Efficacy of air filtration and education interventions on fine particulate matter among rural Native American homes heated with wood stoves: Results from the EldersAIR randomized trial.

BACKGROUND: Native Americans living in rural areas often rely upon wood stoves for home heating that can lead to elevated indoor concentrations of fine particulate matter (PM2.5). Wood stove use is associated with adverse health outcomes, which can be a particular risk in vulnerable populations including older adults. OBJECTIVES: We assessed the impact of portable air filtration units and educational approaches that incorporated elements of traditional knowledge on indoor and personal PM2.5 concentrations among rural, Native American elder households with wood stoves. METHODS: EldersAIR was a three-arm, pre-post randomized trial among rural households from the Navajo Nation and Nez Perce Tribe in the United States. We measured personal and indoor PM2.5 concentrations over 2-day sampling periods on up to four occasions across two consecutive winter seasons in elder participant homes. We assessed education and air filtration intervention efficacy using linear mixed models. RESULTS: Geometric mean indoor PM2.5 concentrations were 50.5 % lower (95 % confidence interval: -66.1, -27.8) in the air filtration arm versus placebo, with similar results for personal PM2.5. Indoor PM2.5 concentrations among education arm households were similar to placebo, although personal PM2.5 concentrations were 33.3 % lower for the education arm versus placebo (95 % confidence interval: -63.2, 21.1). SIGNIFICANCE: The strong partnership between academic and community partners helped facilitate a culturally acceptable approach to a clinical trial intervention within the study communities. Portable air filtration units can reduce indoor PM2.5 that originates from indoor wood stoves, and this finding was supported in this study. The educational intervention component was meaningful to the communities, but did not substantially impact indoor PM2.5 relative to placebo. However, there is evidence that the educational interventions reduced indoor PM2.5 in some subsets of the study households. More study is required to determine ways to optimize educational interventions within Native American communities.

Growing from Our Roots: Strategies for Developing Culturally Grounded Health Promotion Interventions in American Indian, Alaska Native, and Native Hawaiian Communities.

Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts "from the ground up." Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions.

Lessons learned from a woodstove changeout on the Nez Perce Reservation.

A woodstove changeout program was conducted within 16 homes on the Nez Perce Reservation in Idaho to evaluate the effectiveness of a woodstove changeout in improving indoor air quality. PM(2.5) samples were collected within the common area (rooms where the stoves were located) of the homes both before and after the installation of cleaner burning EPA-certified stoves. During the pre- and post-changeout sampling, indoor PM(2.5) mass, Organic Carbon (OC), Elemental Carbon (EC), and chemical markers of woodsmoke (including levoglucosan) were measured. Sampling results from this study showed that indoor air quality was improved in 10 of the 16 homes following the woodstove changeout and educational training program. Five homes had increased indoor PM(2.5) concentrations following the changeout, while one home did not have final PM(2.5) results for comparison. The median pre-changeout PM(2.5) mass (as measured by TSI DustTraks) was 39.2 µg/m³, with a median post-changeout concentration of 19.0 µg/m³. This resulted in an overall 52% reduction in median indoor PM(2.5), a 36% reduction in mean indoor PM(2.5) and a 60% reduction in PM(2.5) spikes when the old stoves were replaced with EPA-certified stoves. Another significant finding of the project was that targeted education and outreach is a critical component of the overall success of the program. Effective messaging to homeowners on proper use of their new stove is a necessary task of a woodstove changeout.