Indoor Air Quality in homes on Tribal Lands

“The decline in health is the inevitable outcome of the collapse of place”[1].

Tribes are disproportionately impacted by poor indoor air quality resulting from substandard housing, over-crowding, poor ventilation, unsafe cooking and heating practices, indoor smoking, and poor outdoor air quality.  Poor ventilation can cause moisture and mold problems and elevated radon levels, as well as high concentrations of air toxics related to household cleaning products and use of personal care products.  Other sources of air pollution can quickly degrade the indoor air, including combustion pollutants from wood stoves from cooking and heating or unvented gas appliances.  Since people spend a majority of their time indoors, specifically in their homes, poor indoor air quality can impact health and wellbeing of residents.

Native American children, older adults, and individuals with preexisting conditions are more vulnerable to the adverse health impacts of indoor air pollution.  Older adults are more likely to have chronic obstructive pulmonary disease (COPD) and asthma; younger children are more likely to have asthma and other lower respiratory tract infections (Singleton et al. 2005).  Indoor air pollution can exacerbate asthma and COPD (IOM 2000, Liu 2008).  Brim et al. (2008) reports that 13% of American Indian/Alaska Native (AI/AN) children has asthma compared with 9.6% of the general U.S. population of children.  Recent research by Singleton et al. (2012) reports that lower-respiratory-tract-infection (LRTI)-associated hospitalization rate for AI/AN children aged <5-y was 32% lower in 2006-2008 than the 1998-1999 rate, indicating some progress in improving child health (some of this is due to vaccines). But it was still 1.6 times higher than the general U.S. children rate.  Additionally a great disparity was seen for AI/AN infants for pneumonia hospitalization, with a 3-fold higher rate in AI/AN infants compared to the U.S. general infant population.  Singleton et al. states that closing this disparity gap “will require addressing housing and sanitation inequities and ensuring high immunization rates and access to care.”  Increased risks of hospitalization for pneumonia, respiratory syncytial virus (RSV), LRTI, and invasive pneumococcal disease have been associated with household crowding and woodstove use (Bulkow et al. 2002, Robin et al. 1996).  It is reported that these higher rates contribute to a high burden of chronic supportive lung disease (Redding et al. 2009).

Next year the US Environmental Protection Agency will be funding  research studies to better understand indoor air quality issues on tribal lands and associated health effects.  Ways to improve the indoor air quality are also a focus.  Its about time we focus on the indoor air of all people in this nation: the vulnerable, city dwellers, rural communities, and tribal areas.  Click here to learn more about the US EPAs IAQ Tribal Partners Program.


Brim SN, Rudd RA, Funk RH, Callahan DB (2008). Asthma prevalence among US children in underrepresented minority populations; American Indian/Alaska Native, Chines, Filipino, and Asian Indian. Pediatrics 122:e217-e222.

Bulkow LR, Singleton RJ, Karron RA, Harrison LH (2002). Risk factors for severe respiratory syncytial virus infection among Alaska Native children. Pediatrics 109:210-216.

IOM (2012). The Health Impact Assessment of New Energy Sources: Shale Gas Extraction, in Roundtable on Environmental Health, Medicine and Research, Institute of Medicine, National Academy Press, Washington, D.C.

Liu Y, Lee K, Perez-Padilla R, Hudson NL, Mannino DM (2008). Outdoor and indoor air pollution and COPD-related diseases in high- and low-income countries. The International Journal of Tuberculosis and Lung Disease 12:115-127.

Redding GJ, Byrnes CA (2009). Chronic respiratory symptoms and diseases among indigenous children.  Pediatric Clinics of North America 56:1323-1342.

Robin LF, Less PS, Winget M, Steinhoff M, Moulton LH, Santosham M et al. (1996). Wood-burning stoves and lower respiratory illness in Navajo children. Pediatric Infectious Disease Journal 15:859-865.

Singleton RJ, Holman RC, Cobb N, Curns AT (2005). Asthma hospitalizations among American Indian and Alaska Native people and for the general U.S. population.  Chest 130:1554-1562.

Singleton RJ, Holman RC, Folkema AM, Wenger JD, Steiner CA, Redd JT (2012). Trends in lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general US child population. The Journal of Pediatrics 161:296-302.

[1] Fullilove (2000).