Critical Review of Health Impacts of Wildfire Smoke Exposure

Pollution and toxicity of heavy metals in wildfires-affected soil and surface water: A review and meta-analysis

Wildfires, both natural and man-made, release and mobilize hazardous substances such as heavy metal(loids) (HM), which are known carcinogens. Following intense rainfall events, HM bound to soil organic matter are transported from the soil to surface water, resulting in water quality degradation. This study reviews the pollution status of HM in wildfire-affected soil and surface water, as well as their toxic effects on aquatic organisms and humans. The rate of HM release during wildfires depends on factors such as the type of tree burned and fire severity. The mobility of HM from soil to surface water is influenced by soil pH, organic matter content, rainfall intensity, and duration. The risk priority number (RPN) analysis indicates that both wildfire-affected soil and surface water require remediation to address HM contamination. HM concentrations in both soil and surface water decrease over time due to soil erosion, wind, storm events, and the depletion of burnt residues. The greatest percentage changes in HM concentrations in burned soils compared to unburned soils were observed for vanadium (340%), nickel (260%), and arsenic (110%). In surface water, the highest increases were seen for iron (740%), vanadium (530%), and aluminium (510%). Wildfire-affected water has been shown to cause toxic effects in aquatic organisms, including DNA damage, oxidative stress, and lipid peroxidation. The consumption of HM-contaminated water and fish poses significant health risks to humans. Therefore, post-fire monitoring of wildfire-affected areas is essential for designing treatment plants, assessing risks, and establishing maximum allowable HM concentrations in water.

The Camp fire and perinatal health: an example of the generalized synthetic control method to identify susceptible windows of exposure

The November 2018 Camp fire was the most destructive wildfire in California history, but its effects on reproductive health are not known. We linked California birth records from 2017-2019 to daily smoke levels using US EPA Air Quality System (AQS) PM2.5 data and NOAA Hazard Mapping System smoke plume polygons during the Camp fire. In the main analysis, pregnancies were considered exposed if they had median AQS PM2.5 levels above 50 μg/m3 for at least 7 days during November 8-22, 2018. We calculated rates of preterm birth and the infant sex ratio based on week of conception and used the generalized synthetic control method to estimate the average treatment effect on the treated and to propose a novel approach to identify potential critical weeks of exposure during pregnancy. We found associations between Camp fire-related smoke exposure and rates of preterm birth, with a risk difference (RD) of 0.005 and a 95% confidence interval (CI) of 0.001-0.010. Exposure during week 10 of pregnancy was consistently associated with increased preterm birth (RD, 0.030; 95% CI, 0.004-0.056). We did not observe differences in the infant sex ratio. Camp fire smoke exposure was associated with increased rates of preterm birth, with sensitive windows in the first trimester. This article is part of a Special Collection on Environmental Epidemiology.

Emergency department visits in California associated with wildfire PM2.5: differing risk across individuals and communities

The threats to human health from wildfires and wildfire smoke (WFS) in the United States (US) are increasing due to continued climate change. A growing body of literature has documented important adverse health effects of WFS exposure, but there is insufficient evidence regarding how risk related to WFS exposure varies across individual or community level characteristics. To address this evidence gap, we utilized a large nationwide database of healthcare utilization claims for emergency department (ED) visits in California across multiple wildfire seasons (May through November, 2012-2019) and quantified the health impacts of fine particulate matter <2.5 μm (PM2.5) air pollution attributable to WFS, overall and among subgroups of the population. We aggregated daily counts of ED visits to the level of the Zip Code Tabulation Area (ZCTA) and used a time-stratified case-crossover design and distributed lag non-linear models to estimate the association between WFS and relative risk of ED visits. We further assessed how the association with WFS varied across subgroups defined by age, race, social vulnerability, and residential air conditioning (AC) prevalence. Over a 7 day period, PM2.5 from WFS was associated with elevated risk of ED visits for all causes (1.04% (0.32%, 1.71%)), non-accidental causes (2.93% (2.16%, 3.70%)), and respiratory disease (15.17% (12.86%, 17.52%)), but not with ED visits for cardiovascular diseases (1.06% (-1.88%, 4.08%)). Analysis across subgroups revealed potential differences in susceptibility by age, race, and AC prevalence, but not across subgroups defined by ZCTA-level Social Vulnerability Index scores. These results suggest that PM2.5 from WFS is associated with higher rates of all cause, non-accidental, and respiratory ED visits with important heterogeneity across certain subgroups. Notably, lower availability of residential AC was associated with higher health risks related to wildfire activity.

Interventions for reducing exposure to air pollution from landscape fires in a changing environment: A systematic review

Emissions from more frequent and prolonged landscape fires (wildfires, risk reduction fires, agricultural burning) can expose populations to high levels of air pollution and exacerbate a range of health conditions. This systematic review aims to map, evaluate, and synthesise the scientific literature reporting interventions that can reduce exposure to landscape fire smoke (LFS). Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Scopus and Web of Science and reviewed relevant literature published until March 2024. Thirty-three studies from four countries met the eligibility criteria. Of the interventions evaluated, air filtration was the most frequently reported, and included use of portable air cleaners (PACs) with high efficiency particulate air (HEPA) filters, ventilation systems with standard and upgraded filters, and low-cost fan filter units (FFU). The effectiveness of PACs for fine particulate matter (PM2.5) reduction ranged between 54 %-92 %. In naturally ventilated residences, concentrations of PM2.5 were 0-44 % lower indoors, and depended on the duration of LFS, building operation, and permeability. Mechanical ventilation with minimum efficiency reporting value (MERV) 5/8 filters in buildings reduced LFS PM2.5 levels by 18-58 %; however, use of higher rated filters (e.g., MERV 12/13) achieved reductions of up to 87 %. Communication interventions, including smartphone apps and alerts/messages from various media sources (e.g., radio, television, internet) had mixed results; nevertheless, inclusion of spirometry and asthma control surveys during app use could improve health outcomes for vulnerable groups. The efficacy of facemasks (N95/P2) was up to 94 % for single pass PM2.5 removal, although they were relatively underutilised. Clean air shelters in public buildings can potentially provide a place for exposure reduction and social support, but have not been sufficiently tested during LFS events. Further research is needed on the effectiveness of interventions during prolonged smoke events, and in low- and middle-income countries.

Wildfire Smoke, the Clean Air Act, and the Exceptional Events Rule: Implications and Policy Alternatives

In recent years, increasing wildfire activity in the western US and Canada has driven declining air quality in some regions of the US. Under EPA's Exceptional Events Rule, states are allowed to exempt daily pollution monitor readings impacted by wildfire smoke from determinations of compliance with Clean Air Act air quality standards. As a result, wildfire smoke is leading to a growing divergence between actual and regulatory air quality. This paper reviews treatment of wildfire smoke under the Clean Air Act and the Exceptional Events Rule. It presents quantitative evidence on the effect of the rule on fulfillment of air quality standards, and an analysis of the degree to which smoke that currently leads to air quality violations is driven by out-of-state fires and fires on federal lands. We suggest a modification to the Exceptional Events Rule under which wildfire emissions would be excluded from air quality regulations only if states adopt government-defined best fire management policies, and we discuss the legal and practical feasibility of such a change.

Perceptions of and Responses to Wildfire Smoke Among New York State Residents: A Cross-Sectional Study

Exposure to wildfire smoke (WFS) is associated with detrimental physical and mental health. Periods of sustained WFS are predicted to increase with climate change, affecting populations globally. Using a retrospective cross-sectional study, we assessed perceptions of and responses to WFS in a cohort of New York State (NYS) residents in Summer 2023. Data were collected using an online survey from October to November 2023. Descriptive statistics summarized respondent experiences, while exploratory analyses identified high-risk populations using chi-square and t-tests. Our sample consisted of 609 primarily healthy, white, and well-educated individuals who spent most of their time in NYS during Summer 2023. Of the 99% that reported experiencing WFS, 92% received and 91% sought out WFS-related air quality information. While only 25% reported a WFS-related illness, 87% experienced at least one symptom with WFS, frequently citing watery eyes (63%), irritated throat (50%), and headaches (49%), with women reporting symptoms more frequently than men (89.1% vs. 81.6%; p = 0.034). A majority (93%) reported taking mitigation actions, including avoiding outdoor activities (75%) and wearing masks (54%). Our results highlight widespread impacts of wildfires in NYS during Summer 2023, with nearly all respondents reporting sustained periods of WFS. Most reported at least one adverse health symptom despite taking preventative measures, indicating that current protective strategies may be insufficient and more effective interventions are needed.

Cancer Risk and Estimated Lithium Exposure in Drinking Groundwater in the US

Importance

Lithium is a naturally occurring element in drinking water and is commonly used as a mood-stabilizing medication. Although clinical studies have reported associations between receiving lithium treatment and reduced cancer risk among patients with bipolar disorder, to our knowledge, the association between environmental lithium exposure and cancer risk has never been studied in the general population.

Objectives

To evaluate the association between exposure to lithium in drinking groundwater and cancer risk in the general population.

Design, Setting, and Participants

This cohort study included participants with electronic health record and residential address information but without cancer history at baseline from the All of Us Research Program between May 31, 2017, and June 30, 2022. Participants were followed up until February 15, 2023. Statistical analysis was performed from September 2023 through October 2024.

Exposure

Lithium concentration in groundwater, based on kriging interpolation of publicly available US Geological Survey data on lithium concentration for 4700 wells across the contiguous US between May 12, 1999, and November 6, 2018.

Main Outcome and Measures

The main outcome was cancer diagnosis or condition, obtained from electronic health records. Stratified Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs for risk of cancer overall and individual cancer types for increasing quintiles of the estimated lithium exposure in drinking groundwater, adjusting for socioeconomic, behavioral, and neighborhood-level variables. The analysis was further conducted in the western and eastern halves of the US and restricted to long-term residents living at their current address for at least 3 years.

Results

A total of 252 178 participants were included (median age, 52 years [IQR, 36-64 years]; 60.1% female). The median follow-up time was 3.6 years (IQR, 3.0-4.3 years), and 7573 incident cancer cases were identified. Higher estimated lithium exposure was consistently associated with reduced cancer risk. Compared with the first (lowest) quintile of lithium exposure, the HR for all cancers was 0.49 (95% CI, 0.31-0.78) for the fourth quintile and 0.29 (95% CI, 0.15-0.55) for the fifth quintile. These associations were found for all cancer types investigated in both females and males, among long-term residents, and in both western and eastern states. For example, for the fifth vs first quintile of lithium exposure for all cancers, the HR was 0.17 (95% CI, 0.07-0.42) in females and 0.13 (95% CI, 0.04-0.38) in males; for long-term residents, the HR was 0.32 (95% CI, 0.15-0.66) in females and 0.24 (95% CI, 0.11-0.52) in males; and the HR was 0.01 (95% CI, 0.00-0.09) in western states and 0.34 (95% CI, 0.21-0.57) in eastern states.

Conclusions and Relevance

In this cohort study of 252 178 participants, estimated lithium exposure in drinking groundwater was associated with reduced cancer risk. Given the sparse evidence and unknown mechanisms of this association, follow-up investigation is warranted.

Physical Health Symptoms and Perceptions of Air Quality among Residents of Smoke-Damaged Homes from a Wildland Urban Interface Fire

The Marshall Fire was a wildland urban interface (WUI) fire that destroyed more than 1000 structures in two communities in Colorado. High winds carried smoke and ash into an unknown number of buildings that, while not incinerated, were significantly damaged. We aimed to understand whether smoke or ash damage to one's home was associated with physical health impacts of the fire event for people living in and around the fire zone whose homes were not completely destroyed. We analyzed data collected from participants who responded to Wave 1 (six months postfire; N = 642) or Wave 2 (one-year postfire; N = 413) of the Marshall Fire Unified Research Survey. We used self-reported exposure to smells and ash in their homes as measures of exposure and also created spatial exposure measures based on proximity to destroyed structures. Reporting a headache was statistically significantly associated with all exposure metrics (self-reported and spatial proximity), and reporting a strange taste in one's mouth was also significantly associated with having more destroyed buildings within 250 m of the home. Study findings can inform response planning for future WUI fires to protect the health of residents of smoke-damaged homes.

Perceived wildfire risk and past experiences with wildfire smoke influence public support for prescribed burning in the western conterminous United States

BACKGROUND

Prescribed burning is an important fuel management tool to prevent severe wildfires. There is a pressing need to increase its application to reduce dry fuels in the western United States, a region that has experienced many damaging wildfires. Public support for this practice is tempered by concern around smoke impacts and escape risks. This study aims to understand how recent experiences with wildfire smoke and perceived risk of smoke events affect public support for prescribed burning.

METHODS

Data were from the May 2023 Household Emergency Preparedness Survey, an online panel survey of 1,727 adults in 12 western conterminous states, applying survey weights to reflect the underlying population demographics. In weighted logistic regression models, we evaluated associations between predictor variables (past experiences with smoke, wildfire risk perception) and support for prescribed burns in general or near a respondent's neighborhood, adjusting for age, race/ethnicity, gender, education, household income, and wildland urban interface status. Mediation models were used to assess whether perceived risk of smoke exposure mediates the relationship between recent smoke experience and support for prescribed burning.

RESULTS

Approximately two-thirds of the population supported prescribed burning in general, and more than half supported prescribed burning near their neighborhood. 44% reported experiencing a smoke event in the past 3 years, which increased the odds of support for prescribed burning in general (OR = 2.03, 95%CI 1.51-2.74) and near their neighborhood (OR = 1.59, 95% CI 1.20-2.09). High perceived risk of future smoke impacts was associated with support for prescribed burns in general (adjusted OR = 1.66, 95% CI = 1.15-2.39) and near their residence (adjusted OR = 1.72, 95%CI = 1.23-2.39). Although only trending towards significance, perceived future risk mediated 16.9% (p = 0.066) of the association between recent smoke experience and support for prescribed burning nearby. Among those who experienced recent smoke events, reporting high degrees of overall smoke impacts or outdoor air quality impacts were positively associated with support for prescribed burns.

CONCLUSIONS

Recent experience with wildfire smoke and perceived future risk are strongly associated with support for prescribed burns. Educational campaigns can apply these findings to improve public support toward prescribed fire activities and funding to reduce wildfire risks and protect public health.

Systematic review of impacts of occupational exposure to wildfire smoke on respiratory function, symptoms, measures and diseases

BACKGROUND

Wildfire smoke contains numerous hazardous air pollutants which pose serious health risks to humans. Despite this, there has been a limited focus on the assessment of the acute physiological and longer-term respiratory effects of wildfire exposure on firefighters and other emergency workers. Therefore, we undertook a systematic review of the evidence about the respiratory impacts of occupational wildfire smoke exposure among wildfire fighters (WFF).

METHODS

Eligible studies from Medline, Embase and Scopus databases were included if they described the relationship between wildfire exposure and respiratory function, symptoms, measures and diseases amongst emergency personnel or firefighters who had responded to wildfires.

RESULTS

Twenty-six articles met the inclusion criteria. 24 out of 26 (22 out of 23 moderate/high quality) studies provided evidence of adverse respiratory effects, including reduced lung function, increased airway dysfunction and airway inflammation, upper and lower respiratory tract symptoms and increased asthma incidence related to wildfires or prescribed burns exposure among WFF and police responders. Fourteen out of 19 studies showed statistically significant declines in spirometry measures of lung function (mostly short-term studies). Two studies using complex lung function tests showed a significant effect on peripheral airway function.

DISCUSSION

This review found a convincing body of evidence that occupational exposure to wildfires or prescribed burns has both acute and possibly longer-term respiratory effects among WFFs and some other emergency personnel. Given that these events are increasing, more needs to be done to identify those most at risk and mitigate these risks.

Evaluating Chemical Transport and Machine Learning Models for Wildfire Smoke PM2.5: Implications for Assessment of Health Impacts

Growing wildfire smoke represents a substantial threat to air quality and human health. However, the impact of wildfire smoke on human health remains imprecisely understood due to uncertainties in both the measurement of exposure of population to wildfire smoke and dose-response functions linking exposure to health. Here, we compare daily wildfire smoke-related surface fine particulate matter (PM2.5) concentrations estimated using three approaches, including two chemical transport models (CTMs): GEOS-Chem and the Community Multiscale Air Quality (CMAQ) and one machine learning (ML) model over the contiguous US in 2020, a historically active fire year. In the western US, compared against surface PM2.5 measurements from the US Environmental Protection Agency (EPA) and PurpleAir sensors, we find that CTMs overestimate PM2.5 concentrations during extreme smoke episodes by up to 3-5 fold, while ML estimates are largely consistent with surface measurements. However, in the eastern US, where smoke levels were much lower in 2020, CTMs show modestly better agreement with surface measurements. We develop a calibration framework that integrates CTM- and ML-based approaches to yield estimates of smoke PM2.5 concentrations that outperform individual approach. When combining the estimated smoke PM2.5 concentrations with county-level mortality rates, we find consistent effects of low-level smoke on mortality but large discrepancies in effects of high-level smoke exposure across different methods. Our research highlights the differences across estimation methods for understanding the health impacts of wildfire smoke and demonstrates the importance of bench-marking estimates with available surface measurements.

Concentration of particulate matter and atmospheric pollutants in the residential area of Kathmandu Valley: A case study of March-April 2021 forest fire events

Forest fires have become more intense and frequent in recently changing climates. The wide variety of pollutants released by forest fire include greenhouse gases, photochemically reactive compounds, and fine and coarse particulate matter. This study investigated the impact of forest fire events on air quality in the Kathmandu Valley during March-April 2021 using ground air quality monitoring stations and satellite data. The three fire periods were studied (a) Pre-fire from 21st - 23rd March (b) first-fire episode from 24th -27th March and (c) second fire episode from 1st - 5th April of 2021. The concentrations of PM2.5 reached to maximum 199 μg/m3 during pre-fire period, 371 μg/m3 and 280 μg/m3 during first and second fire event respectively. The second fire episode had lower PM2.5 concentration despite higher fire counts (449) compared to the first episode suggesting influence of fire activities near to vicinity of Kathmandu valley during second fire episode. There was a two-day lag between the beginning of forest fire events and an increase in PM2.5 levels in Kathmandu. Satellite observation showed varying patterns for different pollutants. HCHO levels responded quickly to fire activity, while AOD and CO levels increased after a few days. Also, low wind speed, low temperature, and low relative humidity additionally elevated these pollutants in Kathmandu. This study emphasizes the extent of the impact of forest fires on air quality and the importance of considering meteorological and satellite data to understand the distribution of pollutants during such events.

Wildfire smoke and health impacts: a narrative review

OBJECTIVE

Air pollution emission associated with wildfires is a global concern, contributing to air quality deterioration and severely impacting public health. This narrative review aims to provide an overview of wildfire smoke (WFS) characteristics and associated impacts on adults' and children's health.

DATA SOURCE

Literature review based on a bibliographic survey in PubMed (National Library of Medicine, United States), SciELO (Scientific Electronic Library Online), and Google Scholar databases. Observational, cross-sectional, longitudinal, and review studies were considered, prioritizing peer-reviewed articles published in the last 10 years (2014-2024).

DATA SYNTHESIS

Wildfire smoke (WFS) contributes to the deterioration of air quality, resulting in increased exposure to air pollution especially in wildland-urban interfaces. WFS contains particulate matter (PM) in a range of sizes and chemical compositions, as well as multiple toxic gasses. The health impacts of WFS are systemic, affecting the respiratory, cardiovascular, and neurological systems. Exposure to WFS is associated with inflammatory and oxidative stress, DNA damage, epigenetic modulations, and stress-disorders in adults and children. Children may be at an increased risk of WFS respiratory impacts, due to their smaller airways and developing lungs.

CONCLUSION

Wildfires are increasing in frequency and intensity, resulting in thousands of premature deaths and hospitalizations worldwide, each year. Preventive measures against wildfire spread must be reinforced, considering the increasing trends of global warming and extreme weather events. Adaptation strategies should be undertaken especially in wildland-urban interface regions, including the improvement of early warning systems, improvement of health care facilities and household preparedness and promotion of risk communication campaigns.

Encountering Prescribed Fire: Characterizing the Intersection of Prescribed Fire and Wildfire in the CONUS

Prescribed fire is applied across the United States as a fuel treatment to manage the impact of wildfires and restore ecosystems. While the recent application of prescribed fire has largely been confined to the southeastern US, the increase in catastrophic wildfires has accelerated the growth of prescribed fire more broadly. To effectively achieve wildfire risk reduction benefits, which includes reducing the amount of smoke emitted, the area treated by prescribed fire must come into contact with a subsequent wildfire. In this study, we applied timely and consistent geospatially resolved data sets of prescribed fires and wildfires to estimate the rate at which an area treated by prescribed fire encounters a subsequent wildfire. We summarize these encounter rates across time intervals, prescribed fire treatment area, and number of previous prescribed fires and by region. On all U.S. Forest Service lands across the Conterminous US (CONUS) 6.2% of prescribed fire treated area from 2003-2022 encountered a subsequent wildfire in 2004-2023. Encounter rates were highest in western US forests, which tend to be more impacted by wildfire than the eastern US, and lower in the eastern US. Encounter rates increased with treatment area in the southeastern US but were relatively flat in the northwest. For the CONUS, encounter rates increased with longer time intervals, associated with diminished potential for reducing wildfire severity, between prescribed fire and the subsequent wildfire area burned. Our results provide timely information on prescribed fire and wildfire interactions that can be leveraged to optimize analyses of the trade-offs between prescribed fire and wildfire.

Air Pollution and Temperature in Seizures and Epilepsy: A Scoping Review of Epidemiological Studies

PURPOSE OF THE REVIEW

Seizures and epilepsy can be debilitating neurological conditions and have few known causes. Emerging evidence has highlighted the potential contribution of environmental exposures to the etiology of these conditions, possibly manifesting via neuroinflammation and increased oxidative stress in the brain. We conducted a scoping review of epidemiological literature linking air pollution and temperature exposures with incidence and acute aggravation of seizures and epilepsy. We systematically searched PubMed, Embase, Web of Science, and APA PsycINFO databases for peer-reviewed journal articles published in English from inception to February 7, 2024.

RECENT FINDINGS

We identified a total of 34 studies: 16 examined air pollution exposure, 12 ambient temperature, and six examined both air pollution and ambient temperature. Most studies were conducted in Asia (China, Taiwan, South Korea, and Japan). Nearly all studies retrospectively derived acute (daily average), ambient, and postnatal exposure estimates from ground monitoring systems and ascertained epilepsy cases or seizure events through record linkage with medical records, health registry systems, or insurance claims data. Commonly assessed exposures were particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), and daily mean ambient temperature. Overall, the main findings across studies lacked consistency, with mixed results reported for the associations of air pollutants and temperature metrics with both seizure incidence and acute aggravations of epilepsy.

Wildfire Smoke: Health Effects, Mechanisms, and Mitigation

Wildfires are becoming more frequent and intense on a global scale, raising concerns about their acute and long-term effects on human health. We conducted a systematic review of the current epidemiological evidence on wildfire health risks and a meta-analysis to investigate the association between wildfire smoke exposure and various health outcomes. We discovered that wildfire smoke increases the risk of premature deaths and respiratory morbidity in the general population. Meta-analysis of cause-specific mortality and morbidity revealed that wildfire smoke had the strongest associations with cardiovascular mortality (RR: 1.018, 95% CI: 1.014-1.021), asthma hospitalization (RR: 1.054, 95% CI: 1.026-1.082), and asthma emergency department visits (RR: 1.117, 95% CI: 1.035-1.204) in the general population. Subgroup analyses of age found that adults and elderly adults were more susceptible to the cardiopulmonary effects of wildfire smoke. Next, we systematically addressed the toxicological mechanisms of wildfire smoke, including direct toxicity, oxidative stress, inflammatory reactions, immune dysregulation, genotoxicity and mutations, skin allergies, inflammation, and others. We discuss wildfire smoke risk mitigation strategies including public health interventions, regulatory measures, and personal actions. We conclude by highlighting current research limitations and future directions for wildfire research, such as elucidating the complex interactions of wildfire smoke components on human health, developing personalized risk assessment tools, and improving resilience and adaptation strategies to mitigate the health effects of wildfires in changing climate.

The temporal trend and disparity in short-term health impacts of fine particulate matter in California (2006-2019)

Most epidemiological studies assume that the relationship between short-term air pollution exposure and health outcomes is constant over time, which ignores potential changes in population composition and particulate matter emission sources. Limited studies have assessed changes in the relationship between fine particulate matter (PM2.5) and adverse health outcomes over time, with mixed results. Additionally, there is a need to identify which subgroups are disproportionately impacted over time by PM2.5-related health consequences. Therefore, we aimed to examine whether temporal trends exist in the relationships between daily PM2.5 exposure and circulatory and respiratory acute care utilization in California from 2006 to 2019. We further assessed whether certain subpopulations are more susceptible to PM2.5 exposure by demographic characteristics and extreme wildfire frequency. Daily PM2.5 concentrations estimated from a stacked ensemble model and daily cause-specific acute care utilization and demographic data from the California Department of Health Care Access and Information. We analyzed this relationship using modified two-stage Bayesian hierarchical models, where we first did not consider temporal trends, then stratified by two periods, and finally flexibly considered non-linear changes over time. Increases in circulatory (0.56 %; 95 % credible interval (CI): 0.17 %, 0.96 %) and respiratory acute care utilization risk (2.61 %; 95%CI: 2.29 %, 2.94 %) were found with every 10 μg/m3 increase in PM2.5 on the same day and previous two days. These risks were found to increase over time, where 0.13 % (95%CI: 0.02 %, 0.22 %) and 1.40 % (95%CI: 1.24 %, 1.54 %) increases were identified for circulatory and respiratory acute care utilizations, respectively, from the first (2006-2012) to second period (2013-2019). Differences by age, sex, race/ethnicity, and extreme wildfire frequency were noted. These findings confirm that air pollution guidelines should consider the dynamic nature of epidemiological dose-response and can provide insight for targeted air pollution control and adaptation policies designed to reduce PM2.5 exposure, particularly for the most susceptible subpopulations.

Fire Smoke Elevated the Carbonaceous PM2.5 Concentration and Mortality Burden in the Contiguous U.S. and Southern Canada

Despite emerging evidence on the health impacts of fine particulate matter (PM2.5) from wildland fire smoke, the specific effects of PM2.5 composition on health outcomes remain uncertain. We developed a three-level, chemical transport model-based framework to estimate daily full-coverage concentrations of smoke-derived carbonaceous PM2.5, specifically Organic Carbon (OC) and Elemental Carbon (EC), at a 1 km2 spatial resolution from 2002 to 2019 across the contiguous U.S. (CONUS) and Southern Canada (SC). Cross-validation demonstrated that the framework performed well at both the daily and monthly levels. Modeling results indicated that increases in wildland fire smoke have offset approximately one-third of the improvements in background air quality. In recent years, wildland fire smoke has become more frequent and carbonaceous PM2.5 concentrations have intensified, especially in the Western CONUS and Southwestern Canada. Smoke exposure is also occurring earlier throughout the year, leading to more population being exposed. We estimated that long-term exposure to fire smoke carbonaceous PM2.5 is responsible for 7,462 and 259 non-accidental deaths annually in the CONUS and SC, respectively, with associated annual monetized damage of 68.4 billion USD for the CONUS and 1.97 billion CAD for SC. The Southeastern CONUS, where prescribed fires are prevalent, contributed most to these health impacts and monetized damages. Given the challenges posed by climate change for managing prescribed and wildland fires, our findings offer critical insights to inform policy development and assess future health burdens associated with fire smoke exposure.

Firefighters' occupational exposure to air pollution: impact on COPD and asthma-study protocol

INTRODUCTION

Firefighting continues to be among the most hazardous yet least studied occupations in terms of the impact of exposure to occupational disease. In particular, firefighters are at increased risk of adverse health effects due to exposure to significant levels of potentially harmful substances, namely carbon monoxide, particulate matter and formaldehyde, during their professional duties.This paper reports an epidemiologic study aiming to reduce the gaps in assessing the long-term effects of air pollution exposure to forest fires' combat on firefighters, namely regarding chronic obstructive pulmonary Disease (COPD) and asthma.

METHODS AND ANALYSIS

Based on the implementation in an area with high forest fires (in Portugal), the study will analyse firefighters' exposure to fire emissions by measuring air pollutants with personal exposure monitors during forest fire combat through a retrospective cohort study (exposed vs non-exposed). Moreover, based on answers to validated questionnaires and medical examinations to be performed by medical doctors, the study will assess the prevalence, incidence and exacerbation of COPD and asthma in firefighters, thus considering both short-term and long-term effects. Based on the results above referred, the study aims to evaluate the impact of exposure and inhalation dose of air pollutants during forest fires' combat on the development of the above-referred chronic diseases. The approximate number of participants in the study will never be less than 186, guaranteeing 80% of study power (significant at a 5% level).

ETHICS AND DISSEMINATION

The study has been approved by the Ethical Committee of Centro Hospitalar Universitário São João. The results will be published in international and national journals and conferences, allowing the results obtained to be communicated to the scientific community. Moreover, up-to-date data will be disseminated to stakeholders and decision-makers to help them decide on triggering official control measures.

Preoperative Exposure to Fine Particulate Matter and Risk of Postoperative Complications: A Single Center Observational Cohort Bayesian Analysis

Background

While exposure to fine particulate matter air pollution (PM 2.5 ) is known to cause adverse health effects, its impact on postoperative outcomes in US adults remains understudied. Perioperative exposure to PM 2.5 may induce inflammation that interacts insidiously with the surgical stress response, leading to higher postoperative complications.

Methods

We conducted a single center, retrospective cohort study using data from 49,615 surgical patients living along Utah's Wasatch Front and who underwent elective surgical procedures at a single academic medical center from 2016-2018. Patients' addresses were geocoded and linked to daily Census-tract level PM 2.5 estimates. We hypothesized that elevated PM 2.5 concentrations in the week prior to surgery would be associated with an increase in a bundle of major postoperative complications. A hierarchical Bayesians regression model was fit adjusting for age, sex, season, neighborhood disadvantage, and the Elixhauser index of comorbidities.

Results

Postoperative complications increased in a dose-dependent manner with higher concentrations of PM 2.5 exposure, with a relative increase of 8% in the odds of complications (OR=1.082) for every 10ug/m 3 increase in the highest single-day 24-hr PM 2.5 exposure during the 7 days prior to surgery. For a 30 fold increase in PM 2.5 (1 ug/m 3 to 30ug/m 3 ) the odds of complication rose to over 27% (95%CI: 4%-55%). The association persisted after controlling for comorbidities and confounders; our inferences were robust to modeling choices and sensitivity analysis.

Conclusions

In this large Utah cohort, exposure to elevated PM 2.5 concentrations in the week before surgery was associated with a dose-dependent increase in postoperative complications, suggesting a potential impact of air pollution on surgical outcomes. These findings merit replication in larger datasets to identify populations at risk and define the interaction and impact of different pollutants. PM 2.5 exposure is a potential perioperative risk factor and, given the unmitigated air pollution in urban areas, a global health concern.

Landscape fire PM2.5 and hospital admissions for cause-specific cardiovascular disease in urban China

There is a growing interest in the health impacts of PM2.5 originating from landscape fires. We conducted a time-series study to investigate the association between daily exposure to landscape fire PM2.5 and hospital admissions for cardiovascular events in 184 major Chinese cities. We developed a machine learning model combining outputs from chemical transport models, meteorological information and observed air pollution data to determine daily concentrations of landscape fire PM2.5. Furthermore, we fitted quasi-Poisson regression to evaluate the link between landscape fire PM2.5 concentrations and cardiovascular hospitalizations in each city, and conducted random-effects meta-analysis to pool the city-specific estimates. Here we show that, on a national scale, a rise of 1-μg/m3 in landscape fire PM2.5 concentrations is positively related to a same-day 0.16% (95% confidence interval: 0.01%-0.32%) increase in hospital admissions for cardiovascular disease, 0.28% (0.12%-0.44%) for ischemic heart disease, and 0.25% (0.02%-0.47%) for ischemic stroke. The associations remain significant even after adjusting for other sources of PM2.5. Our findings indicate that transient elevation in landscape fire PM2.5 levels may increase risk of cardiovascular diseases.

Clair JM, Warneke C, Wolfe GM, Womack C. Evolution of Reactive Organic Compounds and Their Potential Health Risk in Wildfire Smoke

Wildfires are an increasing source of emissions into the air, with health effects modulated by the abundance and toxicity of individual species. In this work, we estimate reactive organic compounds (ROC) in western U.S. wildland forest fire smoke using a combination of observations from the 2019 Fire Influence on Regional to Global Environments and Air Quality (FIREX-AQ) field campaign and predictions from the Community Multiscale Air Quality (CMAQ) model. Standard emission inventory methods capture 40-45% of the estimated ROC mass emitted, with estimates of primary organic aerosol particularly low (5-8×). Downwind, gas-phase species abundances in molar units reflect the production of fragmentation products such as formaldehyde and methanol. Mass-based units emphasize larger compounds, which tend to be unidentified at an individual species level, are less volatile, and are typically not measured in the gas phase. Fire emissions are estimated to total 1250 ± 60 g·C of ROC per kg·C of CO, implying as much carbon is emitted as ROC as is emitted as CO. Particulate ROC has the potential to dominate the cancer and noncancer risk of long-term exposure to inhaled smoke, and better constraining these estimates will require information on the toxicity of particulate ROC from forest fires.

Catastrophic impact of extreme 2019 Indonesian peatland fires on urban air quality and health

Tropical peatland fires generate substantial quantities of airborne fine particulate matter (PM2.5) and in Indonesia are intensified during El Niño-related drought leading to severe air quality impacts affecting local and distant populations. Limited in-situ data often necessitates reliance on air quality models, like that of the Copernicus Atmosphere Monitoring Service, whose accuracy in extreme conditions is not fully understood. Here we demonstrate how a network of low-cost sensors around Palangka Raya, Central Kalimantan during the 2019 fire season, quantified extreme air quality and city-scale variability. The data indicates relatively strong model performance. Health impacts are substantial with estimates of over 1200 excess deaths in the Palangka Raya region, over 3200 across Central Kalimantan and more than 87,000 nationwide in 2019 due to fire-induced PM2.5 exposure. These findings highlight the need for urgent action to mitigate extreme fire events, including reducing fire use and landscape remediation to prevent peat fire ignition.

Predicting health impacts of wildfire smoke in Amazonas basin, Brazil

Worldwide, smoke from forest fires has deleterious health effects. Even so, because of the complexity of fire mechanics, public health authorities face challenges in forecasting and thus mitigating population exposure to smoke. The population in the Amazon basin regularly suffers from fire smoke tied to agriculture and land-use change. The people of Manaus, a city of two million in the center of the basin, suffer the consequences. The study herein evaluates the time lag between fire occurrence and hospital admission for cardiorespiratory illness. Understanding the time lag is key to forecasting and mitigating the public health effects. The study approach is sequential application of four increasingly complex methods of machine learning to examine the relationships among black carbon concentrations, fire count, meteorology, and hospital admissions. The mean absolute percentage error (MAPE) for predicting hospital admissions ranged from 27% to 38%. Furthermore, a one-day lag was observed between the detection of fires and the manifestations of respiratory health hazards. This finding suggests the potential for developing an early warning system, which could enable public health officials to issue advisories or implement preventive actions during the brief period before hospital admissions begin to rise. The findings have applicability not only to the population exposed to fires in the Amazon basin but also to populations where smoke is prevalent, notably increasingly in Australia, southern Europe, the western USA, southern Canada, and southeast Asia.

The Effects of Wildfires on the Mental and Physical Health of School-Age Children in North America: A Scoping Review

BACKGROUND

Wildfires are occurring more often and with greater intensity, leading to longer and harsher fire seasons. As a result, children are more frequently exposed to wildfire smoke, which increases their risk of mental and physical health effects.

PURPOSE

The purpose of our scoping review is to explore the current literature on what is known about the direct and indirect impacts of wildfires on the mental and physical health of school-age children in North America (5 to 18-year-olds).

METHODS

A health sciences librarian-assisted literature search, with input from the research team, was performed.

RESULTS

A total of 16 studies were selected. Common mental health symptoms such as anxiety, depression, suicidal thinking, and post-traumatic stress disorder have been identified. The findings of this review are in line with recent studies showing a connection between adult wildfire exposure and respiratory conditions; however, no cardiovascular health effects in children were identified.

CONCLUSIONS

The available studies in our review demonstrate that wildfires do increase the impacts on both mental and physical health postexposure in school-age children. Future research should specifically include larger samples, more qualitative and longitudinal studies that can more effectively analyze the effects of wildfire events on psychological factors over time, conceptual frameworks, and exposure metrics specific for PM2.5 from wildfire smoke.

Associations between short-term exposure to airborne carbonaceous particles and mortality: A time-series study in London during 2010-2019

Exposure to ambient particulate matter (PM) has been identified as a major global health concern; however, the importance of specific chemical PM components remains uncertain. Recent studies have suggested that carbonaceous aerosols are important detrimental components of the particle mixture. Using time-series methods, we investigated associations between short-term exposure to carbonaceous particles and mortality in London, UK. Daily counts of non-accidental, respiratory, and cardiovascular deaths were obtained between 2010 and 2019. For the same period, daily concentrations of carbonaceous particles: organic (OC), elemental (EC), wood-burning (WC), total carbon (TC) and equivalent black carbon (eBC) were sourced from two centrally located monitoring sites (one urban-traffic and one urban-background). Generalized additive models were used to estimate the percentage change in mortality risk associated with interquartile range increases in particulate concentrations. Lagged effects up to 3 days were examined. Stratified analyses were conducted by age, sex, and season, separate analyses were also performed by site-type. For non-accidental mortality, positive associations were observed for all particle species at lag1, including statistically significant percentage risk changes in WC (0.51% (95%CI: 0.19%, 0.82%) per IQR (0.68 μg/m3)) and OC (0.45% (95%CI: 0.04%, 0.87% per IQR (2.36 μg/m3)). For respiratory deaths, associations were greatest for particulate concentrations averaged over the current and previous 3 days, with increases in risk of 1.70% (95%CI: 0.64%, 2.77%) for WC and 1.31% (95%CI: -0.08%, 2.71%) for OC. No associations were found with cardiovascular mortality. Results were robust to adjustment for particle mass concentrations. Stratified analyses suggested particulate effects were greatest in the summer and respiratory associations more pronounced in females. Our findings are supportive of an association between carbonaceous particles and non-accidental and respiratory mortality. The strongest evidence of an effect was for WC; this is of significance given the rising popularity of wood-burning for residential space heating and energy production across Europe.

Impact of the 2022 New Mexico, US wildfires on air quality and health

The 2022 wildfires in New Mexico, United States, were unparalleled compared to past wildfires in the state in both their scale and intensity, resulting in poor air quality and a catastrophic loss of habitat and livelihood. Among all wildfires in New Mexico in 2022, six wildfires were selected for our study based on the size of the burn area and their proximity to populated areas. These fires accounted for approximately 90 % of the total burn area in New Mexico in 2022. We used a regional chemical transport model and data-fusion technique to quantify the contribution of these six wildfires (April 6 to August 22) on particulate matter (PM2.5: diameter ≤ 2.5 μm) and ozone (O3) concentrations, as well as the associated health impacts from short-term exposure. We estimated that these six wildfires emitted 152 thousand tons of PM2.5 and 287 thousand tons of volatile organic compounds to the atmosphere. We estimated that the average daily wildfire smoke PM2.5 across New Mexico was 0.3 μg/m3, though 1 h maximum exceeded 120 μg/m3 near Santa Fe. Average wildfire smoke maximum daily average 8-h O3 (MDA8-O3) contribution was 0.2 ppb during the study period over New Mexico. However, over the state 1 h maximum smoke O3 exceeded 60 ppb in some locations near Santa Fe. Estimated all-cause excess mortality attributable to short term exposure to wildfire PM2.5 and MDA8-O3 from these six wildfires were 18 (95 % Confidence Interval (CI), 15-21) and 4 (95 % CI: 3-6) deaths. Additionally, we estimate that wildfire PM2.5 was responsible for 171 (95 %: 124-217) excess cases of asthma emergency department visits. Our findings underscore the impact of wildfires on air quality and human health risks, which are anticipated to intensify with global warming, even as local anthropogenic emissions decline.

Cleaning indoor air-what works for respiratory health: An updated literature review and recommendations

Indoor air pollution is a growing public health concern globally and is associated with increased respiratory symptoms and morbidity. Individuals spend most of their time indoors, and pollutant-related health effects are often driven by the indoor environment. Understanding effective interventions to improve indoor air quality and their impact on respiratory outcomes is key to decreasing the burden of air pollution for high-risk populations across the life-span. This review applies a hierarchy of interventions framework specific to respiratory health effects and focuses on recent studies of interventions to improve indoor air quality among high-risk populations with chronic respiratory disease published in the past 3 years. While policy and source control interventions are likely the most effective and equitable approaches to improve indoor air quality and benefit population health, these were less extensively investigated. Engineering interventions, such as air cleaner interventions, were the most widely studied. Several studies, including those focused on asthma and chronic obstructive pulmonary disease, demonstrated improvement in symptoms and medication receipt with interventions in both home- and school-based settings. Combined multilevel interventions with engineering and behavioral interventions led to improved respiratory outcomes in some, but not all, studies. Placing the recent work in the context of the broader literature, we identify gaps in research. Further research is needed to understand intervention effectiveness over time and an increased focus on policy and source control interventions that can mitigate risk in vulnerable populations.

Robust differential gene expression patterns in the prefrontal cortex of male mice exposed to an occupationally relevant dose of laboratory-generated wildfire smoke

Wildfires have become common global phenomena concurrent with warmer and drier climates and are now major contributors to ambient air pollution worldwide. Exposure to wildfire smoke has been classically associated with adverse cardiopulmonary health outcomes, especially in vulnerable populations. Recent work has expanded our understanding of wildfire smoke toxicology to include effects on the central nervous system and reproductive function; however, the neurotoxic profile of this toxicant remains ill-explored in an occupational context. Here, we sought to address this by using RNA sequencing to examine transcriptomic signatures in the prefrontal cortex of male mice modeling career wildland firefighter smoke exposure. We report robust changes in gene expression profiles between smoke-exposed samples and filtered air controls, evidenced by 2,862 differentially expressed genes (51.2% increased). We further characterized the functional relevance of these genes highlighting enriched pathways related to synaptic transmission, neuroplasticity, blood-brain barrier integrity, and neurotransmitter metabolism. Additionally, we identified possible contributors to these alterations through protein-protein interaction network mapping, which revealed a central node at ß-catenin and secondary hubs centered around mitochondrial oxidases, the Wnt signaling pathway, and gene expression machinery. The data reported here will serve as the foundation for future experiments aiming to characterize the phenotypic effects and mechanistic underpinnings of occupational wildfire smoke neurotoxicology.

Long-term exposure to wildland fire smoke PM2.5 and mortality in the contiguous United States

Despite the substantial evidence on the health effects of short-term exposure to ambient fine particles (PM2.5), including increasing studies focusing on those from wildland fire smoke, the impacts of long-term wildland fire smoke PM2.5 exposure remain unclear. We investigated the association between long-term exposure to wildland fire smoke PM2.5 and nonaccidental mortality and mortality from a wide range of specific causes in all 3,108 counties in the contiguous United States, 2007 to 2020. Controlling for nonsmoke PM2.5, air temperature, and unmeasured spatial and temporal confounders, we found a nonlinear association between 12-mo moving average concentration of smoke PM2.5 and monthly nonaccidental mortality rate. Relative to a month with the long-term smoke PM2.5 exposure below 0.1 μg/m3, nonaccidental mortality increased by 0.16 to 0.63 and 2.11 deaths per 100,000 people per month when the 12-mo moving average of PM2.5 concentration was of 0.1 to 5 and 5+ μg/m3, respectively. Cardiovascular, ischemic heart disease, digestive, endocrine, diabetes, mental, and chronic kidney disease mortality were all found to be associated with long-term wildland fire smoke PM2.5 exposure. Smoke PM2.5 contributed to approximately 11,415 nonaccidental deaths/y (95% CI: 6,754, 16,075) in the contiguous United States. Higher smoke PM2.5-related increases in mortality rates were found for people aged 65 and above. Positive interaction effects with extreme heat were also observed. Our study identified the detrimental effects of long-term exposure to wildland fire smoke PM2.5 on a wide range of mortality outcomes, underscoring the need for public health actions and communications that span the health risks of both short- and long-term exposure.

Air Quality Sensor Experts Convene: Current Quality Assurance Considerations for Credible Data

Air sensors can provide valuable non-regulatory and supplemental data as they can be affordably deployed in large numbers and stationed in remote areas far away from regulatory air monitoring stations. Air sensors have inherent limitations that are critical to understand before collecting and interpreting the data. Many of these limitations are mechanistic in nature, which will require technological advances. However, there are documented quality assurance (QA) methods to promote data quality. These include laboratory and field evaluation to quantitatively assess performance, the application of corrections to improve precision and accuracy, and active management of the condition or state of health of deployed air quality sensors. This paper summarizes perspectives presented at the U.S. Environmental Protection Agency's 2023 Air Sensors Quality Assurance Workshop (https://www.epa.gov/air-sensor-toolbox/quality-assurance-air-sensors#QAworkshop) by stakeholders (e.g., manufacturers, researchers, air agencies) and identifies the most pressing needs. These include QA protocols, streamlined data processing, improved total volatile organic compound (TVOC) data interpretation, development of speciated VOC sensors, and increased documentation of hardware and data handling. Community members using air sensors need training and resources, timely data, accessible QA approaches, and shared responsibility with other stakeholders. In addition to identifying the vital next steps, this work provides a set of common QA and QC actions aimed at improving and homogenizing air sensor QA that will allow stakeholders with varying fields and levels of expertise to effectively leverage air sensor data to protect human health.

House Dust Mite Proteins Adsorb on Multiwalled Carbon Nanotubes Forming an Allergen Corona That Intensifies Allergic Lung Disease in Mice

The increasing use of multiwalled carbon nanotubes (MWCNTs) could increase the risk of allergic lung disease in occupational or consumer settings. We previously reported that MWCNTs exacerbated allergic lung disease in mice induced by extract from house dust mites (HDM), a common cause of asthma in humans. Because MWCNTs avidly bind biomolecules to form protein coronas that can modify immunotoxicity, we hypothesized that exacerbation of allergic lung disease in mice caused by coexposure to MWCNTs and HDM extract was due to the formation of an allergen corona. In a first set of experiments, male and female C57BL/6J mice were coexposed to MWCNTs and HDM extract over 3 weeks compared to MWCNTs or HDM extract alone. In a second set of experiments, mice were exposed to pristine MWCNTs or MWCNTs with an HDM allergen corona (HDM-MWCNTs). HDM-MWCNTs were formed by incubating MWCNTs with HDM extract, where ∼7% of proteins adsorbed to MWCNTs, including Der p 1 and Der p 2. At necropsy, bronchoalveolar lavage fluid was collected from lungs to assess lactate dehydrogenase, total protein and inflammatory cells, while lung tissue was used for histopathology, qPCR, and Western blotting. Compared to MWCNTs or HDM extract alone, coexposure to MWCNTs and HDM extract or exposure to HDM-MWCNTs increased pathological outcomes associated with allergic lung disease (eosinophilia, fibrosis, mucous cell metaplasia), increased mRNAs associated with fibrosis (Col1A1, Arg1) and enhanced STAT6 phosphorylation in lung tissue. These findings indicated that exacerbation of HDM-induced allergic lung disease by MWCNTs is due to an allergen corona.

A Hexagonal Aim as a Driver of Change for Health Care and Health Insurance Systems

Policy Points Improving health systems requires the pursuit of both patient-centered care and a supportive environment for health professionals. This Quadruple Aim includes improving the experience of care, improving the health of populations, reducing per capita costs of care, and improving the work life of the care providers. We propose expanding a recently defined Fifth Aim of health equity to include health democracy, ensuring that that the health and health care wants, needs, and responsibilities of populations are being met, and also propose adding a Sixth Aim of preserving and improving the health of the environment to create the best health possible. As social tension and environmental changes continue to impact the structure of our society, this "Hexagonal Aim" might provide additional ethical guiderails as we set our health care goals to foster sustainable and improved population health.

NPCC4: Climate change and New York City's health risk

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report considers climate health risks, vulnerabilities, and resilience strategies in New York City's unique urban context. It updates evidence since the last health assessment in 2015 as part of NPCC2 and addresses climate health risks and vulnerabilities that have emerged as especially salient to NYC since 2015. Climate health risks from heat and flooding are emphasized. In addition, other climate-sensitive exposures harmful to human health are considered, including outdoor and indoor air pollution, including aeroallergens; insect vectors of human illness; waterborne infectious and chemical contaminants; and compounding of climate health risks with other public health emergencies, such as the COVID-19 pandemic. Evidence-informed strategies for reducing future climate risks to health are considered.

Application of the wildland fire emissions inventory system to estimate fire emissions on forest lands of the United States

BACKGROUND

Forests are significant terrestrial biomes for carbon storage, and annual carbon accumulation of forest biomass contributes offsets affecting net greenhouse gases in the atmosphere. The immediate loss of stored carbon through fire on forest lands reduces the annual offsets provided by forests. As such, the United States reporting includes annual estimates of direct fire emissions in conjunction with the overall forest stock and change estimates as a part of national greenhouse gas inventories within the United Nations Framework Convention on Climate Change. Forest fire emissions reported for the United States, such as the 129 Tg CO2 reported for 2022, are based on the Wildland Fire Emissions Inventory System (WFEIS). Current WFEIS estimates are included in the Inventory of U.S. Greenhouse Gas Emissions and Sinks: 1990-2022 published in 2024 by the United States Environmental Protection Agency. Here, we describe WFEIS the fire emissions inventory system we used to address current information needs, and an analysis to confirm compatibility of carbon mass between estimated forest fire emissions and carbon in forest stocks.

RESULTS

The summaries of emissions from forests are consistent with previous reports that show rates and interannual variability in emissions and forest land area burned are generally greater in recent years relative to the 1990s. Both emissions and interannual variability are greater in the western United States. The years with the highest CO2 emissions from forest fires on the 48 conterminous states plus Alaska were 2004, 2005, and 2015. In some years, Alaska emissions exceed those of the 48 conterminous states, such as in 2022, for example. Comparison of forest fire emission to forest carbon stocks indicate there is unlikely any serious disconnect between inventory and fire emissions estimates.

CONCLUSIONS

The WFEIS system is a user-driven approach made available via a web browser. Model results are compatible with the scope and reporting needs of the annual national greenhouse gas inventories.

Climate change and public health in California: A structured review of exposures, vulnerable populations, and adaptation measures

California faces several serious direct and indirect climate exposures that can adversely affect public health, some of which are already occurring. The public health burden now and in the future will depend on atmospheric greenhouse gas concentrations, underlying population vulnerabilities, and adaptation efforts. Here, we present a structured review of recent literature to examine the leading climate risks to public health in California, including extreme heat, extreme precipitation, wildfires, air pollution, and infectious diseases. Comparisons among different climate-health pathways are difficult due to inconsistencies in study design regarding spatial and temporal scales and health outcomes examined. We find, however, that the current public health burden likely affects thousands of Californians each year, depending on the exposure pathway and health outcome. Further, while more evidence exists for direct and indirect proximal health effects that are the focus of this review, distal pathways (e.g., impacts of drought on nutrition) are more uncertain but could add to this burden. We find that climate adaptation measures can provide significant health benefits, particularly in disadvantaged communities. We conclude with priority recommendations for future analyses and solution-driven policy actions.

Seasons of smoke and fire: preparing health systems for improved performance before, during, and after wildfires

Increased frequency, intensity, and duration of wildfires are intensifying exposure to direct and smoke-related hazards in many areas, leading to evacuation and smoke-related effects on health and health systems that can affect regions extending over thousands of kilometres. Effective preparation and response are currently hampered by inadequate training, continued siloing of disciplines, insufficient finance, and inadequate coordination between health systems and governance at municipal, regional, national, and international levels. This Review highlights the key health and health systems considerations before, during, and after wildfires, and outlines how a health system should respond to optimise population health outcomes now and into the future. The focus is on the implications of wildfires for air quality, mental health, and emergency management, with elements of international policy and finance also addressed. We discuss commonalities of existing climate-resilient health care and disaster management frameworks and integrate them into an approach that addresses issues of financing, leadership and governance, health workforce, health information systems, infrastructure, supply chain, technologies, community interaction and health-care delivery, before, during, and after a wildfire season. This Review is a practical briefing for leaders and health professionals facing severe wildfire seasons and a call to break down silos and join with other disciplines to proactively plan for and fund innovation and coordination in service of a healthier future.

Improving Wildfire Readiness Among Patients With Chronic Obstructive Pulmonary Disease and Asthma: Applying a Population Health Approach to Climate Change

As a result of climate change, wildfire frequency, duration, and severity are increasing in the United States. Exposure to wildfire-related air pollutants can lead to negative health outcomes, particularly among patients with preexisting respiratory diseases (e.g., asthma and chronic obstructive pulmonary disease) and those who are at higher risk for developing these conditions. Underserved communities are disproportionately affected for multiple reasons, including lack of financial and social resources, increased exposure to air pollutants at home and at work, and impaired access to health care. To best serve clinically high-risk and underserved populations, health systems must leverage community public health data, develop and mobilize a wildfire preparedness action plan to identify populations at high risk, and implement interventions to mitigate the consequences of poor air quality. University of California, Davis Health, located at the epicenter of the largest wildfires in California's history, has developed the 5 pillar Wildfire Population Health Approach: (1) identify clinically at-risk and underserved patient populations using well-validated, condition-targeted registries; (2) assemble multidisciplinary care teams to understand the needs of these communities and patients; (3) create custom analytics and wildfire-risk stratification; (4) develop care pathways based on wildfire-risk tiers by disease, risk of exposure, and health care access; and (5) identify outcome measures tailored to interventions with a commitment to continuous, iterative improvement efforts. The Wildfire Population Health Approach provides an action plan for health systems and care teams to meet the needs of clinically at-risk and underserved patients affected by the increasing health threat posed by climate change-related wildfires.

Estimated Impacts of Prescribed Fires on Air Quality and Premature Deaths in Georgia and Surrounding Areas in the US, 2015-2020

Smoke from wildfires poses a substantial threat to health in communities near and far. To mitigate the extent and potential damage of wildfires, prescribed burning techniques are commonly employed as land management tools; however, they introduce their own smoke-related risks. This study investigates the impact of prescribed fires on daily average PM2.5 and maximum daily 8-h averaged O3 (MDA8-O3) concentrations and estimates premature deaths associated with short-term exposure to prescribed fire PM2.5 and MDA8-O3 in Georgia and surrounding areas of the Southeastern US from 2015 to 2020. Our findings indicate that over the study domain, prescribed fire contributes to average daily PM2.5 by 0.94 ± 1.45 μg/m3 (mean ± standard deviation), accounting for 14.0% of year-round ambient PM2.5. Higher average daily contributions were predicted during the extensive burning season (January-April): 1.43 ± 1.97 μg/m3 (20.0% of ambient PM2.5). Additionally, prescribed burning is also responsible for an annual average increase of 0.36 ± 0.61 ppb in MDA8-O3 (approximately 0.8% of ambient MDA8-O3) and 1.3% (0.62 ± 0.88 ppb) during the extensive burning season. We estimate that short-term exposure to prescribed fire PM2.5 and MDA8-O3 could have caused 2665 (95% confidence interval (CI): 2249-3080) and 233 (95% CI: 148-317) excess deaths, respectively. These results suggest that smoke from prescribed burns increases the mortality. However, refraining from such burns may escalate the risk of wildfires; therefore, the trade-offs between the health impacts of wildfires and prescribed fires, including morbidity, need to be taken into consideration in future studies.

All-cause, cardiovascular, and respiratory mortality and wildfire-related ozone: a multicountry two-stage time series analysis

BACKGROUND

Wildfire activity is an important source of tropospheric ozone (O3) pollution. However, no study to date has systematically examined the associations of wildfire-related O3 exposure with mortality globally.

METHODS

We did a multicountry two-stage time series analysis. From the Multi-City Multi-Country (MCC) Collaborative Research Network, data on daily all-cause, cardiovascular, and respiratory deaths were obtained from 749 locations in 43 countries or areas, representing overlapping periods from Jan 1, 2000, to Dec 31, 2016. We estimated the daily concentration of wildfire-related O3 in study locations using a chemical transport model, and then calibrated and downscaled O3 estimates to a resolution of 0·25° × 0·25° (approximately 28 km2 at the equator). Using a random-effects meta-analysis, we examined the associations of short-term wildfire-related O3 exposure (lag period of 0-2 days) with daily mortality, first at the location level and then pooled at the country, regional, and global levels. Annual excess mortality fraction in each location attributable to wildfire-related O3 was calculated with pooled effect estimates and used to obtain excess mortality fractions at country, regional, and global levels.

FINDINGS

Between 2000 and 2016, the highest maximum daily wildfire-related O3 concentrations (≥30 μg/m3) were observed in locations in South America, central America, and southeastern Asia, and the country of South Africa. Across all locations, an increase of 1 μg/m3 in the mean daily concentration of wildfire-related O3 during lag 0-2 days was associated with increases of 0·55% (95% CI 0·29 to 0·80) in daily all-cause mortality, 0·44% (-0·10 to 0·99) in daily cardiovascular mortality, and 0·82% (0·18 to 1·47) in daily respiratory mortality. The associations of daily mortality rates with wildfire-related O3 exposure showed substantial geographical heterogeneity at the country and regional levels. Across all locations, estimated annual excess mortality fractions of 0·58% (95% CI 0·31 to 0·85; 31 606 deaths [95% CI 17 038 to 46 027]) for all-cause mortality, 0·41% (-0·10 to 0·91; 5249 [-1244 to 11 620]) for cardiovascular mortality, and 0·86% (0·18 to 1·51; 4657 [999 to 8206]) for respiratory mortality were attributable to short-term exposure to wildfire-related O3.

INTERPRETATION

In this study, we observed an increase in all-cause and respiratory mortality associated with short-term wildfire-related O3 exposure. Effective risk and smoke management strategies should be implemented to protect the public from the impacts of wildfires.

FUNDING

Australian Research Council and the Australian National Health and Medical Research Council.

Air Quality Monitoring and the Safety of Farmworkers in Wildfire Mandatory Evacuation Zones

The increasing frequency and severity of wildfires due to climate change pose health risks to migrant farm workers laboring in wildfire-prone regions. This study focuses on Sonoma County, California, investigating the effectiveness of air monitoring and safety protections for farmworkers. The analysis employs AirNow and PurpleAir PM2.5 data acquired during the 2020 wildfire season, comparing spatial variability in air pollution. Results show significant differences between the single Sonoma County AirNow station data and the PurpleAir data in the regions directly impacted by wildfire smoke. Three distinct wildfire pollution episodes with elevated PM2.5 levels are identified to examine the regional variations. This study also examines the system used to exempt farmworkers from wildfire mandatory evacuation orders, finding incomplete information, ad hoc decision-making, and scant enforcement. In response, we make policy recommendations that include stricter requirements for employers, real-time air quality monitoring, post-exposure health screenings, and hazard pay. Our findings underscore the need for significant consideration of localized air quality readings and the importance of equitable disaster policies for protecting the health of farmworkers (particularly those who are undocumented migrants) in the face of escalating wildfire risks.

Impacts of heat and wildfire on preterm birth

BACKGROUND

Climate change continues to increase the frequency, intensity, and duration of heat events and wildfires, both of which are associated with adverse pregnancy outcomes. Few studies simultaneously evaluated exposures to these increasingly common exposures.

OBJECTIVES

We investigated the relationship between exposure to heat and wildfire smoke and preterm birth (PTB).

METHODS

In this time-stratified case-crossover study, participants consisted of 85,806 California singleton PTBs (20-36 gestational weeks) from May through October of 2015-2019. Birthing parent ZIP codes were linked to high-resolution daily weather, PM2.5 from wildfire smoke, and ambient air pollution data. Heat day was defined as a day with apparent temperature >98th percentile within each ZIP code and heat wave was defined as ≥2 consecutive heat days. Wildfire-smoke day was defined as a day with any exposure to wildfire-smoke PM2.5. Conditional logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (CI) comparing exposures during a hazard period (lags 0-6) compared to control periods. Analyses were adjusted for relative humidity, fine particles, and ozone.

RESULTS

Wildfire-smoke days were associated with 3.0% increased odds of PTB (ORlag0: 1.03, CI: 1.00-1.05). Compared with white participants, associations appeared stronger among Black, Hispanic, Asian, and American Indians/Alaskan Native participants. Heatwave days (ORlag2: 1.07, CI: 1.02-1.13) were positively associated with PTB, with stronger associations among those simultaneously exposed to wildfire smoke days (ORlag2: 1.19, CI: 1.11-1.27). Similar findings were observed for heat days and when other temperature metrics (e.g., maximum, minimum) were used.

DISCUSSION

Heat and wildfire increased PTB risk with evidence of synergism. As the occurrence and co-occurrence of these events increase, exposure reduction among pregnant people is critical, especially among racial/ethnic minorities.

Air pollution from biomass burning disrupts early adolescent cortical microarchitecture development

Exposure to outdoor particulate matter (PM2.5) represents a ubiquitous threat to human health, and particularly the neurotoxic effects of PM2.5 from multiple sources may disrupt neurodevelopment. Studies addressing neurodevelopmental implications of PM exposure have been limited by small, geographically limited samples and largely focus either on macroscale cortical morphology or postmortem histological staining and total PM mass. Here, we leverage residentially assigned exposure to six, data-driven sources of PM2.5 and neuroimaging data from the longitudinal Adolescent Brain Cognitive Development Study (ABCD Study®), collected from 21 different recruitment sites across the United States. To contribute an interpretable and actionable assessment of the role of air pollution in the developing brain, we identified alterations in cortical microstructure development associated with exposure to specific sources of PM2.5 using multivariate, partial least squares analyses. Specifically, average annual exposure (i.e., at ages 8-10 years) to PM2.5 from biomass burning was related to differences in neurite development across the cortex between 9 and 13 years of age.

Environmentally Not So Friendly: Global Warming, Air Pollution, and Wildfires: JACC Focus Seminar, Part 1

Environmental stresses are increasingly recognized as significant risk factors for adverse health outcomes. In particular, various forms of pollution and climate change are playing a growing role in promoting noncommunicable diseases, especially cardiovascular disease. Given recent trends, global warming and air pollution are now associated with substantial cardiovascular morbidity and mortality. As a vicious cycle, global warming increases the occurrence, size, and severity of wildfires, which are significant sources of airborne particulate matter. Exposure to wildfire smoke is associated with cardiovascular disease, and these effects are underpinned by mechanisms that include oxidative stress, inflammation, impaired cardiac function, and proatherosclerotic effects in the circulation. In the first part of a 2-part series on pollution and cardiovascular disease, this review provides an overview of the impact of global warming and air pollution, and because of recent events and emerging trends specific attention is paid to air pollution caused by wildfires.

Long-term exposure to wildland fire smoke PM2.5 and mortality in the contiguous United States

Despite the substantial evidence on the health effects of short-term exposure to ambient fine particles (PM2.5), including increasing studies focusing on those from wildland fire smoke, the impacts of long-term wildland fire smoke PM2.5 exposure remain unclear. We investigated the association between long-term exposure to wildland fire smoke PM2.5 and non-accidental mortality and mortality from a wide range of specific causes in all 3,108 counties in the contiguous U.S., 2007-2020. Controlling for non-smoke PM2.5, air temperature, and unmeasured spatial and temporal confounders, we found a non-linear association between 12-month moving average concentration of smoke PM2.5 and monthly non-accidental mortality rate. Relative to a month with the long-term smoke PM2.5 exposure below 0.1 μg/m3, non-accidental mortality increased by 0.16-0.63 and 2.11 deaths per 100,000 people per month when the 12-month moving average of PM2.5 concentration was of 0.1-5 and 5+ μg/m3, respectively. Cardiovascular, ischemic heart disease, digestive, endocrine, diabetes, mental, and chronic kidney disease mortality were all found to be associated with long-term wildland fire smoke PM2.5 exposure. Smoke PM2.5 contributed to approximately 11,415 non-accidental deaths/year (95% CI: 6,754, 16,075) in the contiguous U.S. Higher smoke PM2.5-related increases in mortality rates were found for people aged 65 above. Positive interaction effects with extreme heat (monthly number of days with daily mean air temperature higher than the county's 90th percentile warm season air temperature) were also observed. Our study identified the detrimental effects of long-term exposure to wildland fire smoke PM2.5 on a wide range of mortality outcomes, underscoring the need for public health actions and communications that span the health risks of both short- and long-term exposure.

Mortality attributable to PM2.5 from wildland fires in California from 2008 to 2018

In California, wildfire risk and severity have grown substantially in the last several decades. Research has characterized extensive adverse health impacts from exposure to wildfire-attributable fine particulate matter (PM2.5), but few studies have quantified long-term outcomes, and none have used a wildfire-specific chronic dose-response mortality coefficient. Here, we quantified the mortality burden for PM2.5 exposure from California fires from 2008 to 2018 using Community Multiscale Air Quality modeling system wildland fire PM2.5 estimates. We used a concentration-response function for PM2.5, applying ZIP code-level mortality data and an estimated wildfire-specific dose-response coefficient accounting for the likely toxicity of wildfire smoke. We estimate a total of 52,480 to 55,710 premature deaths are attributable to wildland fire PM2.5 over the 11-year period with respect to two exposure scenarios, equating to an economic impact of $432 to $456 billion. These findings extend evidence on climate-related health impacts, suggesting that wildfires account for a greater mortality and economic burden than indicated by earlier studies.

Neuroinflammation is dependent on sex and ovarian hormone presence following acute woodsmoke exposure

Woodsmoke (WS) exposure is associated with significant health-related sequelae. Different populations can potentially exhibit varying susceptibility, based on endocrine phenotypes, to WS and investigating neurological impacts following inhaled WS is a growing area of research. In this study, a whole-body inhalation chamber was used to expose both male and female C57BL/6 mice (n = 8 per group) to either control filtered air (FA) or acute WS (0.861 ± 0.210 mg/m3) for 4 h/d for 2 days. Neuroinflammatory and lipid-based biological markers were then assessed. In a second set of studies, female mice were divided into two groups: one group was ovariectomized (OVX) to simulate an ovarian hormone-deficient state (surgical menopause), and the other underwent Sham surgery as controls, to mechanistically assess the impact of ovarian hormone presence on neuroinflammation following FA and acute WS exposure to simulate an acute wildfire episode. There was a statistically significant impact of sex (P ≤ 0.05) and statistically significant interactions between sex and treatment in IL-1β, CXCL-1, TGF-β, and IL-6 brain relative gene expression. Hippocampal and cortex genes also exhibited significant changes in acute WS-exposed Sham and OVX mice, particularly in TGF-β (hippocampus) and CCL-2 and CXCL-1 (cortex). Cortex GFAP optical density (OD) showed a notable elevation in male mice exposed to acute WS, compared to the control FA. Sham and OVX females demonstrated differential GFAP expression, depending on brain region. Overall, targeted lipidomics in phosphatidylcholine (PC) and phosphatidylethanolamine (PE) serum and brain lipids demonstrated more significant changes between control FA and acute WS exposure in female mice, compared to males. In summary, male and female mice show distinct neuroinflammatory markers in response to acute WS exposure. Furthermore, ovarian hormone deficiency may impact the neuroinflammatory response following an acute WS event.