Carl Case Study

1. Overview of Carl's Situation

Carl is a 42-year-old Yupik male who is married with four kids; lives with his family and his mother; college graduate; and is the tribal council chief of his village. His wife does not smoke or chew. His mother quit chewing iqmik years ago when she began suffering from dementia. Carl knows that his oldest daughter is smoking and that his oldest son is chewing. Carl does not smoke and never has tried any other forms of tobacco.

The information below from the Yukon-Kuskokwim Health Corporation provides a quick review of iqmik.

2. History with Iqmik

Carl started chewing iqmik at four years old when he premasticated tobacco and ash for his grandfather and father. Everyone in his village chews iqmik and he was raised with it and no negative cultural connotations were involved with its use. In fact, one of the gifts Carl received at his birth was iqmik.

All of his siblings and relatives have chewed iqmik but Carl has noticed over the years that most of them have quit, moved onto cigarettes, or have become ill. Carl is still ambivalent about the negative use of iqmik but has been contemplating quitting since his father's death from heart attack. However, he has started chewing more since his father’s death, his mother's illness (forcing her to move in with him as the caretaker), and because his job has become more demanding. He previously chewed 4-5 times per day. Now he 10 chews times a day.

3. Consequences for Carl

Carl is considering setting a quit date a month from now to give it a try. Carl reports past issues with coronary artery disease, a slight heart attack in the past year, sores in mouth, shortness of breath, and coughing. Recently, Carl has noticed that the sores in his mouth seem to be making his tongue raw as well. Carl remembers his tongue feeling “weird” when he was younger and is feeling that again since he has increased the amount he chews. Carl tries to exercise regularly be it chopping wood or in the form of other work around the home. He states that if he could lose 10-15 pounds he’d be happier. Carl does not report depression but feels some anxiety from time to time. Carl does not bring this up with his doctor because he does not want prescription medicines. He does not drink alcohol.  Carl has never tried to quit.

4. How and Why Carl Uses iqmik

Carl uses iqmik throughout the day but mainly when he is thinking, feeling anxious, wanting to cheer up, focusing, hunting, and when he simply wants something in his mouth.  Carl is stressed as the sole provider and caretaker of his household and as a political figure and role model in his village. He feels a lot of pressure to be the best that he can be and not let anyone down.

Carl is internally struggling with the decision to quit. He feels iqmik is a part of him, his culture and it ties him to his father and grandfather. He remembers happy times with them while sharing iqmik. Carl does not want to lose his sense of self or culture but he is worried about his health and the health of those around him. Carl heard of the program from a nice woman from ANTHC who was doing outreach in his village.

5. Data

The main reasons that Carl is ambivalent about quitting are:

• Iqmik has been an integral part of life and culture

• It is what he has known for almost forty years

Importance level is 7/10 and Confidence is 6/10 because he just not sold on the idea of quitting or getting help.

Fagerstrom:

Chew: 9/10

Chews within 5 mins of waking

Sometimes swallows the juices when in meetings or conversation

Hates to give up 1st morning chew

Chews more than 3 a day

Chews about the same throughout the day and does not chew when he is ill.