Medicaid‑Insured Children with Medical Complexity in a Rural State.

Objectives: To describe children with medical complexity (CMC) in Montana according to their clinical characteristics, rurality and distance from specialty care, and to assess for disparities in geographic access to specialty care for American Indian children.

Methods: In this cross-sectional study we categorized children in 2016-2021 Montana Medicaid claims data using the Pediatric Medical Complexity Algorithm and compared the associations of medical complexity and demographic traits using Chi-squared tests. Using a database of providers we calculated drive times from children's residences to the nearest pediatric subspecialist and calculated bootstrap confidence intervals for the difference in median driving distances by complexity and race.

Randomized trial in rural Native American homes heated with wood stoves: results from the EldersAIR study.

Residential wood burning has both practical and traditional value among many indigenous communities of the United States Mountain West, although household biomass burning also results in emissions that are harmful to health. In a household-level three-arm placebo-controlled randomized trial we tested the efficacy of portable filtration units and education interventions on improving pulmonary function and blood pressure measures among elder participants that use wood stoves for residential heating. A total of 143 participants were assigned to the Education (n=49), Filter (n=47), and Control (n=47) arms.

Wildland Firefighter Work History and Clinical Indicators of Cardiovascular Health.

Objective: To determine the association between the occupational history as a wildland firefighter (WFF) and clinical indicators of cardiovascular health.

Methods: Among 2862 WFFs, we evaluated associations between the number of total days assigned on fire and high-risk categories of three clinically measured cardiovascular indicators.

Results: Almost one-third (32%) of WFFs had one or more clinical measures that would place them in high-risk categories for body mass index, blood pressure, and total cholesterol.

Seasonal extreme temperatures and short-term fine particulate matter increases pediatric respiratory healthcare encounters in a sparsely populated region of the intermountain western United States.

Background: Western Montana, USA, experiences complex air pollution patterns with predominant exposure sources from summer wildfire smoke and winter wood smoke. In addition, climate change related temperatures events are becoming more extreme and expected to contribute to increases in hospital admissions for a range of health outcomes. Evaluating while accounting for these exposures (air pollution and temperature) that often occur simultaneously and may act synergistically on health is becoming more important.

Subclinical Measures of Cardiovascular Health Among Wildland Firefighters.

Objective: The aim of the study is to compare subclinical measures of cardiovascular health among wildland firefighters (WFFs) to the US general population.

Methods: Our cross-sectional study compared body mass index, total cholesterol, and blood pressure in 11,051 WFFs aged 17 to 64 years using Department of the Interior Medical Screening Program clinical screening examinations between 2014-2018 to National Health and Nutrition Examination Survey of 2015-2016 cycle using adjusted logistic regression analyses.

Results: The logistic regression model shows significantly higher odds of hypertension and prehypertension in WFFs (2.

Seasonal extreme temperatures and short-term fine particulate matter increases child respiratory hospitalizations in a sparsely populated region of the intermountain western United States.

Background: Western Montana, USA, experiences complex air pollution patterns with predominant exposure sources from summer wildfire smoke and winter wood smoke. In addition, climate change related temperatures events are becoming more extreme and expected to contribute to increases in hospital admissions for a range of health outcomes. Few studies have evaluated these exposures (air pollution and temperature) that often occur simultaneously and may act synergistically on health.

Daily 1 km terrain resolving maps of surface fine particulate matter for the western United States 2003-2021.

We developed daily maps of surface fine particulate matter (PM) for the western United States. We used geographically weighted regression fit to air quality station observations with Moderate Resolution Imaging Spectroradiometer (MODIS) aerosol optical depth (AOD) data, and meteorological data to produce daily 1-kilometer resolution PM concentration estimates from 2003-2020. To account for impacts of stagnant air and inversions, we included estimates of inversion strength based on meteorological conditions, and inversion potential based on human activities and local topography.

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 (PM). 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 PM concentrations among rural, Native American elder households with wood stoves.

Outdoor and indoor fine particulate matter at skilled nursing facilities in the western United States during wildfire and non-wildfire seasons.

Wildfire activity is increasing in parts of the world where extreme drought and warming temperatures contribute to fireprone conditions, including the western United States. The elderly are among the most vulnerable, and those in long-term care with preexisting conditions have added risk for adverse health outcomes from wildfire smoke exposure. In this study, we report continuous co-located indoor and outdoor fine particulate matter (PM ) measurements at four skilled nursing facilities in the western United States.

Efficacy of Air Filtration and Education Interventions on Indoor Fine Particulate Matter and Child Lower Respiratory Tract Infections among Rural U.S. Homes Heated with Wood Stoves: Results from the KidsAIR Randomized Trial.

Background: Millions of rural U.S. households are heated with wood stoves.

Case-fatality study of workers and residents with radiographic asbestos disease in Libby, Montana.

Background: Vermiculite ore from Libby, Montana contains on average 24% of a mixture of toxic and carcinogenic amphibole asbestiform fibers. These comprise primarily winchite (84%), with smaller quantities of richterite (11%) and tremolite (6%), which are together referred to as Libby amphibole (LA).

Methods: A total of 1883 individuals who were occupationally and/or environmentally exposed to LA and were diagnosed with asbestos-related pleuropulmonary disease (ARPPD) following participation in communitywide screening programs supported by the Agency for Toxic Substances and Disease Registry (ATSDR) and followed up at the Center for Asbestos Related Disease (CARD) between 2000 and 2010.

Carbon monoxide exposures in wildland firefighters in the United States and targets for exposure reduction.

Background: Every year thousands of wildland firefighters (WFFs) work to suppress wildfires to protect public safety, health, and property. Although much effort has been put toward mitigating air pollutant exposures for the public and WFFs, the current burden in this worker population is unclear as are the most effective exposure reduction strategies.

Objective: Quantify fireline carbon monoxide (CO) exposures in WFFs and identify predictors of exposures.

Creating Clean Air Spaces During Wildland Fire Smoke Episodes: Web Summit Summary.

Effective strategies to reduce indoor air pollutant concentrations during wildfire smoke events are critically needed. Worldwide, communities in areas prone to wildfires may suffer from annual smoke exposure events lasting from days to weeks. In addition, there are many areas of the world where high pollution events are common and where methods employed to reduce exposure to pollution may have relevance to wildfire smoke pollution episodes and vice versa.

Indoor fine particulate matter and demographic, household, and wood stove characteristics among rural US homes heated with wood fuel.

Household heating using wood stoves is common practice in many rural areas of the United States (US) and can lead to elevated concentrations of indoor fine particulate matter (PM ). We collected 6-day measures of indoor PM during the winter and evaluated household and stove-use characteristics in homes at three rural and diverse study sites. The median indoor PM concentration across all homes was 19 µg/m , with higher concentrations in Alaska (median = 30, minimum = 4, maximum = 200, n = 10) and Navajo Nation homes (median = 29, minimum = 3, maximum = 105, n = 23) compared with Montana homes (median = 16, minimum = 2, maximum = 139, n = 59).

The delayed effect of wildfire season particulate matter on subsequent influenza season in a mountain west region of the USA.

Particularly in rural settings, there has been little research regarding the health impacts of fine particulate matter (PM) during the wildfire season smoke exposure period on respiratory diseases, such as influenza, and their associated outbreaks months later. We examined the delayed effects of PM concentrations for the short-lag (1-4 weeks prior) and the long-lag (during the prior wildfire season months) on the following winter influenza season in Montana, a mountainous state in the western United States. We created gridded maps of surface PM for the state of Montana from 2009 to 2018 using spatial regression models fit with station observations and Moderate Resolution Imaging Spectroradiometer (MODIS) aerosol optical thickness data.

Wood stove interventions and child respiratory infections in rural communities: KidsAir rationale and methods.

Background: Acute lower respiratory tract infections (LRTIs) account for >27% of all hospitalizations among US children under five years of age. Residential burning of biomass for heat leads to elevated indoor levels of fine particulate matter (PM) that often exceed current health based air quality standards. This is concerning as PM exposure is associated with many adverse health outcomes, including a greater than three-fold increased risk of LRTIs.

Group Gardening in a Native American Community: A Collaborative Approach.

. There is increasing awareness of the potential health benefits derived from gardening activities. Gardening practices are gaining momentum in Native American (NA) communities, yet no efforts have applied a community-based participatory research approach within a social-ecological model to understand opportunities and barriers for group gardening on an American Indian reservation.

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.

Case series: rheumatological manifestations attributed to exposure to Libby Asbestiform Amphiboles.

Unlabelled: An increased risk for Systemic Autoimmune Diseases (SAID) has been reported in Libby, Montana, where extensive exposures to fibrous amphiboles occurred due to mining and use of asbestos-laden vermiculite. In addition, positive antinuclear autoantibody tests are associated with exposure to Libby Asbestiform Amphiboles (LAA) in both humans and mice. Among 6603 subjects who underwent health screening at the Center for Asbestos Related Diseases (CARD, Libby MT), 13.

ERS/ATS workshop report on respiratory health effects of household air pollution.

Exposure to household air pollution (HAP) from solid fuel combustion affects almost half of the world population. Adverse respiratory outcomes such as respiratory infections, impaired lung growth and chronic obstructive pulmonary disease have been linked to HAP exposure. Solid fuel smoke is a heterogeneous mixture of various gases and particulates.

Libby Amphibole Disease: Pulmonary Function and CT Abnormalities in Vermiculite Miners.

Objective: This article describes radiologic and pulmonary function findings among miners exposed to Libby amphibole. Computed tomography (CT) permits the detection of the characteristic thin, lamellar pleural thickening (LPT).

Methods: Individuals who worked at the mine for a minimum of 6 months had chest CT and pulmonary function tests.

Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves.

Background: Household air pollution due to biomass combustion for residential heating adversely affects vulnerable populations. Randomized controlled trials to improve indoor air quality in homes of children with asthma are limited, and no such studies have been conducted in homes using wood for heating.

Objectives: Our aims were to test the hypothesis that household-level interventions, specifically improved-technology wood-burning appliances or air-filtration devices, would improve health measures, in particular Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores, relative to placebo, among children living with asthma in homes with wood-burning stoves.

Environmental asbestos exposure and risk of mesothelioma.

Mesothelioma is commonly considered an occupational disease occurring as a result of asbestos exposure in the workplace. Several avenues for environmental asbestos exposures have been described and may be associated with asbestos related disease, including mesothelioma. Worker take-home asbestos, or para-occupational exposure, has been well documented and is the most commonly reported pathway for asbestos exposure among mesothelioma cases that do not have history of occupational asbestos exposure.

Reducing indoor air pollutants with air filtration units in wood stove homes.

Background: Biomass burning has been shown to be a major source of poor indoor air quality (IAQ) in developing and higher income countries across the world. Specifically, wood burning for cooking and heating contributes to high indoor concentrations of fine (particles with aerodynamic diameters<2.5μm; PM) and coarse (particles with aerodynamic diameters <10μm and >2.