The geographic distribution and economic value of climate change-related ozone health impacts in the United States in 2030

Environmental Impacts on Cardiovascular Health and Biology: An Overview

Environmental stressors associated with human activities (eg, air and noise pollution, light disturbance at night) and climate change (eg, heat, wildfires, extreme weather events) are increasingly recognized as contributing to cardiovascular morbidity and mortality. These harmful exposures have been shown to elicit changes in stress responses, circadian rhythms, immune cell activation, and oxidative stress, as well as traditional cardiovascular risk factors (eg, hypertension, diabetes, obesity) that promote cardiovascular diseases. In this overview, we summarize evidence from human and animal studies of the impacts of environmental exposures and climate change on cardiovascular health. In addition, we discuss strategies to reduce the impact of environmental risk factors on current and future cardiovascular disease burden, including urban planning, personal monitoring, and mitigation measures.

Updated assessment of occupational safety and health hazards of climate change

Workers, particularly outdoor workers, are among the populations most disproportionately affected by climate-related hazards. However, scientific research and control actions to comprehensively address these hazards are notably absent. To assess this absence, a seven-category framework was developed in 2009 to characterize the scientific literature published from 1988-2008. Using this framework, a second assessment examined the literature published through 2014, and the current one examines literature from 2014-2021. The objectives were to present literature that updates the framework and related topics and increases awareness of the role of climate change in occupational safety and health. In general, there is substantial literature on worker hazards related to ambient temperatures, biological hazards, and extreme weather but less on air pollution, ultraviolet radiation, industrial transitions, and the built environment. There is growing literature on mental health and health equity issues related to climate change, but much more research is needed. The socioeconomic impacts of climate change also require more research. This study illustrates that workers are experiencing increased morbidity and mortality related to climate change. In all areas of climate-related worker risk, including geoengineering, research is needed on the causality and prevalence of hazards, along with surveillance to identify, and interventions for hazard prevention and control.

Toxic External Exposure Leading to Ocular Surface Injury

The surface of the eye is directly exposed to the external environment, protected only by a thin tear film, and may therefore be damaged by contact with ambient particulate matter, liquids, aerosols, or vapors. In the workplace or home, the eye is subject to accidental or incidental exposure to cleaning products and pesticides. Organic matter may enter the eye and cause infection. Ocular surface damage can trigger a range of symptoms such as itch, discharge, hyperemia, photophobia, blurred vision, and foreign body sensation. Toxin exposure can be assessed clinically in multiple ways, including via measurement of tear production, slit-lamp examination, corneal staining, and conjunctival staining. At the cellular level, environmental toxins can cause oxidative damage, apoptosis of corneal and conjunctival cells, cell senescence, and impaired motility. Outcomes range from transient and reversible with complete healing to severe and sight-compromising structural changes. Classically, evaluation of tolerance and safety was carried out using live animal testing; however, new in vitro and computer-based, in silico modes are superseding the gold standard Draize test. This review examines how environmental features such as pollutants, temperature, and seasonality affect the ocular surface. Chemical burns to the eye are considered, and approaches to protect the ocular surface are detailed.

Physiological status of House Sparrows (Passer domesticus) along an ozone pollution gradient

Mexico City is one of the most polluted cities in the world, and one in which air contamination is considered a public health threat. Numerous studies have related high concentrations of particulate matter and ozone to several respiratory and cardiovascular diseases and a higher human mortality risk. However, almost all of those studies have focused on human health outcomes, and the effects of anthropogenic air pollution on wildlife species is still poorly understood. In this study, we investigated the impacts of air pollution in the Mexico City Metropolitan Area (MCMA) on house sparrows (Passer domesticus). We assessed two physiological responses commonly used as biomarkers: stress response (the corticosterone concentration in feathers), and constitutive innate immune response (the concentration of both natural antibodies and lytic complement proteins), which are non-invasive techniques. We found a negative relationship between the ozone concentration and the natural antibodies response (p = 0.003). However, no relationship was found between the ozone concentration and the stress response or the complement system activity (p > 0.05). These results suggest that ozone concentrations in air pollution within MCMA may constrain the natural antibody response in the immune system of house sparrows. Our study shows, for the first time, the potential impact of ozone pollution on a wild species in the MCMA presenting the Nabs activity and the house sparrow as suitable indicators to assess the effect of air contamination on the songbirds.

Climate change and cardiovascular disease: implications for global health

Climate change is the greatest existential challenge to planetary and human health and is dictated by a shift in the Earth's weather and air conditions owing to anthropogenic activity. Climate change has resulted not only in extreme temperatures, but also in an increase in the frequency of droughts, wildfires, dust storms, coastal flooding, storm surges and hurricanes, as well as multiple compound and cascading events. The interactions between climate change and health outcomes are diverse and complex and include several exposure pathways that might promote the development of non-communicable diseases such as cardiovascular disease. A collaborative approach is needed to solve this climate crisis, whereby medical professionals, scientific researchers, public health officials and policymakers should work together to mitigate and limit the consequences of global warming. In this Review, we aim to provide an overview of the consequences of climate change on cardiovascular health, which result from direct exposure pathways, such as shifts in ambient temperature, air pollution, forest fires, desert (dust and sand) storms and extreme weather events. We also describe the populations that are most susceptible to the health effects caused by climate change and propose potential mitigation strategies, with an emphasis on collaboration at the scientific, governmental and policy levels.

Modeling future asthma attributable to fine particulate matter (PM2.5) in a changing climate: a health impact assessment

Exposure to fine particulate matter (PM_2.5) is associated with asthma development as well as asthma exacerbation in children. PM_2.5 can be directly emitted or can form in the atmosphere from pollutant precursors. PM_2.5 emitted and formed in the atmosphere is influenced by meteorology; future changes in climate may alter the concentration and distribution of PM_2.5. Our aim is to estimate the future burden of climate change and PM_2.5 on new and exacerbated cases of childhood asthma. Projected concentrations of PM_2.5 are based on the Geophysical Fluid Dynamics Laboratory Coupled Model version 3 climate model, the Representative Concentration Pathway 8.5 greenhouse gas scenario, and two air pollution emissions datasets: a 2011 emissions dataset and a 2040 emissions dataset that reflects substantial reductions in emissions of PM_2.5 as compared to the 2011 inventory. We estimate additional PM_2.5-attributable asthma as well as PM_2.5-attributable albuterol inhaler use for four future years (2030, 2050, 2075, and 2095) relative to the year 2000. Exacerbations, regardless of the trigger, are counted as attributable to PM_2.5 if the incident disease is attributable to PM_2.5. We project 38 thousand (95% CI 36, 39 thousand) additional PM_2.5-attributable incident childhood asthma cases and 29 million (95% CI 27, 31 million) additional PM_2.5-attributable albuterol inhaler uses per year in 2030, increasing to 200 thousand (95% CI 190, 210 thousand) additional incident cases and 160 million (95% CI 150, 160 million) inhaler uses per year by 2095 relative to 2000 under the 2011 emissions dataset. These additional PM_2.5-attributable incident asthma cases and albuterol inhaler use would cost billions of additional U.S. dollars per year by the late century. These outcomes could be mitigated by reducing air pollution emissions.

Climate impacts on air quality and child health and wellbeing: Implications for Oceania

Despite the enormous gains in reducing child mortality resulting from the United Nations Millennium Development Goals, in some ways children's future wellbeing has never been under greater threat. Climate and environmental change, primarily driven by poor air quality, represents a major threat to child health and wellbeing, through both direct and indirect effects. Climate change has multiple environmental consequences impacting negatively on child health and wellbeing, including increases in ambient temperature, rising atmospheric carbon dioxide (CO₂₎ , altered distribution of rainfall, ocean warming, rising sea level and more frequent and severe adverse weather events. Multiple pathways link these exposures to a wide variety of adverse health outcomes. Countries in Oceania are especially likely to be subjected to the effects of increases in ambient temperature, altered distribution of rainfall, ocean warming and sea level rise. These changes pose a significant risk to children and provide a moral imperative for us to act to protect child health.

Regional temperature-ozone relationships across the U.S. under multiple climate and emissions scenarios

The potential effects of 21st century climate change on ozone (O₃) concentrations in the United States are investigated using global climate simulations to drive higher-resolution regional meteorological and chemical transport models. Community Earth System Model (CESM) and Coupled Model version 3 (CM3) simulations of the Representative Concentration Pathway 8.5 scenario are dynamically downscaled using the Weather Research and Forecasting model, and the resulting meteorological fields are used to drive the Community Multiscale Air Quality model. Air quality is modeled for five 11-year periods using both a 2011 air pollutant emission inventory and a future projection accounting for full implementation of promulgated regulatory controls. Across the U.S., CESM projects daily maximum temperatures during summer to increase 1-4°C by 2050 and 2-7°C by 2095, while CM3 projects warming of 2-7°C by 2050 and 4-11°C by 2095. The meteorological changes have geographically varying impacts on O₃ concentrations. Using the 2011 emissions dataset, O₃ increases 1-5 ppb in the central Great Plains and Midwest by 2050 and more than 10 ppb by 2095, but it remains unchanged or even decreases in the Gulf Coast, Maine, and parts of the Southwest. Using the projected emissions, modeled increases are attenuated while decreases are amplified, indicating that planned air pollution control measures ameliorate the ozone climate penalty. The relationships between changes in maximum temperature and changes in O₃ concentrations are examined spatially and quantified to explore the potential for developing an efficient approach for estimating air quality impacts of other future climate scenarios.Implications: The effects of climate change on ozone air quality in the United States are investigated using two global climate model simulations of a high warming scenario for five decadal periods in the 21st century. Warming summer temperatures simulated under both models lead to higher ozone concentrations in some regions, with the magnitude of the change increasing with temperature over the century. The magnitude and spatial extent of the increases are attenuated under a future emissions projection that accounts for regulatory controls. Regional linear regression relationships are developed as a first step toward development of a reduced form model for efficient estimation of the health impacts attributable to changes in air quality resulting from a climate change scenario.

A temperature binning approach for multi-sector climate impact analysis

Characterizing the future risks of climate change is a key goal of climate impacts analysis. Temperature binning provides a framework for analyzing sector-specific impacts by degree of warming as an alternative or complement to traditional scenario-based approaches in order to improve communication of results, comparability between studies, and flexibility to facilitate scenario analysis. In this study, we estimate damages for nine climate impact sectors within the contiguous United States (US) using downscaled climate projections from six global climate models, at integer degrees of US national warming. Each sector is analyzed based on socioeconomic conditions for both the beginning and the end of the century. The potential for adaptive measures to decrease damages is also demonstrated for select sectors; differences in damages across adaptation response scenarios within some sectors can be as much as an order of magnitude. Estimated national damages from these sectors based on a reactive adaptation assumption and 2010 socioeconomic conditions range from $600 million annually per degree of national warming for winter recreation to $8 billion annually per degree of national warming for labor impacts. Results are also estimated per degree of global temperature change and for 2090 socioeconomic conditions.

Climate Change and the Practice of Medicine: Essentials for Resident Education

Despite calls for including content on climate change and its effect on health in curricula across the spectrum of medical education, no widely used resource exists to guide residency training programs in this effort. This lack of resources poses challenges for training program leaders seeking to incorporate evidence-based climate and health content into their curricula. Climate change increases risks of heat-related illness, infections, asthma, mental health disorders, poor perinatal outcomes, adverse experiences from trauma and displacement, and other harms. More numerous and increasingly dangerous natural disasters caused by climate change impair delivery of care by disrupting supply chains and compromising power supplies. Graduating trainees face a knowledge gap in understanding, managing, and mitigating these many-faceted consequences of climate change, which-expected to intensify in coming decades-will influence both the health of their patients and the health care they deliver. In this article, the authors propose a framework of climate change and health educational content for residents, including how climate change (1) harms health, (2) necessitates adaptation in clinical practice, and (3) undermines health care delivery. The authors propose not only learning objectives linked to the Accreditation Council for Graduate Medical Education core competencies for resident education but also learning formats and assessment strategies in each content area. They also present opportunities for implementation of climate and health education in residency training programs. Including this content in residency education will better prepare doctors to deliver anticipatory guidance to at-risk patients, manage those experiencing climate-related health effects, and reduce care disruptions during climate-driven extreme weather events.

Air Pollution Health Risk Assessment (AP-HRA), Principles and Applications

Air pollution is a major public health problem. A significant number of epidemiological studies have found a correlation between air quality and a wide variety of adverse health impacts emphasizing a considerable role of air pollution in the disease burden in the general population ranging from subclinical effects to premature death. Health risk assessment of air quality can play a key role at individual and global health promotion and disease prevention levels. The Air Pollution Health Risk Assessment (AP-HRA) forecasts the expected health effect of policies impacting air quality under the various policy, environmental and socio-economic circumstances, making it a key tool for guiding public policy decisions. This paper presents the concept of AP-HRA and offers an outline for the proper conducting of AP-HRA for different scenarios, explaining in broad terms how the health hazards of air emissions and their origins are measured and how air pollution-related impacts are quantified. In this paper, seven widely used AP-HRA tools will be deeply explored, taking into account their spatial resolution, technological factors, pollutants addressed, geographical scale, quantified health effects, method of classification, and operational characteristics. Finally, a comparative analysis of the proposed tools will be conducted, using the SWOT (strengths, weaknesses, opportunities, and threats) method.

Adverse Environmental Exposure and Respiratory Health in Children

The burden imposed by pollution falls more on those living in low-income and middle-income countries, affecting children more than adults. Most air pollution results from incomplete combustion and contains a mixture of particulate matter and gases. Air pollution exposure has negative impacts on respiratory health. This article concentrates on air pollution in 2 settings, the child's home and the ambient environment. There is an inextricable 2-way link between air pollution and climate change, and the effects of climate change on childhood respiratory health also are discussed.

Associations Between Simulated Future Changes in Climate, Air Quality, and Human Health

IMPORTANCE

Future changes in climate are likely to adversely affect human health by affecting concentrations of particulate matter sized less than 2.5 μm (PM2.5) and ozone (O3) in many areas. However, the degree to which these outcomes may be mitigated by reducing air pollutant emissions is not well understood.

OBJECTIVE

To model the associations between future changes in climate, air quality, and human health for 2 climate models and under 2 air pollutant emission scenarios.

DESIGN, SETTING, AND PARTICIPANTS

This modeling study simulated meteorological conditions over the coterminous continental US during a 1995 to 2005 baseline and over the 21st century (2025-2100) by dynamically downscaling representations of a high warming scenario from the Community Earth System Model (CESM) and the Coupled Model version 3 (CM3) global climate models. Using a chemical transport model, PM2.5 and O3 concentrations were simulated under a 2011 air pollutant emission data set and a 2040 projection. The changes in PM2.5 and O3-attributable deaths associated with climate change among the US census-projected population were estimated for 2030, 2050, 2075, and 2095 for each of 2 emission inventories and climate models. Data were analyzed from June 2018 to June 2020.

MAIN OUTCOMES AND MEASURES

The main outcomes were simulated change in summer season means of the maximum daily 8-hour mean O3, annual mean PM2.5, population-weighted exposure, and the number of avoided or incurred deaths associated with these pollutants. Results are reported for 2030, 2050, 2075, and 2095, compared with 2000, for 2 climate models and 2 air pollutant emissions data sets.

RESULTS

The projected increased maximum daily temperatures through 2095 were up to 7.6 °C for the CESM model and 11.8 °C for the CM3 model. Under each climate model scenario by 2095, compared with 2000, an estimated additional 21 000 (95% CI, 14 000-28 000) PM2.5-attributable deaths and 4100 (95% CI, 2200-6000) O3-attributable deaths were projected to occur. These projections decreased to an estimated 15 000 (95% CI, 10 000-20 000) PM2.5-attributable deaths and 640 (95% CI, 340-940) O3-attributable deaths when simulated using a future emission inventory that accounted for reduced anthropogenic emissions.

CONCLUSIONS AND RELEVANCE

These findings suggest that reducing future air pollutant emissions could also reduce the climate-driven increase in deaths associated with air pollution by hundreds to thousands.

Synergistic health effects of air pollution, temperature, and pollen exposure: a systematic review of epidemiological evidence

BACKGROUND

Exposure to heat, air pollution, and pollen are associated with health outcomes, including cardiovascular and respiratory disease. Studies assessing the health impacts of climate change have considered increased exposure to these risk factors separately, though they may be increasing simultaneously for some populations and may act synergistically on health. Our objective is to systematically review epidemiological evidence for interactive effects of multiple exposures to heat, air pollution, and pollen on human health.

METHODS

We systematically searched electronic literature databases (last search, April 29, 2019) for studies reporting quantitative measurements of associations between at least two of the exposures and mortality from any cause and cardiovascular and respiratory morbidity and mortality specifically. Following the Navigation Guide systematic review methodology, we evaluated the risk of bias of individual studies and the overall quality and strength of evidence.

RESULTS

We found 56 studies that met the inclusion criteria. Of these, six measured air pollution, heat, and pollen; 39 measured air pollution and heat; 10 measured air pollution and pollen; and one measured heat and pollen. Nearly all studies were at risk of bias from exposure assessment error. However, consistent exposure-response across studies led us to conclude that there is overall moderate quality and sufficient evidence for synergistic effects of heat and air pollution. We concluded that there is overall low quality and limited evidence for synergistic effects from simultaneous exposure to (1) air pollution, pollen, and heat; and (2) air pollution and pollen. With only one study, we were unable to assess the evidence for synergistic effects of heat and pollen.

CONCLUSIONS

If synergistic effects between heat and air pollution are confirmed with additional research, the health impacts from climate change-driven increases in air pollution and heat exposure may be larger than previously estimated in studies that consider these risk factors individually.

Prevalence of childhood asthma in US military and non-military families: Comparisons by rural-urban residence and geographic region

OBJECTIVE

We sought to determine variables associated with asthma among children from military and non-military families.

METHODS

We performed secondary data analysis on the 2016 Behavioral Risk Factor Surveillance System. Parents with and without military experience (n = 61,079) were asked whether a child ever had asthma and currently has asthma. We used two multiple logistic regression models to determine the influence of rurality and geographic region on "ever" and "current" asthma in children of military and non-military families, while controlling for socio-demographic and behavioral variables.

RESULTS

Overall childhood asthma prevalence for children in military families was lower than non-military families (ever, 9.7% vs. 12.9%; currently, 6.2% vs. 8.2%) in 2016. However, multiple logistic regression showed variation in "ever" and "current" asthma among children of military and non-military families by rurality and race.

DISCUSSION

Developers of public health asthma interventions should consider targeting African-American children of military families living in urban areas. This population is approximately twice as likely to have asthma as Caucasian children of non-military families.

How will air quality effects on human health, crops and ecosystems change in the future?

Future air quality will be driven by changes in air pollutant emissions, but also changes in climate. Here, we review the recent literature on future air quality scenarios and projected changes in effects on human health, crops and ecosystems. While there is overlap in the scenarios and models used for future projections of air quality and climate effects on human health and crops, similar efforts have not been widely conducted for ecosystems. Few studies have conducted joint assessments across more than one sector. Improvements in future air quality effects on human health are seen in emission reduction scenarios that are more ambitious than current legislation. Larger impacts result from changing particulate matter (PM) abundances than ozone burdens. Future global health burdens are dominated by changes in the Asian region. Expected future reductions in ozone outside of Asia will allow for increased crop production. Reductions in PM, although associated with much higher uncertainty, could offset some of this benefit. The responses of ecosystems to air pollution and climate change are long-term, complex, and interactive, and vary widely across biomes and over space and time. Air quality and climate policy should be linked or at least considered holistically, and managed as a multi-media problem. This article is part of a discussion meeting issue 'Air quality, past present and future'.

Health and economic impacts of air pollution induced by weather extremes over the continental U.S

Extreme weather events may enhance ozone (O₃) and fine particulate matter (PM_2.5) pollution, causing additional adverse health effects. This work aims to evaluate the health and associated economic impacts of changes in air quality induced by heat wave, stagnation, and compound extremes under the Representative Concentration Pathways (RCP) 4.5 and 8.5 climate scenarios. The Environmental Benefits Mapping and Analysis Program-Community Edition is applied to estimate health and related economic impacts of changes in surface O₃ and PM_2.5 levels due to heat wave, stagnation, and compound extremes over the continental U.S. during past (i.e., 2001-2010) and future (i.e., 2046-2055) decades under the two RCP scenarios. Under the past and future decades, the weather extremes-induced concentration increases may lead to several tens to hundreds O₃-related deaths and several hundreds to over ten thousands PM_2.5-related deaths annually. High mortalities and morbidities are estimated for populated urban areas with strong spatial heterogeneities. The estimated annual costs for these O₃ and PM_2.5 related health outcomes are $5.5-12.5 and $48.6-140.7 billion U.S. dollar for mortalities, and $8.9-97.8 and $19.5-112.5 million for morbidities, respectively. Of the extreme events, the estimated O₃- and PM_2.5-related mortality and morbidity attributed to stagnation are the highest, followed by heat wave or compound extremes. Large increases in heat wave and compound extreme events in the future decade dominate changes in mortality during these two extreme events, whereas population growth dominates changes in mortality during stagnation that is projected to occur less frequently. Projected reductions of anthropogenic emissions under bothRCP scenarios compensate for the increased mortality due to increasedoccurrence for heat wave and compound extremes in the future. These results suggest a need to further reduce air pollutant emissions during weather extremes to minimize the adverse impacts of weather extremes on air quality and human health.

The Impact of Chronic Ambient Exposure to PM2.5 and Ozone on Asthma Prevalence and COPD Mortality Rates in the Southeastern United States

Respiratory diseases affect millions of people across the United States annually. Two of the most common respiratory diseases are chronic obstructive pulmonary disease (COPD) and asthma. Mortality rates due to COPD have increased by an estimated 30% between 1980 and 2014, with significant variances among geographic regions. Both acute and chronic ambient exposures to fine particulate matter (PM_2.5) and ozone have been associated with exacerbations of respiratory diseases in numerous studies, and exposure to air pollutants are considered as the largest health risk factor globally. This study adds to the current literature by reporting the results of a time series analysis of the impact of PM_2.5 and ozone on prevalence rates of asthma and mortality rates for COPD at regional and county levels across the southeastern United States for the years 2005-2014. While general reductions in levels of PM_2.5 and ozone were demonstrated across all years, a distributed lag model showed continued strong associations between PM_2.5 and prevalence of asthma and mortality due to COPD, even at relatively small increases in ambient exposure (<1 μg/m³) across the southeastern United States. The results of the study support the need for additional research that considers factors such as patient demographics, medical histories, and health disparities in combination with ambient exposures to known pollutants.

Evaluating changes in ambient ozone and respiratory-related healthcare utilization in the Washington, DC metropolitan area

Ozone pollution is a known respiratory irritant, yet we do not fully understand the magnitude or timing of respiratory effects based on short-term exposure. We investigated the associations between ambient ozone concentrations and respiratory symptoms as measured by healthcare utilization events. We used comprehensive electronic health records to identify respiratory responses to changes in ambient ozone levels. We constructed a dataset from Kaiser Permanente Mid-Atlantic States (KPMAS) that included information on 2013 and 2014 daily utilization rates for a broad range of healthcare utilization - nurse calls/emails, provider visits, emergency department and urgent care visits (ED/UC) and hospital admissions - by census block. We used 8-h average ozone concentrations collected from 48 air monitoring stations in the region via the Air Data database of the USEPA. We estimated the association between changes in ambient ozone (exposure windows of current day, 1-day lag and 3-day moving average) and changes in healthcare utilization using linear regression controlling for census tract-level socioeconomic indicators and temperature. Increases in ozone were associated with increases in three of the four utilization event types. A 10 ppb increase in 1-day ozone was associated with a 2.95% (95% CI: 1.93%, 3.96%) increase in calls/emails, a 1.56% (95% CI: 0.38%, 2.74%) increase in ED/UC visits and a 1.10% (95% CI: 0.48%, 1.73%) increase in provider visits. We did not find associations between ozone and hospital admissions. Proportionally, highest effects were found for nurse calls/emails possibly indicating a high number of mild effects that may be underreported in studies that examine only ED visits or hospital admissions.

Ozone-related asthma emergency department visits in the US in a warming climate

Ozone exposure is associated with higher risk of asthma-related emergency department visits. The meteorological conditions that govern ozone concentration are projected to be more favorable to ozone formation over much of the United States due to continued climate change, even as emissions of anthropogenic ozone precursors are expected to decrease by 2050. Our goal is to quantify the health benefits of a climate change mitigation scenario versus a "business-as-usual" scenario, defined by the United Nations Intergovernmental Panel on Climate Change Representative Concentration Pathways (RCPs) 4.5 and 8.5, respectively, using the health impact analytical program Benefits Mapping and Analysis Program - Community Edition (BenMAP - CE) to project the number of asthma ED visits in 2045-2055. We project an annual average of 3100 averted ozone-related asthma ED visits during the 2045-2055 period under RCP4.5 versus RCP8.5, with all other factors held constant, which translates to USD $1.7 million in averted costs annually. We identify counties with tens to hundreds of avoided ozone-related asthma ED visits under RCP4.5 versus RCP8.5. Overall, we project a heterogeneous distribution of ozone-related asthma ED visits at different spatial resolutions, specifically national, regional, and county levels, and a substantial net health and economic benefit of climate change mitigation.

Quantifying the air quality and health benefits of greening freight movements

Commercial vehicle movements have a large effect on traffic-related air pollution in metropolitan areas. In the Greater Toronto and Hamilton Area (GTHA), commercial vehicles include large and medium diesel trucks as well as light-duty gasoline-fuelled trucks. In this study, the emissions of various air pollutants associated with diesel commercial vehicles were estimated and their impacts on urban air quality, population exposure, and public health were quantified. Using data on diesel trucks in the GTHA and a chemical transport model at a spatial resolution of 1 km², the contribution of commercial diesel movements to air quality was estimated. This contribution amounts to about 6-22% of the mean population exposure to nitrogen dioxide (NO₂) and black carbon (BC), depending on the municipality, but is systematically lower than 3% for fine particulate matter (PM_2.5) and ozone (O₃). Using a comparative risk assessment approach, we estimated that the emissions of all diesel commercial vehicles within the GTHA are responsible for an annual total of at least 9810 Years of Life Lost (YLL), corresponding to $3.2 billion of annual social costs. We also assessed the impact of decreasing freeway-sourced diesel emissions along Highway 401, one of the busiest highways in North America. This is comparable with a removal of 250 to 1000 diesel trucks per day along that corridor, which could be replaced by alternative technologies. The mean NO₂ and BC exposures of the population living within 500 m of the highway would decrease by 9% and 11%, respectively, with reductions as high as 22%. Such a measure would save 1310 YLL annually, equivalent to $428 million in social benefits.

New Approaches to Identifying and Reducing the Global Burden of Disease From Pollution

Pollution from multiple sources causes significant disease and death worldwide. Some sources are legacy, such as heavy metals accumulated in soils, and some are current, such as particulate matter. Because the global burden of disease from pollution is so high, it is important to identify legacy and current sources and to develop and implement effective techniques to reduce human exposure. But many limitations exist in our understanding of the distribution and transport processes of pollutants themselves, as well as the complicated overprint of human behavior and susceptibility. New approaches are being developed to identify and eliminate pollution in multiple environments. Community-scale detection of geogenic arsenic and fluoride in Bangladesh is helping to map the distribution of these harmful elements in drinking water. Biosensors such as bees and their honey are being used to measure heavy metal contamination in cities such as Vancouver and Sydney. Drone-based remote sensors are being used to map metal hot spots in soils from former mining regions in Zambia and Mozambique. The explosion of low-cost air monitors has allowed researchers to build dense air quality sensing networks to capture ephemeral and local releases of harmful materials, building on other developments in personal exposure sensing. And citizen science is helping communities without adequate resources measure their own environments and in this way gain agency in controlling local pollution exposure sources and/or alerting authorities to environmental hazards. The future of GeoHealth will depend on building on these developments and others to protect a growing population from multiple pollution exposure risks.

Indoor air chemistry: Terpene reaction products and airway effects

Reactive chemistry is ubiquitous indoors with a wealth of complex oxidation reactions; some of these are initiated by both homogeneous and heterogeneous reaction of ozone with unsaturated organic compounds and subsequent the hydroxyl radical, either in the gas-phase or on reactive surfaces. One major focus has been the reaction of common and abundant terpene-based fragrances in indoor air emitted from many wood-based materials, a variety of consumer products, and citrus fruits and flowers. Inhalation of the terpenes themselves are generally not considered a health concern (both acute and long-term) due to their low indoor air concentrations; however, their gas- and surface reactions with ozone and the hydroxyl radical produce a host of products, both gaseous, i. a. formaldehyde, and ultrafine particles formed by condensation/nucleation processes. These reaction products may be of health concern. Human cell bioassays with key reaction products from ozone-initiated terpene reactions have shown some inflammatory reactions, but results are difficult to interpret for human exposure and risk assessment. Acute effects like sensory irritation in eyes and airways are unlikely or present at very low intensity in real life conditions based on rodent and human exposure studies and known thresholds for sensory irritation in eyes and airways and derived human reference values for airflow limitation and pulmonary irritation. Some fragrances and their ozone-initiated reaction products may possess anti-inflammatory properties. However, long-term effects of the reaction products as ultrafine particles are poorly explored. Material and product surfaces with high ozone deposition velocities may significantly impact the perceived air quality by altered emissions from both homogeneous and heterogeneous surface reactions.

Health impacts and cost-benefit analyses of surface O3 and PM2.5 over the U.S. under future climate and emission scenarios

Health impacts of surface ozone (O₃) and fine particulate matter (PM_2.5) are of major concern worldwide. In this work, the Environmental Benefits Mapping and Analysis Program tool is applied to estimate the health and economic impacts of projected changes in O₃ and PM_2.5 in the U.S. in future (2046-2055) decade relative to current (2001-2010) decade under the Representative Concentration Pathway (RCP) 4.5 and 8.5 climate scenarios. Future annual-mean O₃ reductions under RCP 4.5 prevent ~1,800 all-cause mortality, 761 respiratory hospital admissions (HA), and ~1.2 million school loss days annually, and result in economic benefits of ~16 billion, 29 million, and 132 million U.S. dollars (USD), respectively. By contrast, the projected future annual-mean O₃ increases under RCP8.5 cause ~2,400 mortality, 941 respiratory HA, and ~1.6 million school loss days annually and result in economic disbenefits of ~21 billion, 36 million, and 175 million USD, respectively. Health benefits of reduced O₃ double under RCP4.5 and health dis-benefits of increased O₃ increase by 1.5 times under RCP8.5 in future with 2050 population and baseline incidence rate. Because of the reduction in projected future PM_2.5 over CONUS under both scenarios, the annual avoided all-cause deaths, cardiovascular HA, respiratory HA, and work loss days are ~63,000 and ~83,000, ~5,300 and ~7,000, ~12,000 and ~15,000, and ~7.8 million and ~10 million, respectively, leading to economic benefits of ~560 and ~740 billion, ~240 and ~320 million, ~450 and ~590 million, and ~1,400 and ~1,900 million USD for RCP4.5 and 8.5, respectively. Health benefits of reduced PM_2.5 for future almost double under both scenarios with the largest benefits in urban areas. RCP8.5 projects larger health and economic benefits due to a greater reduction in PM_2.5 but with a warmer atmosphere and higher O₃ pollution than RCP4.5. RCP4.5 leads to multiple-benefit goals including reduced O₃ and PM_2.5, reduced mortality and morbidity, and saved costs. Greater reduction in future PM_2.5 under RCP4.5 should be considered to achieve larger multi-benefits.

Estimating the Health-Related Costs of 10 Climate-Sensitive U.S. Events During 2012

Climate change threatens human health, but there remains a lack of evidence on the economic toll of climate-sensitive public health impacts. We characterize human mortality and morbidity costs associated with 10 climate-sensitive case study events spanning 11 US states in 2012: wildfires in Colorado and Washington, ozone air pollution in Nevada, extreme heat in Wisconsin, infectious disease outbreaks of tick-borne Lyme disease in Michigan and mosquito-borne West Nile virus in Texas, extreme weather in Ohio, impacts of Hurricane Sandy in New Jersey and New York, allergenic oak pollen in North Carolina, and harmful algal blooms on the Florida coast. Applying a consistent economic valuation approach to published studies and state estimates, we estimate total health-related costs from 917 deaths, 20,568 hospitalizations, and 17,857 emergency department visits of $10.0 billion in 2018 dollars, with a sensitivity range of $2.7-24.6 billion. Our estimates indicate that the financial burden of deaths, hospitalizations, emergency department visits, and associated medical care is a key dimension of the overall economic impact of climate-sensitive events. We found that mortality costs (i.e., the value of a statistical life) of $8.4 billion exceeded morbidity costs and lost wages ($1.6 billion combined). By better characterizing health damages in economic terms, this work helps to shed light on the burden climate-sensitive events already place on U.S. public health each year. In doing so, we provide a conceptual framework for broader estimation of climate-sensitive health-related costs. The high health-related costs associated with climate-sensitive events highlight the importance of actions to mitigate climate change and adapt to its unavoidable impacts.

Joint effect of heatwaves and air quality on emergency department attendances for vulnerable population in Perth, Western Australia, 2006 to 2015

BACKGROUND

As global warming and the frequency and intensity of heatwaves increases, health service utilization, including emergency department attendances (EDA) have correspondingly increased across the world. The impact of air quality on health adds to the complexity of the effects. Potential joint effects between heatwaves and air quality on EDA have been rarely reported in the literature, prompting this study.

OBJECTIVES

To investigate the potential joint effect of heatwaves and air quality on the EDA for vulnerable populations in the Perth metropolitan area, Western Australia.

METHODS

A time series design was used. Daily data on EDA, heatwaves (excess heat factor>0) and air pollutants (CO, SO₂, NO₂, O₃, PM₁₀ and PM_2.5) were collected for Perth, Western Australia from 2006 to 2015. Poisson regression modelling was used to assess the associations between heatwaves, air quality, and EDA. Risk assessments on age, gender, Aboriginality, socio-economic status (SES), and joint effect between heatwaves and air quality on EDA were conducted.

RESULTS

The EDA rate was higher in heatwave days (77.86/100,000/day) compared with non-heatwave days (73.90/100,000/day) with rate ratio of 1.053 (95% confidence interval 1.048, 1.058). The EDA rate was higher in males, people older than 60 years or younger than 15 years, Aboriginal people, and people with low SES. Exposure to CO, SO₂, O₃ and PM_2.5 increased risk on EDA and exposure to PM_2.5 showed joint effect with heatwave and increased risk of EDA by 6.6% after adjustment of all other risk factors.

CONCLUSIONS

EDA is an important indicator to evaluate heatwave related morbidity for emergency medical service as EDA rate increased during heatwaves with relative high concentrations of air pollutants. As all air pollutants measured in the study were lower than the Australian National Standards, the joint effect of heatwaves and air quality needs to be further examined when it exceeds the standards.

Impact of weather and climate change with indoor and outdoor air quality in asthma: A Work Group Report of the AAAAI Environmental Exposure and Respiratory Health Committee

Weather and climate change are constant and ever-changing processes that affect allergy and asthma. The purpose of this report is to provide information since the last climate change review with a focus on asthmatic disease. PubMed and Internet searches for topics included climate and weather change, air pollution, particulates, greenhouse gasses, traffic, insect habitat, and mitigation in addition to references contributed by the individual authors. Changes in patterns of outdoor aeroallergens caused by increasing temperatures and amounts of carbon dioxide in the atmosphere are major factors linked to increased duration of pollen seasons, increased pollen production, and possibly increased allergenicity of pollen. Indoor air pollution threats anticipated from climate changes include microbial and mold growth secondary to flooding, resulting in displacement of persons and need for respiratory protection of exposed workers. Air pollution from indoor burning of mosquito repellants is a potential anticipatory result of an increase in habitat regions. Air pollution from fossil fuel burning and traffic-related emissions can alter respiratory defense mechanisms and work synergistically with specific allergens to enhance immunogenicity to worsen asthma in susceptible subjects. Community efforts can significantly reduce air pollution, thereby reducing greenhouse gas emission and improving air quality. The allergist's approach to weather pattern changes should be integrated and anticipatory to protect at-risk patients.

Climate damages and adaptation potential across diverse sectors of the United States

There is a growing capability to project the impacts and economic effects of climate change across multiple sectors. This information is needed to inform decisions regarding the diversity and magnitude of future climate impacts and explore how mitigation and adaptation actions might affect these risks. Here, we summarize results from sectoral impact models applied within a consistent modelling framework to project how climate change will affect 22 impact sectors of the United States, including effects on human health, infrastructure and agriculture. The results show complex patterns of projected changes across the country, with damages in some sectors (for example, labour, extreme temperature mortality and coastal property) estimated to range in the hundreds of billions of US dollars annually by the end of the century under high emissions. Inclusion of a large number of sectors shows that there are no regions that escape some mix of adverse impacts. Lower emissions, and adaptation in relevant sectors, would result in substantial economic benefits.

Comprehensively assessing the drivers of future air quality in California

In this study we analyze the impact of major drivers of future air quality, both separately and simultaneously, for the year 2035 in three major California air basins: the South Coast Air Basin (SoCAB), the San Francisco Bay Area (SFBA), and the San Joaquin Valley (SJV). A variety of scenarios are considered based on changes in climate-driven meteorological conditions and both biogenic and anthropogenic emissions. Anthropogenic emissions are based on (1) the California Air Resources Board (CARB) California Emissions Projection Analysis Model (CEPAM), (2) increases in electric sector emissions due to climate change, and (3) aggressive adoption of alternative energy technologies electrification of end-use technologies, and energy efficiency measures. Results indicate that climate-driven changes in meteorological conditions will significantly alter day-to-day variations in future ozone and PM_2.5 concentrations, likely increasing the frequency and severity of pollution periods in regions that already experience poor air quality and increasing health risks from pollutant exposure. Increases in biogenic and anthropogenic emissions due to climate change are important during the summer seasons, but have little effect on pollutant concentrations during the winter. Results also indicate that controlling anthropogenic emissions will play a critical role in mitigating climate-driven increases in both ozone and PM_2.5 concentrations in the most populated areas of California. In the absence of anthropogenic emissions controls, climate change will worsen ozone air quality throughout the state, increasing exceedances of ambient air quality standards. If planned reductions in anthropogenic emissions are implemented, ozone air quality throughout the less urban areas of the state may be improved in the year 2035, but regions such as the SoCAB and the east SFBA will likely continue to experience high ozone concentrations throughout the summer season. Climate change and anthropogenic emissions controls are both found to decrease wintertime PM_2.5 concentrations in the SJV, eliminating nearly all exceedances of PM_2.5 National Ambient Air Quality Standards (NAAQS) in the year 2035. However, reductions in anthropogenic emissions are unable to fully mitigate the impact of climate change on PM_2.5 concentrations in the SoCAB and east SFBA. Thus, while future air quality in the SJV is projected to be improved in the year 2035, air quality in the SoCAB and east SFBA will remain similar or marginally worsen compared to present day levels. Conversely, we find that aggressive adoption of alternative energy technologies including renewable resources, electrification of end-use technologies, and energy efficiency measures can offset the impacts of climate change. Overall, the two main drivers for air quality in 2035 are changes in meteorological conditions due to climate change and reductions in anthropogenic emissions.

Characterizing Spatial Variability of Climate-Relevant Hazards and Vulnerabilities in the New England Region of the United States

Weather and climate have substantial effects on human health. While much is known about how morbidity and mortality are affected by moderate-to-extreme heat, poor air quality, and heavy precipitation individually, less is known about the cumulative occurrence of these climatic hazards, and the extent to which they spatially overlap with community-scale vulnerabilities. Specifically, there is interest in determining whether individuals living in places with the highest exposure to multiple health hazardous climatic conditions are also more vulnerable to having negative health outcomes. Presented here is a spatial analysis of the distribution of health-relevant climatic hazards and social vulnerabilities across the New England region of the northeastern United States. We show that the frequency of excessive heat days, heavy precipitation days, and ozone (O3) and fine particulate matter (PM2.5) exceedances during the warm seasons (May-September) from 2009 to 2014 have distinct spatial distributions and are statistically significantly correlated across space with indicators of social vulnerability. We further quantify an integrated measure of the hazards and vulnerabilities to illustrate the spatial heterogeneity of overall risk, as well as to demonstrate how the choice of spatial scale influences the identification of high-risk areas. These methods are transferrable to other locations and contexts, which could be of utility not only to geographers and epidemiologists, but also to policymakers tasked with allocating public health resources to populations at greatest risk of weather- and climate-related health effects.

Effect of Health-Related Uncertainty and Natural Variability on Health Impacts and Cobenefits of Climate Policy

Climate policy can mitigate health risks attributed to intensifying air pollution under climate change. However, few studies quantify risks of illness and death, examine their contribution to climate policy benefits, or assess their robustness in light of natural climate variability. We employ an integrated modeling framework of the economy, climate, air quality, and human health to quantify the effect of natural variability on U.S. air pollution impacts under future climate and two global policies (2 and 2.5 °C stabilization scenarios) using 150 year ensemble simulations for each scenario in 2050 and 2100. Climate change yields annual premature deaths related to fine particulate matter and ozone (95CI: 25 000-120 000), heart attacks (900-9400), and lost work days (3.6M-4.9M) in 2100. It raises air pollution health risks by 20%, while policies avert these outcomes by 40-50% in 2050 and 70-88% in 2100. Natural variability introduces "climate noise", yielding some annual estimates with negative cobenefits, and others that reach 100% of annual policy costs. This "noise" is three times the magnitude of uncertainty (95CI) in health and economic responses in 2050. Averaging five annual simulations reduces this factor to two, which is still substantially larger than health-related uncertainty. This study quantifies the potential for inaccuracy in climate impacts projected using too few annual simulations.

Updates to the Noah Land Surface Model in WRF-CMAQ to Improve Simulated Meteorology, Air Quality, and Deposition

Regional, state, and local environmental regulatory agencies often use Eulerian models to investigate the potential impacts on pollutant deposition and air quality from changes in land use, anthropogenic and natural emissions, and climate. The Noah land surface model (LSM) in the Weather Research and Forecasting (WRF) model is widely used with the Community Multiscale Air Quality (CMAQ) model for such investigations, but there are many inconsistencies that need to be changed so that they are consistent with dry deposition and emission processes. In this work, the Noah LSM in WRFv3.8.1 is improved in its linkage to CMAQv5.2 by adding important parameters to the WRF/Noah output, updating the WRF soil and vegetation reference tables that influence CMAQ wet and dry photochemical deposition processes, and decreasing WRF/Noah's top soil layer depth to be consistent with CMAQ processes (e.g., windblown dust and bidirectional ammonia exchange). The modified WRF/Noah-CMAQ system (both off-line and coupled) impacts meteorological predictions of 2-m temperature (T2; increases and decreases), 2-m mixing ratio (Q2; decreases), and 10-m wind speed (WSPD10; decreases) in the United States. These changes are mostly driven by leaf area index values and aerodynamic roughness lengths updated in the vegetation tables based on satellite data, with additional impacts from soil tables updated based on recent soil data. Improvements in the consistency in the treatment of land surface processes between CMAQ and WRF resulted in improvements in both estimated meteorological (e.g., T2, WSPD10, and latent heat fluxes) and chemical (e.g., ozone, sulfur dioxide, and windblown dust) model estimates.

Updates to the Noah Land Surface Model in WRF-CMAQ to Improve Simulated Meteorology, Air Quality, and Deposition

Regional, state, and local environmental regulatory agencies often use Eulerian models to investigate the potential impacts on pollutant deposition and air quality from changes in land use, anthropogenic and natural emissions, and climate. The Noah land surface model (LSM) in the Weather Research and Forecasting (WRF) model is widely used with the Community Multiscale Air Quality (CMAQ) model for such investigations, but there are many inconsistencies that need to be changed so that they are consistent with dry deposition and emission processes. In this work, the Noah LSM in WRFv3.8.1 is improved in its linkage to CMAQv5.2 by adding important parameters to the WRF/Noah output, updating the WRF soil and vegetation reference tables that influence CMAQ wet and dry photochemical deposition processes, and decreasing WRF/Noah's top soil layer depth to be consistent with CMAQ processes (e.g., windblown dust and bidirectional ammonia exchange). The modified WRF/Noah-CMAQ system (both off-line and coupled) impacts meteorological predictions of 2-m temperature (T2; increases and decreases), 2-m mixing ratio (Q2; decreases), and 10-m wind speed (WSPD10; decreases) in the United States. These changes are mostly driven by leaf area index values and aerodynamic roughness lengths updated in the vegetation tables based on satellite data, with additional impacts from soil tables updated based on recent soil data. Improvements in the consistency in the treatment of land surface processes between CMAQ and WRF resulted in improvements in both estimated meteorological (e.g., T2, WSPD10, and latent heat fluxes) and chemical (e.g., ozone, sulfur dioxide, and windblown dust) model estimates.

Examining WRF's Sensitivity to Contemporary Land-Use Datasets across the Contiguous United States Using Dynamical Downscaling

Land-use (LU) representation plays a critical role in simulating air-surface interactions that affect meteorological conditions and regional climate. In the Noah LSM within the WRF Model, LU categories are used to set the radiative properties of the surface and to influence exchanges of heat, moisture, and momentum between the air and land surface. Previous literature examined the sensitivity of WRF simulations to LU using short-term meteorological modeling approaches. Here, the sensitivity to LU representation is studied using continental-scale dynamical downscaling, which typically uses longer temporal and larger spatial scales. Two LU datasets, the U.S. Geological Survey (USGS) dataset and the 2006 National Land Cover Dataset (NLCD), are utilized in 3-yr dynamically downscaled WRF simulations over a historical period. Precipitation and 2-m air temperature are evaluated against observation-based datasets for simulations covering the contiguous United States. The WRF-NLCD simulation tends to produce lower precipitation than the WRF-USGS run, with slightly warmer mean monthly temperatures. However, WRF-NLCD results in more notable increases in the frequency of hot days [i.e., days with temperature >90°F (32.2°C)]. These changes are attributable to reductions in forest and agricultural area in the NLCD relative to USGS. There is also subtle but important sensitivity to the method of interpolating LU data to the WRF grid in the model preprocessing. In all cases, the sensitivity resulting from changes in the LU is smaller than model error. Although this sensitivity is small, it persists across spatial and temporal scales.

Human exposure to ozone in school and office indoor environments

BACKGROUND

Although it is recognized that ozone causes acute and chronic health effects and that even trace amounts of ozone are potentially deleterious to human health, information about global and local exposures to ozone in different indoor environments is limited. To synthesize the existing knowledge, this review analyzes the magnitude of and the trends in global and local exposure to ozone in schools and offices and the factors controlling the exposures.

METHODS

In conducting the literature review, Web of Science, SCOPUS, Google Scholar, and PubMed were searched using 38 search terms and their combinations to identify manuscripts, reports, and directives published between 1973 and 2018. The search was then extended to the reference lists of relevant articles.

RESULTS

The calculated median concentration of ozone both in school (8.50 μg/m³) and office (9.04 μg/m³) settings was well below the WHO guideline value of 100 μg/m³ as a maximum 8 h mean concentration. However, a large range of average concentrations of ozone was reported, from 0.8-114 μg/m³ and from 0 to 96.8 μg/m³ for school and office environments, respectively, indicating situations where the WHO values are exceeded. Outdoor ozone penetrating into the indoor environment is the main source of indoor ozone, with median I/O ratios of 0.21 and 0.29 in school and office environments, respectively. The absence of major indoor ozone sources and ozone sinks, including gas-phase reactions and deposition, are the reasons for lower indoor than outdoor ozone concentrations. However, there are indoor sources of ozone that are of significance in certain indoor environments, including printers, photocopiers, and many other devices and appliances designed for indoor use (e.g., air cleaners), that release ozone either intentionally or unintentionally. Due to significantly elevated outdoor ozone concentrations during summer, summer indoor concentrations are typically elevated. In addition, the age of a building and various housing aspects (carpeting, air conditioning, window fans, and window openings) have been significantly associated with indoor ozone levels.

CONCLUSIONS

The existing means for reducing ozone and ozone reaction products in school and office settings are as follows: 1) reduce penetration of outdoor ozone indoors by filtering ozone from the supply air; 2) limit the use of printers, photocopiers, and other devices and appliances that emit ozone indoors; 3) limit gas-phase reactions by limiting the use of materials and products (e.g. cleaning chemicals) the emissions of which react with ozone.

Adapting air quality management for a changing climate: Survey of local districts in California

Air quality can be affected by weather and thus is sensitive to a changing climate. Wildfire (influenced by weather), consecutive high temperature summer days, and other extreme events are projected to become more severe and frequent with climate change. These may create challenging conditions for managing air quality despite policy targets to reduce precursor and pollutant emissions. Although extreme events are becoming more intense and interest in climate adaptation is increasing among public health practitioners, little attention in scholarly literature and policy covers climate adaptation for air quality governance. Understanding the management and managers' perspectives at the local level provides insight about the needs for climate adaptation, including their adaptation status, perspectives, responsibilities, and roles. This study explores local manager perspectives and experiences of managing air quality within a changing climate as one puzzle piece to understand the gap in climate adaptation within the air quality sector. A broader goal is to contribute to the discussion of developing a multi-jurisdictional vision for reducing the impacts of air quality in a changing climate. In 2016 local air quality district managers in California were invited to participate in an online survey of 39 questions focused on extreme event impacts on air quality. The questionnaire focused on present air quality threats and extreme event challenges, adaptation status and strategies, adaptive capacities, perceived barriers to adaptation, and jurisdictional responsibilities and roles. Over 85 percent of the 35 local air districts in California participated in the survey, which represents 80 percent of the state's population. High awareness and knowledge of climate change among local managers indicates they are ready to adopt and take action on policies that would support climate adaptation, but barriers reported suggests they may need policies and adequate funding to take action and make necessary changes.

IMPLICATIONS

Downscaled global climate models project an increasing severity and frequency of extreme events. In the southwestern United States, these include wildfire, heat events, and dry periods, among others, all of which can place an extra burden on air quality managers and emitters to achieve air quality standards even as they reduce emissions. Despite climate change presenting increasing challenges to meet air quality standards, in the southwestern United States, policy and action to mitigate these impacts have been surprisingly absent. California presents a valuable case study on the topic because of its historic leadership in air quality management for the United States and also because of its initiatives in combating climate change. Yet still we found that adaptation has not been incorporated into air quality management thus far, but local managers seem sufficiently knowledgeable and willing.

Impacts of transportation sector emissions on future U.S. air quality in a changing climate. Part I: Projected emissions, simulation design, and model evaluation

Emissions from the transportation sector are rapidly changing worldwide; however, the interplay of such emission changes in the face of climate change are not as well understood. This two-part study examines the impact of projected emissions from the U.S. transportation sector (Part I) on ambient air quality in the face of climate change (Part II). In Part I of this study, we describe the methodology and results of a novel Technology Driver Model (see graphical abstract) that includes 1) transportation emission projections (including on-road vehicles, non-road engines, aircraft, rail, and ship) derived from a dynamic technology model that accounts for various technology and policy options under an IPCC emission scenario, and 2) the configuration/evaluation of a dynamically downscaled Weather Research and Forecasting/Community Multiscale Air Quality modeling system. By 2046-2050, the annual domain-average transportation emissions of carbon monoxide (CO), nitrogen oxides (NO_x), volatile organic compounds (VOCs), ammonia (NH₃), and sulfur dioxide (SO₂) are projected to decrease over the continental U.S. The decreases in gaseous emissions are mainly due to reduced emissions from on-road vehicles and non-road engines, which exhibit spatial and seasonal variations across the U.S. Although particulate matter (PM) emissions widely decrease, some areas in the U.S. experience relatively large increases due to increases in ship emissions. The on-road vehicle emissions dominate the emission changes for CO, NO_x, VOC, and NH₃, while emissions from both the on-road and non-road modes have strong contributions to PM and SO₂ emission changes. The evaluation of the baseline 2005 WRF simulation indicates that annual biases are close to or within the acceptable criteria for meteorological performance in the literature, and there is an overall good agreement in the 2005 CMAQ simulations of chemical variables against both surface and satellite observations.

The potential effects of climate change on air quality across the conterminous U.S. at 2030 under three Representative Concentration Pathways

The potential impacts of climate change on regional ozone (O3) and fine particulate (PM2.5) air quality in the United States are investigated by linking global climate simulations with regional scale meteorological and chemical transport models. Regional climate at 2000 and at 2030 under three Representative Concentration Pathways (RCPs) is simulated by using the Weather Research and Forecasting (WRF) model to downscale 11-year time slices from the Community Earth System Model (CESM). The downscaled meteorology is then used with the Community Multiscale Air Quality (CMAQ) model to simulate air quality during each of these 11-year periods. The analysis isolates the future air quality differences arising from climate-driven changes in meteorological parameters and specific natural emissions sources that are strongly influenced by meteorology. Other factors that will affect future air quality, such as anthropogenic air pollutant emissions and chemical boundary conditions, are unchanged across the simulations. The regional climate fields represent historical daily maximum and daily minimum temperatures well, with mean biases less than 2 K for most regions of the U.S. and most seasons of the year and good representation of variability. Precipitation in the central and eastern U.S. is well simulated for the historical period, with seasonal and annual biases generally less than 25%, with positive biases exceeding 25% in the western U.S. throughout the year and in part of the eastern U.S. during summer. Maximum daily 8-h ozone (MDA8 O3) is projected to increase during summer and autumn in the central and eastern U.S. The increase in summer mean MDA8 O3 is largest under RCP8.5, exceeding 4 ppb in some locations, with smaller seasonal mean increases of up to 2 ppb simulated during autumn and changes during spring generally less than 1 ppb. Increases are magnified at the upper end of the O3 distribution, particularly where projected increases in temperature are greater. Annual average PM2.5 concentration changes range from -1.0 to 1.0 μg m-3. Organic PM2.5 concentrations increase during summer and autumn due to increased biogenic emissions. Aerosol nitrate decreases during winter, accompanied by lesser decreases in ammonium and sulfate, due to warmer temperatures causing increased partitioning to the gas phase. Among meteorological factors examined to account for modeled changes in pollution, temperature and isoprene emissions are found to have the largest changes and the greatest impact on O3 concentrations.

A Maieutic Exploration of Nudging Strategies for Regional Climate Applications Using the WRF Model

The use of nudging in the Weather Research and Forecasting (WRF) Model to constrain regional climate downscaling simulations is gaining in popularity because it can reduce error and improve consistency with the driving data. While some attention has been paid to whether nudging is beneficial for downscaling, very little research has been performed to determine best practices. In fact, many published papers use the default nudging configuration (which was designed for numerical weather prediction), follow practices used by colleagues, or adapt methods developed for other regional climate models. Here, a suite of 45 three-year simulations is conducted with WRF over the continental United States to systematically and comprehensively examine a variety of nudging strategies. The simulations here use a longer test period than did previously published works to better evaluate the robustness of each strategy through all four seasons, through multiple years, and across nine regions of the United States. The analysis focuses on the evaluation of 2-m temperature and precipitation, which are two of the most commonly required downscaled output fields for air quality, health, and ecosystems applications. Several specific recommendations are provided to effectively use nudging in WRF for regional climate applications. In particular, spectral nudging is preferred over analysis nudging. Spectral nudging performs best in WRF when it is used toward wind above the planetary boundary layer (through the stratosphere) and temperature and moisture only within the free troposphere. Furthermore, the nudging toward moisture is very sensitive to the nudging coefficient, and the default nudging coefficient in WRF is too high to be used effectively for moisture.

The Interplay of Climate Change and Air Pollution on Health

PURPOSE OF REVIEW

Air pollution significantly affects health, causing up to 7 million premature deaths annually with an even larger number of hospitalizations and days of sick leave. Climate change could alter the dispersion of primary pollutants, particularly particulate matter, and intensify the formation of secondary pollutants, such as near-surface ozone. The purpose of the review is to evaluate the recent evidence on the impacts of climate change on air pollution and air pollution-related health impacts and identify knowledge gaps for future research.

RECENT FINDINGS

Several studies modelled future ozone and particulate matter concentrations and calculated the resulting health impacts under different climate scenarios. Due to climate change, ozone- and fine particle-related mortalities are expected to increase in most studies; however, results differ by region, assumed climate change scenario and other factors such as population and background emissions. This review explores the relationships between climate change, air pollution and air pollution-related health impacts. The results highly depend on the climate change scenario used and on projections of future air pollution emissions, with relatively high uncertainty. Studies primarily focused on mortality; projections on the effects on morbidity are needed.

Co-benefits of global, domestic, and sectoral greenhouse gas mitigation for US air quality and human health in 2050

Reductions in greenhouse gas (GHG) emissions can bring ancillary benefits of improved air quality and reduced premature mortality, in addition to slowing climate change. Here we study the co-benefits of global and domestic GHG mitigation on US air quality and human health in 2050 at fine resolution using dynamical downscaling of meteorology and air quality from global simulations to the continental US, and quantify for the first time the co-benefits from foreign GHG mitigation. Relative to the reference scenario from which RCP4.5 was created, global GHG reductions in RCP4.5 avoid 16000 PM_2.5-related all-cause deaths yr^-1 (90% confidence interval, 11700-20300), and 8000 (3600-12400) O₃-related respiratory deaths yr^-1 in the US in 2050. Foreign GHG mitigation avoids 15% and 62% of PM_2.5- and O₃-related total avoided deaths, highlighting the importance of foreign mitigation for US health. GHG mitigation in the US residential sector brings the largest co-benefits for PM_2.5-related deaths (21% of total domestic co-benefits), and industry for O₃ (17%). Monetized benefits for avoided deaths from ozone and PM_2.5 are $137 ($87-187) per ton CO₂ at high valuation and $45 ($29-62) at low valuation, of which 31% are from foreign GHG reductions. These benefits likely exceed the marginal cost of GHG reductions in 2050. The US gains significantly greater air quality and health co-benefits when its GHG emission reductions are concurrent with reductions in other nations. Similarly, previous studies estimating co-benefits locally or regionally may greatly underestimate the full co-benefits of coordinated global actions.

Characterizing the impact of projected changes in climate and air quality on human exposures to ozone

The impact of climate change on human and environmental health is of critical concern. Population exposures to air pollutants both indoors and outdoors are influenced by a wide range of air quality, meteorological, behavioral, and housing-related factors, many of which are also impacted by climate change. An integrated methodology for modeling changes in human exposures to tropospheric ozone (O₃) owing to potential future changes in climate and demographics was implemented by linking existing modeling tools for climate, weather, air quality, population distribution, and human exposure. Human exposure results from the Air Pollutants Exposure Model (APEX) for 12 US cities show differences in daily maximum 8-h (DM8H) exposure patterns and levels by sex, age, and city for all scenarios. When climate is held constant and population demographics are varied, minimal difference in O₃ exposures is predicted even with the most extreme demographic change scenario. In contrast, when population is held constant, we see evidence of substantial changes in O₃ exposure for the most extreme change in climate. Similarly, we see increases in the percentage of the population in each city with at least one O₃ exposure exceedance above 60 p.p.b and 70 p.p.b thresholds for future changes in climate. For these climate and population scenarios, the impact of projected changes in climate and air quality on human exposure to O₃ are much larger than the impacts of changing demographics. These results indicate the potential for future changes in O₃ exposure as a result of changes in climate that could impact human health.

Impacts of oak pollen on allergic asthma in the United States and potential influence of future climate change

Future climate change is expected to lengthen and intensify pollen seasons in the U.S., potentially increasing incidence of allergic asthma. We developed a proof-of-concept approach for estimating asthma emergency department (ED) visits in the U.S. associated with present-day and climate-induced changes in oak pollen. We estimated oak pollen season length for moderate (Representative Concentration Pathway (RCP) 4.5) and severe climate change scenarios (RCP8.5) through 2090 using five climate models and published relationships between temperature, precipitation, and oak pollen season length. We calculated asthma ED visit counts associated with 1994-2010 average oak pollen concentrations and simulated future oak pollen season length changes using the Environmental Benefits Mapping and Analysis Program, driven by epidemiologically derived concentration-response relationships. Oak pollen was associated with 21,200 (95% confidence interval, 10,000-35,200) asthma ED visits in the Northeast, Southeast, and Midwest U.S. in 2010, with damages valued at $10.4 million. Nearly 70% of these occurred among children age <18 years. Severe climate change could increase oak pollen season length and associated asthma ED visits by 5% and 10% on average in 2050 and 2090, with a marginal net present value through 2090 of $10.4 million (additional to the baseline value of $346.2 million). Moderate versus severe climate change could avoid >50% of the additional oak pollen-related asthma ED visits in 2090. Despite several key uncertainties and limitations, these results suggest that aeroallergens pose a substantial U.S. public health burden, that climate change could increase U.S. allergic disease incidence, and that mitigating climate change may have benefits from avoided pollen-related health impacts.

Climate change impacts on projections of excess mortality at 2030 using spatially varying ozone-temperature risk surfaces

We project the change in ozone-related mortality burden attributable to changes in climate between a historical (1995-2005) and near-future (2025-2035) time period while incorporating a non-linear and synergistic effect of ozone and temperature on mortality. We simulate air quality from climate projections varying only biogenic emissions and holding anthropogenic emissions constant, thus attributing changes in ozone only to changes in climate and independent of changes in air pollutant emissions. We estimate non-linear, spatially varying, ozone-temperature risk surfaces for 94 US urban areas using observed data. Using the risk surfaces and climate projections we estimate daily mortality attributable to ozone exceeding 40 p.p.b. (moderate level) and 75 p.p.b. (US ozone NAAQS) for each time period. The average increases in city-specific median April-October ozone and temperature between time periods are 1.02 p.p.b. and 1.94 °F; however, the results varied by region. Increases in ozone because of climate change result in an increase in ozone mortality burden. Mortality attributed to ozone exceeding 40 p.p.b. increases by 7.7% (1.6-14.2%). Mortality attributed to ozone exceeding 75 p.p.b. increases by 14.2% (1.6 28.9%). The absolute increase in excess ozone mortality is larger for changes in moderate ozone levels, reflecting the larger number of days with moderate ozone levels.

An Overview of Occupational Risks From Climate Change

Changes in atmosphere and temperature are affecting multiple environmental indicators from extreme heat events to global air quality. Workers will be uniquely affected by climate change, and the occupational impacts of major shifts in atmospheric and weather conditions need greater attention. Climate change-related exposures most likely to differentially affect workers in the USA and globally include heat, ozone, polycyclic aromatic hydrocarbons, other chemicals, pathogenic microorganisms, vector-borne diseases, violence, and wildfires. Epidemiologic evidence documents a U-, J-, or V-shaped relationship between temperature and mortality. Whereas heat-related morbidity and mortality risks are most evident in agriculture, many other outdoor occupational sectors are also at risk, including construction, transportation, landscaping, firefighting, and other emergency response operations. The toxicity of chemicals change under hyperthermic conditions, particularly for pesticides and ozone. Combined with climate-related changes in chemical transport and distribution, these interactions represent unique health risks specifically to workers. Links between heat and interpersonal conflict including violence require attention because they pose threats to the safety of emergency medicine, peacekeeping and humanitarian relief, and public safety professionals. Recommendations for anticipating how US workers will be most susceptible to climate change include formal monitoring systems for agricultural workers; modeling scenarios focusing on occupational impacts of extreme climate events including floods, wildfires, and chemical spills; and national research agenda setting focusing on control and mitigation of occupational susceptibility to climate change.

Economic Burden of Hospitalizations for Heat-Related Illnesses in the United States, 2001-2010

Understanding how heat waves affect morbidity and mortality, as well as the associated economic costs, is essential for characterizing the human health impacts of extreme heat under a changing climate. Only a handful of studies have examined healthcare costs associated with exposures to high temperatures. This research explores costs associated with hospitalizations for heat-related illness (HRI) in the United States using the 2001 to 2010 Nationwide Inpatient Sample (NIS). Descriptive statistics of patient data for HRI hospitalizations were examined and costs of hospitalizations were reported using the all-payer inpatient cost-to-charge ratio. Costs were examined using a log-gamma model with patient and hospital characteristics included as fixed effects. Adjusted mean costs were then compared across racial groups. The mean costs of HRI hospitalizations were higher among racial/ethnic minorities compared to Whites, who accounted for almost 65% of all HRI hospitalizations. Observed differences in costs based on income, insurance, and gender were also significant. These results suggest that these populations are suffering disproportionately from health inequity, thus, they could shoulder greater disease and financial burdens due to climate change. These findings may have important implications in understanding the economic impact public health planning and interventions will have on preventing hospitalizations related to extreme heat.

Survey of Ambient Air Pollution Health Risk Assessment Tools

Designing air quality policies that improve public health can benefit from information about air pollution health risks and impacts, which include respiratory and cardiovascular diseases and premature death. Several computer-based tools help automate air pollution health impact assessments and are being used for a variety of contexts. Expanding information gathered for a May 2014 World Health Organization expert meeting, we survey 12 multinational air pollution health impact assessment tools, categorize them according to key technical and operational characteristics, and identify limitations and challenges. Key characteristics include spatial resolution, pollutants and health effect outcomes evaluated, and method for characterizing population exposure, as well as tool format, accessibility, complexity, and degree of peer review and application in policy contexts. While many of the tools use common data sources for concentration-response associations, population, and baseline mortality rates, they vary in the exposure information source, format, and degree of technical complexity. We find that there is an important tradeoff between technical refinement and accessibility for a broad range of applications. Analysts should apply tools that provide the appropriate geographic scope, resolution, and maximum degree of technical rigor for the intended assessment, within resources constraints. A systematic intercomparison of the tools' inputs, assumptions, calculations, and results would be helpful to determine the appropriateness of each for different types of assessment. Future work would benefit from accounting for multiple uncertainty sources and integrating ambient air pollution health impact assessment tools with those addressing other related health risks (e.g., smoking, indoor pollution, climate change, vehicle accidents, physical activity).