BEND, Ore. - At 10 years old, Trish Ulyatt would stroll into Redmond convenience stores to buy a carton of cigarettes.
More often than not, she'd walk out with the smokes under her arm, thanks to a self-written note claiming they were for her mother.
Now, as an adult living in the southwest Bend suburb of Deschutes River Woods, reformed smoker Ulyatt says things have changed in Central Oregon.
But the mountain biking mecca image that Bend projects is not entirely representative of the region. Smokers still feel very much at home there.
A recent survey of roughly 4,000 Oregonians, partially funded by OPB and Oregon Health Sciences University, found that 11 percent of Central Oregonians self-identify as regular smokers.
On average, only 7 percent of Oregonians in other regions of the state say they smoke cigarettes regularly, according to the study.
The numbers highlight a stark contrast between the healthy living image of Bend and the realities of the region.
"Prineville is very different from Bend," said Carly Rachocki of Crook County's Health Department. "We have one bike path in town, and it doesn't connect to anything."
Ulyatt — a cruise ship musician who smoked for 20 years before quitting — knows that difference between Bend and the rest of Central Oregon all too well.
"It's rare to see smoking downtown," Ulyatt said. "In the outskirts, it's just normal."
And the farther from the brewpubs and bike stores in downtown Bend one goes, the more smoking and tobacco use increase.
County statistics show Deschutes County has an adult smoking rate of 14 percent. Jefferson County trends higher at 15 percent, and the largely rural Crook County comes in at 17 percent — higher than Oregon's smoking average.
"We have a cowboy culture here that historically has embraced smoking and especially smokeless tobacco," said Kris Williams, who works on tobacco cessation for the Crook County Health Department.
Shoestring resources also contribute to contrasts in smoking rates between Bend and the rest of Central Oregon.
The Bend Memorial Clinic offers free counseling services to people who want to quit, but it's the only such program in the region. Elsewhere, smokers have to pay for classes on quitting or rely on Oregon's smoking cessation hotline.
Oregon spends around $7 million a year on tobacco cessation programs, far short of the Centers for Disease Control's recommended $43 million.
Ultimately, the Central Oregon culture around teen tobacco use could be the biggest hurdle to stamping out smoking there.
Deschutes County has one of the highest rates of 11th-graders smoking in the region. County data shows 20 percent of juniors there smoke. The state average is just 12 percent.
Anne Palmer, who runs Bend Medical Clinic's quitting service, attributes that spike to economic struggles for many in Central Oregon, permissive attitudes toward tobacco and alcohol use, and the rising popularity of electronic cigarettes.
E-cigarettes look and feel like real cigarettes, but vaporize liquid nicotine cartridges rather than burn tobacco leaves.
Supporters say they're a safe alternative to cigarettes that can help people quit.
Palmer says they're little more than a gateway to real cigarettes, and she's never seen anyone quit using them.
"The fact that Big Tobacco has enthusiastically entered the e-cigarette market is another cause of considerable concern," Palmer said.
Currently, e-cigarettes are mostly unregulated in Oregon, meaning a child of any age can technically buy them. They also come in flavors like cherry and bubblegum, which Palmer says are targeted toward children.
"I think it's unfortunate that just as smoking was waning in its cool factor, here comes e-cigs," she said.
Health professionals in the region are fighting back, however.
In Crook County, they've made some inroads by targeting an influx of new health care professionals to the area. Reaching out to health care professionals, Williams said, has shown effectiveness at turning people away from tobacco because people tend to trust their nurses, doctors and dentists when it comes to health matters.
And that single bike trail in Prineville? The area is actively working toward more bike and pedestrian paths in the future.
Progress also can be seen in Ulyatt's own neighborhood.
When she moved to Deschutes River Woods in 2001, nearly everyone smoked. They'd have weekly "hangouts" and smoke around a campfire.
When Ulyatt quit in July, however, she was the second-to-last holdout amongst her neighbors.
She said Bend's effort to "get out of the smoker's lounge" helped her, through simple peer pressure.
"Everyone kind of wants to fit in and I think that's why people start when they're younger," Ulyatt said. "But now everyone is quitting, so that's the thing people do to fit in. I know I want to fit in that way."