Native American Heritage Month

The 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.

What started at the turn of the century as an effort to gain a day of recognition for the significant contributions the first Americans made to the establishment and growth of the U.S., has resulted in a whole month being designated for that purpose.

In 1915, the annual Congress of the American Indian Association meeting in Lawrence, Kansas, formally approved a plan concerning American Indian Day. Congress president, Rev. Sherman Coolidge, an Arapahoe, later issued a proclamation on Sept. 28, 1915, which declared the second Saturday of each May as an American Indian Day and contained the first formal appeal for recognition of Indians as citizens.

The year before this proclamation was issued, Red Fox James, a Blackfoot Indian, rode horseback from state to state seeking approval for a day to honor Indians. On December 14, 1915, he presented the endorsements of 24 state governments at the White House. There is no record, however, of such a national day being proclaimed. The first American Indian Day in a state was declared on the second Saturday in May 1916 by the governor of New York.

In 1986, President Reagan proclaimed the week of November 23-30 as "American Indian Week." In 1990, George H. W. Bush approved a joint resolution that designated November as “National American Indian Heritage Month.” Every President since 1995 has issued annual proclamations designating the month of November, National Native American Heritage Month, as the time to celebrate the diverse culture, accomplishments, and contributions of people who were the first inhabitants of the present-day United States, including American Indians, Native Hawaiians and Alaska Natives. This is also a time to acknowledge and honor the resilience and resistance in the face of violent efforts to separate Native Groups from their land, culture and each other.

There is a vast variation among tribes with over 700+ federally recognized tribes existing here in the United States and an additional 500+ non-federally recognized tribes. View a list of Federal and State recognized Tribes and learn more about North American Natives and their vast distinctions.

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Land Acknowledgment

In certain countries, such as New Zealand, Australia, Canada and some Tribal nations in the U.S., it is becoming more prevalent to open events and gatherings by acknowledging the Indigenous inhabitants of the land where they are located. Land acknowledgement is an impactful way to show honor and respect to the Indigenous Peoples who were on these lands long before the founding of the U.S. Here is an example of a land acknowledgement statement.

Learn more about land acknowledgement and the Indigenous lands where you reside:

Commercial Tobacco vs. Traditional Tobacco

The National Native Network, a national network of Tribes, Tribal organizations and health programs working to decrease commercial tobacco use and cancer health disparities among American Indians and Alaska Natives across the U.S., helps to explain the difference between Traditional, Sacred, and Ceremonial tobacco vs. commercial tobacco as follows:

“Traditional and commercial tobacco are different in the way that they are planted and grown, harvested, prepared, and used. Traditional tobacco is and has been used in sacred ways by American Indians for centuries. Its use differs by Tribe, with Alaska Natives generally not using traditional tobacco at all.

Commercial tobacco is manufactured by companies for recreational and habitual use in cigarettes, e-cigarettes, smokeless tobacco, pipe tobacco, cigars, hookahs, and other products. It contains thousands of chemicals and produces over 7,000 chemical compounds when burned, many of which are carcinogenic, cause heart and other diseases, and premature death (1).

Commercial tobacco use prevention and cessation outreach among American Indians and Alaska Natives should be informed by and tailored to the Tribal community’s culture.”

"Tobacco: Honoring our Traditions and our Health” depicts tobacco prevention efforts in Wisconsin Tribal communities, highlighting the importance of reclaiming traditional tobacco. This video was produced by the Tribal Public and Environmental Health Think Tank.

“Our focus is 10 or 15 years from now when we ask a kid, ‘What does tobacco mean to you?’ They don’t say, ‘It’s cigarette smoking.’ It’s more about traditional tobacco use and what it means to them to put out tobacco in the morning for prayer.” - Clint Isham, Independent Tribal Relations Consultant

Spotlight Series: Tribal Leaders and Organizations in Lung Health

The American Lung Association proudly partners with Tribal leaders and organizations to raise awareness about lung health and devise community-informed, effective ways to address disparities. Here are some highlights of these impactful partnerships:

American Indian Community Housing Organization | Duluth, Minnesota

The American Indian Community Housing Organization (AICHO) joined together with the American Lung Association and coalition partners as part of the Lethal Lure campaign to limit access to flavored tobacco products, including menthol in Duluth, MN. AICHO’s Dr. Robert Powless Cultural Center’s art gallery hosted the visual storytelling that launched the campaign.

During this time, AICHO purchased a former grocery store in a low-income neighborhood and began the process to renovate the property into an Indigenous food market, deli with healthy, Indigenous grab-and-go options and coffee shop with community education/meeting space. As part of their vision for the market and the community, AICHO also made the decision not to sell commercial tobacco in the new market.

Janna Vallo, Commercial Tobacco Control and Prevention Coordinator 
Albuquerque Area Southwest Tribal Epidemiology Center | Albuquerque, New Mexico

Janna Vallo is from the Pueblo of Acoma. She is the Commercial Tobacco Control & Prevention Coordinator under the CDC Good Health and Wellness in Indian Country Program at the Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC). Janna currently chairs the New Mexico Credentialing Board for Behavioral Health Professionals, the New Mexico Allied Council on Tobacco, and the Southwest Tribal Tobacco Coalition. Janna provides interactive facilitation, networking, technical support, and training opportunities for Tribal communities seeking to build their knowledge around Commercial Tobacco Prevention, while respecting traditional and sacred uses of tobacco.

Although the pandemic gave us a challenging year, AASTEC was able to reach out to all their local tribal partners, as well as national tribal partners, to provide monthly virtual presentations around commercial tobacco. They provided technical assistance as requested to tribes around commercial tobacco and COVID-19. They also created packets for tribal casinos to positively encourage them to maintain their smoke-free status, with the hopes of them making it a long-term policy. AASTEC worked to embrace the change to a virtual platform that allowed us to network and collaborate nationally to grow the efforts around commercial tobacco cessation and prevention. They consider this work continuous and fun!

Tucson Indian Center | Tuscon, Arizona

The Tucson Indian Center has successfully facilitated the American Lung Association’s Freedom from Smoking (FFS) program, since 2019.  The Center’s FFS programming is unique because they include the medicine wheel model and talk about the differences between commercial tobacco products and Traditional Tobacco. This approach is in line with the Center’s vision statement of providing culturally competent, respectful, and compassionate wellness services. Many in their urban Indian community have successfully completed and quit smoking using the FFS program. The Center looks forward to many more years of offering the FFS program and they will continue to work towards protecting the health of their urban Native American community.

Alaska Native Tribal Consortium | Alaska

The Alaska Native Tribal Health Consortium (ANTHC) is a non-profit Tribal health organization that serves almost 180,000 Alaska Native and American People in Alaska. The American Lung Association has partnered with ANTHC on several initiatives, including commercial tobacco policy, successfully advancing Smoke Free Alaska, sponsorships of our Breathe Easy Breakfast and Asthma Walk, and participation in the Clean Air Challenge.

In 2012, the Lung Association recognized ANTHC with the Breathe Easy Champion Award for outstanding leadership in improving the lives of Alaskans. Since 1997 when ANTHC was established to provide statewide health services to Alaska Native people, ANTHC and its Tribal health partners have shown remarkable innovation in providing health care in some of Alaska’s most challenging environments with very limited resources.

ANTHC has also played a vital role in COVID-19 vaccine distribution in not only Anchorage but to the most remote parts of the state of Alaska. The ANTHC, with the Alaska Department of Health and Social Services, established the Alaska Vaccine Task Force, led by state and Tribal leaders, to embed Tribal and state coordination into all aspects of the vaccination process including allocation, distribution, communication, and funding. As of October 2021, fifty-seven percent of the state of Alaska has received one dose of the vaccine while 65.26% of Alaska Native and American Indian people has received at least 1 does of the vaccine.

The American Indian Health Commission | Washington State

American Indian Health Commission (AIHC) for Washington State acknowledges the historical and cultural context of the barriers to vaccination and disease prevention experienced by American Indian and Alaska Native (AI/AN) populations. AIHC is a non-profit organization working to improve the health of AI/AN populations by addressing inequities in governmental policies and systems through tribal and state collaboration. AIHC works for 29 federally recognized Tribes, two Urban Indian Health Organizations, and other Tribal health organizations.

AIHC’s Tribal and Urban Indian Health Immunization Coalition (TUIHIC) is the first Tribal immunizations coalition in the nation. TUIHIC is experienced in efforts to address AI/AN immunizations and vaccine access, surveillance, prevention practices, infectious disease, and health literacy. Since 2008, TUIHIC’s has conceptualized 100% immunization coverage in Indian Country. TUIHIC applied the tribal centric evidence-informed ‘Pulling Together for Wellness’ framework in the development of the model Tribal and Urban Indian Vaccination Record Cards. The National Congress of American Indians issued a resolution urging federal, state, and local governments to recognize official Tribal/Urban Indian Vaccination Record Cards.

The Lung Association in Washington State works in partnership with the AIHC TUIHIC to increase COVID-19 Vaccine confidence and address commercial tobacco prevention and cessation to preventing respiratory disease.

Lung Health and Indigenous Communities

Outdoor Air Quality

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 communities(2).

Indoor Air Quality

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 2021, more than 1,000 casinos and gaming facilities are 100% smokefree, including at least 154 operating on Tribal lands.

Chronic Obstructive Pulmonary Disease (COPD)

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

Check out the Lung Association’s What Triggers Your Asthma worksheet, available in Navajo as well as English and other languages, to help you identify what might make your asthma worse.

Impact of COVID-19

American Indian, Alaska Native, Indigenous, and other peoples of color have been disproportionately affected by the COVID-19 pandemic. Despite ongoing traumas and colonization attempts, Indigenous Peoples continue to adapt, thrive, and pass on knowledge and history to the next generations.

One example is the handling of the COVID-19 pandemic during which Indigenous communities have applied historical memory of prior biological warfare and pandemics. While others in the United States avoided, denied and delayed, most Tribes shut borders, contained and quarantined, provided support (food, water, medicine, transportation) where needed and rushed to vaccinate. Cherokee Nation was vaccinating at least 500 Tribal citizens a day as soon as the vaccine was available. Navajo called in Doctors Without Borders to provide additional medical care that the Indian Health Service could not provide. Communities in the Midwest prioritized vaccinating Elders, who speak their traditional languages to preserve cultural teachings. In Alaska, tribal health organizations relied on longstanding strategies developed to reach geographically isolated communities.

Drawing on a long history of resilience, Indigenous People have brought their own solutions to dealing with the pandemic, rooted in centuries of accumulated knowledge and cultural traditions. Our COVID-19 Vaccine Toolkit serves as a guide for families and individuals to explore concerns, answer questions and start a conversation about vaccination. This guide also shares the resiliency of Native Americans throughout the pandemic and how they are supporting efforts to end COVID-19.

Lung Cancer

Everyone deserves the opportunity to lead a full and healthy life. Sadly, systemic issues have contributed to health disparities, including for those with lung cancer. People of color who are diagnosed with lung cancer face worse outcomes compared to white Americans because they are less likely to be diagnosed early, less likely to receive surgical treatment, and more likely to not receive any treatment. Addressing racial disparities in access to care is critical to addressing racial disparities in lung cancer care.

Indigenous Peoples (American Indians/Alaska Natives) with lung cancer were 14% less likely to be diagnosed early, 19% less likely to receive surgical treatment, and 15% more likely to not receive any treatment compared to white Americans. Learn more in our State of Lung Cancer report.


  1. U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress. A Report of the Surgeon General. 2014.
  2. National Tribal Air Association. The Status of Tribal Air Report. 2021.

Page last updated: November 4, 2021

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