Native Americans and Lung Health

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.

Land Acknowledgment

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:

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Air Quality

Outdoor Air
Indigenous person outside in traditional clothing.

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

Indoor Air
Woman with mask on sits at a machine in a casino.

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.

Commercial vs. Traditional Tobacco Use

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.

The American Lung Association supports those breaking free of commercial tobacco use through several different Freedom From Smoking services and programs. To start your quit journey now, visit Lung.org/quit-smoking.

FREE One-Year Membership

To serve those who face a disproportionate burden of tobacco use and tobacco-related illness, we offer a FREE one-year membership to our premiere self-paced, online cessation program Freedom From Smoking Plus ($99.95 value.)

Lung Health and the Indigenous Community

Chronic Obstructive Pulmonary Disease (COPD)

Learn how to identify indoor air quality issues in the home that can worsen COPD symptoms and how to remediate to improve air quality.

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.

Asthma
Indigenous woman with two children.

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.

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.

Commercial Tobacco Use
Yupik Eskimo Village in Alaska. The Bering Sea is the right of the image and bison graze on a hill in the foreground.

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.

  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. https://www.ntaatribalair.org/status-of-tribal-air-report/
Asthma Educator Institute
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Freedom From Smoking Clinic
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