local Grantees
Alaska is a large state with a small population, and a lack of public health and transportation infrastructure can complicate outreach efforts. “Only 3 communities in Alaska have over 10,000 people,” Grigsby explains. “Most of our communities are very small and rural.” Common public health education strategies, like media campaigns, don’t always work in areas where people may not have access to broadcast television.
To reach rural areas, TPC relies on a network of grantees. “We find grantees in local communities to help us do needs assessments and determine which evidence-based strategies are most appropriate.” Grigsby emphasizes the need to work with local partners. “Our reach as a program simply can’t happen without our community grantees.”
Grantees work to effect policy change at the state and local level. “They approach community leaders to talk about the health burdens of tobacco use and try to change the culture. Changing policy is really the only way to impact some of our smaller communities,” Grigsby says.
Promoting Smoke-Free Policies in Housing and Schools
In addition to promoting tobacco cessation support resources like the Alaska Tobacco Quit Line, TPC takes a multi-faceted approach to promote smoke-free indoor environments. Two main strategies focus on smoke-free policies in multi-unit housing and in schools.
Because most childhood secondhand smoke exposure takes place in the home, 4 smoke-free housing policies are an important prevention strategy. TPC partners with the American Lung Association of Alaska and the Alaska Tobacco Control Alliance to promote smoke-free multi-unit housing, including an online tool to help renters find smoke-free units.
Policies that prohibit the use of tobacco products on school property are another key way to prevent secondhand smoke exposure and change the culture around tobacco use. Local grantees approach schools to help them implement or strengthen tobacco-free policies and programs, like peer-to-peer mentorship. TPC also does outreach work to help pregnant women stop using tobacco products and provides technical assistance to programs like Head Start, helping them teach parents about the benefits of smoke-free environments.
Meeting Alaska’s Unique Challenges
Eliminating the disparity in cigarette smoking rates among Alaska Native populations is a priority for TPC. The program partners with the Alaska Native Tribal Health Consortium to coordinate outreach efforts in rural communities. One TPC staff member also works full time to help grantees engage tribal elders, whose support is critical to facilitate policy change in Alaska Native communities. Of the 229 Alaska Native tribes, 136 have adopted tobacco-free policies so far.9
Remote areas pose special challenges. One health center in a rural Alaska town might serve residents from over 50 villages who can only reach the town by boat or snowmobile. Rural residents often rely on community health workers as their main source of health care. As a result, some communities don’t have local grantees. “It can be hard to find people with the right background and expertise to partner with in these smaller communities,” Grigsby says. “So we provide a lot of training and support.”
Grigsby acknowledges that smoke-free policies can be a tough sell in these communities, where as many as 4 in 10 adults smoke cigarettes. “We’re asking our partners to advocate for these changes when all of their friends, siblings, and parents smoke. It can be a hard job.”
But Grigsby remains optimistic. “We’ve seen some really big successes. Our statewide smoking rate is declining, and data continue to show that fewer children are exposed to smoke at home. That tells us the grantees are doing great work.”
Looking Ahead to a Smoke-Free Alaska
One item on Grigsby’s wish list is a statewide smoke-free law. “Most voters are in Anchorage, which has a municipal smoke-free policy,” she explains. “They don’t even realize that there’s no state-level law.” With help from partners like Americans for Nonsmokers’ Rights, Grigsby hopes that will change soon.
Grigsby is also encouraged to see health care centers working to implement health system change. Alaska’s Federally Qualified Health Centers (FQHCs) have shown interest in improving tobacco cessation efforts in their communities. “We’ve moved beyond policy and we’re starting to see some real changes in the health care system, as well.”
In the coming year, TPC plans to focus on preventing tobacco use initiation in middle and high school students—and reversing the rise of e-cigarette use. For Grigsby, tobacco prevention in Alaska communities comes down to collaboration. “What’s most rewarding about this work is identifying new partners and looking for opportunities to build on each other’s strengths.”
1 https://www.cdc.gov/tobacco/basic_information/secondhand_smoke/index.htm
2 https://www.healthypeople.gov/2020/data-search/Search-the-Data#objid=5296
3 Alaska Tobacco Facts 2017, Alaska BRFSS combined file 2013–2015
4 https://www.cdc.gov/tobacco/basic_information/secondhand_smoke/children-home/index.htm
5 Alaska Tobacco Facts 2017, Alaska BRFSS combined file 2013–2015
6 Alaska Youth Risk Behavior Survey 2017
7 Data provided by Alaska Tobacco Prevention and Control Program.
8 Alaska Tobacco Prevention and Control Program Annual Report 2017
9 Alaska Tobacco Prevention and Control Program Annual Report 2017
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