A Guide to Healthy Homes

for Medical and Health Professionals –

American Indian and Alaska Native Communities

www.hud.gov/healthyhomes

■ Covers the health issues and related needs of families and individuals

■ Includes the Eight Principles of a Healthy Home 

OFFICE OF

LEAD HAZARD CONTROL

AND HEALTHY HOMES

Healthy 

Children Healthy Families Healthy Communities
U.S. Department of Housing and Urban Development

Office of Lead Hazard Control and Healthy Homes

April 2020

Introduction

 “Many tribal communities have a traditional understanding of inter-dependent ties 

with the land, and it can be said that when the environment (dwelling) is “sick,” the 

people may become sick.

It is important to be aware of certain concerns when communicating with residents 

on the operation and maintenance of their home. Good housekeeping practices can 

alleviate many of the conditions associated with an “unhealthy home.’”

— National Tribal Air Association, 

in Letter to HUD’s Office of Lead Hazard Control and Healthy Homes

OFFICE OF

LEAD HAZARD CONTROL

AND HEALTHY HOMES

Healthy 

Children

Healthy

Families

Healthy

Communities
www.hud.gov/healthyhomes 1

A Guide to Healthy Homes

for Medical and Health Professionals 

How do families know if they have a safe and healthy home?

This guide will help community health and medical professionals gain a deeper 

understanding of potential hazards inside their resident's homes. Any one or 

combination of the hazards described, can be a cause for an intervention. Any 

family member can be a change agent and make a difference. Please be aware 

that the content of this publication is helpful to you and the residents you serve, 

but it is not intended to be, or impart, medical advice.

This guide’s content was developed by the U.S. Department of Housing and Urban 

Development’s Office of Lead Hazard Control and Healthy Homes (HUD/OLHCHH), 

in collaboration with the U.S. Department of Agriculture’s National Institute of Food 

and Agriculture (USDA/NIFA); the U.S. Environmental Protection 

Agency (EPA); and the U.S. Department of Health and Human 

Service (HHS), including the Indian Health Service (IHS). Housing 

offices are sometimes small, with staff wearing many hats. To 

help health professionals, three other companion publications 

were developed for tribal leaders, family members, and tribal 

decisionmakers. The OLHCHH website of https://www.hud.gov/

program_offices/healthy_homes/Tribal_Healthy_Homes has two 

digital stories that relate directly to the health of Native Americans 

and their homes. The videos were provided, for the most part, by 

the Fort Peck Tribe in Montana.

 HUD’s Office of Native American Programs (ONAP) 

administers programs specifically targeted to Native Americans: American Indian, 

Alaskan Native, or Native Hawaiian individuals and families, and federally 

recognized tribal governments. A newsletter contains Federal News, Trainings, Funding 

Announcements for Tribes/Tribal Entities, a very extensive listing of resources as well as 

federal partners, and Tribal News. The ONAP website is www.hud.gov/codetalk.

 HUD/OLHCHH also offers a publication called Everyone Deserves a Safe and Healthy 

Home that offers valuable supplemental information on the hazards covered here. This 

publication also highlights how a single unhealthy housing problem can produce 

multiple health effects. It is downloadable at https://www.hud.gov/sites/documents/

STAKEHOLDER_EDSHH.PDF.

Helping American Indians and Alaska 

Natives Have Safe and Healthy Homes
2 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

A healthy home is one that is maintained to avoid injuries and illnesses to occupants. People spend more than 70% of their time in their 

homes and their home environment is an important determinant of health. 

Common indoor health concerns are lead hazards, air quality, mold and 

moisture, pest management, and injury prevention. The Eight Principles 

of a Healthy Home explain more about these and other hazards, and 

actions needed for prevention. Reduction of negative health impacts from 

improper ventilation and poor indoor air quality are especially serious 

concerns in many households.

A practical approach to implementing healthy homes for families is to 

facilitate cleaning and maintenance plans for each family and doing an 

overall home assessment related to the family’s vulnerabilities and unique 

circumstances.

The home assessment and intervention process can begin the first time 

a health professional meets with a resident. Alternatively, referrals can 

be made by other professionals, residents, and others who call directly - 

because of a perceived health concern or problem.

In applying these core concepts to a home (educating residents), health 

practitioners must account for many things. Tribal traditions and cultures 

are diverse. Hazards can also vary widely by region, due to differences in 

climate, weather events, sizes and types of homes, building materials used, 

home construction techniques, and other factors. Local issues, such as local 

water quality, also can apply.

Some hazards, such as outside wells and soil in yards and around foundations, are outside the home but can greatly impact occupants. Technical 

materials and scientific research results are available on HUD’s Healthy 

Homes website (weblink at https://www.hud.gov/program_offices/healthy_

homes). Additional valuable resources are at the end of this publication.

Common indoor 

health concerns are 

lead hazard control, 

air quality, mold 

and moisture, pest 

management, and 

injury prevention. 

Who can use this guide?

➤ Clinicians

➤ Primary Health Care Providers

➤ Community Health Workers

➤ Nurse Practitioners
www.hud.gov/healthyhomes 3

A Guide to Healthy Homes

for Medical and Health Professionals 

The Eight Principles of a Healthy Home - The Cornerstone

HUD’s Office of Lead Hazard Control and Healthy Homes defines Eight Principles of a Healthy Home. 

Briefly, they are:

❶Keep it dry:Prevent water from entering 

the home through leaks 

in roofing systems, prevent 

rainwater from entering the 

home due to poor drainage, 

and check interior plumbing for any leaking.

❷Keep it clean:

Control the source of dust 

and contaminants, creating 

smooth and cleanable 

surfaces, reducing clutter, 

and using effective wetcleaning methods.

❸Keep it safe:

Store poisons out of the 

reach of children and 

properly label. Secure loose 

rugs and keep children’s play 

areas free from hard or sharp 

surfaces. Install smoke and carbon monoxide 

detectors and keep fire extinguishers on 

hand.

❹Keep it well ventilated: 

Ventilate bathrooms and 

kitchens and use wholehouse ventilation for 

supplying fresh air to 

reduce the concentration of 

contaminants in the home.

❺Keep it pest-free:

All pests look for food, water, and 

shelter. Seal cracks and openings 

throughout the home; store food 

in pest-resistant containers. If 

needed, use sticky-traps and baits 

in closed containers, along with least-toxic 

pesticides such as boric acid powder.

❻Keep it contaminant-free:

Reduce lead-related hazards 

in pre-1978 homes by fixing 

deteriorated paint and keeping 

floors and window areas clean 

using a wet-cleaning approach. Test the 

home for radon, a naturally occurring 

dangerous gas that enters homes through 

soil, crawlspaces, and foundation cracks. 

Install a radon removal system if levels 

above the EPA action level are detected.

❼Keep it well maintained:

Inspect, clean, and repair the 

home routinely. Take care of 

minor repairs and problems 

before they become large 

repairs and problems.

❽Keep it thermally controlled:

Houses that do not maintain 

adequate temperatures may 

place the safety of residents at 

increased risk from exposure 

to extreme cold or heat.
4 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

10 Tips for a Healthy Home You Can Use for Residents

1. If you think your child has been in contact with lead, contact your 

child's health care provider. They can help you decide whether to 

test your child's blood to see if it has high levels of lead. (www.cdc.

gov/nceh/lead/parents.htm).

2. Never use a gas oven or cooktop to heat your home.

3. Ask your doctor about a home checklist for asthma triggers.

4. Open doors and/or windows to prevent mold from forming if the 

outside humidity is below 50%.

5. Do not allow smoking in your car or home.

6. Install smoke and carbon monoxide detectors or a combination.

7. Get your home tested for radon. High levels can be fixed with 

remedial measures.

8. Test well water and other water sources every two years.

9. Use mattress and pillowcase covers to protect from dust mites and 

wash them regularly.

10. While a space heater is in use, open a door from the room where 

the heater is located to the rest of the house and open a window 

slightly.

Also, here is a handy way to work closely with residents. 

The City of Fort Collins, Colorado, Healthy Homes program 

mission is to foster a healthier community by improving 

indoor air quality, and provide a safer home environment 

through volunteer based education. To this end, the 

Do-It-Yourself Assessment Tool (weblink at https://

healthyhomes.fcgov.com/) Follows an intuitive design and is 

customizable. The tool facilitates interaction between healthy 

homes educators and residents about potential hazards in 

homes. To use, only a simple, password-protected “account” 

has to be created. This enables saving of results, and more.

Many tribal health workers have found that a 

disproportionate number of their patients exhibit infectious 

and/or chronic respiratory symptoms. While there is a genetic 

component, research indicates that environmental exposures 

associated with the indoor environment are strongly correlated 

with asthma, allergies, immune suppression, and infectious 
www.hud.gov/healthyhomes 5

A Guide to Healthy Homes

for Medical and Health Professionals 

respiratory conditions. As a medical or health professional, you have opportunities with residents to not 

only treat them for illness, but also inquire as to the cause which could be related to their home site.

The healthy home assessment process promotes the Eight Principles. The process identifies 

health and safety risks, during which you gather some basic but vital information about resident's 

home and housekeeping habits. 

Some symptoms may only present 

themselves when the resident is 

at home. Or, the resident wakes 

up feeling worse and better after 

leaving the home. 

Reported health concerns 

are often of two types:

Acute Symptoms:

Dry or burning mucous membranes 

in the nose, eyes, and throat; 

sneezing; stuffy or runny nose; 

fatigue or lethargy; headache; 

dizziness; nausea; irritability.

Health Effects

Allergies, asthma, neurological, 

lethargy, infections, cancer.

The environmental history will help to determine if a home assessment is appropriate, necessary, or 

whether there are alternatives. For more about environmental histories and home

assessments, please visit 

https://www.childrensmercy.org/in-the-community/healthy-home-program/

or https://envirn.org/wp-content/uploads/2017/03/davis-home-environmental-health-and-safetyassessment-tool.pdf

Special Concern:

Particulate Matter, Vapor and Gases

Particulate matter, vapor, and gases from stoves, heaters, fireplaces and chimneys represent serious 

potential threats in tribal homes. Wood smoke can affect everyone, but children, teenagers, older 

adults, people with lung disease (including asthma and COPD), and people with heart disease are 

most at risk.

In addition to environmental tobacco smoke, unvented kerosene and gas space heaters, 

woodstoves, fireplaces and gas stoves can cause indoor air pollution. The major pollutants are carbon 

To learn if the occupants' health 

concerns could be related 

to housing, conducting an 

environmental history is 

invaluable. The goal is to better 

understand more about resident 

activities and site concerns:

■ The resident's physical surroundings

■ The type, age, and condition of the home they live in. 

This includes:

➤ The heating/cooling systems

➤ Where the resident spends time

➤ The resident's routine activities - for example, hobbies,

chemicals used in and around the home, and 

occupations

➤ Potential hazards, identity risks, and/or exposure times
6 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

monoxide, nitrogen dioxide and particles. Unvented kerosene heaters may 

also generate acid monoxides.

Many household products, such as paints, cleaners, and air 

fresheners, release volatile organic compounds (VOCs) into the air. VOC 

levels can be up to ten times higher indoors than outdoors.

Residents exposed to VOCs may experience short-term health effects 

like headaches, nausea, or fatigue, or long-term health effects such as 

damage to liver, kidney, and central nervous system.

Smoke from wood burning contains a mixture of gases and 

particulate matter (PM) that can cause health problems such as burning 

eyes, runny nose, and illnesses such as bronchitis. The smoke contains 

several toxic air pollutants, including benzene, formaldehyde, acrolein 

and polycyclic aromatic hydrocarbons (PAHs).

Checklist: Here are some actions to encourage residents to take:

 Install smoke and carbon monoxide detectors.

 Never use a gas stove to heat the home.

 Install properly-sized cleaner-burning heating appliances such as: electric 

furnace, natural gas or propane stoves or EPA-certified wood and pellet stoves.

 While a space heater is in use, open a door from the room where the heater is 

located to the rest of the house and open a window slightly.

 Install and use exhaust fans that are ducted to the outside, over gas cooking 

stoves and ranges and keep the burners properly adjusted.

 Inspect central air handling systems, including furnaces, flues, and chimneys, 

annually, and promptly repair cracks or damaged parts.

Special Concern: Are There Elders in 

the Resident’s Home?

Often, elders live with the family or nearby. 

The Centers for Disease Control and Prevention 

estimates that one in four older adults aged 65 

years or older, fall each year. The majority of 

these falls occur in the home.

Smoke from wood 

burning contains a 

mixture of gases and 

particulate matter (PM) 

that can cause health 

problems.

Many household products 

release volatile organic 

compounds (VOCs) into 

the air. 
www.hud.gov/healthyhomes 7

A Guide to Healthy Homes

for Medical and Health Professionals 

Key Actions

■ Encourage occupants to install grab bars in bathrooms and toilets.

■ Check railings to make sure they are not loose.

■ Check that there is adequate lighting throughout the house, unit, or building.

■ Find temporary shelter for elderly or ill family members during extended 

periods of hot or cold indoor temperatures, if they are living in homes without 

adequate heating or cooling. 

Special Concern: Cigarette Smoking

Tobacco smoke, whether used for ceremonies or leisure, can 

cause severe problems for those who already have breathing 

problems. Cigarette smoke causes health problems, especially 

for people with asthma, and people who are not themselves 

smoking but are exposed to secondhand smoke in the air from 

other people's smoking. Smoke from tobacco products can create 

residue that sticks on surfaces; this residue is commonly referred to as 

thirdhand smoke.

Thirdhand smoke can be hard to remove because it can withstand 

vacuuming and wiping. It can irritate the airways of people with allergies 

or asthma and may be associated with long-term health problems such as 

cancer. All tobacco products such as cigarettes, e-cigarettes, hookah, and 

even smokeless tobacco can contribute to this harmful residue. Encourage 

residents to smoke outside and away from children.

Sources of Often Overlooked Health Problems in Homes

➤ Lead: Was the home built before 1978? 1950?

➤ Radon: Was the home ever tested for radon?

➤ Carbon Monoxide: Do residents have a carbon monoxide detector?

Sources of Often Ignored Health Problems

➤ Environmental Tobacco Smoke: Does anyone in the family smoke? Do they want help quitting?

➤ Consumer Chemicals: What cleaning chemicals are being used? Where are they stored?

➤ Pesticides: Are any pesticides used? Where are they stored?
8 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

A Closer Look at Housing Health Hazards 

Typically Affecting Families

The most common healthy homes hazards are briefly described below. For a more in-depth view, Everyone Deserves a Safe and Healthy 

Home: A Stakeholder Guide (weblink at https://www.hud.gov/sites/dfiles/

HH/documents/STAKEHOLDER_EDSHH.PDF) provides greater detail 

on these and other hazards. This guide also has a companion app, the

Healthy Homes Partners app (weblink at https://apps.apple.com/us/

app/healthy-homes-partners/id1244368357), which includes the same 

information as the guide and a room-by-room checklist.

Lead

In line with the CDC’s recommendation, HUD/

OLHCHH recommends that children, especially 

children enrolled in Medicaid, should be screened 

with a blood lead test at ages 12 months and 24 

months old, or, if they have not previously been 

screened, within the 36 to 72 months old period. Of 

course, if a child has an elevated blood lead level, 

their healthcare provider will decide how much 

more frequently the child should be tested.

Prevention of lead exposure can be done by testing paint and dust 

in homes built before 1978, and bare soil on the property, determining 

if residents are exposed via paint chips, plumbing, dust, toys, blinds, 

pottery, etc., wherever they spend the majority of their time (e.g., in other 

care providers’ homes with grandparents or relatives; outdoors). Once the 

sources of lead are identified, then lead exposure can be reduced through 

keeping family members away from the sources.

Additional help, for both the general public and professionals, 

is available by calling the National Lead Information Center. This 

toll-free telephone hotline is maintained by the US Environmental 

Protection Agency and HUD/OLHCHH, at 1-800-424-LEAD (5323). 

For persons with hearing or speech difficulties, dial 711, the FCC's 

Telecommunications Relay Service number (www.fcc.gov/consumers/

guides/711-telecommunications-relay-service) (TTY 711).

Children should be 

screened with a blood 

lead test at ages 12 

months and 24 months 

old, or, if they have 

not previously been 

screened, within the 

36 to 72 months old 

period. 
www.hud.gov/healthyhomes 9

A Guide to Healthy Homes

for Medical and Health Professionals 

Alaska Native children living in rural southwest Alaska experience some of 

the highest reported rates of hospitalisation 

from lower respiratory tract infections 

(LRTIs) [1]. 

The pneumonia hospitalisation rate 

for infants from Alaska’s southwest Yukon 

Kuskokwim (YK) Delta region is tenfold 

higher than for other US infants [1].

Bronchiectasis, a chronic lung sequela 

of early and severe pneumonia, has nearly 

disappeared from the developed world, but 

is still frequently seen among southwest 

Alaska Native children [2,3].

Previous research demonstrates that 

substandard indoor air quality (IAQ) and 

inadequate housing lead to increased and 

more severe respiratory disease [4–8].

Inadequate housing conditions in 

southwest Alaska can negatively affect 

IAQ [3,9–11]. Household crowding, indoor 

smoke, lack of piped water and poverty 

have been independently associated with 

LRTIs. These factors are more common in 

rural southwest Alaska than in the general 

US population [12–14], and help explain the 

disparity in LRTIs and chronic lung sequela 

in children from this region.

Source: Singleton, R., et al. Impact of home 

remediation and household education on indoor air 

quality, respiratory visits and symptoms in Alaska 

Native children

Indoor Air Quality

People spend the majority of time indoors, making Indoor 

Air Quality (IAQ) and the reduction of pollutants in the 

home vital. IAQ is a critical issue facing many families today 

and improving IAQ can result in significant improvements 

in occupants’ health. This can decrease medical costs and 

greatly improve quality of life.

Common air quality concerns include smoke, road dust, 

mold, carbon monoxide, and others. Indoor air pollutants can 

come from the off-gassing of Volatile Organic Compounds 

(VOC) from chemicals and engines within the home, 

household cleaners, or contaminants tracked into the home.

Babies, young children, elders, and people with 

compromised respiratory systems are at greater risk of 

irritation and respiratory illness from poor indoor air quality 

and indoor pollutants. Irritation from indoor air quality and 

indoor pollutants can present itself in many different ways, 

including cough, cold, allergic reaction, sinus issues, asthma 

attacks, and general breathing problems.

Asthma

Exposure and sensitization to indoor allergens and irritants 

are factors in the development and exacerbation of 

asthma. Disparities in the effects of asthma may be due to 

disproportionate exposure to indoor environmental asthma 

triggers associated with substandard housing, 

among other risk factors. Residents have been 

shown to improve their asthma management, 

reduce exposure to triggers, and decrease 

symptoms as a result of home-based multitrigger, multicomponent interventions with an 

environmental focus conducted 

by health professionals, 

like Community Health 

Representatives.
10 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

The symptoms of 

CO poisoning are 

frequently mistaken 

for the flu and many 

people don’t even 

know they’ve been 

breathing in CO.

Mold and Moisture

Mold indicates a moisture problem. The 

key to mold control is moisture control. 

Ideally, humidity should be between 30-

50% inside the home. Molds are a part of 

the natural environment and are present 

nearly everywhere. Spores grow when they 

have moisture and a food source. Mold 

spores can irritate the lungs, especially 

those with a compromised respiratory 

system. If visible mold growth is present, 

sampling or testing is unnecessary. No 

EPA or other federal limits have been set for mold or mold spores.

The health effects of mold are often tied to allergies and sensitivity. 

The majority of residents are not born with an allergy or sensitivity 

to mold, but develop these responses after chronic exposure. This is 

particularly pervasive in tribal communities where mold is prevalent. 

Sensitization is common in the mold-impacted tribal housing units, as 

the mold contamination is often present for years before it is treated.

Carbon Monoxide

Carbon monoxide (CO) is a colorless, odorless, and poisonous 

gas produced by the incomplete burning of solid, liquid, 

and gaseous fuels. Appliances fueled with natural gas, 

liquefied petroleum, oil, kerosene, coal, charcoal, or wood 

may produce CO. If these appliances are used in the home, a 

CO detector/alarm that meets the current UL standard 2034 

(check the package) or the IAS 6-96 standard should be properly installed 

and maintained.

A CO detector/alarm can provide added protection but is no substitute 

for proper operation and maintenance of CO producing appliances. The 

symptoms of CO poisoning are frequently mistaken for the flu and many 

people don’t even know they’ve been breathing in CO. If the family can 

afford one, a combination smoke detector and carbon monoxide detector 

is preferred.
www.hud.gov/healthyhomes 11

A Guide to Healthy Homes

for Medical and Health Professionals 

Asbestos fibers are very 

light and easily carried 

through the air, they 

can be inhaled without 

a person realizing it.

Asbestos

Asbestos, like lead, was banned from usage in homes and buildings in 

the 1970s but may be still present in older homes. It is especially crucial 

that loose asbestos not be inhaled or touched.

Asbestos can cause very serious long-term health problems such as 

lung disease and cancer. 

Common uses in the past were to insulate pipes and attics. It also 

could be used in or around floor tiles, sheet vinyl flooring, cement 

shingles or roofing, plaster and joint compounds, and gaskets. Since 

asbestos fibers are very light and easily carried through the air, they 

can be inhaled without a person realizing it. The asbestos remains in 

the lungs. Smokers have a higher risk from asbestos exposure. Removal 

should be done by a licensed professional.

Drinking Water

A potable water source should be used to 

drink, prepare food and baby formula, 

bathe, and clean with. Drinking water may 

become non-potable for a variety of reasons 

like contamination of a well or water system 

disruptions. Contaminants may be bacteria, 

viruses, nitrate, lead or copper, among other 

secondary pollutants like odor and color. 

Consumers should know where their water 

comes from (i.e. source). If it is a private well, 

residents should have it tested for diseasecausing bacteria and other contaminants 

annually and protected.
12 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

Hazardous Household Products

Many products found in the home, like cleaners and medications, 

make life convenient so it can be easy to forget that seemingly harmless 

materials can be toxic if used incorrectly. Bleach, cleaners, fuels, batteries, 

oil, wood or metal polish, drain cleaners, shoe polish and many other 

materials should be correctly labeled, properly stored, and used according 

to manufacturer’s instructions to prevent exposure from misuse or 

consumption.

Secure and proper storage cannot be over-emphasized. Medication

overdoses, whether intentional or unintentional, are considered poisonings. 

The National Poison Help Line is 800-222-1222 (TTY 711) and will 

automatically redirect calls to your regional poison control center.

Pesticides

Pesticides and other household chemicals including bug spray, pet flea/

tick collars, rat poison, weed killer, and others are frequently misused, 

and accessible to children. They should be correctly labeled, properly 

stored, and used according to manufacturer’s instructions. Additional 

precautions like wearing gloves or eye protection may be required. 

Making pesticides inaccessible to children and used according to the 

manufacturer’s instructions are important steps to preventing exposure.

Home Safety

Falls, crashes, fires, brain injuries, choking, violence, suicide, firearms, 

drowning and more are very significant public health burdens that can 

all be prevented. Interventions and behaviors that may be considered 

common sense cannot be reinforced enough; hand washing; eye exams, 

removing trip hazards; walk on sidewalks when possible and be seen 

using lights and/or reflective clothing; supervise children when playing or 

swimming; ensure operable smoke alarms are installed and have a home 

fire escape plan; learn first aid and CPR.
www.hud.gov/healthyhomes 13

A Guide to Healthy Homes

for Medical and Health Professionals 

Temperature Control

Every home needs to be 

temperature controlled in order to 

ensure that families are safe from 

extreme temperatures and are 

comfortable. Homes that are not 

may place the family, especially 

the elderly and ill family members, at increased risk.

A home’s heating and cooling system should provide a 

stable temperature that also prevents excessive moisture, 

heat and cold. The heating and air conditioning systems 

should be serviced yearly by a qualified professional. Air 

filters should be cleaned or changed when dirty (usually 

every three (3) months). Families with pets or smokers should 

change filters more frequently. Also, consider having a home 

energy audit from the local utility company or local housing 

agency. During cold or heat spells, temporary shelter may be 

needed for tribal Elders or ill family members.

Radon

Radon comes from the natural 

radioactive breakdown of uranium 

and other radioactive elements 

in soil, rock, and water. Radon is 

most commonly found in soil, clay 

or rock from around and underneath a home’s foundation. 

It can cause lung cancer, when inhaled. Some areas of the 

United States have higher levels of radon than others.

Homes should be tested for radon. If the home tests high for 

radon (a reading of 4 or higher), a licensed or certified radon 

professional should be contacted. (See www.epa.gov/radon.)

Tribal Healthy Homes Project

To help address indoor radon concerns and to establish a 

baseline of general housing conditions, 

two northern pueblo communities 

partnered with the Albuquerque 

Area Southwest Tribal Epidemiology 

Center (AASTEC) located in 

Albuquerque, New Mexico. AASTEC 

epidemiologists collaborated with 

the health and community services, 

Indian Health Service Environmental 

Health Department, health boards, 

environmental services departments, 

one housing authority, and the 

community health representative (CHR) 

programs in both pueblo communities 

to help develop an extensive spatial 

database. AASTEC geospatially 

mapped homes, measured their indoor 

radon concentrations, and recorded 

general housing conditions. Prior to 

the Tribal Healthy Homes Project, 

each community expressed a desire 

to apply for environmental health 

grants. However, existing data were 

limited on indoor radon measurement 

as well as current housing conditions. 

Therefore, this project provided an 

ideal opportunity for each community 

to customize and develop a survey 

of housing attributes and indoor air 

quality levels; with the end result of an 

indoor radon dataset as well as indepth home assessments.

SOURCE: https://tribalepicenters.org/

blog/2018/01/31/aastec-success-story-january-2018/
14 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

Special Concern: Educating Family Members on Substance 

Abuse and Addiction

Although not strictly a housing maintenance problem, substance abuse in homes, include methamphetamine (meth), opioid addiction, and 

alcohol, poses many dangers and can destroy lives.

There is grave concern for the health of family members living in a 

meth-contaminated home. Many occupants are not aware of the severe 

impact /damage that meth has on the safety, security, and health of the 

residents; nor on the viability of the home. Smoking meth in a home can 

infiltrate the HVAC system, walls, carpets, and furniture. It is costly to 

remediate. 

Young children are particularly vulnerable when they crawl around 

the home. Meth labs create significant environmental hazards. In addition 

to having detrimental impacts on the health of family members, it is also 

extremely costly to remove the contaminants.

In addition to providing resources to the addict, family members need 

resources as well. Family members are the change agents, and if you help 

them, lives can be saved. Meth testing kits, from local health departments, 

are increasingly available to home buyers, renters, and many others. Some 

resources are: National Helpline of the U.S. Substance Abuse and Mental 

Health Service Administration (SAMHSA), at 1-800-662-HELP (4357); 

Voluntary Guidelines for Methamphetamine Laboratory Cleanup at https://

www.drugabuse.gov/patients-families and https://www.epa.gov/sites/

production/files/documents/meth_lab_guidelines.pdf.

For Tribal Residents Living 

in Manufactured or Mobile 

Homes

Some community residents may come into the clinic and focus on their activities or routines 

when describing ailments, but possibly the real 

culprit from chronic health problems may be 

environmental. With many people spending at 

least a half of their day in the home, it may be 
www.hud.gov/healthyhomes 15

A Guide to Healthy Homes

for Medical and Health Professionals 

that the respiratory issue or fatigue tribal members feel may be directly 

related to their home.

Some lower income residents may live in a mobile home. With the 

construction methods, health-related professionals must consider possible 

moisture problems – which can also produce respiratory issues.

Though lead paint may not be a problem (but lead in water may be 

one), building materials might separate and cause health complications 

for toddlers and young children who spend much of their time on the floor 

or cruising window sill areas. Be sure when asking questions on the intake 

form when the last time resident’s furnace filters were changed, or fuel lines 

were checked, to avoid VOCs from being present.

If symptoms seem to suggest carbon monoxide poisoning, be sure to 

ask if propane is the primary fuel for cooking/heating and if the flue on the 

mechanical equipment has been professionally checked for leaks. While 

beginning the examination, ask residents if they have skirting around 

the belly of the trailer and if so, have they tested for radon. Due to the 

frequency of fires in mobile homes, ask if residents have fire detectors.

When A Natural Disaster Occurs

Health care professionals can be involved in rebuilding communities after natural disasters. Consequently, it is important to know that 

a home damaged by floods is likely to pose serious health risks. These 

typically stem from mold, polluted water, and many other unsafe 

conditions. Storm damaged homes are dangerous.

HUD’s Rebuild Healthy Homes Guide to Post-Disaster Restoration for a Safe 

and Healthy Home covers restoration “A-Z” in plain language. An app, 

based on the publication, is available at: https://apps.apple.com/us/app/

rebuild-healthy-homes/id980660616.

Wild fires are prevalent in some parts of the country. You should advise 

your patients to pay attention to air quality reports. The Air Quality 

Index (AQI) uses color-coded categories to report when air quality is good, 

moderate or unhealthy. 

Use common sense. If it looks and smells smoky outside, it is probably not 

a good time to go for a jog, mow the lawn or allow children to play outdoors.

Individuals with asthma or other respiratory or lung conditions 

should follow their provider's directions on taking medicines. They should 
16 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

call their provider if 

symptoms worsen.

 If a person has 

heart or lung disease, 

is an older adult, or 

has children, they 

should talk with their 

provider about whether 

and when they should 

leave the area. When 

smoke is heavy for a 

prolonged period of 

time, fine particles can 

build up indoors even 

though a person may 

not see them.

Summary

This guide has covered many ways that health workers and health professionals serving Native Americans can help implement healthy 

homes practices.

It is important to know who your local tribal healthy homes partners 

are. Collaborate with them. Refer residents to these specialists, who 

may be able to help tribal members to a healthy home. Tribal healthy 

homes partners may include: a housing authority; a health authority; 

an environmental protection program; and/or community health 

representatives.

To recap, here are some basic actions that health-related professionals 

can take to help residents. As a medical or health professional, you can 

enhance residents’ awareness of how the home environment can affect 

their health and guide them to make their homes healthier.
www.hud.gov/healthyhomes 17

A Guide to Healthy Homes

for Medical and Health Professionals 

A Path to a Healthy Home

❶ 

Step 1 If an assessment is 

recommended, prepare for

hazard identification at the 

family’s home

➤ Learn and know heathy homes

terms, hazards and attributes.

➤ Establish a clear purpose for the 

assessment.

➤ Make initial contact with family/

individual - collect general 

information. Gather information 

about resident's home and 

behaviors.

➤ Learn about health history as 

appropriate.

➤ Formulate initial hypotheses.

➤ As an option, your residents can 

use the online Healthy Homes DoIt-Yourself Assessment (DIY) Tool at 

Fort Collins DIY Home Assessment

(weblink at https://www.fcgov.com/

healthyhomes/)

❷ Step 2 Apply exposure

assessment and risk criteria

➤ Conduct a site visit or walkthrough, or provide family 

with an organization that routinely 

conducts assessments.

➤ Qualitative and Quantitative 

Assessment. Determine if 

basic, intermediate or advanced 

assessment is needed.

➤ Risk criteria for assessing can 

be either health or environment 

based, preferably both. 

➤ Encourage and facilitate a cleaning 

plan for families, based on the 

overall assessment related to their 

vulnerabilities.

➤ Look for and educate residents on 

keeping the home dry and well 

ventilated; will involve counseling 

and referrals.

➤ Generate assessment report with 

actions.

➤ Use resources such as the EPA/HUD 

National Lead Information Center 

1-800-424-LEAD (TTY 711).

❸ Step 3 Other potential follow ups

➤ Continue to educate for healthy 

homes practices. 

➤ Reach out to and work with other 

professionals to integrate healthy 

home principles into housing.
18 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

 Room by Room Checklist for a Healthy Home

This checklist is a great way to learn more about health related hazards in homes. For medical 

and health professionals, it can be used to establish a healthy homes assessment protocol with the 

families you serve. For more information on this material and recommended actions please visit 

www.hud.gov/healthyhomes or download the Healthy Homes Basics App to have as a resource at 

your fingertips whenever you are ready.

1. Living, Dining, and Family Rooms

 If the home was built before 1978, check 

painted doors, windows, trim, and walls for 

lead

 Vacuum carpets regularly to reduce asthma 

triggers

 Replace corded blinds with un-corded (pole) 

blinds, or move window blind cords out of 

reach of children to prevent strangulation

 Check lighting and extension cords for fraying 

or bare wires

 Avoid having lighting and extension cords in 

floor pathways

 Purchase children’s toys that do not have 

small parts for choking and do not contain 

lead

 Secure heavy items (televisions, bookcases) to 

walls to prevent tip overs

2. Kitchen

 If the home was built before 1978, check 

painted doors, windows, trim, and walls for 

lead

 Use a range hood exhausted to the outside 

(or open window) to ventilate while cooking

 Clean up liquids and foods right after spills

 Keep matches, glassware, knives, and 

cleaning supplies out of reach of children

 Avoid leaving food and water out overnight 

 Mop floors at least weekly

 Place Poison Control Hotline number (800) 

222–1222 on the refrigerator and in every 

room (TTY 711)

 Do not allow children to be in kitchen 

unsupervised when the range or oven is on

3. Bedroom(s)

 If the home was built before 1978, check 

painted doors, windows, trim, and walls for 

lead

 Replace corded blinds with un-corded (pole) 

blinds, or move window blind cords out of 

reach of children to prevent strangulation.

 Make sure room has a working smoke 

detector

 Make sure the hall outside of bedrooms has a 

working carbon monoxide detector.

 Use mattress and pillow covers, and vacuum 

carpets regularly to reduce asthma triggers

4. Entry

 Use floor mats by entry doors to reduce 

bringing lead dust and other toxins into the 

home

 Remove shoes at entry if lead is present in the 

soil or paint 
www.hud.gov/healthyhomes 19

A Guide to Healthy Homes

for Medical and Health Professionals 

	  Repair or install weather seals around the 

 perimeter of doors 

5. Bathrooms

 If the home was built before 1978, check 

painted doors, windows, trim, and walls for 

lead

 Use an exhaust fan to ventilate after shower or 

bath use

 Use slip resistant mats in showers and tubs

 Clean up water from floors right after spills

 Keep medicines and cleaning supplies locked 

away and out of reach of children

 If an older adult or someone with mobility or 

balance concerns is present in the home, install 

grab bars at toilets, showers, and tubs

6. Laundry

 Vent clothes dryer to the outside (through roof 

or wall, not into the attic)

 Keep laundry soaps and detergents out of 

reach of children

 Wash sheets and blankets weekly to reduce 

asthma triggers

 Regularly remove lint from dryer screen

7. Attic

 Clean up clutter to prevent rodents and insects 

from finding places to nest

 Check exposed attic insulation for asbestos 

and consult with an asbestos professional for 

removal

 Make sure eave and roof vents are not blocked 

with insulation

8. Basement (or Crawlspace)

 If the home was built before 1978, check 

painted doors, windows, trim, and walls

for lead

 Seal holes in walls and around windows

and doors to keep rodents and pests out

of living spaces

 Clean up clutter to prevent rodents and insects 

from finding places to nest

 Test the home for radon. If test shows 

radon above EPA action levels, seal slab and 

foundation wall cracks, and if the problem 

persists, consider installing a radon 

mitigation system

 Keep pesticides and cleaning supplies locked 

away and out of reach of children

 Seal all cracks in slabs and foundation walls for 

moisture, radon, and pest protection

9. Garage

 Never run lawnmowers, cars, or combustion 

equipment inside the garage even if the 

garage door is open

 Keep gasoline, pesticides, and cleaning 

supplies out of reach of children

 Clean up oil, gasoline, and other spills 

immediately. Hardware stores sell products 

that can absorb the spill safely. 

 If a floor drain is present, make sure it drains to 

well beyond the outside of the home

10.Outside

 If the home was built before 1978, check 

painted doors, windows, trim, and walls 

for lead

 If painted walls, doors, windows, or trim may 

contain lead, keep children away from peeling 

or damaged paint and prevent children from 

playing around the ground next to the walls 

 Remove leaves and debris from gutters 

regularly and extend downspouts to drain 

away from the house

 Replace missing or broken shingles or flashings
20 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

 Clean window wells of trash and debris

 Install and maintain fences completely around 

pools with openings less than 1/4 inch

 If the home was built before 1978, check 

hardboard siding for asbestos

 Make sure private wells are sealed and capped

 Consider testing well for pesticides, organic 

chemicals, and heavy metals before you use it 

for the first time

 Test private water supplies annually for nitrate 

and coliform bacteria

 Do not leave open garbage containers near 

the home

 Repair broken glass in windows and doors

 Seal holes in walls and around windows and 

doors to keep rodents and pests out of living 

spaces

11. General

 If the home was built before 1978, use leadsafe work practices for all renovation and 

repairs and test children in the home for lead 

exposure

 Check piping connecting the home to the 

water main and the piping in the home for 

lead (lead pipes are dull and can be scratched 

easily with a penny). Lead pipes are more 

likely to be found in homes built before 1986

 No smoking inside the home

 Have a professional maintain yearly all gas 

appliances and check for carbon monoxide 

leaks and proper venting

 Do not use candles or incense in the home 

when adult supervision is not present

 Secure balcony and stair railings, and install 

no-slip nosings

 Replace burned-out bulbs in lights over stairs 

and landings

 Run a dehumidifier if indoor humidity is 

above 50 percent or there is condensation on 

windows

 Make sure all gas burning appliances, 

furnaces, heaters, and fireplaces ventilate to 

the outside

 Replace the furnace filter with a MERV 8 or 

higher every three months

 If mold is visible in any room, refer to mold 

removal guidelines from the EPA, CDC, or 

HUD

 Install child-proof locks on cabinets and childproof covers on electrical outlets

 Keep water temperature at less than 120 

degrees

 Keep firearms in locked safes

 Use pest management recommendations or 

safer alternative products before applying 

pesticides

 Keep all cleaning products in original 

containers and do not mix two products 

together

 Keep all hazardous products and chemicals in 

locked cabinets away from children.
www.hud.gov/healthyhomes 21

A Guide to Healthy Homes

for Medical and Health Professionals 

Important Resources

This is a selection of a wide range of organizations, websites, and educational materials, that expand 

upon this publication. Visit OLHCHH’s website at https://www.hud.gov/program_offices/healthy_

homes/Tribal_Healthy_Homes to view tribal healthy home digital stories. These relate directly to the 

health of Native Americans by addressing the health of their homes. Each story provides a history 

about the importance of traditional housing and what the “home” traditionally means.

Overview:

The Healthy Homes Program Guidance 

Manual (July 2012): This comprehensive 

manual (260 pages) was developed by HUD/

OLHCHH and many select partners and offers 

guidance and tools to help users establish or 

improve healthy homes/housing programs. It 

provides a broad range of practical information 

that will be of interest to organizations, 

programs, and individuals concerned about 

the need for healthy housing. The content 

takes into account that no “one size fits all” in 

designing healthy homes programs at the local 

level. https://www.hud.gov/sites/documents/

HHPGM_FINAL_CH1.PDF.

Tribal Green Building Toolkit (2015) 

This publication (160 pages) is designed to help 

tribal officials, planners, architects, builders, 

housing developers, community members, and 

others develop and/or adapt building codes to 

support green building concepts and practices. 

Tribes with and without building codes can 

utilize the toolkit. The toolkit was created by 

the U.S. Environmental Protection Agency, with 

extensive involvement and contributions of 

Native Americans.

The implementation of “green building” offers a 

significant opportunity to revitalize sustainable 

cultural practices, by integrating with tribal 

traditions and values. Tribes can help maintain 

natural resources that historically sustained 

them, through these green building codes. This 

product can be downloaded at: https://www.

epa.gov/green-building-tools-tribes/tribalgreen-building-toolkit

HUD/OLHCHH Hazard-Specific Factsheets:

➤ Asbestos: https://www.cancer.gov/aboutcancer/causes-prevention/risk/substances/

asbestos/asbestos-fact-sheet

➤ Asthma: https://www.hud.gov/program_

offices/healthy_homes/healthyhomes/

asthma

➤ Allergy: https://www.hud.gov/program_

offices/healthy_homes/healthyhomes/

allergies

➤ Home Safety: https://www.hud.gov/

program_offices/healthy_homes/

healthyhomes/homesafety

➤ Mold: https://www.hud.gov/program_offices/

healthy_homes/healthyhomes/mold

➤ Lead: https://www.hud.gov/program_offices/

healthy_homes/healthyhomes/lead
22 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

➤ Radon: https://www.hud.gov/program_

offices/healthy_homes/healthyhomes/radon

➤ Carbon Monoxide: https://www.hud.

gov/program_offices/healthy_homes/

healthyhomes/carbonmonoxide

Interactive Healthy Homes Apps

➤ Healthy Homes Basics App: This HUD/

USDA product is for the general public. It 

introduces users, in clear terms, to healthy 

homes concepts. Content also covers many 

ways to have a healthy home. Download 

the app at https://apps.apple.com/us/app/

healthy-homes-basics/id1092367352.

➤ Healthy Homes Youth App: This HUD/USDA 

product is for middle schoolers and helps 

them learn about healthy homes. Available 

at https://itunes.apple.com/us/app/healthyhomes-youth/id1434450117?mt=8.

➤ Healthy Homes Do-It-Yourself Assessment 

Tool: The Healthy Homes Do-It-Yourself 

Assessment Tool walks users through each 

room and provides a simple, low, and nocost solution to many common healthy 

housing problems. https://healthyhomes.

fcgov.com/.

➤ Healthy Homes Partners App: This HUD/

USDA product is for stakeholders. It is 

non technical but goes beyond the above 

consumer version. https://itunes.apple.

com/us/app/healthy-homes-partners/

id1244368357?mt=8.

Key Hotlines

All the phone numbers below may also be 

reached by people who are deaf or hard of 

hearing, or who have speech disabilities, by 

teletype at 711.

➤ Poison Control Centers, (800) 222-1222

➤ HUD and EPA National Lead Information 

Center, 1-800-424-LEAD, (800) 424-5323

➤ EPA Safe Drinking Water Hotline,

(800) 426-4791

➤ National Pesticide Information Center, 

(800) 858-7378

➤ FDA, Food Safety Information Service 

Hotline, (888) SAFE-FOOD, (888) 723-33663

➤ Centers for Disease Control and 

Prevention (cigarette smoking), 1-800- 

QUIT-NOW, or (800) 7848-669

➤ National Radon Information, (800) SOSRADON, (800) 767-7236

➤ Window Covering Safety Council,

(800) 506-4636

General Safe and Healthy Homes 

Information Sources (for both the 

public and professionals)

➤ Indian Health Service, www.ihs.gov/

➤ IHS' local Urban Indian Health Program, 

www.ihs.gov/urban/nationalprograms/

➤ Tribal Healthy Homes Network,

http://thhnw.org/
www.hud.gov/healthyhomes 23

A Guide to Healthy Homes

for Medical and Health Professionals 

➤ Institute for Tribal Environmental 

Professionals,

www7.nau.edu/itep/main/Home/.

➤ Tribal Public and Environmental Health 

Think Tank, https://www.apha.org/topicsand-issues/environmental-health/partners/

think-tank.

➤ Tribal Epidemiology Centers, 

https://tribalepicenters.org/.

➤ Indian Health Service, 

https://www.ihs.gov/dehs/.

➤ Local or state health department

➤ U.S. Department of Housing and Urban 

Development, www.hud.gov.

➤ Office of Lead Hazard Control and 

Healthy Homes,

https://www.hud.gov/healthyhomes.

➤ Office of Native American Programs, 

www.hud.gov/codetalk.

➤ U.S. Department of Agriculture, National 

Institute of Food and Agriculture, 

https://nifa.usda.gov/.

➤ Cooperative Extension Service for 

Healthy Homes Extension educators,

https://nifa.usda.gov/extension or 

https://impact.extension.org/.

➤ National Healthy Homes Partnership,

https://extensionhealthyhomes.org/

➤ U.S. Environmental Protection Agency, 

www.epa.gov.

➤ U.S. Centers for Disease Control and 

Prevention, www.cdc.gov, (800) 232-4636

➤ U.S. Consumer Product Safety Commission,

www.cpsc.gov, (800) 638-2772

➤ U.S. Department of Energy,

www.energy.gov.

➤ National Center for Healthy Housing, 

https://nchh.org/

➤ Children’s Environmental Health 

Partnership, https://cehn.org/.

➤ National Safety Council,

https://www.nsc.org/.

➤ Pediatric Environmental Health Specialty 

Units, https://www.pehsu.net/.

National Tribal Air Association,

https://www.ntaatribalair.org/

Lead

There is no safe level of lead in blood. Even low 

levels of lead can affect a child’s IQ, ability to 

pay attention, and academic achievement. A 

blood lead level of 3.5 micrograms per deciliter 

or greater identifies a child who has been highly 

exposed to lead. Lead can be found in various 

places. The Protect Your Family from Lead (from 

HUD, EPA, and the CPSC) booklet has tips to 

help you protect your family from exposure to 

lead: https://www.epa.gov/lead/protect-yourfamily-lead-your-home.

The U.S. Food and Drug Administration 

(FDA) and Consumer Product Safety Commission 

(CPSC) issue recall alerts when unsafe levels of 

lead are detected in food items, children’s toys, 

or other products. More information is available 

on the FDA recalls (https://www.fda.gov/safety/

recalls-market-withdrawals-safety-alerts) and 

CPSC recalls (https://www.cpsc.gov/recalls) 

online.
24 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

Healthy Homes Principles: The Healthy Homes Principles serve as 

a guide for addressing many of the topics discussed in this booklet. The 

Everyone Deserves a Safe and Healthy Home guides summarize the 

Healthy Homes Principles and have room-by-room checklists:

• For a quick but thorough overview of healthy homes, Everyone 

Deserves a Safe and Healthy Home: A Consumer Action 

Guide (weblink at https://www.hud.gov/sites/documents/

SAFEANDHEALTHYHOME.PDF) is a 12-page booklet written for the 

general public. It outlines the eight principles of healthy housing and 

provides a useful overview of key healthy homes issues, including 

lead-based paint, asthma and allergies, mold and moisture, radon, 

household chemicals, pests, carbon monoxide, home safety, asbestos, 

home temperature control, and indoor air quality.

 For each hazard, this publication provides critical action steps. 

It also includes a room-by-room checklist. Housing counselors can 

use this guide to educate themselves and their clients. For those who 

prefer an online resource, the Healthy Homes Basics App (weblink at 

 https://apps.apple.com/us/app/healthy-homes-basics/id1092367352) 

teaches the same information in an interactive format and provides 

quizzes to reinforce key messages.

• For a more in-depth view, Everyone Deserves a Safe and Healthy 

Home: A Stakeholder Guide (weblink at https://www.hud.gov/

sites/documents/STAKEHOLDER_EDSHH.PDF) is a 40-page guide 

that provides additional detail on each of the hazards described 

in the Consumer Action Guide. It is written for stakeholders, such 

as such as medical and health professionals, that assist people in 

maintaining and improving their safety and health. This guide 

also has a companion app, the Healthy Homes Partners app, 

(weblink at https://apps.apple.com/us/app/healthy-homes-partners/

id1244368357) which includes the same information as the guide 

and a room-by-room checklist.

• The Protect Yourself from Lead in Your Home (weblink at https://

www.epa.gov/lead/protect-your-family-lead-your-home) pamphlet 

was created specifically to educate homebuyers and renters about 

lead-based paint and the protections provided by federal law. It is 

available in several languages, and it walks through the key things 

a homebuyer or renter must know about lead-based paint, the rules 

that protect consumers from lead-based paint, and the measures 

people can take to protect themselves from lead exposure.

A stakeholder guide for protecting the health of children and families

Lead  

Mold and Moisture 

Asthma and Allergies 

Radon 

Carbon Monoxide 

Indoor Environmental Quality 

Unsafe Drinking Water 

Household Chemicals

Pests 

Home Safety 

Home Comfort 

Asbestos 

Everyone Deserves a

Safe and 

Healthy Home

www.hud.gov/healthyhomes

Protect the health of children and families

a consumer action guide www.hud.gov/healthyhomes

Everyone Deserves a

Safe and 

Healthy Home

OFFICE OF

LEAD HAZARD CONTROL

AND HEALTHY HOMES

Healthy 

Children HealthyFamilies HealthyCommunities
www.hud.gov/healthyhomes 25

A Guide to Healthy Homes

for Medical and Health Professionals 

➤ HUD and EPA National Lead Information

Center, (800) 424-LEAD, (800) 424-5323 

➤ U.S. Environmental Protection Agency, 

https://www.epa.gov/lead.

➤ U.S. Centers for Disease Control and 

Prevention, https://www.cdc.gov/nceh/lead/.

Asthma and Allergies:

➤ American Lung Association, https://www.

lung.org/ (800) LUNG-USA

➤ American Cleaning Institute, https://www.

cleaninginstitute.org/ (202) 347-2900

➤ Allergy and Asthma Network, https://www.

allergyasthmanetwork.org/ (800) 878-4403

➤ U.S. Environmental Protection Agency, 

https://www.epa.gov/asthma.

Indoor Air Quality

Volatile Organic Compounds (VOC):

➤ Learn how to reduce exposure to VOCs at 

https://www.epa.gov/indoor-air-quality-iaq/

volatile-organic-compounds-impact-indoorair-quality.

Wood Smoke:

➤ Learn more about the health effects of wood 

smoke at https://www.epa.gov/burnwise/

wood-smoke-and-your-health.

➤ Learn how to protect your family at https://

www.epa.gov/burnwise/learn-you-burn-woodwhat-you-can-do.

Fire Place Safety:

➤ Learn about safe wood-burning practices at 

https://www.epa.gov/burnwise/best-woodburning-practices#safe.

Third hand Smoke:

The California Department of Public Health 

(CDPH) states that all tobacco products such 

as cigarettes, e-cigarettes, hookah, and even 

smokeless tobacco can contribute to this harmful 

residue. More information is available at

➤ California Department of Public Health,

https://www.cdph.ca.gov/Programs/CCDPHP/

DCDIC/CTCB/CDPH%20Document%20

Library/Community/EducationalMaterials/

ThirdhandSmokeFactSheet.pdf.

➤ American Academy of Pediatrics, https://

www.healthychildren.org/English/healthissues/conditions/tobacco/Pages/How-ParentsCan-Prevent-Exposure-Thirdhand-Smoke.

aspx.

Scented Products:

Some people may feel discomfort around 

scented personal care products and household 

products with fragrance. Also, some of these 

products, such as air fresheners, may contain 

VOCs. Consider using unscented products when 

possible.

Vacuuming:

On carpets, using a vacuum cleaner that has a 

high-efficiency particulate air (HEPA) filter will 

help control the very fine dust and particles.
26 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

Mold and Moisture:

➤ U.S. Environmental Protection Agency, 

https://www.epa.gov/mold.

➤ U.S. Centers for Disease Control and 

Prevention, https://www.cdc.gov/mold/.

Carbon Monoxide:

Additional information is available online from 

the CDC (https://www.cdc.gov/co/) and EPA

(https://www.epa.gov/indoor-air-quality-iaq/

carbon-monoxides-impact-indoor-air-quality). 

Another important tip is to never use a 

portable generator indoors; they should only be 

used outside. The Consumer Product Safety 

Commission has additional information on 

using portable generators at: https://www.cpsc.

gov/safety-education/safety-guides/carbonmonoxide/portable-generator-related-carbonmonoxide-deaths.

Radon:

➤ U.S. Environmental Protection Agency,

https://www.epa.gov/radon

➤ State radon contacts, https://www.epa.gov/

radon/find-information-about-local-radonzones-and-state-contact-information

➤ National Radon Program Services (KSU), 

https://sosradon.org/, (800) 767-7236

Drinking Water:

If you have questions or concerns about your 

drinking water, call the EPA Safe Drinking Water 

Hotline at 1-800-426-4791 or visit https://www.

epa.gov/ground-water-and-drinking-water. 

Information about protecting private drinking 

water wells is available at https://www.epa.gov/

privatewells.

➤ U.S. Environmental Protection Agency,

https://www.epa.gov/ground-water-anddrinking-water/basic-information-about-yourdrinking-water (800) 426-4791

➤ Centers for Disease Control and Prevention, 

https://www.cdc.gov/healthywater/drinking/

Household Chemicals:

➤ U.S. Environmental Protection Agency, 

https://www.epa.gov/pesticides and https://

www.epa.gov/saferchoice

➤ Poison Control Centers, (800) 222-1222

➤ Household Products Database, https://hpd.

nlm.nih.gov/

Pests:

➤ U.S. Environmental Protection Agency, 

https://www.epa.gov/bedbugs and https://

www.epa.gov/pesticides

Integrated Pest Management (IPM):

Traditional pest control involves the routine 

application of pesticides. In contrast, IPM focuses 

on pest prevention and uses pesticides only as 

needed. This provides a long-term, cost-effective 

and environmentally sensitive pest control. More 

information on IPM and safe pest control is 

available at https://www.epa.gov/safepestcontrol/

do-you-really-need-use-pesticide. Stop Pests in 

Housing (www.StopPests.org) provides resources 

on ways to deal with pests that avoid or reduce 
www.hud.gov/healthyhomes 27

A Guide to Healthy Homes

for Medical and Health Professionals 

exposure to pesticides. EPA’s Citizen’s Guide to Pest 

Control and Pesticide Safety is available at https://

www.epa.gov/safepestcontrol/citizens-guide-pestcontrol-and-pesticide-safety. 

Home Safety:

➤ Poison Control Centers, (800) 222-1222

➤ National SAFE KIDS Campaign, https://

www.safekids.org/, (202) 662-0600

➤ National Safety Council, https://www.nsc.

org/, (800) 621-7615

Temperature Control:

➤ U.S. Department of Energy, https://www.

energy.gov/energysaver/energy-saver

➤ Energy Information Administration,

https://www.eia.gov/

➤ U.S. Environmental Protection Agency 

Indoor Air Plus, https://www.epa.gov/

indoorairplus

➤ Mercury cleanup and disposal, https://

www.epa.gov/cfl/cleaning-broken-cfl

➤ Energy Star, https://www.energystar.gov/

➤ Residential Energy Services Network, http://

www.resnet.us/

Cigarette Smoking:

➤ Centers for Disease Control and Prevention 

smoking cessation, 1-800 QUIT-NOW

➤ American Lung Association, https://www.

lung.org/, (800) LUNGUSA

➤ E-Cigarettes: 

Using e-cigarettes can harm your health and 

can expose children and others to harmful 

secondhand and thirdhand smoke. More 

information about e-cigarettes is available at 

the links below.

➤ U.S. Surgeon General, https://e-cigarettes.

surgeongeneral.gov/

➤ Centers for Disease Control and Prevention 

(CDC), https://www.cdc.gov/tobacco/basic_

information/e-cigarettes/index.htm

➤ California Department of Public 

Health, https://www.cdph.ca.gov/

Programs/CCDPHP/DCDIC/CTCB/Pages/

CaliforniaTobaccoControlBranch.aspx
28 www.hud.gov/healthyhomes

Helping Native Americans Have Safe and Healthy Homes

Project Director: Kitt Rodkey, MBA, HUD 

Office of Lead Hazard Control and Healthy 

Homes, Washington, DC

Project Coordinator: Michael Goldschmidt, 

AIA, LEED AP, Director – USDA-NIFA Healthy 

Homes Partnership, University of Missouri

Acknowledgements

The U.S. Department of Housing and Urban 

Development, Office of Lead Hazard Control 

and Healthy Homes, thanks the following 

individuals for their many valued comments 

and information used in the preparation of this 

publication: 

National Tribal Air Association (NTAA) 

Indoor Air Quality Work Group:

• NTAA Chairman Wilfred J. Nabahe, 

Chairman, and All Members of the Indoor Air 

Quality Work Group

• Ernie Grooms, Group Lead and All Members 

of the NTAA Indoor Air Quality Work Group

• Andy Bessler, Project Director, NTAA, Institute 

for Tribal Health Professionals, Northern 

Arizona University, Flagstaff, Arizona

Project Team:

U.S. Environmental Protection Agency

• Lou Witt, Program Analyst, Indoor 

Environments Division, Washington, DC

• Erin McTigue, Alaska Tribal Air Program 

and Tribal Indoor Air Program Coordinator, 

Region 10 

• Priyanka Pathak, Air Toxics, Radiation, and 

Indoor Air Office, Region 9

U.S. Department of Housing and Urban 

Development

• Kitt Rodkey, Senior Outreach Specialist, HUD 

Office of Lead Hazard Control and Healthy 

Homes 

• Dr. Peter Ashley, PhD, Director of Policy and 

Standards Division, HUD OLHCHH

• Iris Friday, Native American Program 

Specialist, HUD Northwest Office of Native 

American Programs, Seattle, WA

• Dr. Warren Friedman, PhD, CIH, Senior 

Advisor to the Director, HUD OLHCHH

• Karen Griego, Healthy Homes Representative, 

HUD OLHCHH

• Aaron J. Salkoski, HUD OLHCHH

Additional Contributors:

• Kristin Hill, Tribal Public and Environmental 

Health Think Tank

• Gillian Mittelstaedt, MPA, Executive Director, 

Tribal Healthy Homes Network, Issaquah, 

Washington

• Arthur Nash Jr., Energy Faculty and State 

Radon Outreach Coordinator, University of 

Alaska, Fairbanks

• Mansel A. Nelson, Senior Program 

Coordinator, Tribal Environmental 

Education, Institute for Tribal Environmental 

Professionals, Northern Arizona University, 

Flagstaff, AZ

• CAPT Stephen R. Piontkowski, MSEH, REHS, 

Senior Environmental Health Officer, Indian 

Health Service, U.S. Department of Health 

and Human Services
Native American Heritage Month

Every November, we celebrate Native American 

Heritage Month. The observance recognizes and 

honors the ancestry, cultures, traditions, history, and 

contributions of Native people.

Tribal leaders are dedicated to building strong, 

healthy Native communities that support the 

educational aspirations of their youth and economic 

prosperity of their families. 

HUD stands strong in our commitment to address 

pressing needs in Indian Country while upholding 

our government-to-government relationship. Our 

staff in the Office of Lead Hazard Control, and 

Office of Native American Programs work tirelessly 

to support Indian Tribes' self-determination as they 

develop affordable housing, expand homeownership 

opportunities, and address critical infrastructure 

needs. 

We hope that this publication will be useful to you.
U.S. Department of Housing and Urban Development

Funding for this guide is provided through an interagency agreement between the U.S. Department of Agriculture – 

National Institute of Food and Agriculture (NIFA) and the U.S. Department of Housing and Urban Development – 

Office of Lead Hazard Control and Healthy Homes (OLHCHH). 

Project Coordination provided by Michael Goldschmidt, 

University of Missouri and National Director – Healthy Homes Partnership

April 2020

Tribal Contacts: