tailing wastes, and active and inactive surface mines (U.S. EPA, 1989). Polychlorinated biphenyls (PCBs) are a group of synthetic chemicals that cause both cancerous and noncancerous eects (U.S. EPA, 2025). PCBs were manufactured in the U.S. between 1929 and 1977 (U.S. EPA, 2025). The manufacturing of PCBs stopped in 1976 when the Toxic Substances Control Act was passed because of the evident harm- ful eects to the environment and human health. Despite this stop in production, the 2014 National Health and Nutrition Exami- nation Survey determined that Asian, Pacific Islander, Native American, or multiracial groups had the highest blood PCB values for people ages 12–30 years (Xue et al., 2014). Moreover, aluminum factories have con- taminated the St. Lawrence River in New York, which is a traditional source of fish for the Mohawk Nation at Akwesasne (Manjeshwar, 2021). As a result of the contamination, the Mohawk people have been exposed to bioac- cumulated PCBs, which are recognized as risks for diabetes and cancer and can have negative eects on neurological, immune, reproductive, and endocrine systems (U.S. EPA, 2024a). A study found that older adults (defined in this study as ages 47–79 years) from the Mohawk Nation experienced much higher rates of cog- nitive decline attributed to significantly higher levels of blood PCBs compared with other age groups (Sasaki et al., 2023). The Tribal Lands Assistance Center (TLAC) is a resource center for Native com- munities to receive technical assistance for challenges caused by environmental contam- ination. TLAC is a product of collaboration of U.S. EPA, the Tribal Waste and Response Steering Committee, the Tribal Superfund Working Group, and the Institute for Tribal Environmental Professionals. TLAC provides all federally recognized tribes with training for professionals and ocials to lead cul- turally driven decisions to determine how a contaminated site might be used or restored. Enabling tribal jurisdictions to pursue legal action is a key step in rectifying the dispro- portionate impacts of environmental contam- ination on Native lands. As an example, for nearly a century a lead-smelting company released dozens of toxic chemicals, including mercury, into the Columbia River on the Confederated Tribes of the Colville Reservation in Washington
(Gilio-Whitaker, 2019). In 2004, a lawsuit began against the smelting company and resulted in the Colville Nation winning a $193 million settlement in 2012. The Colville Nation used the funds to restore the contami- nated land and pay individual settlements to its members. Air Quality Air pollution has led to excess morbidity and mortality from a variety of health impacts (Manisalidis et al., 2020). Negative health eects linked to particulate matter (PM) exposure include the development or exac- erbation of chronic lung problems, heart attacks, hospital admissions, and emergency department visits for heart and lung disease (ITEP, 2021). In particular, cardiovascular disease occurs at significantly higher rates among AI/AN individuals than in White individuals and is the leading cause of death among AI/AN populations (Espey et al., 2014). Chronic and acute exposures to air pollution have major negative impacts on human health (Manisalidis et al., 2020). As of 2019, ambient air pollution was the sixth- leading risk factor and top environmental factor for deaths worldwide and is estimated to have caused 4.2 million premature deaths (World Health Organization [WHO], 2024). Air pollution is estimated to cause between 1,000 and 4,300 excess premature deaths nationally per year by 2050 (CDC, 2024c). A 2021 study funded by U.S. EPA found race to be a significant factor in exposure to air pollution, with data showing that people of color experience 75% of the overall expo- sure (Tessum et al., 2021). Mortality related to air quality is also aected by low socioeconomic status (Josey et al., 2023). An analysis of mortality and PM 2.5 exposures using Medicaid data found that structural racism and low socioeco- nomic status compound to create dispropor- tionate mortality (Josey et al., 2023). Despite known exposures among AI/AN populations, as well as elevated risks stemming from prev- alent comorbidities and socio-vulnerabilities, there is a gap in the literature investigating these impacts. The eects of air quality are a concern for Indian Country; however, few epidemiological and exposure studies exist. A study that used Medicare data found that all-cause mortality with yearly, increas- ing PM 2.5 exposure was higher among Native
Americans than the general population (Di et al., 2017). Further, Di et al. (2017) noted that the data set had wide confidence intervals and that many Native Americans use other healthcare and insurance services. In a study by Li et al. (2022), various PM 2.5 models were created that compared predicted ambient air quality between American Indian-populated counties and non-American Indian-populated counties from 2000–2018. The researchers found that compared with non-American Indian- populated counties, the American Indian- populated counties had higher rates of PM 2.5 according to an adjusted model. By the end of the study period, PM 2.5 levels declined in both counties. The rate of decline for PM 2.5 levels during the study period, however, was significantly greater in non-American Indian-populated counties. Overall, there is a gap in both epidemiological and air quality exposure studies for AI/AN communities. Li et al. (2022) suggest that a lack of federal air quality monitors in rural, remote areas where tribal nations tend to be located is generally a limitation of air quality studies. There are gaps in air quality throughout Indian Country (Watson et al., 1997). Typi- cally, federal air quality monitors are placed in urban, populated areas. Many Indigenous Peoples, however, live in rural regions. The lack of air quality data is partially attributed to inadequate equipment and insucient funding for equipment to monitor air quality (ITEP, 2021). Necessary equipment such as data loggers, wind and temperature sensors, and nephelometers (i.e., PM 2.5 monitors) are examples of equipment that is essential to monitor air quality in communities. A narrative by Carol Kriebs from the Koo- tenai Tribe of Idaho expressed that equip- ment failure is happening across Indian Country, and funding is needed to upgrade air monitoring equipment (ITEP, 2021). Kriebs explained that the data logger used at the Kootenai Tribe of Idaho was so outdated that it was no longer serviceable. The replace- ment equipment they received from the Idaho Department of Environmental Quality was also in the process of being phased out. Tribal members of the Nottawaseppi Huron Band of the Potawatomi in Michi- gan do not receive specific funding for air quality monitoring. Given the disparities in health outcomes for tribal communities
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June 2025 • Journal of Environmental Health
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