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Tobacco-Free Alaska > Community Spotlight > October 2016

October 2016 Community Spotlight:
Yukon-Kuskokwim Health Corporation Raises the Bar on Tobacco Prevention

YKHC partners with Alaska’s Tobacco Prevention and Control Program and starts several efforts to prevent tobacco use and promote tobacco cessation

Tobacco-Free Alaska - Community Spotlight on YKHC Partner for Cessation - October 2016

Throughout Alaska, community and tribal policies are directly reducing the health risks of tobacco by helping people quit tobacco use, prevent adults and children from starting tobacco use, and reduce exposure to the toxins in secondhand smoke.

The Yukon-Kuskokwim region in Southwest Alaska is one of the largest geographic regions in the state that faces challenges related to traveling from community to community due to difficult weather, the lack of roads and cost for airfare. The Yukon-Kuskokwim Health Corporation (YKHC), headquartered in Bethel, is striving to overcome those challenges and implement key efforts to reduce or eliminate the leading cause of death and disease in Alaska – tobacco use.

YKHC’s Role in Improving Healthcare, Tobacco Prevention

Bethel is a regional hub that serves 56 communities, each with a federally recognized tribe. The tribes have authorized YKHC to act on their behalf to provide health care services under the Indian Self-Determination and Education Assistance Act of 1975. YKHC’s health care system—including village clinics, sub-regional clinics, and a regional hospital in Bethel — provides primary health services, dental and eye care, mental health services, substance abuse counseling and treatment, health promotion and disease prevention programs, environmental health services and more.

Since 2008, YKHC has received financial and staff support from the State of Alaska Tobacco Prevention and Control (TPC) program through the Community-Based Prevention Grant Program. YKHC’s Tobacco Prevention program is committed to implementing proven methods to prevent the initiation of tobacco use among youth and young adults, eliminating exposure to secondhand smoke, and making it less socially acceptable to use tobacco.

Reducing Tobacco Use

YKHC and its partner — a local tobacco prevention coalition called the Delta Tobacco Control Alliance (DTCA) — have made significant progress passing policies that reduce tobacco use and increase tobacco’s price:

  • In 1998, Bethel was the first community in Alaska to pass a local workplace ordinance that banned smoking inside workplaces and eliminated exposure to the toxins in secondhand smoke.
  • Bethel was also the first rural community to enact a local price increase on cigarettes and other tobacco products, motivating several other communities to follow suit.
  • YKHC is the health corporation that has produced the highest number of tribal smokefree or tobacco-free policies in the state, despite serving a large number of tribes and its geographic challenges.

The YKHC Board of Directors recently approved the addition of a sixth ‘Napartet’ (means pillar in Yup’ik), the organization’s strategic plan known as Healthy People. This strategic initiative prioritizes population health improvements, specifically aiming to reduce tobacco use among youth and young adults and improve oral health in the YK region.

YKHC enhanced its Brief Tobacco Intervention model by improving RAVEN, YKHC’s electronic health record system to screen for tobacco use, advise quitting and refer patients to their tobacco cessation program. This model puts emphasis on two products that have high use in the region: commercial smokeless tobacco and Iqmik (a homemade mix of tobacco leaves and burned tree fungus ash that is highly addictive due to its ability to increase available free nicotine to nearly 100 percent).[1]

Increasing tobacco cessation referrals and creating a tobacco-free campus

The Brief Tobacco Intervention is an evidence-based approach that ensures each patient is screened for tobacco use and history, advised to quit, and referred to a cessation counselor. All YKHC cessation counselors are fluent in both Yup’ik and English so they can provide effective services to anyone in need. Customizing the Electronic Health Records system allowed for faster, nearly automatic referrals to these counselors. This significantly increased cessation referral rates.

Before customizing the Electronic Health Records system, reports showed only 20 cessation referrals each month. Cessation referrals jumped to 119 within the first month of changes to the records system, and 209 in the second month after changes. Total referrals have since tapered off to an average of about 160 per month.

YKHC also has strengthened its tobacco-free campus policy, both in Bethel and in the surrounding 56 village clinics. YKHC has established a task force to update its existing campus policy so that it will consider the local cultures, vast geography, and the multiple locations throughout the YK Delta that house and care for residents.

YKHC is committed to reducing the high rates of tobacco use in the YK region. It is one of six public health regions in the state that partner with Alaska’s TPC program to reduce tobacco use and promote cessation. To learn more about these partnerships, visit

  1. Angstman, Patten et al., Am J of Health Behav. 2007;31(3):249-260