Alana Kronstal's new public awareness campaign aims to cut Nunavut's sky-high smoking rates.

On the streets of Iqaluit, cheery Alana Kronstal is known as “the tobacco lady.” Young and old, everyone seems to know the 31-year-old, who is leading the charge against smoking in Nunavut, home of the highest smoking rates in Canada. “Nowhere in Canada has a campaign been launched starting with such a majority of smokers,” Kronstal says. “We’re trying to do something that hasn’t been done yet.”

The statistics are staggering when compared to the rest of the country: according to Statistics Canada, 53 percent of the Nunavut population smokes and private studies cite numbers as high as 70 percent among the territory’s predominantly Inuit population. Children as young as two pick butts off the street to imitate their parents. Studies show up to 80 percent of the territory’s pregnant women smoke.

Luckily for the anti-smoking faction, the federal government has granted Kronstal and her team $700,000 for a new public awareness campaign. Tentatively called Tobacco Has No Place Here, the PSA will focus on challenging the cultural norm of smoking in Nunavut. Kronstal’s team has hired two firms (one local) to grab the territory’s attention through social media buzz, YouTube vignettes, community feasts during the campaign’s rollout in January, an art installation in Iqaluit, and more.

“We’re a small community spread over a vast landscape. People know each other well,” says Kronstal, who has worked on smaller-scale campaigns in the Northwest Territories. “If we share personal stories, put a face to this issue, celebrate individuals who’ve successfully quit smoking, we’re getting somewhere.”

While sky-high lung cancer and tuberculosis rates are often overshadowed by Nunavut’s other struggles—high suicide rates, substance abuse, isolation, and poverty—Kronstal believes her campaign can change lives: “It’s having a very real impact on people’s health and the life expectancy of an entire population.”

Nunavut’s campaign is currently partially funded under the Federal Tobacco Control Strategy. Since the strategy launched 10 years ago, nationwide smoking rates have dropped to 21 percent, leaving the government to wonder if it still needs to invest in getting people to quit. The funding strategy is currently up for renewal, and Kronstal isn’t sure what will happen in Nunavut if it’s canned. “Is it a done deal now? Obviously for some of the provinces, the issue [of smoking] has changed,” she says. “But for people in Nunavut, it’s not a dead issue. It’s not an issue that’s been solved yet.”

Leonardo DiCaprio enjoyng an e-cigarette in March 2009. The electronic cigarettes are touted as a quitting aid.

E-cigarettes are battery-powered devices that detect the user’s pull and vaporize a nicotine solution that recreates the smoking experience without carcinogens, odour, ashes, stubs, or even litter. Without the 4,000 chemicals added to a traditional burning cigarette, pure nicotine is a relatively harmless drug that’s often compared to caffeine.

Developed several years ago in China, the product didn’t sell much in Asia (a real pack of Chinese smokes costs a mere 40 cents) and was largely ignored in North America. But that all changed in March, when the luscious pout of Leonardo DiCaprio was photographed taking a drag off an e-cigarette. This was great news for Bill Marangos, president of SmokeStik International and maker of the actor’s e-smoke of choice. Before that moment, he says, “98 percent of people didn’t know about this product.”

But with this publicity, however, came some unwanted attention. Pressured by special interest groups, Health Canada—previously wary to even classify the product— cracked the whip in March with an advisory. Since they contain nicotine, SmokeStiks and all other e-cigarettes now require approval under the Food and Drugs Act, and so these products are currently off the market while they undergo Health Canada’s nearly year-long new drug review.

Without their fix, e-smokers are again jonesing for a working quit-aid. Marangos—a former three-pack-a-day smoker—claims SmokeStik’s success rate to be 10 times the measly 5 percent norm, though without any peer review studies available, it’s possible Marangos is just blowing smoke.

So e-cigarettes’ effectiveness as a quitting tool is currently debatable, says Jeff Daiter, chief medical director at Ontario Addiction Treatment Centres. But, he explains, “maybe it’s better than the patch or gum because you get the sensation.” He’s excited to incorporate a nicotine-free version of the device into his addiction research. “The deck is stacked against smokers,” he adds. “Anything we can do would be great.”

In the meantime, e-smokers will have to quit—or keep smoking—the old-fashioned way.

When Lusaka went smoke free, they really went smoke-free. Photo by Michael Musenga.

As the wheels hit the hot asphalt of the runway, I look up to see the frenetic expressions on the faces of my fellow passengers—a look that falls somewhere between anxious and anaphylactic, and it’s clear they’re desperate to get off the plane. It’s been a short and relatively painless flight from Nairobi, Kenya, to Lusaka, Zambia, our final destination. But these people obviously need a cigarette. Once nearly ubiquitous, smoking has been on the wane, particularly in Canada, where it seems new antismoking legislation comes into effect almost biweekly. First it was bars, then restaurants. Now even some patios are off limits to those who like to suck back thick blue smoke in the great outdoors.

There are new no-smoking laws cropping up in nearly every country, from Argentina to right here in Zambia. The developing world has been the tobacco industry’s cash cow for years now, as cigarette companies have replaced lapsed smokers in the United States, Canada, and Europe with millions of new ones in Asia and Africa.

Zambians aren’t much for smoking, actually: about 22 percent of Zambian adults light up, about the same as Canada—but Zambia’s anti-smoking laws are a lot more stringent. When I arrived in Lusaka, a new public smoking ban had been in effect for a little more than a month. On the surface, the ban is similar to legislation you might find in any other country in the world: smoking is prohibited in public spaces, and failure to comply is punishable by a fine of 400,000 Zambian kwachas, or around $100 (roughly the average monthly income in Zambia) and up to two years in prison.

But in Zambia the term “public space” has been left entirely open to interpretation. In fact, any public space under the jurisdiction of Zambian law must adhere to the new smoking ban. This includes restaurants, bars, and shopping centres, but also open-air markets or parking lots—effectively any space outside of your own home. The ban is further complicated by the fact that it may be enforced not only by police officers, but also “complainants,” essentially any civilian who finds your smoke offensive and decides you’re violating the law. A spokesperson for the Lusaka city council went so far as to suggest that the law might be enacted retroactively against a person who still had the lingering smell of cigarettes on him or her, even if he or she weren’t actually smoking.

I don’t smoke, but a straw poll of friends and colleagues who do suggested they were confused and concerned. The police themselves, who are tasked with enforcing the new law, have few directions as to what constitutes a “public space.” Smoking friends worried they may have to pay a “fee” (in reality, a bribe) to avoid arrest. It remains to be seen whether the new law will improve the health of Zambian citizens, but it certainly means my fellow plane passengers will have a while yet to wait before crossing the tarmac, claiming their bags, leaving the airport, and finding a secluded place to furtively strike a match.

Four of the country’s 16 medical schools admitted to accepting research-targeted grants between 1996 and 1999, and three said they accepted donations, which are not tied to specific research projects. The average grant was for more than $160,000, while the average donation came in at $18,000. “It’s not surprising that the tobacco industry gives money to medical schools,” says Joanna Cohen, the study’s principal researcher. “I am disappointed that the medical schools would actually take the money.”

The figures might actually be much higher considering five medical schools refused to disclose financial information.

Cohen can’t name the schools that admitted to accepting the cash because researchers promised respondents they would remain anonymous. “Anonymity is a common research practice as far as individuals are concerned, so we decided to extend this to the universities, to take all precautions to get the best results.”

None of the schools that participated in the study has a policy preventing it from accepting money from the tobacco industry. Cynthia Callard, executive director of Physicians for a Smoke-Free Canada, says that’s a huge problem and something medical schools have to change soon. “It was a little bit of a hidden issue,” says Callard. “But now it’s been brought to light and something should be done about it.”

In Australia, 70 percent of medical faculties have policies against accepting tobacco funds. Unfortunately, things do not seem to be moving very quickly here in Canada. Audrey Cheung, director of research grants at U of T, says the school has no policy regarding the acceptance of tobacco funding, nor does the university plan on adopting a ban. “I’m not aware of any move in that direction,” she says, “either at the university or at the faculty level.”