Native Americans and Lung HealthThe American Lung Association honors the first inhabitants of what became the United States, including American Indians, Native Hawaiians and Alaska Natives.
In recognition of Native American Heritage Month, the American Lung Association takes a look at the history of this awareness month, key cultural facts surrounding Indigenous Peoples and lung health issues impacting Tribal communities. We are also proud to present our “Spotlight Series” of partners across the country who make considerable impacts to the Lung Association’s mission and who have contributed to the effort to eliminate lung disease in their communities as well as lung health resources pertinent to Indigenous communities.
Clean air is essential to health. Yet more than four in ten Americans are still breathing unhealthy air, and the burden is not evenly shared. Air pollution can compound the health impacts of respiratory diseases like asthma and COPD, which are often more common in Indigenous Peoples. For example, air pollution can be a trigger for asthma attacks and asthma rates are higher among American Indian & Alaskan Native populations.
Air quality near many Tribal Nations is often not monitored. Historically, reservations were forced into areas less desirable to expanding white settlers, which today means many are in remote rural locations. Conversely, regulatory air monitoring often occurs in larger centers of states. To address this disconnect, some Tribal Communities have begun their own air monitoring program and many are members of the National Tribal Air Association (NTAA).
The NTAA publishes the annual Status of Tribal Air Report to help Tribes and the public understand and use the latest scientific evidence to protect their people and advance air quality. In 2020, the NTAA also released a white paper detailing the Science and Connections Between Air Pollution, Tribes and Public Health. Many of the metropolitan areas with the highest populations of American Indians and Alaska Natives, such as Phoenix, Los Angeles, Seattle, Denver, and New York, are listed on our “State of the Air” most polluted cities.
Wildfires continue to be a large concern to air quality in Indian Country, according to the Status of Tribal Air Report. The hotter temperatures and dryer conditions have led to wildfires on or near Tribal lands. Preparing for, defending against, and cleaning up after catastrophic wildfires have strained Tribal budgets. The financial impact of wildfires is also exacerbated given the health impacts that Indigenous Peoples face due to high levels of smoke inundation into the effected communities2.
Smokefree Tribal Casinos
The American Lung Association advocates for commercial casinos to be included in state smoke-free air laws and for tribes to choose to operate casinos located on their sovereign tribal lands smokefree. Everyone deserves the chance to lead a healthy life, and that means having a safe work environment free from the health harms associated with secondhand smoke. According to the U.S. Surgeon General, there is no safe level of exposure to secondhand smoke.
Secondhand smoke causes lung cancer and heart disease and worsens existing health conditions, including asthma and COPD; it is also a risk factor for susceptibility to more severe COVID-19 symptoms. As of October 2022, more than 1,000 casinos and gaming facilities are 100% smokefree, including at least 151 operating on Tribal lands.
Lung Health and the Indigenous Community
In partnership and with funding from the U.S. Department of Housing and Urban Development, the American Lung Association conducted a study to determine the impact of indoor air quality on Tribal elders with COPD. Partnering with several Tribal communities in the Upper Midwest including Pine Ridge, Standing Rock, Cheyenne River, Fond du Lac, and others. The Lung Association assessed the homes of 120 Tribal elders, identified conditions which might contribute to poor indoor air quality, and made remediations to those home conditions.
The American Lung Association’s Enhancing Care for Children with Asthma’s quality improvement initiative works with primary care clinics to ensure guidelines-based care. The Lung Association has been privileged to partner with several Indian Health Service clinics, including Gallop, Shiprock, Alamogordo, Four Corners (Red Rock), and the Oklahoma City Indian Clinic and Indian Health Board in Minneapolis. Find out more about this program at Lung.org/EnhancingCare.
Lower Kuskokwim School District, Alaska
The Lower Kuskokwim School District is a sprawling rural school district located in southwestern Alaska that is comparable in size to West Virginia. The district is made up of 27 schools and has a total enrollment of just under 4,000 Yupik Eskimo students. The only way to travel between schools is either by bush plane, boat, or snowmobile.
The region is known for a spit tobacco called Iq’mik which is made from the ashes of a tree fungus, leaf tobacco, and coffee. Alaska Native children in the area are often introduced to this unique form of tobacco at a very early age and it is not uncommon to have children as young as five struggling with addiction to Iq’mik.
With school district tobacco policy violations increasing, the district was looking to replace suspension with a more restorative approach. The district decided to pilot the American Lung Association’s Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health (INDEPTH) as an alternative to suspension at Bethel Regional High School. Trained facilitators from the Yukon-Kuskokwim Health Corporation are currently offering the classes, supported by local Alaska American Lung Association staff. Principal Alicia Miner said she hopes INDEPTH will eventually replace suspension as the school’s preferred tobacco policy violation response. Learn more about this effort here.