1. A M ULTI -F ACETED A PPROACH TO I MPROVING IAQ IN R URAL A LASKA H OMES Presented By: Lacey Walsh, REHS 2015 National Tribal Forum on Air Quality

2. I NTRODUCTION Who we are… ● The Alaska Native Tribal Health Consortium (ANTHC) ● Largest tribally managed health organization in the nation ● Vision: Alaska Native people are the healthiest people in the world ● Mission: Providing the highest quality health services in partnership with our people and the Alaska Tribal Health System

3. R ESPIRATORY H EALTH Alaska Native children have some of the highest rates of respiratory illness ever documented ● Causes ● Poor indoor air quality ● Lack of in-home piped water services

4. B ACKGROUND Alaska Native/American Indian children bear a high burden of respiratory disease ● (1.6 x’s that of general US child rate) Among AN/AI children, infants carry highest burden Among all AN/AI children, Alaska Natives suffer from the highest rates of respiratory disease

5. B ACKGROUND Lower respiratory tract infection associated hospitalizations for Alaska Native children: ● 3 X’s that of general US children rate (<5 years) ● (41.2 vs. 13.8 per 1000/year) ● 3.7 X’s that of general US children rate (infants) ● (136.4 vs. 37.1 per 1000/year)

6. T HE P ROBLEM ANTHC Environmental Health received a request from a pulmonologist and created healthy homes study to determine the relationship between the home environment and children’s respiratory health Our goal is to improve the respiratory health of Alaska Native children, and provide a model to be used in indigenous communities throughout North America

7. S HAPING A P ROJECT The home is an “environment” and it can have an effect you and your family’s health Following 7 principles can help improve the health of you, your family, and your home

8. W HAT ARE THE 7 P RINCIPLES ? 1. Contaminant-Free 2. Ventilated 3. Dry 4. Safe 5. Maintained 6. Clean 7. Pest-Free

9. S TEPS Identify homes with children that have chronic respiratory illness ● Children 1-12 yrs with 4 or more clinic visits OR 1 respiratory hospitalization in the previous year Assess the home ● Modify the home to improve air quality Monitor air quality before and after modification ● Promote behavior changes

10. H OME S ELECTION Determine which communities meet criteria for chronic respiratory illness Select two communities based on Tribal interest and need Receive consent to perform the study from the Tribe Contact eligible households

11. H OME A SSESSMENT ANTHC and Regional Health Corporation Staff, along with Housing Authority Staff Members, assess each home Inadequate ventilation, leaky woodstove, moisture problems Identify water use Identify risky behaviors The resident, housing personnel, environmental health personnel determine a scope of work

13. A IR S AMPLING Particulate Matter 2.5 Volatile Organic Compounds Carbon Dioxide Temperature Relative Humidity Carbon Monoxide

15. N EW AND / OR I MPROVED V ENTS Ventilation intake plugged with a rag New ventilation intake

16. C OOKING S TOVE E XHAUSTS I NSTALLED Cooking stove with no range exhaust Cooking stove with a new range exhaust

17. W OODSTOVE R EPLACEMENT New EPA-certified, low-emission woodstove Old woodstove

18. M EASURING THE I NTERVENTIONS Home Modifications (2 weeks after modifications) Improving Ventilation Replacing Heating Devices Remediating excessive moisture damage Education (1 year after modifications) Providing report cards of IAQ data from each home Respiratory Therapist Visit Postcards, Phone Calls, Site Visits

19. T HANK Y OU AJ Salkoski Email: ajsalkoski@anthc.org Phone: 907-729-4518 Lacey Walsh, REHS Email: lmwalsh@anthc.org Phone: 907-729-5609 ANTHC Environmental Health