Indoor Air Nicotine, Nitrogen Dioxide Exposure, and COVID‐19 Outcomes in a Great Plains Tribal Community

Introduction Indigenous communities in the United States have disproportionately high tobacco use and reliance on propane for heating and cooking fuel compared to other demographic groups. Of concern is exposure to air nicotine (AN) and NO 2 in indoor environments and their potential impact on respiratory infections. Objective The objective of this study is to assess indoor air pollution and COVID‐19 infection outcomes in multigenerational households within the Cheyenne River Sioux Tribe (CRST). Methods The COVID‐19 Wayakta He? (“Are you on guard against COVID‐19?”) Study recruited 290 multigenerational households with two adults at least 9 years apart. All participants responded to a questionnaire on COVID‐19 outcomes, housing conditions, and environmental health factors. Households deployed passive AN and NO 2 air monitors in their homes for 1 week. Each participant provided saliva samples for COVID‐19 serological testing. Results The geometric mean AN concentration was 0.052 μ g/m 3 (range: 0.017–5.35); 40.1% of households had AN detected. The geometric mean NO 2 concentration was 10.5 ppb (range: 0.65–138). The odds of previous COVID‐19 infection were 1.21 (95% CI: 1.01, 1.51) times higher for those exposed to AN; the odds of self‐reported long COVID‐19 disease were 3.69 (95% CI: 1.11, 16.6) times higher for those exposed to NO 2 . Conclusion Indoor air exposures to AN and NO 2 increased the odds of having COVID‐19 infection and long COVID‐19 outcomes. The combination of toxic chemical exposures, increased prevalence of existing chronic diseases, and structural social problems placed Indigenous communities at increased risk of having COVID‐19 infections. High exposures to household AN and NO 2 and the occurrence of COVID‐19 disease highlight the importance of consistently including exposure assessments to design targeted interventions in Tribal communities.