n-u wumMn>z 580.25; on Em Acknowledgments The American Lung Association “State of the Air® 2016” is the result of the hard work of many people: In the American Lung Association National Office: Paul G. Billings, who supervised the work; Janice E. Nolen, MA, who directed the project, analyzed data, wrote the text, and coordinated print and web presentations; Thu Anh Vu Tran, who assisted with the data analysis and report preparation; Lyndsay Moseley Alexander and Laura Kate Bender, who integrated the Healthy Air Campaign with this report; Zach Jump, MA, who converted the raw data into meaningful tables and comparisons and calculated all the population data; Susan Rappaport, MPH, who supervised the data analysis; Norman Edelman, MD, and Al Rizzo, MD, who reviewed the science and health discussions; Neil Ballentine, who directed the online presentation; Todd Nimirowski, who designed and created the user experiences online; Lauren Innocenzi and MacKenzie Olsberg, who managed content production online; Laura Lavelle, who developed social sharing and digital engagement strategy; Kim Lacina, Allison MacMunn, and Gregg Tubbs, who coordinated internal and external communications and media outreach; Michael Albiero, who designed the logo and report cover; and Craig Finstad, who coordinated sharing the data with direct mail donors. In the nationwide American Lung Association: All Lung Association charters reviewed and commented on the data for their states. Hard-working staff across the nation went out of their way to ensure that their state and local air directors were informed and had a chance to review the draft data. Outside the American Lung Association: Allen S. Lefohn of A.S.L. and Associates, who compiled the data; Deborah Shprentz, who assisted with the research and review of the science; Beaconfire RedEngine Consulting, who uploaded the data to the website; and Our Designs, Inc., who designed the print version. Great appreciation goes to the National Association of Clean Air Agencies, who along with their Executive Director Bill Becker, strove to make this report better through their comments, review and concerns. Many of their members reviewed and commented on the individual state data presented and the methodology to make this report more accurate. We appreciate them as our partners in the fight against air pollution. This report should in no way be construed as a comment on the work they do. The American Lung Association assumes sole responsibility for the content of the American Lung Association “State of the Air® 2016”. American Lung Association National Headquarters 55 W. Wacker Drive, Suite 1150 Chicago, IL 60601 Advocacy Office 1301 Pennsylvania Avenue, NW, Suite 800 Washington, DC 20004 Phone: 1 (800) 586-4872 Fax: (202) 452-1805 www.stateoftheair.org www.Lung.org Copyright © 2016 by the American Lung Association American Lung Association, State of the Air, and Fighting for Air are registered trademarks of the American Lung Association. Fighting for Air Designed by Our Designs, Inc., Nashville, TN 2 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 Contents The State of the Air 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Rankings People at Risk in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Most-Polluted Cities in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . 14 Most-Polluted Counties in the U.S. . . . . . . . . . . . . . . . . . . . . . . 17 Cleanest Cities in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Cleanest Counties in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Health Effects of Ozone and Particle Pollution . . . . . . . . . . . . . . . . . 28 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 State Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 STATE OF THE AIR 2016 The State of the Air 2016 The “State of the Air 2016” found continued improvement in air quality in 2012–2014, showing lower levels of year-round particle pollution and ozone. Still, more than half of all Americans—166 million people—live in counties where they are exposed to unhealthful levels of these pollutants. The “State of the Air 2016” report shows that cleaning up pollution continues successfully in much of the nation. In the 25 cities with the worst pollution, the majority saw improvements from last year. Many saw their lowest levels ever of year-round particle pollution or ozone pollution. State of the Air 2016 shows that more than one in two people had unhealthy air quality in their communities. Yet, even as most cities experienced strong improvement, too many cities suffered worse episodes of unhealthy air. While most of the nation has much cleaner air quality than even a decade ago, a few cities reported their worst number of unhealthy days since the report began, including some that experienced extreme weather events. The “State of the Air 2016” report provides evidence that a changing climate will make it harder to protect human health. The “State of the Air 2016” report shows that, even with continued improvement, too many people in the United States live where the air is unhealthy for them to breathe. Despite that continued need and the nation’s progress, some people seek to weaken the Clean Air Act, the public health law that has driven the cuts in pollution since 1970, and to undermine the ability of the nation to fight for healthy air. The “State of the Air 2016” report looks at levels of ozone and particle pollution found in official monitoring sites across the United States in 2012, 2013, and 2014. The report uses the most current quality-assured nationwide data available for these analyses. The report examines particle pollution (PM2.5) in two different ways: averaged yearround (annual average) and over short-term levels (24-hour). For both ozone and short-term particle pollution, the analysis uses a weighted average number of days that allows recognition of places with higher levels of pollution. For the year-round particle pollution rankings, the report uses averages calculated and reported by the U.S. Environmental Protection Agency (EPA). For comparison, the “State of the Air 2015” report covered data from 2011, 2012, and 2013. Overall Trends Thanks to stronger standards for pollutants and for the sources of pollution, the United States has seen continued reduction in ozone and particle pollution as well as other pollutants for decades. Figure 1 from the EPA shows that since 1970, the air has gotten cleaner while the population, the economy, energy use and miles driven increased greatly. As the economy continues to grow, overall air emissions that create the six most-widespread pollutants continue to drop. Overall, the best progress came in the continued reduction of ozone and year-round particle pollution, thanks to cleaner power plants and increased use of cleaner vehicles and engines. Continued progress to cleaner air remains crucial to reduce the risk of premature death, asthma attacks and lung cancer. However, a changing climate is making it harder to protect human health. Many cities reduced their ozone pollution in 2012–2014 below that reported in 2011–2013. In 2015, EPA updated and strengthened the national ozone standard, officially recognizing that ozone is unhealthy to breathe at lower levels than previously thought. In preparing “State of the Air 2016,” the Lung Association reexamined all the ozone data for all prior years, back to 1996–1998 covered by the first report in 2000, using the new standard. Even using that more protective standard, six of the 25 most ozone-polluted cities reported their fewest unhealthy ozone days ever. 4 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 STATE OF THE AIR 2016 Sixteen of the most-polluted cities had their lowest year-round particle pollution levels in the history of this report. Still, some cities had higher year-round levels and one city reported its highest levels. Unfortunately, many cities suffered more spikes in short-term particle pollution, particularly in the West, where continuing drought and heat may have increased the dust, grass and wild fires, while burning wood as a heat source appears to contribute to the problem in many smaller cities. Seven of the 25 most-polluted cities had their highest number of unhealthy days on average ever reported. Still missing, however, are particle pollution data from all of Illinois, Florida and most of Tennessee because of problems with data processing in laboratories and other data issues. This means that no one knows if the levels of particle pollution were unhealthy in many cities that have historic problems with particle pollution, including Chicago and St. Louis. 240% 220% 238% Gross Domesধc Product 200% 180% 172% Vehicle Miles Traveled 160% 140% 120% Populaধon 100% 80% 60% 56% 40% 45% 20% 27% 0% Energy Consumpধon CO2 Emissions –20% –40% –60% –80% -69% Aggregate Emissions (Six Common Pollutants) 70 80 90 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 Figure 1: Air pollution emissions have dropped steadily since 1970 thanks to the Clean Air Act. As the economy continues to grow, emissions that contribute to the most widespread pollutants continue to drop. (Source: U.S. EPA, Air Quality Trends, 2016.) Los Angeles reported its best air quality ever in the history of the State of the Air report. Los Angeles remains the metropolitan area with the worst ozone pollution, as it has for all but one of the 16 reports. However, Los Angeles reported its best air quality ever in the State of the Air report’s history, with the lowest average year-round particles, and fewest high-ozone and high-particle days. Bakersfield (CA) returned to the top of both lists for most-polluted for particle pollution, thanks to worse year-round and short-term exposures. Steps taken under the Clean Air Act have driven the cleanup of pollution seen in this year’s report. Cleaning up power plants has helped drive the reduction in year-round particles and ozone, especially in the middle and eastern states. The retirement of old, dirty diesel engines has also reduced emissions. At the same time, climate change has increased the challenges to protecting public health. The rise in short-term particle pollution provides current examples of how major changes in drought and rainfall are already affecting public health. Wildfires and drought, along with high use of wood-burning devices for heat, coupled with stagnant weather patterns that concentrated pollution in some areas, contributed to the extraordinarily high numbers of days with unhealthy particulate matter in 2012–2014. 5 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 STATE OF THE AIR 2016 Year-round particle pollution The best progress continues to be in reduced year-round particle pollution levels. Seventeen of the cities with the highest levels of year-round particles reduced their levels over the previous report. Sixteen of these had their lowest levels ever. Using the most current data calculated by EPA, only 12 of these 25 cities failed to meet the national air quality standards for annual particle pollution. Cities in the list of the top 25 most polluted for year-round particle pollution that reached their lowest levels ever included Fresno–Madera, CA, last year’s #1 mostpolluted city, now ranked #3; and Los Angeles, now ranked #4. Fourteen other cities reached their best levels ever: Modesto–Merced, CA; Pittsburgh; Cleveland; Philadelphia; Indianapolis; Altoona, PA; Cincinnati; Houston; Johnstown–Somerset, PA; Lancaster, PA; Birmingham, AL; Fairbanks, AK; Little Rock, AR; and Wheeling, WV. Erie–Meadville, PA, also improved over the 2015 report. Not all made progress. Seven cities saw their year-round levels increase over the previous report, including the two most polluted cities, Bakersfield, CA, and Visalia– Porterville–Hanford, CA. Others with worse year-round particle pollution were San Jose–San Francisco–Oakland; Harrisburg–York–Lebanon, PA; and Louisville, KY. None of those five cities met the national health standard. Two others also had worse yearround levels but did meet the national health standard: Detroit and San Luis Obispo, CA, which reached its worst annual particle levels ever. El Centro, CA, retained the same annual particle pollution level as in the previous report. Data remain missing for many major cities. Data are unavailable for cities that have been on the most-polluted list in years past, including St. Louis and Chicago. It is impossible to know whether the air quality there improved or worsened. Problems with data processing in Illinois, Florida and most of Tennessee prevented people in those states from having information on their particle pollution levels for this period. Ozone pollution Most cities improved their ozone levels, some to their lowest levels ever. Los Angeles continues its success at cleaning up ozone, dropping its average number of unhealthy days to its lowest level ever. Los Angeles still suffers the most ozone pollution in the nation, as it has historically. Five other cities with historically high ozone experienced their lowest number of unhealthy ozone days on average since the “State of the Air” report began in 2000: the #3 most-polluted city, Visalia–Porterfield–Hanford, CA; Sacramento, CA; Dallas–Fort Worth; El Centro, CA; and Houston. Other metropolitan areas showing improvement in 2012–2014 were Phoenix; Denver; Las Vegas; Fort Collins, CO; New York City–Newark; El Paso–Las Cruces, TX–NM; San Jose–San Francisco; Grand Rapids, MI; St. Louis; Tulsa, OK; Chicago; Sheboygan, WI; San Louis Obispo, CA; Oklahoma City, OK; and Edwards–Glenwood Springs, CO. Four cities among the 25 most-polluted—Bakersfield, CA; Fresno–Madera, CA; Modesto–Merced, CA; and San Diego—had more high-ozone days on average in this report compared to the 2015 report. Twenty of the 25 most ozone-polluted cities are in the West and Southwest. California historically has had multiple cities with high ozone readings and still does. Now Texas and Colorado each have three cities on the most-polluted list, and Arizona and Oklahoma each have two cities on the list. Only five cities in the East and Midwest remain ranked among the 25 most polluted. Eastern cities improved their rankings in large part because of reduced emissions from power plants and vehicles. Even with improved ozone levels, these western cities now have worse ozone than much larger eastern cities. Some ozone levels, especially in smaller cities, may be linked to increased oil and gas extraction, transmission and processing nearby. 6 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 STATE OF THE AIR 2016 EPA strengthened the ozone air quality standard late in 2015, adjusting the Air Quality Index to reflect the more protective standard. The Lung Association’s assessment is based on newly downloaded data using the levels defined under the 2015 Air Quality Index as the range for unhealthy levels back to 1996. Short-term particle pollution Once again, spikes in unhealthy particle pollution rolled back progress in too many cities. Bakersfield returned to top this list of the cities with the highest number of days with unhealthy particle pollution, again ranking #1 on both measures of particle pollution. Eleven other metro areas in the top 25 suffered more days with unhealthy levels, including seven with their worst-ever averages in 2012–2014: Fairbanks, AK; Missoula, MT; Lancaster, PA; Reno–Carson City–Fernley, NV; El Centro, CA; Anchorage, AK; and South Bend–Elkhart–Mishawaka, IN–MI. Four others had more unhealthy days on average than in the 2015 report: Logan, UT–ID; Harrisburg–York–Lebanon, PA; Philadelphia; and Eugene, OR. Fortunately, twelve cities had fewer days in 2012–2014 than in the previous report that covered 2011–2013. Two cities, Los Angeles and Pittsburgh, reached their fewest ever number of unhealthy days on average in any prior report. The other ten improving cities were Fresno–Madera, CA; Visalia–Porterfield–Hanford, CA; Modesto–Merced, CA; Salt Lake City–Provo–Orem, UT; San Jose–San Francisco; Yakima, WA; Sacramento, CA; El Paso–Las Cruces, TX–NM; Phoenix; and New York City–Newark. Medford–Grants Pass, OR, retained the same short-term particle pollution level as in the previous report. Data remain missing on cities in three states. Problems with data processing in Illinois, Florida and most of Tennessee prevented people in those states from having information on their particle pollution levels for this period. Cleanest Cities Four cities ranked on all three lists of the cleanest cities in 2012–2014. That means they had no days in the unhealthy level for ozone or short-term particle pollution and were on the list of the cleanest cities for year-round particle pollution. Listed alphabetically, the four cities are: Burlington–South Burlington, VT Honolulu, HI Elmira–Corning, NY Salinas, CA Thirteen other cities ranked among the cleanest cities for both year-round and shortterm levels of particle pollution. That means they had no days in the unhealthy level for short-term particle pollution and were on the list of the cleanest cities for year-round particle pollution. They are: Albany–Schenectady, NY Pittsfield, MA Bangor, ME Rapid City–Spearfish, SD Cheyenne, WY Redding–Red Bluff, CA Duluth, MN–WI Sierra Vista–Douglas, AZ Farmington, NM Syracuse–Auburn, NY Grand Island, NE Wilmington, NC Houma–Thibodaux, LA 7 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 STATE OF THE AIR 2016 Eight cities other ranked among the cleanest for ozone and short-term particle pollution. That means they had no days in the unhealthy level for ozone or short-term particle pollution. They are: Bellingham, WA McAllen–Edinburg, TX Brunswick, GA Monroe–Ruston–Bastrop, LA Dothan–Enterprise–Ozark, AL Montgomery, AL Gadsden, AL Tuscaloosa, AL Two other cities made the list of cleanest for ozone and year-round particle pollution. Bismarck, ND; Fargo–Wahpeton, ND–MN, had no days in the unhealthy level for ozone pollution and were on the list of the cleanest cities for year-round particle pollution. Looking at the nation as a whole, the “State of the Air 2016” finds— People at Risk ■■ ■■ ■■ ■■ 8 LUNG.org More than half the people (more than 52.1%) in the United States live in counties that have unhealthful levels of either ozone or particle pollution. More than 166 million Americans live in 418 counties where they are exposed to unhealthful levels of air pollution in the form of either ozone or short-term or year-round levels of particles. ■■ This is an increase from the 2015 report and reflects that many more counties have unhealthy levels of ozone now recognized by the updated national standard for ozone EPA adopted last October. The Lung Association bases the grading system for ozone data in this year’s report on this stronger standard. More than half the people in the United States (51.1%) live in areas with unhealthful levels of ozone. Counties that were graded F for ozone levels have a combined population of more than 162.9 million. These people live in the 395 counties where the monitored air quality places them at risk for premature death, aggravated asthma, difficulty breathing, cardiovascular harm and lower birth weight. The actual number who breathe unhealthy levels of ozone is likely much larger, since this number does not include people who live in adjacent counties in metropolitan areas where no monitors exist. More than 14 percent of people in the United States live in an area with too many days with unhealthful levels of particle pollution. Close to 45 million Americans live in 58 counties that experienced too many days with unhealthy spikes in particle pollution, a decrease from the last report. This number may undercount the total because of lack of data from Illinois, Tennessee and Florida. Short-term spikes in particle pollution can last from hours to several days and can increase the risk of heart attacks, strokes and emergency room visits for asthma and cardiovascular disease, and most importantly, can increase the risk of early death. Nearly 22.8 million people (7.1%) in the United States live in counties with unhealthful year-round levels of particle pollution. These people live in the 20 counties where chronic levels are regularly a threat to their health. This number may undercount the total because of lack of data from Illinois, Tennessee and Florida. Even when levels are fairly low, exposure to particles over time can increase risk of hospitalization for asthma, damage to the lungs and, significantly, increase the risk of premature death. AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 STATE OF THE AIR 2016 Nearly 20 million people (6.3%) in the United States live in 13 counties with unhealthful levels of all three: ozone and short-term and year-round particle pollution. With the risks from airborne pollution so great, the American Lung Association seeks to inform people who may be in danger. Many people are at greater risk because of their age or because they have asthma or other chronic lung disease, cardiovascular disease or diabetes. The following list identifies the numbers of people in each at-risk group. The numbers living in counties that fail all three tests may be undercounted because of the missing data on particle pollution in Illinois, Tennessee and Florida. ■■ Nearly 20 million people in the U.S. live in counties where the outdoor air failed all three tests. ■■ ■■ ■■ ■■ ■■ ■■ What Needs to Be Done Older and Younger—Nearly 22.3 million adults age 65 and over and more than 39.1 million children under 18 years old live in counties that received an F for at least one pollutant. More than 2.4 million seniors and more than 4.9 million children live in counties failing all three tests. People with Asthma—Nearly 3.6 million children and close to 11.4 million adults with asthma live in counties of the United States that received an F for at least one pollutant. Nearly 441,000 children and close to 1.2 million adults with asthma live in counties failing all three tests. Chronic Obstructive Pulmonary Disease (COPD)—More than 7.8 million people with COPD live in counties that received an F for at least one pollutant. More than 727,000 people with COPD live in counties failing all three tests. Cardiovascular Disease—More than 10.2 million people with cardiovascular diseases live in counties that received an F for at least one pollutant; nearly 1.1 million people live in counties failing all three tests. Diabetes—More than 3.6 million people with diabetes live in counties that received an F for either short-term or year-round particle pollution; more than 1.5 million live in counties failing both tests. Having diabetes increases the risk of harm from particle pollution. Poverty—More than 24.8 million people with incomes meeting the federal poverty definition live in counties that received an F for at least one pollutant. Nearly 3.8 million people in poverty live in counties failing all three tests. Evidence shows that people who have low incomes may face higher risk from air pollution. Our nation has made significant progress, but clearly more must be done to reduce the burden of air pollution and improve the health of millions of Americans. Cleaning up air pollution requires a strong and coordinated effort on the part of our federal and state leaders. The President, the EPA Administrator, members of Congress, governors and state leaders all have a key role to play. These current and future leaders have a choice to make: either support steps to improve the air we breathe so that it does not cause or worsen lung disease, or allow pressure from polluting industries to weaken healthy air protections. The Lung Association urges our nation’s leaders to stand up for public health and take these important steps for to improve the air we all breathe. Protect the Clean Air Act Our nation’s continued air quality improvement shown in the “State of the Air 2016” report is possible because of the Clean Air Act, a strong public health law put in place by an overwhelming bipartisan majority in Congress more than 45 years ago. The Clean Air Act requires that the EPA and each state take steps to clean up the air and protect public health by reducing pollution. Unfortunately, some in Congress continue to seek weakening changes to the Clean Air Act that would dismantle progress made in the last 45 years and make it harder to achieve future reductions. To achieve the promise of the Clean Air Act, Congress must protect the Clean Air Act—making sure it remains strong, fully implemented and enforced. 9 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 STATE OF THE AIR 2016 Reduce Carbon Pollution from Power Plants by Adopting Strong State Clean Power Plans In 2015 EPA adopted the Clean Power Plan, a flexible, practical toolkit for the states to reduce carbon pollution from power plants approximately 32 percent (below 2005 levels) by 2030. States can choose a variety of ways to cut carbon pollution with the Clean Power Plan. They can choose to require cleaner fuels for existing utilities, improve energy efficiency, produce more clean energy and partner with other states to jointly reduce carbon pollution. In February 2015, the Supreme Court issued a stay on the plan, putting EPA’s enforcement of the plan on a temporary hold while the case is heard in the courts. However, states can still move forward developing their plans. Power plants are the largest stationary source of carbon pollution in the United States. The electric sector contributed 40 percent of all energy-related carbon dioxide (CO2) emissions in 2013.1 Scientists tell us that carbon pollution contributes to a warming climate, enhancing conditions for ozone formation and making it harder to reduce this lethal pollutant. Climate change also leads to particle pollution from increased droughts and wildfires. Taking steps to reduce carbon pollution from electricity generation will also reduce ozone and particle pollution from these plants at the same time. EPA’s own analysis shows that these co-benefits can prevent up to 3,600 premature deaths and up to 90,000 asthma attacks in children in 2030. The Lung Association calls on governors to direct their states to develop strong plans to reduce carbon pollution from power plants and protect public health. Set Strong Limits on Air Pollution that Blows Across State Lines Air pollution, including ozone and particle pollution, can be transported by the wind hundreds of miles away from its source, placing a significant health burden on communities and states that have no ability to limit pollution from neighboring states. EPA has proposed a revised Cross-State Air Pollution Rule to reduce transported ozone pollution to protect downwind communities who otherwise have limited ability to intervene or protect themselves. The Lung Association urges EPA to adopt stronger limits on transported ozone pollution to help downwind states protect their citizens from pollution blown hundreds of miles across the nation. Reduce Emissions from Existing and New Oil and Gas Operations EPA needs to adopt health-protective standards to reduce harmful emissions of methane, volatile organic compounds and other pollutants from production wells, processing plants, transmission pipelines and storage units within the oil and natural gas industry. EPA has proposed standards for new and modified facilities, which is a crucial first step. But as this report went to press, the rules are not yet final. They must be finalized to begin to curb these emissions. Further, EPA needs to propose strong, enforceable standards for the existing oil and gas infrastructure without delay. These standards would not only help to mitigate climate change and its associated health risks by curtailing emissions of methane—an especially potent greenhouse gas—but would also limit emissions of major precursors to ozone, as well as other toxic and carcinogenic air pollutants, benefiting public health in communities across the country. Clean Up Harmful Emissions from Dirty Diesel Vehicles and Heavy Equipment Rules EPA put in effect over the past several years mean that new diesel vehicles and equipment must be much cleaner. Still, millions of diesel trucks, buses, and heavy equipment (such as bulldozers) will likely be in use for thousands more miles, spewing dangerous diesel exhaust into communities and neighborhoods. The good news is that affordable technology exists to cut emissions by 90 percent. Congress needs to fund EPA’s diesel cleanup (“retrofit”) program. Congress should also require that clean diesel equipment be used in federally-funded construction programs. 10 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 STATE OF THE AIR 2016 In 2015, EPA and the California Air Resources Board (CARB) announced two notices of violation alleging Volkswagen, Porsche and Audi diesel cars included software that circumvents emissions standards for nitrogen oxides. This software is a “defeat device” as defined by the Clean Air Act. EPA and CARB allege that these diesel passenger cars from model years 2009–2016 have emissions up to 40 times greater than the standards. The Lung Association called on EPA and CARB to ensure that their enforcement action recalled and repaired or scrapped all such vehicles and offset all excess pollution. Further, EPA must strengthen its compliance and enforcement activities to prevent future violations. Improve the Air Pollution Monitoring Network The grades in this report come from information from the nationwide air pollution monitoring network. That network forms the infrastructure for healthy air. States and local governments use monitors to accurately measure the amount of air pollution in the community. Less than one-third of all counties have ozone or particle pollution monitors, seriously limiting the ability to adequately detect and track the levels of harmful air pollution. Unfortunately, funds for existing air pollution monitors have been cut across the nation. More monitoring is needed near roadways to measure the highest levels of exposures from air pollution related to traffic. More monitoring is needed in communities that have expanded oil and gas extraction operations. These resources may be cut further unless Congress and the White House resolve to protect the health of the nation from air pollution. With such challenges to our monitoring infrastructure, it may be harder for the nation to ensure accurate, reliable quality data in the future. What You Can Do You can do a great deal to help reduce air pollution outdoors by speaking up and stepping up. Here’s how. 1. Speak up for Healthy Air Protections. Tell EPA we need strong standards for methane and other toxic emissions from existing oil and gas operations, and strong limits on ozone pollution that crosses state lines. Send a message to Congress. Urge Congress to support cleaner, healthier air and oppose measures to block or delay the cleanup of air pollution. All members of Congress should support and protect the Clean Air Act. Share your story. Do you or any member of your family have a personal reason to fight for healthier, cleaner air? Go to www.FightingForAir.org to let us know how healthy air affects you. Your story helps us remind decision-makers what is at stake when it comes to clean air. Get involved. Participate in your state’s development of the Clean Power Plan and support state and local efforts to clean up air pollution. To find your local air pollution control agency, go to www.4cleanair.org. 2. Step up to Curb Pollution in Your Community. Drive less. Combine trips, walk, bike, carpool or vanpool, and use buses, subways or other alternatives to driving. Vehicle emissions are a major source of air pollution. Support community plans that provide ways to get around that don’t require a car, such as more sidewalks, bike trails and transit systems. Use less electricity. Turn out the lights and use energy-efficient appliances. Generating electricity is one of the biggest sources of pollution, particularly in the eastern United States. 11 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 STATE OF THE AIR 2016 Don’t burn wood or trash. Burning firewood and trash is among the largest sources of particle pollution in many parts of the country. If you must use a fireplace or stove for heat, convert your woodstove to natural gas, which has far fewer polluting emissions. Compost and recycle as much as possible and dispose of other waste properly; don’t burn it. Support efforts in your community to ban outdoor burning of construction and yard wastes. Avoid the use of outdoor hydronic heaters, also called outdoor wood boilers, which are frequently much more polluting than woodstoves. Make sure your local school system requires clean school buses, which includes replacing or retrofitting old school buses with filters and other equipment to reduce emissions. Make sure your local schools don’t idle their buses, a step that can immediately reduce emissions. 1 U.S. Environmental Protection Agency. Inventory of Greenhouse Gas Emissions and Sinks: 1990–2013. Washington, DC: U.S. EPA, 2015. EPA 430-R-14-003. 12 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS People at Risk from Short-Term Particle Pollution (24-Hour PM2.5) Chronic Diseases Age Groups Number In Counties where Adult Pediatric 65 and Total of the Grades were: Asthma Asthma COPD CV Disease Diabetes Poverty Under 18 Over Population Counties Grade A (0.0) 5,634,860 1,699,065 3,992,941 5,056,593 6,092,561 11,420,772 17,442,485 10,822,989 76,975,016 290 Grade B (0.3-0.9) 2,382,168 784,312 1,692,698 2,229,098 2,741,954 5,509,895 8,865,641 4,593,097 36,590,177 115 Grade C (1.0-2.0) 1,118,280 295,913 697,292 946,685 1,181,511 2,030,389 3,392,095 2,209,061 15,708,269 46 Grade D (2.1-3.2) 899,938 256,516 629,838 797,734 933,023 2,146,557 2,872,156 1,676,436 12,490,502 18 2,824,682 975,823 1,788,009 2,489,571 3,369,444 7,368,681 10,994,661 5,748,309 44,966,104 58 National Population in Counties with PM2.5 Monitors 15,270,307 4,706,762 10,737,608 13,965,809 17,198,710 33,878,399 51,281,927 30,418,036 221,658,939 632 Grade F (3.3+) People at Risk from Year-Round Particle Pollution (Annual PM2.5) Chronic Diseases Age Groups Number In Counties where Adult Pediatric 65 and Total of the Grades were: Asthma Asthma COPD CV Disease Diabetes Poverty Under 18 Over Population Counties Pass 22,362,111 34,992,221 1,764,408 4,258,671 5,538,179 National Population in Counties with PM2.5 Monitors 15,270,307 4,706,762 10,737,608 13,965,809 17,198,710 33,878,399 51,281,927 Fail 10,554,384 3,229,312 1,421,031 7,310,666 509,027 918,039 9,479,187 11,628,522 1,287,953 20,378,024 151,129,336 2,888,246 448 22,772,198 20 30,418,036 221,658,939 632 People at Risk from Ozone Chronic Diseases Age Groups Number In Counties where Adult Pediatric 65 and Total of the Grades were: Asthma Asthma COPD CV Disease Poverty Under 18 Over Population Counties Grade A (0.0) 996,060 293,042 718,889 979,323 2,395,247 3,323,875 2,348,924 14,925,068 93 Grade B (0.3-0.9) 998,391 274,728 768,943 1,013,052 2,048,541 3,116,957 2,314,844 14,299,054 94 Grade C (1.0-2.0) 1,307,083 392,290 1,071,789 1,387,111 3,062,616 4,186,602 3,014,184 19,181,631 109 Grade D (2.1-3.2) 1,513,397 464,202 1,124,908 1,402,163 2,772,834 4,923,487 2,898,281 21,517,834 72 Grade F (3.3+) 11,163,952 3,508,338 7,696,079 10,078,888 24,346,333 38,390,638 21,809,273 162,937,961 395 National Population in Counties with Ozone Monitors 16,338,629 5,035,060 11,618,849 15,171,179 35,267,358 55,030,370 33,120,973 237,780,220 810 Note: The State of the Air 2016 covers the period 2012-2014. A full explanation of the sources of data and methodology is in Methodology. 13 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS People at Risk In 25 U.S. Cities Most Polluted by Short-Term Particle Pollution (24-hour PM2.5) 2016 Rank1 Metropolitan Statistical Areas 1 Bakersfield, CA 2 Fresno–Madera, CA 3 Total Population2 Under 183 65 and Pediatric Adult Over3 Asthma.4,6 Asthma5,6 COPD7 CV Disease8 Diabetes9 Poverty10 206,604 874,589 257,512 86,198 22,811 47,274 27,545 39,611 58,509 1,120,522 321,538 127,627 28,482 61,434 37,066 54,190 78,465 293,929 Visalia–Porterville–Hanford, CA 608,467 186,159 61,302 16,490 32,302 18,893 27,286 39,992 160,479 4 Modesto–Merced, CA 798,350 225,241 92,260 19,952 44,214 26,914 39,399 57,132 160,041 5 Fairbanks, AK 6 Salt Lake City–Provo-Orem, UT 7 Logan, UT—ID 8 San Jose–San Francisco–Oakland, CA 9 Los Angeles–Long Beach, CA 10 Missoula, MT 112,684 21,839 15,363 1,555 8,935 5,475 5,801 6,945 17,216 11 Reno–Carson City–Fernley, NV 597,837 130,592 97,747 8,848 38,360 34,676 45,621 47,522 89,277 11 Lancaster, PA 533,320 128,671 87,385 13,929 39,794 27,486 39,175 44,979 54,499 13 El Centro, CA 179,091 51,111 21,523 4,527 9,863 6,046 8,897 12,791 40,162 14 Pittsburgh–New Castle–Weirton, PA—OH—WV 2,653,781 512,313 489,155 55,262 210,546 154,349 218,588 249,655 331,578 15 Yakima, WA 247,687 73,891 31,719 4,826 16,075 10,398 12,998 14,992 50,044 16 Anchorage, AK 398,892 101,730 36,091 9,374 23,752 12,587 16,994 20,760 39,450 1 7 Sacramento-Roseville, CA 2,513,103 592,935 358,196 52,523 149,894 96,523 144,007 205,390 397,024 18 Philadelphia–Reading–Camden, PA—NJ—DE—MD 7,164,790 1,601,349 1,058,447 164,662 520,226 350,165 491,940 577,817 950,284 18 Harrisburg–York–Lebanon, PA 1,239,677 271,569 204,056 29,398 95,249 66,506 94,211 108,812 129,647 20 El Paso–Las Cruces, TX—NM 1,050,374 290,708 124,863 20,269 55,486 39,945 58,111 81,066 250,142 21 Eugene, OR 358,337 68,413 62,334 4,963 29,455 16,575 24,260 26,412 64,722 21 South Bend–Elkhart-Mishawaka, IN—MI 723,537 178,540 110,538 15,281 58,635 48,571 53,112 58,902 111,135 21 Phoenix–Mesa-Scottsdale, AZ 4,489,109 1,121,933 638,383 122,364 325,041 226,682 264,470 327,660 753,716 24 New York–Newark, NY—NJ—CT—PA 1,392,285 1,785,585 3,281,939 25 Medford–Grants Pass, OR 99,357 23,924 7,913 2,205 5,999 2,938 3,875 4,764 9,011 2,423,912 749,941 222,480 50,564 145,851 59,401 93,542 115,627 267,966 41,232 11,968 2,889 7,834 3,153 4,831 5,817 17,696 8,607,423 131,364 1,876,296 1,168,168 166,204 523,893 330,069 488,003 703,447 968,270 18,550,288 4,419,138 2,287,192 391,452 1,093,121 670,009 981,745 1,425,473 3,174,300 23,632,722 293,886 5,198,379 3,383,979 60,420 63,154 473,026 1,812,756 1,039,620 4,383 23,312 14,641 22,447 24,063 54,487 Notes: 1. Cities are ranked using the highest weighted average for any county within that Combined or Metropolitan Statistical Area. 2. Total Population represents the at-risk populations for all counties within the respective Combined or Metropolitan Statistical Area. 3. Those under 18 and 65 and over are vulnerable to PM2.5 and are, therefore, included. They should not be used as population denominators for disease estimates. 4. Pediatric asthma estimates are for those under 18 years of age and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 5. Adult asthma estimates are for those 18 years and older and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 6. Adding across rows does not produce valid estimates. Adding the disease categories (asthma, COPD, etc.) will double-count people who have been diagnosed with more than one disease. 7. COPD estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 8. CV disease is cardiovascular disease and estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 9. Diabetes estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 10. Poverty estimates come from the U.S. Census Bureau and are for all ages. 14 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS People at Risk In 25 U.S. Cities Most Polluted by Year-Round Particle Pollution (Annual PM2.5) 2016 Rank1 Metropolitan Statistical Areas Total Population2 Under 183 65 and Pediatric Adult Over3 Asthma.4,6 Asthma5,6 COPD7 CV Disease8 Diabetes9 Poverty10 1 Bakersfield, CA 874,589 257,512 86,198 22,811 47,274 27,545 39,611 58,509 206,604 2 Visalia–Porterville–Hanford, CA 608,467 186,159 61,302 16,490 32,302 18,893 27,286 39,992 160,479 3 Fresno–Madera, CA 1,120,522 321,538 127,627 28,482 61,434 37,066 54,190 78,465 293,929 4 Los Angeles–Long Beach, CA 391,452 1,093,121 670,009 981,745 1,425,473 3,174,300 5 El Centro, CA 179,091 51,111 21,523 4,527 9,863 6,046 8,897 12,791 40,162 6 Modesto-Merced, CA 798,350 225,241 92,260 19,952 44,214 26,914 39,399 57,132 160,041 6 San Jose–San Francisco–Oakland, CA 1,876,296 1,168,168 166,204 523,893 330,069 488,003 703,447 968,270 8 Pittsburgh–New Castle–Weirton, PA—OH—WV 2,653,781 512,313 489,155 55,262 210,546 154,349 218,588 249,655 331,578 9 Harrisburg–York–Lebanon, PA 1,239,677 271,569 204,056 29,398 95,249 66,506 94,211 108,812 129,647 10 Louisville/Jefferson County–Elizabethtown– Madison, KY—IN 1,498,593 348,103 213,057 35,700 134,900 132,472 132,990 138,376 213,396 11 Cleveland–Akron–Canton, OH 3,497,851 763,909 583,516 79,634 296,253 229,278 285,478 327,871 527,700 12 Philadelphia–Reading–Camden, PA—NJ—DE—MD 7,164,790 1,601,349 1,058,447 164,662 520,226 350,165 491,940 577,817 950,284 13 Indianapolis–Carmel-Muncie, IN 2,353,935 581,717 304,412 46,418 190,921 152,034 157,184 183,577 342,625 14 Cincinnati–Wilmington–Maysville, OH—KY—IN 2,208,450 532,957 302,529 55,681 186,179 148,558 168,576 191,278 304,362 14 Altoona, PA 16 Houston–The Woodlands, TX 16 San Luis Obispo–Paso Robles– Arroyo Grande, CA 16 Lancaster, PA 16 Johnstown–Somerset, PA 20 Detroit–Warren–Ann Arbor, MI 21 Erie–Meadville, PA 22 Birmingham–Hoover–Talladega, AL 23 Little Rock–North Little Rock, AR 23 Fairbanks, AK 23 Wheeling, WV—OH 18,550,288 8,607,423 4,419,138 2,287,192 125,955 25,897 24,360 2,803 9,732 7,144 10,387 11,828 18,367 6,686,318 1,793,010 668,355 126,257 322,667 251,119 362,663 515,515 1,014,700 279,083 50,639 48,977 4,486 17,852 11,905 18,081 25,139 38,048 533,320 128,671 87,385 13,929 39,794 27,486 39,175 44,979 54,499 213,950 40,609 43,588 4,396 16,796 12,637 18,455 20,999 29,818 5,315,251 1,206,783 779,744 123,521 448,280 362,499 401,894 414,592 854,741 365,618 79,430 59,913 8,598 28,186 19,491 27,596 31,850 55,897 1,317,269 305,150 195,649 40,271 96,700 102,850 119,939 129,794 227,444 902,443 215,116 126,381 19,823 60,518 60,538 83,498 83,957 138,677 99,357 23,924 7,913 2,205 5,999 2,938 3,875 4,764 9,011 145,205 28,098 27,933 2,779 12,814 13,249 15,016 15,880 22,863 Notes: 1. Cities are ranked using the highest Design Value for any county within that Combined or Metropolitan Statistical Area. 2. Total Population represents the at-risk populations for all counties within the respective Combined or Metropolitan Statistical Area. 3. Those under 18 and 65 and over are vulnerable to PM2.5 and are, therefore, included. They should not be used as population denominators for disease estimates. 4. Pediatric asthma estimates are for those under 18 years of age and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 5. Adult asthma estimates are for those 18 years and older and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 6. Adding across rows does not produce valid estimates. Adding the disease categories (asthma, COPD, etc.) will double-count people who have been diagnosed with more than one disease. 7. COPD estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 8. CV disease is cardiovascular disease and estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 9. Diabetes estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 10. Poverty estimates come from the U.S. Census Bureau and are for all ages. 15 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS People at Risk In 25 Most Ozone-Polluted Cities 2016 Rank1 Metropolitan Statistical Areas Total Population2 Under 183 65 and Pediatric Adult Over3 Asthma.4,6 Asthma5,6 COPD7 CV Disease8 Poverty9 3,174,300 1 Los Angeles–Long Beach, CA 18,550,288 4,419,138 2,287,192 391,452 1,093,121 670,009 981,745 2 Bakersfield, CA 874,589 257,512 86,198 22,811 47,274 27,545 39,611 206,604 3 Visalia–Porterville–Hanford, CA 608,467 186,159 61,302 16,490 32,302 18,893 27,286 160,479 4 Fresno–Madera, CA 1,120,522 321,538 127,627 28,482 61,434 37,066 54,190 293,929 5 Phoenix–Mesa–Scottsdale, AZ 4,489,109 1,121,933 638,383 122,364 325,041 226,682 264,470 753,716 6 Sacramento–Roseville, CA 2,513,103 592,935 358,196 52,523 149,894 96,523 144,007 397,024 7 Modesto–Merced, CA 798,350 225,241 92,260 19,952 44,214 26,914 39,399 160,041 8 Denver–Aurora, CO 3,345,261 793,140 390,042 73,088 213,917 98,921 141,891 366,306 9 Las Vegas–Henderson, NV—AZ 2,315,324 537,815 341,926 38,006 145,606 123,949 161,771 367,162 10 Fort Collins, CO 324,122 66,316 45,174 6,111 21,566 10,288 15,005 40,447 11 Dallas–Fort Worth, TX—OK 7,352,613 1,955,521 783,598 138,192 357,988 283,225 412,255 1,070,914 12 El Centro, CA 13 San Diego–Carlsbad, CA 14 New York–Newark, NY—NJ—CT—PA 15 Houston–The Woodlands, TX 16 16 179,091 51,111 21,523 4,527 9,863 6,046 8,897 40,162 3,263,431 728,756 414,831 64,554 195,372 119,112 174,704 467,248 23,632,722 5,198,379 3,383,979 473,026 1,812,756 1,039,620 1,392,285 3,281,939 6,686,318 1,793,010 668,355 126,257 322,667 251,119 362,663 1,014,700 San Jose–San Francisco–Oakland, CA 8,607,423 1,876,296 1,168,168 166,204 523,893 330,069 488,003 968,270 El Paso–Las Cruces, TX—NM 1,050,374 290,708 124,863 20,269 55,486 39,945 58,111 250,142 18 St. Louis–St. Charles–Farmington, MO—IL 2,910,738 661,874 433,117 69,380 216,710 171,469 212,938 375,430 19 Tulsa–Muskogee–Bartlesville, OK 1,139,468 283,780 165,606 33,208 83,664 69,226 91,441 168,032 20 Grand Rapids–Wyoming–Muskegon, MI 1,421,374 347,314 192,463 35,549 117,357 92,343 100,472 201,409 21 Chicago–Naperville, IL—IN—WI 9,928,312 2,352,737 1,281,668 196,172 704,799 447,098 583,987 1,363,034 22 Sheboygan, WI 115,290 26,246 18,698 2,665 9,151 4,811 6,945 10,165 23 San Luis Obispo–Paso Robles–Arroyo Grande, CA 279,083 50,639 48,977 4,486 17,852 11,905 18,081 38,048 24 Oklahoma City–Shawnee, OK 1,408,578 350,012 180,934 40,959 103,616 80,811 105,397 210,010 25 Edwards–Glenwood Springs, CO 128,008 30,024 13,219 2,767 8,229 3,748 5,292 11,121 Notes: 1. Cities are ranked using the highest weighted average for any county within that Combined or Metropolitan Statistical Area. 2. Total Population represents the at-risk populations for all counties within the respective Combined or Metropolitan Statistical Area. 3. Those under 18 and 65 and over are vulnerable to PM2.5 and are, therefore, included. They should not be used as population denominators for disease estimates. 4. Pediatric asthma estimates are for those under 18 years of age and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 5. Adult asthma estimates are for those 18 years and older and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 6. Adding across rows does not produce valid estimates. Adding the disease categories (asthma, COPD, etc.) will double-count people who have been diagnosed with more than one disease. 7. COPD estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 8. CV disease is cardiovascular disease and estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 9. Poverty estimates come from the U.S. Census Bureau and are for all ages. 16 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS People at Risk in 25 Counties Most Polluted by Short-Term Particle Pollution (24-hour PM2.5) At-Risk Groups 2016 Rank1 County ST Total Population2 Under 183 65 and Pediatric Adult Over3 Asthma4,6 Asthma5,6 COPD7 High PM2.5 Days in Unhealthy Ranges, 2012–2014 CV Disease8 Diabetes9 Poverty10 Weighted Avg.11 Grade12 1 Kern CA 874,589 257,512 86,198 22,811 47,274 27,545 39,611 58,509 206,604 48.7 F 2 Fresno CA 965,974 278,941 107,886 24,709 52,769 31,650 46,170 66,992 261,387 44.7 F 3 Kings CA 150,269 41,383 13,678 3,666 8,273 4,636 6,575 9,814 33,174 40.7 F 4 Stanislaus CA 531,997 145,429 64,423 12,882 29,928 18,489 27,190 39,304 95,456 32.5 F 5 Lemhi ID 7,726 1,408 2,111 130 543 394 666 639 1,392 32.2 F 6 Madera CA 154,548 42,597 19,741 3,773 8,665 5,416 8,020 11,473 32,542 26.0 F 7 Fairbanks North Star Borough AK 99,357 23,924 7,913 2,205 5,999 2,938 3,875 4,764 9,011 23.2 F 8 Ravalli MT 41,030 8,309 9,488 592 3,068 2,548 3,042 3,328 7,013 21.8 F 9 Salt Lake UT 1,091,742 309,309 104,910 20,855 68,208 28,129 44,485 55,027 128,385 20.2 F 10 Cache UT 118,343 36,806 10,196 2,482 7,088 2,718 4,171 5,154 16,303 19.7 F 11 San Joaquin CA 715,597 199,024 84,210 17,630 39,987 24,581 36,051 52,309 145,167 19.0 F 12 Merced CA 266,353 79,812 27,837 7,070 14,286 8,424 12,209 17,828 64,585 16.8 F 13 Utah UT 560,974 195,605 40,251 13,188 31,749 11,802 17,516 21,978 69,472 14.5 F 14 Franklin ID 13,021 4,426 1,772 408 746 436 659 663 1,393 13.2 F 15 Tulare CA 458,198 144,776 47,624 12,824 24,029 14,258 20,711 30,178 127,305 13.0 F 16 Shoshone ID 12,390 2,446 2,692 225 856 573 919 914 2,310 12.7 F 17 Riverside CA 2,329,271 613,655 307,271 54,358 132,989 83,667 124,150 177,332 392,706 11.2 F 18 Santa Cruz CA 271,804 54,682 36,624 4,844 16,880 10,546 15,538 22,490 42,076 11.0 F 19 Weber UT 240,475 70,164 26,702 4,731 14,854 6,374 10,490 12,731 29,322 10.8 F 20 Lake OR 7,838 1,449 1,799 105 634 414 639 685 1,429 10.2 F 21 Missoula MT 112,684 21,839 15,363 1,555 8,935 5,475 5,801 6,945 17,216 9.2 F 22 Plumas CA 18,606 3,201 4,595 284 1,255 979 1,548 2,087 2,556 8.8 F 22 Lancaster PA 533,320 128,671 87,385 13,929 39,794 27,486 39,175 44,979 54,499 8.8 F 22 Washoe NV 440,078 98,655 64,302 6,684 27,801 24,140 31,627 32,983 67,110 8.8 F 22 Inyo CA 18,410 3,785 3,932 335 1,175 872 1,362 1,854 2,533 8.8 F Notes: 1. Counties are ranked by weighted average. See note 11 below. 2. Total Population represents the at-risk populations in counties with PM2.5 monitors. 3. Those under 18 and 65 and over are vulnerable to PM2.5 and are, therefore, included. They should not be used as population denominators for disease estimates. 4. Pediatric asthma estimates are for those under 18 years of age and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 5. Adult asthma estimates are for those 18 years and older and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 6. Adding across rows does not produce valid estimates. Adding the disease categories (asthma, COPD, etc.) will double-count people who have been diagnosed with more than one disease. 7. COPD estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 8. CV disease is cardiovascular disease and estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 9. Diabetes estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 10. Poverty estimates come from the U.S. Census Bureau and are for all ages. 11. The Weighted Average was derived by counting the number of days in each unhealthful range (orange, red, purple, maroon) in each year (2012-2014), multiplying the total in each range by the assigned standard weights (i.e., 1 for orange, 1.5 for red, 2.0 for purple, 2.5 for maroon), and calculating the average. 12. Grade is assigned by weighted average as follows: A=0.0, B=0.3-0.9, C=1.0-2.0, D=2.1-3.2, F=3.3+. 17 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS People at Risk In 25 Counties Most Polluted by Year-Round Particle Pollution (Annual PM2.5) PM2.5 Annual, At-Risk Groups 2012–2014 2016 Rank1 County ST Total Population2 Under 183 65 and Pediatric Adult Over3 Asthma4,6 Asthma5,6 COPD7 CV Disease8 Diabetes9 Poverty10 Design Pass/ Value11 Grade12 1 Kern CA 874,589 257,512 86,198 22,811 47,274 27,545 39,611 58,509 206,604 19.7 Fail 2 Tulare CA 458,198 144,776 47,624 12,824 24,029 14,258 20,711 30,178 127,305 17.2 Fail 3 Kings CA 150,269 41,383 13,678 3,666 8,273 4,636 6,575 9,814 33,174 16.8 Fail 4 Madera CA 154,548 42,597 19,741 3,773 8,665 5,416 8,020 11,473 32,542 15.9 Fail 5 Fresno CA 965,974 278,941 107,886 24,709 52,769 31,650 46,170 66,992 261,387 15.4 Fail 6 Riverside CA 2,329,271 613,655 307,271 54,358 132,989 83,667 124,150 177,332 392,706 14.6 Fail 7 Imperial CA 179,091 51,111 21,523 4,527 9,863 6,046 8,897 12,791 40,162 14.3 Fail 8 Plumas CA 18,606 3,201 4,595 284 1,255 979 1,548 2,087 2,556 14.1 Fail 9 Stanislaus CA 531,997 145,429 64,423 12,882 29,928 18,489 27,190 39,304 95,456 14.0 Fail 9 San Joaquin CA 715,597 199,024 84,210 17,630 39,987 24,581 36,051 52,309 145,167 14.0 Fail 11 Shoshone ID 12,390 2,446 2,692 225 856 573 919 914 2,310 13.1 Fail 12 Allegheny PA 1,231,255 234,334 213,797 25,367 98,074 67,737 96,403 110,810 157,151 13.0 Fail 13 San Bernardino CA 2,112,619 575,325 218,318 50,963 118,259 69,775 100,603 148,690 422,405 12.8 Fail 14 Lebanon PA 136,359 31,262 25,025 3,384 10,246 7,418 10,748 12,252 14,442 12.7 Fail 15 Jefferson KY 760,026 172,157 110,291 18,673 70,389 71,607 71,269 72,313 124,850 12.5 Fail 15 Cuyahoga OH 1,259,828 271,080 207,118 28,259 107,221 82,026 101,553 116,813 241,829 12.4 Fail 16 Los Angeles CA 10,116,705 2,303,617 1,233,007 204,057 603,091 366,048 534,609 778,287 1,863,025 12.3 Fail 16 Delaware PA 13,658 43,259 29,115 40,683 47,277 59,610 12.3 Fail 18 Lemhi ID 7,726 1,408 2,111 130 543 394 666 639 1,392 12.1 Fail 18 Hawaii HI 194,190 42,750 34,035 6,846 14,062 6,079 11,575 15,624 34,598 12.1 Fail 21 Marion IN 934,243 232,996 105,443 18,592 75,854 57,704 57,825 68,523 194,803 11.8 Pass 22 Merced CA 266,353 79,812 27,837 7,070 14,286 8,424 12,209 17,828 64,585 11.7 Pass 22 Blair PA 125,955 25,897 24,360 2,803 9,732 7,144 10,387 11,828 18,367 11.7 Pass 22 Hamilton OH 806,631 187,730 114,279 19,570 67,366 49,264 59,121 69,068 138,939 11.7 Pass 22 Stark OH 375,736 82,402 66,476 8,590 31,729 24,969 31,511 35,886 54,744 11.7 Pass 562,960 126,171 84,703 Notes: 1. Counties are ranked by Design Value. See note 11 below. 2. Total Population represents the at-risk populations in counties with PM2.5 monitors. 3. Those under 18 and 65 and over are vulnerable to PM2.5 and are, therefore, included. They should not be used as population denominators for disease estimates. 4. Pediatric asthma estimates are for those under 18 years of age and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 5. Adult asthma estimates are for those 18 years and older and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 6. Adding across rows does not produce valid estimates. Adding the disease categories (asthma, COPD, etc.) will double-count people who have been diagnosed with more than one disease. 7. COPD estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 8. CV disease is cardiovascular disease and estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 9. Diabetes estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 10. Poverty estimates come from the U.S. Census Bureau and are for all ages. 11. The Design Value is the calculated concentration of a pollutant based on the form of the Annual PM2.5 National Ambient Air Quality Standard and is used by EPA to determine whether the air quality in a county meets the current (2012) standard (U.S. EPA). 12. Grades are based on EPA's determination of meeting or failure to meet the NAAQS for annual PM2.5 levels during 2012-2014. Counties meeting the NAAQS received grades of Pass; counties not meeting the NAAQS received grades of Fail. 18 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS People at Risk in 25 Most Ozone-Polluted Counties At-Risk Groups 2016 Rank1 County ST Total Population2 Under 183 65 and Pediatric Adult Over3 Asthma4,6 Asthma5,6 1 San Bernardino CA 2,112,619 575,325 218,318 50,963 2 Riverside CA 2,329,271 613,655 307,271 3 Kern CA 874,589 257,512 86,198 4 Los Angeles CA 10,116,705 2,303,617 5 Tulare CA 458,198 6 Fresno CA 7 Madera CA 8 Kings 9 High Ozone Days in Unhealthy Ranges, 2012–2014 COPD7 CV Disease8 Poverty9 Weighted Avg.10 Grade11 118,259 69,775 100,603 422,405 152.5 F 54,358 132,989 83,667 124,150 392,706 140.3 F 22,811 47,274 27,545 39,611 206,604 113.3 F 1,233,007 204,057 603,091 366,048 534,609 1,863,025 109.2 F 144,776 47,624 12,824 24,029 14,258 20,711 127,305 107.8 F 965,974 278,941 107,886 24,709 52,769 31,650 46,170 261,387 103.8 F 154,548 42,597 19,741 3,773 8,665 5,416 8,020 32,542 57.7 F CA 150,269 41,383 13,678 3,666 8,273 4,636 6,575 33,174 43.8 F Maricopa AZ 4,087,191 1,023,993 565,934 111,682 295,891 205,053 237,992 687,643 43.2 F 10 El Dorado CA 183,087 38,231 32,882 3,387 11,648 8,290 12,675 20,715 41.3 F 11 Stanislaus CA 531,997 145,429 64,423 12,882 29,928 18,489 27,190 95,456 40.0 F 12 Sacramento CA 1,482,026 361,087 189,691 31,985 86,971 54,148 79,792 264,955 39.2 F 13 Uintah UT 36,867 12,467 3,346 841 2,126 873 1,385 3,512 37.7 F 14 Jefferson CO 558,503 116,545 81,934 10,740 37,019 19,087 27,756 45,482 35.7 F 15 Clark NV 2,069,681 492,248 275,388 33,351 127,039 107,052 139,436 318,965 34.5 F 16 Larimer CO 324,122 66,316 45,174 6,111 21,566 10,288 15,005 40,447 32.2 F 17 Merced CA 266,353 79,812 27,837 7,070 14,286 8,424 12,209 64,585 31.5 F 18 Tarrant TX 1,945,360 526,956 198,779 37,106 93,711 73,574 106,743 291,534 29.7 F 19 Mariposa CA 17,682 2,945 4,336 261 1,199 931 1,470 2,830 28.7 F 20 Imperial CA 179,091 51,111 21,523 4,527 9,863 6,046 8,897 40,162 28.2 F 21 San Diego CA 3,263,431 728,756 414,831 64,554 195,372 119,112 174,704 467,248 27.5 F 22 Denton TX 753,363 196,521 65,706 13,838 36,579 27,662 39,256 64,947 26.7 F 23 Placer CA 371,694 85,109 66,239 7,539 22,720 15,850 24,301 30,490 26.5 F 24 Fairfield CT 945,438 223,021 135,792 21,351 66,025 36,189 53,156 83,132 24.3 F 25 Nevada CA 98,893 17,582 23,179 1,557 6,578 5,015 7,892 11,193 24.0 F Notes: 1. Counties are ranked by weighted average. See note 10 below. 2. Total Population represents the at-risk populations in counties with PM2.5 monitors. 3. Those under 18 and 65 and over are vulnerable to PM2.5 and are, therefore, included. They should not be used as population denominators for disease estimates. 4. Pediatric asthma estimates are for those under 18 years of age and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 5. Adult asthma estimates are for those 18 years and older and represent the estimated number of people who had asthma in 2014 based on state rates (BRFSS) applied to population estimates (U.S. Census). 6. Adding across rows does not produce valid estimates. Adding the disease categories (asthma, COPD, etc.) will double-count people who have been diagnosed with more than one disease. 7. COPD estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 8. CV disease is cardiovascular disease and estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to population estimates (U.S. Census). 9. Poverty estimates come from the U.S. Census Bureau and are for all ages. 10. The Weighted Average was derived by counting the number of days in each unhealthful range (orange, red, purple) in each year (2012-2014), multiplying the total in each range by the assigned standard weights (i.e., 1 for orange, 1.5 for red, 2.0 for purple), and calculating the average. 11. Grade is assigned by weighted average as follows: A=0.0, B=0.3-0.9, C=1.0-2.0, D=2.1-3.2, F=3.3+. 19 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS Cleanest U.S. Cities for Short-Term Particle Pollution (24-hour PM2.5)1 Metropolitan Statistical Area Population Metropolitan Statistical Area Albany–Schenectady, NY 1,173,518 Population Lake Charles, LA 203,883 Alexandria, LA 154,872 Lansing–East Lansing–Owosso, MI 539,391 Asheville–Brevard, NC 475,361 Lexington-Fayette–Richmond–Frankfort, KY 716,090 583,632 Lima–Van Wert–Celina, OH 220,174 Longview–Marshall, TX 284,817 Augusta–Richmond County, GA-SC Austin–Round Rock, TX 1,943,299 Bangor, ME 153,414 Lynchburg, VA 257,835 Beckley, WV 123,373 McAllen–Edinburg, TX 894,028 208,351 Mobile–Daphne–Fairhope, AL 615,234 Monroe–Ruston–Bastrop, LA 253,241 Bellingham, WA Birmingham–Hoover–Talladega, AL 1,317,269 Bowling Green–Glasgow, KY 218,870 Montgomery, AL 373,141 Brunswick, GA 114,806 Morgantown–Fairmont, WV 194,054 Buffalo–Cheektowaga, NY New Orleans–Metairie–Hammond, LA—MS 1,480,408 Burlington–South Burlington, VT 1,214,960 216,167 Oklahoma City–Shawnee, OK 1,408,578 Charleston–Huntington–Ashland, WV—OH—KY 698,809 Owensboro, KY 116,506 Parkersburg–Marietta–Vienna, WV—OH 153,295 Charlotte–Concord, NC—SC 2,537,990 Charlottesville, VA 226,968 Pittsfield, MA 128,715 Chattanooga–Cleveland–Dalton, TN—GA—AL 945,148 Portland–Lewiston–South Portland, ME 630,992 Cheyenne, WY 96,389 Colorado Springs, CO 686,908 Columbus–Marion–Zanesville, OH 2,398,297 Pueblo–Cañon City, CO Raleigh–Durham–Chapel Hill, NC Rapid City–Spearfish, SD 208,377 2,075,126 168,295 Des Moines–Ames–West Des Moines, IA 768,927 Redding–Red Bluff, CA Dothan–Enterprise–Ozark, AL 248,488 Richmond, VA Duluth, MN—WI 280,218 Roanoke, VA Eau Claire–Menomonie, WI 209,329 Rochester–Batavia–Seneca Falls, NY Edwards–Glenwood Springs, CO 128,008 Rome–Summerville, GA 121,002 Elmira–Corning, NY 186,164 Saginaw–Midland–Bay City, MI 384,618 Evansville, IN—KY 315,162 Salinas, CA 431,344 Farmington, NM 123,785 Salisbury, MD–DE Fayetteville–Lumberton–Laurinburg, NC 548,275 San Antonio–New Braunfels, TX Fayetteville–Springdale–Rogers, AR—MO 501,653 Santa Maria–Santa Barbara, CA 440,668 Florence, SC 207,030 Scranton–Wilkes-Barre–Hazleton, PA 559,679 Florence–Muscle Shoals, AL 147,639 Sierra Vista–Douglas, AZ 127,448 Fort Smith, AR—OK 279,592 Springfield–Branson, MO 537,631 Gadsden, AL 103,531 Springfield–Greenfield Town, MA 699,962 Goldsboro, NC 124,456 St. George, UT 151,948 Syracuse–Auburn, NY 740,301 Grand Island, NE 84,755 242,871 1,260,029 313,388 1,177,439 389,922 2,328,652 Grand Rapids–Wyoming–Muskegon, MI 1,421,374 Texarkana, TX–AR 149,235 Greensboro–Winston-Salem–High Point, NC 1,630,368 Toledo–Port Clinton, OH 648,610 Greenville–Washington, NC 222,939 Tulsa–Muskogee–Bartlesville, OK Gulfport–Biloxi–Pascagoula, MS 386,144 Tuscaloosa, AL 237,761 Harrisonburg–Staunton–Waynesboro, VA 250,415 Urban Honolulu, HI 991,788 Hot Springs–Malvern, AR 130,690 Valdosta, GA 143,317 Houma–Thibodaux, LA 211,348 Virginia Beach–Norfolk, VA—NC Huntsville–Decatur–Albertville, AL 688,806 Waterloo–Cedar Falls, IA 169,993 Jackson–Vicksburg–Brookhaven, MS 669,402 Wilmington, NC 272,548 La Crosse–Onalaska, WI—MN 136,749 Youngstown–Warren, OH—PA 658,949 Lafayette–Opelousas–Morgan City, LA 621,845 Note: 1. Monitors in these cities reported no days when PM2.5 levels reached the unhealthful range using the Air Quality Index based on the current (2006) standard (U.S. EPA). 20 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 1,139,468 1,819,427 RANKINGS Top 25 Cleanest U.S. Cities for Year-Round Particle Pollution (Annual PM2.5)1 Cleanest U.S. Cities for Ozone Air Pollution1 Rank2 Metropolitan Statistical Area Design Value3 Metropolitan Statistical Area Population 1 4.5 Farmington, NM 2 4.7 Cheyenne, WY 123,785 3 4.8 Casper, WY 4 5.4 Kahului-Wailuku-Lahaina, HI 163,108 5 5.6 Urban Honolulu, HI 6 5.7 Bismarck, ND 7 6.0 8 6.1 9 10 Population Bellingham, WA 208,351 96,389 Bend-Redmond-Prineville, OR 191,386 81,624 Bismarck, ND 126,597 Brownsville-Harlingen-Raymondville, TX 442,295 991,788 Brunswick, GA 114,806 126,597 Burlington-South Burlington, VT 216,167 Elmira-Corning, NY 186,164 Cape Coral-Fort Myers-Naples, FL Salinas, CA 431,344 Charleston-North Charleston, SC 727,689 6.3 Redding-Red Bluff, CA 242,871 Dothan-Enterprise-Ozark, AL 248,488 6.4 Fargo-Wahpeton, ND-MN 251,218 Elmira-Corning, NY 186,164 11 6.5 Albuquerque-Santa Fe-Las Vegas, NM Eugene, OR 358,337 12 6.6 Burlington-South Burlington, VT 216,167 Fairbanks, AK 13 6.7 Syracuse-Auburn, NY 740,301 Fargo-Wahpeton, ND-MN 251,218 13 6.7 Wilmington, NC 272,548 Gadsden, AL 103,531 13 6.7 Bangor, ME 153,414 Idaho Falls-Rexburg-Blackfoot, ID 234,440 13 6.7 Rapid City-Spearfish, SD 168,295 Lincoln-Beatrice, NE 340,608 17 6.8 Anchorage, AK 398,892 McAllen-Edinburg, TX 894,028 18 7.0 Sierra Vista-Douglas, AZ 127,448 Missoula, MT 112,684 19 7.2 Rochester-Austin, MN 252,101 Monroe-Ruston-Bastrop, LA 253,241 19 7.2 Duluth, MN-WI 280,218 Montgomery, AL 373,141 19 7.2 Grand Island, NE 22 7.3 Albany-Schenectady, NY 22 7.3 Pittsfield, MA 128,715 Salinas, CA 431,344 24 7.4 Yuma, AZ 203,247 Savannah-Hinesville-Statesboro, GA 527,106 24 7.4 Houma-Thibodaux, LA 211,348 Sebring, FL 1,165,798 84,755 1,173,518 1,028,290 99,357 New Bern-Morehead City, NC 196,345 Ocala, FL 339,167 98,236 Notes: 1. This list represents cities with the lowest levels of year-round PM2.5 air pollution. 2. Cities are ranked by using the highest design value for any county within that metropolitan area. Sioux City-Vermillion, IA-SD-NE 182,738 Spokane-Spokane Valley-Coeur d'Alene, WA-ID 688,279 3. The Design Value is the calculated concentration of a pollutant based on the form of the Annual PM2.5 National Ambient Air Quality Standard, and is used by EPA to determine whether the air quality in a county meets the current (2012) standard (U.S. EPA). Tallahassee-Bainbridge, FL-GA 402,971 Tuscaloosa, AL 237,761 Urban Honolulu, HI 991,788 Utica-Rome, NY 296,615 Victoria-Port Lavaca, TX 120,427 Notes: 1. This list represents cities with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on the current (2015) standard (U.S. EPA). 21 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS Cleanest Counties for Short-Term Particle Pollution (24-hour PM2.5)1 County State MSAs and Respective CSA2 County State MSAs and Respective CSA2 Baldwin AL Mobile–Daphne–Fairhope, AL Clarke GA Atlanta–Athens-Clarke County–Sandy Springs, GA Clay AL Clayton GA Atlanta–Athens-Clarke County–Sandy Springs, GA Colbert AL Florence–Muscle Shoals, AL Cobb GA Atlanta–Athens-Clarke County–Sandy Springs, GA DeKalb AL DeKalb GA Atlanta–Athens-Clarke County–Sandy Springs, GA Etowah AL Gadsden, AL Floyd GA Rome–Summerville, GA Houston AL Dothan–Enterprise–Ozark, AL Fulton Jefferson AL Birmingham–Hoover–Talladega, AL GA Atlanta–Athens-Clarke County– Sandy Springs, GA Madison AL Huntsville–Decatur–Albertville, AL Glynn GA Brunswick, GA Mobile AL Mobile–Daphne–Fairhope, AL Hall GA Atlanta–Athens-Clarke County–Sandy Springs, GA Montgomery AL Montgomery, AL Houston GA Macon–Warner Robins, GA Morgan AL Huntsville–Decatur–Albertville, AL Lowndes GA Valdosta, GA Russell AL Columbus–Auburn–Opelika, GA—AL Paulding GA Atlanta–Athens-Clarke County–Sandy Springs, GA Shelby AL Birmingham–Hoover–Talladega, AL Richmond GA Augusta–Richmond County, GA—SC Talladega AL Birmingham–Hoover–Talladega, AL Walker GA Chattanooga–Cleveland–Dalton, TN—GA—AL Tuscaloosa AL Tuscaloosa, AL Washington GA Arkansas AR Honolulu HI Urban Honolulu, HI Ashley AR Kauai HI Garland AR Hot Springs–Malvern, AR Black Hawk IA Jackson AR Delaware IA Polk AR Lee IA Union AR Polk IA Washington AR Fayetteville–Springdale–Rogers, AR—MO Van Buren IA Cochise AZ Sierra Vista–Douglas, AZ Dubois IN Mohave AZ Las Vegas–Henderson, NV—AZ Floyd Pima AZ Tucson–Nogales, AZ IN Louisville/Jefferson County–Elizabethtown– Madison, KY—IN Humboldt CA Spencer IN Lake CA Vanderburgh IN Evansville, IN—KY Mendocino CA Johnson KS Kansas City–Overland Park–Kansas City, MO—KS Monterey CA Salinas, CA Bell KY San Benito CA San Jose–San Francisco–Oakland, CA Boyd KY Charleston–Huntington–Ashland, WV—OH—KY Santa Barbara CA Santa Maria–Santa Barbara, CA Shasta CA Redding–Red Bluff, CA Sonoma CA San Jose–San Francisco–Oakland, CA Yolo CA Sacramento–Roseville, CA Arapahoe CO Denver–Aurora, CO El Paso CO Colorado Springs, CO Garfield Waterloo–Cedar Falls, IA Des Moines–Ames–West Des Moines, IA Campbell KY Cincinnati–Wilmington–Maysville, OH—KY—IN Carter KY Christian KY Clarksville, TN—KY Daviess KY Owensboro, KY Fayette KY Lexington-Fayette–Richmond–Frankfort, KY Hardin KY Louisville/Jefferson County–Elizabethtown– Madison, KY—IN CO Edwards–Glenwood Springs, CO Henderson KY Evansville, IN—KY La Plata CO Madison KY Lexington-Fayette–Richmond–Frankfort, KY Montezuma CO McCracken KY Paducah–Mayfield, KY—IL Pueblo CO Pueblo–Cañon City, CO Pulaski KY Hartford CT Hartford–West Hartford, CT Warren KY Bowling Green–Glasgow, KY Litchfield CT New York–Newark, NY—NJ—CT—PA Calcasieu Parish LA Lake Charles, LA Kent DE Philadelphia–Reading–Camden, PA—NJ—DE—MD Iberville Parish LA Baton Rouge, LA Sussex DE Salisbury, MD—DE Jefferson Parish LA New Orleans–Metairie–Hammond, LA—MS Notes: 1. Monitors in these counties reported no days when PM2.5 levels reached the unhealthful range using the Air Quality Index based on the current (2006) standard (U.S. EPA). 2. MSA and CSA are terms used by the U.S. Office of Management and Budget for statistical purposes. MSA stands for Metropolitan Statisical Area and includes one or more counties. CSA stands for Combined Statistical Area and may include multiple MSAs and individual counties. 22 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS Cleanest Counties for Short-Term Particle Pollution (24-hour PM2.5)1 (cont.) County State MSAs and Respective CSA2 County State MSAs and Respective CSA2 Lafayette Parish LA Lafayette–Opelousas–Morgan City, LA Anoka MN Minneapolis–St. Paul, MN—WI Ouachita Parish LA Monroe–Ruston–Bastrop, LA Dakota MN Minneapolis–St. Paul, MN—WI Rapides Parish LA Alexandria, LA Scott MN Minneapolis–St. Paul, MN—WI St. Bernard Parish LA New Orleans–Metairie–Hammond, LA—MS St. Louis MN Duluth, MN—WI Tangipahoa Parish LA New Orleans–Metairie–Hammond, LA—MS Cass MO Kansas City–Overland Park–Kansas City, MO—KS Terrebonne Parish LA Houma–Thibodaux, LA Cedar MO West Baton Rouge Parish LA Baton Rouge, LA Clay MO Kansas City–Overland Park–Kansas City, MO—KS Berkshire MA Pittsfield, MA Greene MO Springfield–Branson, MO Bristol MA Boston–Worcester–Providence, MA—RI—NH—CT Grenada MS Essex MA Boston–Worcester–Providence, MA—RI—NH—CT Hancock MS Gulfport–Biloxi–Pascagoula, MS Hampden MA Springfield–Greenfield Town, MA Harrison MS Gulfport–Biloxi–Pascagoula, MS Plymouth MA Boston–Worcester–Providence, MA—RI—NH—CT Hinds MS Jackson–Vicksburg–Brookhaven, MS Suffolk MA Boston–Worcester–Providence, MA—RI—NH—CT Jackson MS Gulfport–Biloxi–Pascagoula, MS Worcester MA Boston–Worcester–Providence, MA—RI—NH—CT Alamance NC Greensboro–Winston-Salem–High Point, NC Anne Arundel MD Washington–Baltimore–Arlington, DC—MD— Rankings VA—WV—PA Buncombe NC Asheville–Brevard, NC Caswell NC Catawba NC Hickory–Lenoir, NC Chatham NC Raleigh–Durham–Chapel Hill, NC Cumberland NC Fayetteville–Lumberton–Laurinburg, NC Baltimore MD Washington–Baltimore–Arlington, DC—MD— VA—WV—PA Dorchester MD Washington–Baltimore–Arlington, DC—MD— VA—WV—PA Garrett MD Davidson NC Greensboro–Winston-Salem–High Point, NC Harford MD Washington–Baltimore–Arlington, DC—MD— VA—WV—PA Duplin NC Kent MD Durham NC Raleigh–Durham–Chapel Hill, NC Montgomery MD Washington–Baltimore–Arlington, DC—MD— VA—WV—PA Forsyth NC Greensboro–Winston-Salem–High Point, NC Gaston NC Charlotte–Concord, NC—SC Prince George's MD Washington–Baltimore–Arlington, DC—MD— VA—WV—PA Guilford NC Greensboro–Winston-Salem–High Point, NC Haywood NC Asheville–Brevard, NC Androscoggin ME Portland–Lewiston–South Portland, ME Jackson NC Cumberland ME Portland–Lewiston–South Portland, ME Johnston NC Raleigh–Durham–Chapel Hill, NC Hancock ME Martin NC Kennebec ME Mecklenburg NC Charlotte–Concord, NC—SC Oxford ME Mitchell NC Penobscot ME Bangor, ME Montgomery NC Allegan MI Grand Rapids–Wyoming–Muskegon, MI New Hanover NC Wilmington, NC Bay MI Saginaw–Midland–Bay City, MI Pitt NC Greenville–Washington, NC Berrien MI South Bend–Elkhart–Mishawaka, IN—MI Robeson NC Fayetteville–Lumberton–Laurinburg, NC Chippewa MI Rowan NC Charlotte–Concord, NC—SC Ingham MI Lansing–East Lansing–Owosso, MI Swain NC Kent MI Grand Rapids–Wyoming–Muskegon, MI Wake NC Raleigh–Durham–Chapel Hill, NC Lenawee MI Detroit–Warren–Ann Arbor, MI Wayne NC Goldsboro, NC Macomb MI Detroit–Warren–Ann Arbor, MI Billings ND Missaukee MI Burke ND Monroe MI Detroit–Warren–Ann Arbor, MI Hall NE Grand Island, NE Oakland MI Detroit–Warren–Ann Arbor, MI Scotts Bluff NE Washtenaw MI Detroit–Warren–Ann Arbor, MI Belknap NH Boston–Worcester–Providence, MA—RI—NH—CT Notes: 1. Monitors in these counties reported no days when PM2.5 levels reached the unhealthful range using the Air Quality Index based on the current (2006) standard (U.S. EPA). 2. MSA and CSA are terms used by the U.S. Office of Management and Budget for statistical purposes. MSA stands for Metropolitan Statisical Area and includes one or more counties. CSA stands for Combined Statistical Area and may include multiple MSAs and individual counties. 23 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS Cleanest Counties for Short-Term Particle Pollution (24-hour PM2.5)1 (cont.) County State MSAs and Respective CSA2 County State MSAs and Respective CSA2 Grafton NH Summit OH Cleveland–Akron–Canton, OH Hillsborough NH Boston–Worcester–Providence, MA—RI—NH—CT Trumbull OH Youngstown–Warren, OH—PA Merrimack NH Boston–Worcester–Providence, MA—RI—NH—CT Oklahoma OK Oklahoma City–Shawnee, OK Rockingham NH Boston–Worcester–Providence, MA—RI—NH—CT Sequoyah OK Fort Smith, AR–OK Atlantic NJ Philadelphia–Reading–Camden, PA—NJ—DE—MD Tulsa OK Tulsa–Muskogee–Bartlesville, OK Bergen NJ New York–Newark, NY—NJ—CT—PA Armstrong PA Pittsburgh–New Castle–Weirton, PA—OH—WV Gloucester NJ Philadelphia–Reading–Camden, PA—NJ—DE—MD Beaver PA Pittsburgh–New Castle–Weirton, PA—OH—WV Mercer NJ New York–Newark, NY—NJ—CT—PA Lackawanna PA Scranton–Wilkes-Barre–Hazleton, PA Middlesex NJ New York–Newark, NY—NJ—CT—PA Mercer PA Youngstown–Warren, OH–PA Morris NJ New York–Newark, NY—NJ—CT—PA Monroe PA New York–Newark, NY—NJ—CT—PA Ocean NJ New York–Newark, NY—NJ—CT—PA Washington PA Pittsburgh–New Castle–Weirton, PA—OH—WV Passaic NJ New York–Newark, NY—NJ—CT—PA Westmoreland PA Pittsburgh–New Castle–Weirton, PA—OH—WV Warren NJ New York–Newark, NY—NJ—CT—PA Kent RI Boston–Worcester–Providence, MA—RI—NH—CT San Juan NM Farmington, NM Washington RI Boston–Worcester–Providence, MA–RI–NH–CT Santa Fe NM Albuquerque–Santa Fe–Las Vegas, NM Chesterfield SC Albany NY Albany–Schenectady, NY Edgefield SC Augusta–Richmond County, GA—SC Bronx NY New York–Newark, NY—NJ—CT—PA Florence SC Florence, SC Chautauqua NY Richland SC Columbia–Orangeburg–Newberry, SC Erie NY Buffalo–Cheektowaga, NY Spartanburg SC Greenville–Spartanburg–Anderson, SC Essex NY Brown SD Kings NY New York–Newark, NY—NJ—CT—PA Codington SD Monroe NY Rochester–Batavia–Seneca Falls, NY Custer SD Rapid City–Spearfish, SD New York NY New York–Newark, NY—NJ—CT—PA Jackson SD Onondaga NY Syracuse–Auburn, NY Pennington SD Rapid City–Spearfish, SD Orange NY New York–Newark, NY—NJ—CT—PA Hamilton TN Chattanooga–Cleveland–Dalton, TN—GA—AL Queens NY New York–Newark, NY—NJ—CT—PA Bexar TX San Antonio–New Braunfels, TX Richmond NY New York–Newark, NY—NJ—CT—PA Bowie TX Texarkana, TX—AR Steuben NY Elmira–Corning, NY Ellis TX Dallas–Fort Worth, TX—OK Suffolk NY New York–Newark, NY—NJ—CT—PA Harrison TX Longview–Marshall, TX Allen OH Lima–Van Wert–Celina, OH Hidalgo TX McAllen–Edinburg, TX Athens OH Travis TX Austin–Round Rock, TX Butler OH Cincinnati–Wilmington–Maysville, OH—KY—IN Washington UT St. George, UT Clark OH Dayton–Springfield–Sidney, OH Albemarle VA Charlottesville, VA Franklin OH Columbus–Marion–Zanesville, OH Arlington Greene OH Dayton–Springfield–Sidney, OH VA Washington–Baltimore–Arlington, DC—MD— VA—WV—PA Lake OH Cleveland–Akron–Canton, OH Bristol City VA Johnson City–Kingsport–Bristol, TN—VA Lawrence OH Charleston–Huntington–Ashland, WV—OH—KY Charles City VA Richmond, VA Lorain OH Cleveland–Akron–Canton, OH Chesterfield VA Richmond, VA Lucas OH Toledo–Port Clinton, OH Hampton City VA Virginia Beach–Norfolk, VA—NC Mahoning OH Youngstown–Warren, OH—PA Henrico VA Richmond, VA Medina OH Cleveland–Akron–Canton, OH Loudoun Portage OH Cleveland–Akron–Canton, OH VA Washington–Baltimore–Arlington, DC—MD— VA—WV—PA Preble OH Lynchburg City VA Lynchburg, VA Scioto OH Charleston–Huntington–Ashland, WV—OH—KY Norfolk City VA Virginia Beach–Norfolk, VA—NC Page VA Notes: 1. Monitors in these counties reported no days when PM2.5 levels reached the unhealthful range using the Air Quality Index based on the current (2006) standard (U.S. EPA). 2. MSA and CSA are terms used by the U.S. Office of Management and Budget for statistical purposes. MSA stands for Metropolitan Statisical Area and includes one or more counties. CSA stands for Combined Statistical Area and may include multiple MSAs and individual counties. 24 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS Cleanest Counties for Short-Term Particle Pollution (24-hour PM2.5)1 (cont.) County State MSAs and Respective CSA2 Rockingham VA Harrisonburg–Staunton–Waynesboro, VA Salem City VA Roanoke, VA Virginia Beach City VA Virginia Beach–Norfolk, VA—NC Bennington VT Chittenden VT Burlington–South Burlington, VT Kitsap WA Seattle–Tacoma, WA Whatcom WA Bellingham, WA Ashland WI Dodge WI Milwaukee–Racine–Waukesha, WI Eau Claire WI Eau Claire–Menomonie, WI Forest WI Grant WI Kenosha WI Chicago–Naperville, IL—IN—WI La Crosse WI La Crosse–Onalaska, WI—MN Ozaukee WI Milwaukee–Racine–Waukesha, WI Sauk WI Madison–Janesville–Beloit, WI Taylor WI Vilas WI Waukesha WI Milwaukee–Racine–Waukesha, WI Brooke WV Pittsburgh–New Castle–Weirton, PA—OH—WV Cabell WV Charleston–Huntington–Ashland, WV—OH—KY Hancock WV Pittsburgh–New Castle–Weirton, PA—OH—WV Harrison WV Kanawha WV Charleston–Huntington–Ashland, WV—OH—KY Marion WV Morgantown–Fairmont, WV Marshall WV Wheeling, WV—OH Monongalia WV Morgantown–Fairmont, WV Raleigh WV Beckley, WV Wood WV Parkersburg–Marietta–Vienna, WV—OH Albany WY Laramie WY Cheyenne, WY Park WY Sheridan WY Notes: 1. Monitors in these counties reported no days when PM2.5 levels reached the unhealthful range using the Air Quality Index based on the current (2006) standard (U.S. EPA). 2. MSA and CSA are terms used by the U.S. Office of Management and Budget for statistical purposes. MSA stands for Metropolitan Statistical Area and includes one or more counties. CSA stands for Combined Statistical Area and may include multiple MSAs and individual counties. 25 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS Top 25 Cleanest Counties for Year-Round Particle Pollution (Annual PM2.5)1 2016 Rank2 County State Design Value3 1 Custer SD 3.4 2 Lake CA 4.0 3 Essex NY 4.1 3 Hancock ME 4.4 3 Park WY 4.4 5 Billings ND 4.5 5 San Juan NM 4.5 8 McKenzie ND 4.6 8 Jackson SD 4.6 10 Laramie WY 4.7 11 Dunn ND 4.8 11 Albany WY 4.8 11 Natrona WY 4.8 14 San Benito CA 5.1 14 Kauai HI 5.1 14 Vilas WI 5.1 17 Oliver ND 5.2 17 Kent RI 5.2 17 Ashland WI 5.2 17 Teton WY 5.2 21 Litchfield CT 5.3 21 Mercer ND 5.3 21 Scotts Bluff NE 5.3 24 Maui HI 5.4 25 Belknap NH 5.5 25 Sweetwater WY 5.5 Notes: 1. This list represents counties with the lowest levels of annual PM2.5 air pollution. 2. Counties are ranked by Design Value. 3. The Design Value is the calculated concentration of a pollutant based on the form of the Annual PM2.5 National Ambient Air Quality Standard and is used by EPA to determine whether the air quality in a county meets the current (2012) standard (U.S. EPA). 26 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 RANKINGS Cleanest Counties for Ozone Air Pollution1 County State Metropolitan Statistical Area Denali Borough AK Fairbanks North Star Borough AK Fairbanks, AK Elmore AL Montgomery, AL Etowah AL Gadsden, AL Houston AL Dothan-Enterprise-Ozark, AL Montgomery AL Montgomery, AL Tuscaloosa AL Tuscaloosa, AL Colusa CA Humboldt CA Marin CA San Jose-San Francisco-Oakland, CA Mendocino CA Monterey CA Salinas, CA San Francisco CA San Jose-San Francisco-Oakland, CA Sonoma CA San Jose-San Francisco-Oakland, CA Alachua FL Gainesville-Lake City, FL Baker FL Jacksonville-St. Marys-Palatka, FL-GA Collier FL Cape Coral-Fort Myers-Naples, FL Highlands FL Sebring, FL Holmes FL Lee FL Cape Coral-Fort Myers-Naples, FL Leon FL Tallahassee-Bainbridge, FL-GA Liberty FL Marion FL Ocala, FL Wakulla FL Tallahassee-Bainbridge, FL-GA Chatham GA Savannah-Hinesville-Statesboro, GA Glynn GA Brunswick, GA Sumter GA Honolulu HI Urban Honolulu, HI Polk IA Des Moines-Ames-West Des Moines, IA Story IA Des Moines-Ames-West Des Moines, IA Butte ID Idaho Falls-Rexburg-Blackfoot, ID Ouachita Parish LA Monroe-Ruston-Bastrop, LA Androscoggin ME Portland-Lewiston-South Portland, ME Aroostook ME Oxford ME Crow Wing MN Goodhue MN Minneapolis-St. Paul, MN-WI Mille Lacs MN Minneapolis-St. Paul, MN-WI Stearns MN Minneapolis-St. Paul, MN-WI Washington County State Metropolitan Statistical Area Richland MT Rosebud MT Carteret NC New Bern-Morehead City, NC Macon NC Swain NC Billings ND Burke ND Burleigh ND Bismarck, ND Cass ND Fargo-Wahpeton, ND-MN Dunn ND McKenzie ND Mercer ND Oliver ND Bismarck, ND Lancaster NE Lincoln-Beatrice, NE Belknap NH Boston-Worcester-Providence, MA-RI-NH-CT Grant NM Sandoval NM Albuquerque-Santa Fe-Las Vegas, NM Churchill NV Franklin NY Herkimer NY Utica-Rome, NY Orange NY New York-Newark, NY-NJ-CT-PA Steuben NY Elmira-Corning, NY Columbia OR Portland-Vancouver-Salem, OR-WA Deschutes OR Bend-Redmond-Prineville, OR Lane OR Eugene, OR Aiken SC Augusta-Richmond County, GA-SC Berkeley SC Charleston-North Charleston, SC Charleston SC Charleston-North Charleston, SC Colleton SC Edgefield SC Augusta-Richmond County, GA-SC Oconee SC Greenville-Spartanburg-Anderson, SC Pickens SC Greenville-Spartanburg-Anderson, SC Jackson SD Union SD Sioux City-Vermillion, IA-SD-NE Brewster TX Cameron TX Brownsville-Harlingen-Raymondville, TX Hidalgo TX McAllen-Edinburg, TX Victoria TX Victoria-Port Lavaca, TX Fauquier VA Washington-Baltimore-Arlington, DC-MDVA-WV-PA MN Minneapolis-St. Paul, MN-WI Chittenden VT Burlington-South Burlington, VT Lauderdale MS Clallam WA Fergus MT Pierce WA Seattle-Tacoma, WA Flathead MT Skagit WA Seattle-Tacoma, WA Lewis and Clark MT Spokane Missoula MT Missoula, MT WA Spokane-Spokane Valley-Coeur d'Alene, WA-ID Phillips MT Whatcom WA Bellingham, WA Powder River MT Carbon WY Notes: 1. This list represents counties with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on current (2015) standard (U.S. EPA). 27 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS Health Effects of Ozone and Particle Pollution Two types of air pollution dominate in the U.S.: ozone and particle pollution.1 These two pollutants threaten the health and the lives of millions of Americans. Thanks to the Clean Air Act, the U.S. has far less of both pollutants now than in the past. Still, more than 166 million people live in counties where monitors show unhealthy levels of one or both—meaning the air a family breathes could shorten life or cause lung cancer. So what are ozone and particle pollution? Ozone Pollution It may be hard to imagine that pollution could be invisible, but ozone is. The most widespread pollutant in the U.S. is also one of the most dangerous. Scientists have studied the effects of ozone on health for decades. Hundreds of research studies have confirmed that ozone harms people at levels currently found in the United States. In the last few years, we’ve learned that it can also be deadly. 28 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS What Is Ozone? Ozone (O3) is a gas molecule composed of three oxygen atoms. Often called “smog,” ozone is harmful to breathe. Ozone aggressively attacks lung tissue by reacting chemically with it. oxygen oxygen The ozone layer found high in the upper atmosphere (the stratosphere) shields us from much of the sun’s ultraviolet radiation. However, ozone air pollution at ground level where we can breathe it (in the troposphere) causes serious health problems. Where Does Ozone Come From? oxygen Ozone develops in the atmosphere from gases that come out of tailpipes, smokestacks and many other sources. When these gases come in contact with sunlight, they react and form ozone smog. Ozone (O3) is a gas molecule composed of three oxygen atoms. The essential raw ingredients for ozone come from nitrogen oxides (NOX), hydrocarbons, also called volatile organic compounds (VOCs), and carbon monoxide (CO). They are produced primarily when fossil fuels like gasoline, oil or coal are burned or when some chemicals, like solvents, evaporate. NOX is emitted from power plants, motor vehicles and other sources of high-heat combustion. VOCs are emitted from motor vehicles, chemical plants, refineries, factories, gas stations, paint and other sources. CO is also primarily emitted from motor vehicles.2 If the ingredients are present under the right conditions, they react to form ozone. And because the reaction takes place in the atmosphere, the ozone often shows up downwind of the sources of the original gases. In addition, winds can carry ozone far from where it began. You may have wondered why “ozone action day” warnings are sometimes followed by recommendations to avoid activities such as mowing your lawn or driving your car. Lawn mower exhaust and gasoline vapors are VOCs that could turn into ozone in the heat and sun. VOCs, NOx, CO Who is at risk from breathing ozone? Anyone who spends time outdoors where ozone pollution levels are high may be at risk. Five groups of people are especially vulnerable to the effects of breathing ozone: children and teens;3 ■■ anyone 65 and older;4 ■■ people who work or exercise outdoors;5 ■■ people with existing lung diseases, such as asthma and chronic obstructive pulmonary disease (also known as COPD, which includes emphysema and chronic bronchitis);6 and ■■ people with cardiovascular disease.7 In addition, some evidence suggests that other groups—including women, people who suffer from obesity and people with low incomes—may also face higher risk from ozone.8 More research is needed to confirm these findings. ■■ Ozone When gases that come out of tailpipes and smokestacks come in contact with sunlight, they react and form ozone smog. 29 LUNG.org The impact on your health can depend on many factors, however. For example, the risks would be greater if ozone levels are higher, if you are breathing faster because you’re working outdoors or if you spend more time outdoors. Lifeguards in Galveston, Texas, provided evidence of the impact of even short-term exposure to ozone on healthy, active adults in a study published in 2008. Testing the breathing capacity of these outdoor workers several times a day, researchers found that many lifeguards had greater obstruction in their airways when ozone levels were high. Because of this research, Galveston became the first city in the nation to install an air quality warning flag system on the beach.9 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS How Ozone Pollution Harms Your Health Premature death. Breathing ozone can shorten your life. Strong evidence exists of the deadly impact of ozone in large studies conducted in cities across the U.S., in Europe and in Asia. Researchers repeatedly found that the risk of premature death increased with higher levels of ozone.10 Newer research has confirmed that ozone increased the risk of premature death even when other pollutants also exist.11 Immediate breathing problems. Many areas in the United States produce enough ozone during the summer months to cause health problems that can be felt right away. Immediate problems—in addition to increased risk of premature death—include: shortness of breath, wheezing and coughing; asthma attacks; ■■ increased risk of respiratory infections; ■■ increased susceptibility to pulmonary inflammation; and ■■ increased need for people with lung diseases, like asthma or chronic obstructive pulmonary disease (COPD), to receive medical treatment and to go to the hospital.12 Cardiovascular effects. Inhaling ozone may affect the heart as well as the lungs. A 2006 study linked exposures to high ozone levels for as little as one hour to a particular type of cardiac arrhythmia that itself increases the risk of premature death and stroke.13 A French study found that exposure to elevated ozone levels for one to two days increased the risk of heart attacks for middle-aged adults without heart disease.14 Several studies around the world have found increased risk of hospital admissions or emergency department visits for cardiovascular disease.15 ■■ ■■ Long-term exposure risks. New studies warn of serious effects from breathing ozone over longer periods. With more long-term data, scientists are finding that long-term exposure—that is, for periods longer than eight hours, including days, months or years— may increase the risk of onset of asthma or early death. Examining the records from a long-term national database, researchers found a higher risk of death from respiratory diseases associated with increases in ozone.16 ■■ New York researchers looking at hospital records for children’s asthma found that the risk of admission to hospitals for asthma increased with chronic exposure to ozone. Younger children and children from low-income families were more likely than other children to need hospital admissions even during the same time periods.17 ■■ California researchers analyzing data from their long-term Southern California Children’s Health Study found that some children with certain genes were more likely to develop asthma as adolescents in response to the variations in ozone levels in their communities.18 ■■ Studies link lower birth weight and decreased lung function in newborns to ozone levels in their community.19 This research provides increasing evidence that ozone may harm newborns. Breathing other pollutants in the air may make your lungs more responsive to ozone— and breathing ozone may increase your body’s response to other pollutants. For example, research warns that breathing sulfur dioxide and nitrogen oxide—two pollutants common in the eastern U.S.—can make the lungs react more strongly than to just breathing ozone alone. Breathing ozone may also increase the response to allergens in people with allergies. A large study published in 2009 found that children were more likely to suffer from hay fever and respiratory allergies when ozone and PM2.5 levels were high.20 ■■ EPA finds ozone causes harm and strengthens the national standard. The EPA released their most recent review of the current research on ozone pollution in February 2013.21 The EPA had engaged a panel of expert scientists, the Clean Air Scientific Advisory Committee, to help them assess the evidence; in particular, they examined research published between 2006 and 2012. The EPA concluded that ozone pollution posed multiple, serious threats to health. Their findings are highlighted in the box following. 30 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS EPA Concludes Ozone Pollution Poses Serious Health Threats ■■ Causes respiratory harm (e.g., worsened asthma, worsened COPD, inflammation) ■■ Likely to cause early death (both short-term and long-term exposure) ■■ Likely to cause cardiovascular harm (e.g., heart attacks, strokes, heart disease, congestive heart failure) ■■ May cause harm to the central nervous system ■■ May cause reproductive and developmental harm —U.S. Environmental Protection Agency, Integrated Science Assessment for Ozone and Related Photochemical Oxidants, 2013. EPA/600/R-10/076F. Based on that review, the EPA set more protective limits, called national ambient air quality standards, on ozone pollution in October 2015. These official limits drive the cleanup of ozone pollution nationwide. The Clean Air Act requires EPA to review the standards every five years to make sure that they protect the health of the public. Particle Pollution Ever look at dirty truck exhaust? The dirty, smoky part of that stream of exhaust is made of particle pollution. Overwhelming evidence shows that particle pollution—like that coming from that exhaust smoke—can kill. Particle pollution can increase the risk of heart disease, lung cancer and asthma attacks and can interfere with the growth and work of the lungs. Particle pollution refers to a mix of very tiny solid and liquid particles that are in the air we breathe. But nothing about particle pollution is simple. And it is so dangerous, it can shorten your life. What Is Particle Pollution? Particle pollution refers to a mix of very tiny solid and liquid particles that are in the air we breathe. But nothing about particle pollution is simple. And it is so dangerous, it can shorten your life. Size matters. Particles themselves are different sizes. Some are one-tenth the diameter of a strand of hair. Many are even tinier; some are so small they can only be seen with an electron microscope. Because of their size, you can’t see the individual particles. You can only see the haze that forms when millions of particles blur the spread of sunlight. PM 2.5 HUMAN HAIR 50-70μm (microns) in diameter Combustion particles, organic compounds, metals, etc. < 2.5μm (microns) in diameter PM 10 Dust, pollen, mold, etc. < 10μm (microns) in diameter 90μm (microns) in diameter FINE BEACH SAND Image courtesy of the U.S. EPA The differences in size make a big difference in how they affect us. Our natural defenses help us to cough or sneeze larger particles out of our bodies. But those defenses don’t keep out smaller particles, those that are smaller than 10 microns (or micrometers) in diameter, or about one-seventh the diameter of a single human hair. These particles get trapped in the lungs, while the smallest are so minute that they can pass through the 31 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS lungs into the bloodstream, just like the essential oxygen molecules we need to survive. Researchers categorize particles according to size, grouping them as coarse, fine and ultrafine. Coarse particles fall between 2.5 microns and 10 microns in diameter and are called PM10-2.5. Fine particles are 2.5 microns in diameter or smaller and are called PM2.5. Ultrafine particles are smaller than 0.1 micron in diameter22 and are small enough to pass through the lung tissue into the blood stream, circulating like the oxygen molecules themselves. No matter what the size, particles can harm your health. “A mixture of mixtures.” Because particles are formed in so many different ways, they can be composed of many different compounds. Although we often think of particles as solids, not all are. Some are completely liquid; others are solids suspended in liquids. As the EPA puts it, particles are really “a mixture of mixtures.”23 The mixtures differ between the eastern and western United States and in different times of the year. For example, the Midwest, Southeast and Northeast states have more sulfate particles than the West on average, largely due to the high levels of sulfur dioxide emitted by large, coal-fired power plants. By contrast, nitrate particles from motor vehicle exhaust form a larger proportion of the unhealthful mix in the winter in the Northeast, Southern California, the Northwest, and North Central U.S.24 Who Is at Risk? Anyone who lives where particle pollution levels are high is at risk. Some people face higher risk, however. People at the greatest risk from particle pollution exposure include: Infants, children and teens;25 ■■ People over 65 years of age;26 ■■ People with lung disease such as asthma and chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema; ■■ People with heart disease27 or diabetes;28 ■■ People with low incomes;29 and ■■ People who work or are active outdoors.30 Diabetics face increased risk at least in part because of their higher risk for cardiovascular disease.31 ■■ Breathing particle pollution may trigger illness, hospitalization and premature death. What Can Particles Do to Your Health? Particle pollution can be very dangerous to breathe. Breathing particle pollution may trigger illness, hospitalization and premature death, risks that are showing up in new studies that validate earlier research. Thanks to steps taken to reduce particle pollution, good news is growing from researchers who study the drop in year-round levels of particle pollution. Looking at air quality in 545 counties in the U.S. between 2000 and 2007, researchers found that people had approximately four months added to their life expectancy on average due to cleaner air. Women and people who lived in urban and densely populated counties benefited the most.32 Another long-term study of six U.S. cities tracked from 1974 to 2009 added more evidence of the benefits. Their findings suggest that cleaning up particle pollution had almost immediate health benefits. They estimated that the U.S. could prevent approximately 34,000 premature deaths a year if the nation could lower annual levels of particle pollution by 1 µg/m3.33 Other researchers estimated that reductions in air pollution can be expected to produce rapid improvements in public health, with fewer deaths occurring within the first two years after reductions.34 These studies add to the growing research that cleaning up air pollution improves life and health. 32 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS Short-Term Exposure Can Be Deadly First and foremost, short-term exposure to particle pollution can kill. Peaks or spikes in particle pollution can last for hours to days. Deaths can occur on the very day that particle levels are high, or within one to two months afterward. Particle pollution does not just make people die a few days earlier than they might otherwise—these are deaths that would not have occurred if the air were cleaner.35 Even low levels of particles can be deadly. A 2016 study found that people age 65 and older in New England faced a higher risk of premature death from particle pollution, even in places that met current standards for short-term particle pollution.36 Particle pollution also diminishes lung function, causes greater use of asthma medications and increased rates of school absenteeism, emergency room visits and hospital admissions. Other adverse effects include coughing, wheezing, cardiac arrhythmias and heart attacks. According to extensive research, short-term increases in particle pollution have been linked to: death from respiratory and cardiovascular causes, including strokes;37,38,39,40 ■■ increased mortality in infants and young children;41 ■■ increased numbers of heart attacks, especially among the elderly and in people with heart conditions;42 ■■ inflammation of lung tissue in young, healthy adults;43 ■■ increased hospitalization for cardiovascular disease, including strokes and congestive heart failure;44,45,46 ■■ increased emergency room visits for patients suffering from acute respiratory ailments;47 ■■ increased hospitalization for asthma among children;48,49,50 and ■■ increased severity of asthma attacks in children.51 Again, the impact of even short-term exposure to particle pollution on healthy adults was demonstrated in the Galveston lifeguard study. In addition to the harmful effects of ozone pollution, lifeguards had reduced lung volume at the end of the day when fine particle levels were high.52 ■■ In late 2013, the World Health Organization concluded that particle pollution could cause lung cancer. Year-Round Exposure Breathing high levels of particle pollution day in and day out also can be deadly, as landmark studies in the 1990s conclusively showed53 and as other studies confirmed.54 Chronic exposure to particle pollution can shorten life by one to three years.55 Recent research has confirmed that long-term exposure to particle pollution still kills, even with the declining levels in the U.S. since 200056 and even in areas, such as New England, that currently meet the official limit, or standard, for year-round particle pollution.57 In late 2013, the International Agency for Research on Cancer, part of the World Health Organization concluded that particle pollution could cause lung cancer. The IARC reviewed the most recent research and reported that the risk of lung cancer increases as the particle levels rise.58 Year-round exposure to particle pollution has also been linked to: increased hospitalization for asthma attacks for children living near roads with heavy truck or trailer traffic;59,60 ■■ slowed lung function growth in children and teenagers;61,62 ■■ development of asthma in children up to age 14;63 ■■ significant damage to the small airways of the lungs;64 ■■ increased risk of death from cardiovascular disease;65 and ■■ increased risk of lower birth weight and infant mortality.66 Research into the health risks of 65,000 women over age 50 found that those who ■■ 33 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS lived in areas with higher levels of particle pollution faced a much greater risk of dying from heart disease than had been previously estimated. Even women who lived within the same city faced differing risks depending on the annual levels of pollution in their neighborhood.67 New research has found evidence that long-term exposure to particle pollution may increase the risk of developing diabetes. Two independent reviews of published research found that particle pollution may increase the risk of developing type 2 diabetes mellitus.68 The EPA completed their most recent review of the current research on particle pollution in December 2009.69 The EPA had engaged a panel of expert scientists, the Clean Air Scientific Advisory Committee, to help them assess the evidence. The EPA concluded that particle pollution caused multiple, serious threats to health. Their findings are highlighted in the box below. EPA Concludes Fine Particle Pollution Poses Serious Health Threats Causes early death (both short-term and long-term exposure) Causes cardiovascular harm (e.g., heart attacks, strokes, heart disease, congestive heart failure) ■■ Likely to cause respiratory harm (e.g., worsened asthma, worsened COPD, inflammation) ■■ May cause cancer ■■ May cause reproductive and developmental harm ■■ ■■ —U.S. Environmental Protection Agency, Integrated Science Assessment for Particulate Matter, December 2009. EPA 600/R-08/139F Chemical processes in the atmosphere create most of the tiniest particles. Where Does Particle Pollution Come From? Particle pollution is produced through two separate processes—mechanical and chemical. Mechanical processes break down bigger bits into smaller bits with the material remaining essentially the same, only becoming smaller. Mechanical processes primarily create coarse particles.70 Dust storms, construction and demolition, mining operations, and agriculture are among the activities that produce coarse particles. Tire, brake pad and road wear can also create coarse particles. Bacteria, pollen, mold, and plant and animal debris are also included as coarse particles.71 By contrast, chemical processes in the atmosphere create most of the tiniest fine and ultrafine particles. Combustion sources burn fuels and emit gases. These gases can vaporize and then condense to become a particle of the same chemical compound. Or, they can react with other gases or particles in the atmosphere to form a particle of a different chemical compound. Particles formed by this latter process come from the reaction of elemental carbon (soot), heavy metals, sulfur dioxide (SO2), nitrogen oxides (NOX) and volatile organic compounds with water and other compounds in the atmosphere.72 Burning fossil fuels in factories, power plants, steel mills, smelters, diesel- and gasoline-powered motor vehicles (cars and trucks) and equipment generate a large part of the raw materials for fine particles. So does burning wood in residential fireplaces and wood stoves or burning agricultural fields or forests. Are some particles more dangerous than others? With so many sources of particles, researchers want to know if some particles pose greater risk than others. Researchers are exploring possible differences in health effects of the sizes of particles and particles from different sources, such as diesel particles from trucks and buses or sulfates from coal-fired power plants. Recent studies have tried to answer this question. So far, the answers are complicated. 34 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS Some studies have found different kinds of particles may have greater risk for different health outcomes. For example, one just-released study found that particles from burning fossil fuels, including coal-burning and diesel emissions, increased the risk of dying prematurely from ischemic heart disease, but that particles from wind-blown soil and biomass combustion did not.73 ■■ Another recent study looked at older adults in Connecticut and Massachusetts and found that breathing black carbon, calcium and road dust particles was more likely to send them to the hospital for cardiovascular and respiratory problems than other particles.74 ■■ Some of the same researchers found that when they looked at the risk of low birthweight for newborns in the Northeast and Mid-Atlantic states, different particles harmed some groups more than others.75 Other studies have identified the challenges of exploring all the kinds of particles and their health effects with the limited monitoring across the nation.76 Some particles serve as carriers for other chemicals that are also toxic, so determining which are the most toxic remains hard.77 ■■ The best evidence shows that having less of all types of particles in the air leads to better health and longer lives. Focusing on Children’s Health Children face special risks from air pollution because their lungs are growing and because they are so active. Just like the arms and legs, the largest portion of a child’s lungs will grow long after he or she is born. Eighty percent of their tiny air sacs develop after birth. Those sacs, called the alveoli, are where the life-sustaining transfer of oxygen to the blood takes place. The lungs and their alveoli aren’t fully grown until children become adults.78 In addition, the body’s defenses that help adults fight off infections are still developing in young bodies.79 Children have more respiratory infections than adults, which also seems to increase their susceptibility to air pollution.80 Furthermore, children don’t behave like adults, and their behavior also affects their The largest portion of a child’s lungs will grow long after he or she is born. vulnerability. They are outside for longer periods and are usually more active when outdoors. Consequently, they inhale more polluted outdoor air than adults typically do.81 Air Pollution Increases Risk of Underdeveloped Lungs The Southern California Children’s Health study looked at the long-term effects of particle pollution on teenagers. Tracking 1,759 children who were between ages 10 and 18 from 1993 to 2001, researchers found that those who grew up in more polluted areas face the increased risk of having underdeveloped lungs, which may never recover to their full capacity. The average drop in lung function was 20 percent below what was expected for the child’s age, similar to the impact of growing up in a home with parents who smoked.82 Community health studies are pointing to less obvious, but serious effects from yearround exposure to ozone, especially for children. Scientists followed 500 Yale University students and determined that living just four years in a region with high levels of ozone and related co-pollutants was associated with diminished lung function and frequent reports of respiratory symptoms.83 A much larger study of 3,300 school children in Southern California found reduced lung function in girls with asthma and boys who spent more time outdoors in areas with high levels of ozone.84 35 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS Cleaning Up Pollution Can Reduce Risk to Children There is also real-world evidence that reducing air pollution can help protect children. A 2015 follow-up to that Southern California Children’s Health study showed that reducing pollution could improve children’s health. This time they tracked a different group of 863 children living in the same area, but growing up between 2007 and 2011, when the air in Southern California was much cleaner. They compared these children to those who had been part of their earlier studies when the air was dirtier. Children growing up in the cleaner air had much greater lung function, a benefit that may help them throughout their lives. As the researchers noted, their study suggested that “all children have the potential to benefit from improvements in air quality.” 85 In Switzerland, particle pollution dropped during a period in the 1990s. Researchers there tracked 9,000 children over a nine-year period, following their respiratory symptoms. After taking other factors such as family characteristics and indoor air pollution into account, the researchers noted that during the years with less pollution, the children had fewer episodes of chronic cough, bronchitis, common cold, and conjunctivitis symptoms.86 Disparities in the Impact of Air Pollution Poorer people and some racial and ethnic groups often face higher exposure and greater responses to pollution. The burden of air pollution is not evenly shared. Poorer people and some racial and ethnic groups are among those who often face higher exposure to pollutants and who may experience greater responses to such pollution. Many studies have explored the differences in harm from air pollution to racial or ethnic groups and people who are in a low socioeconomic position, have less education, or live nearer to major sources,87 including a workshop the American Lung Association held in 2001 that focused on urban air pollution and health inequities.88 Many studies have looked at differences in the impact on premature death. Results have varied widely, particularly for effects between racial groups. Some studies have found no differences among races,89 while others found greater responsiveness for Whites and Hispanics, but not African Americans,90 or for African Americans but not other races or ethnic groups.91 Other researchers have found greater risk for African Americans from hazardous air pollutants, including those pollutants that also come from traffic sources.92 Socioeconomic position has been more consistently associated with greater harm from air pollution. Recent studies show evidence of that link. Low socioeconomic status consistently increased the risk of premature death from fine particle pollution among 13.2 million Medicare recipients studied in the largest examination of particle pollution mortality nationwide.93 In the 2008 study that found greater risk for premature death for African Americans, researchers also found greater risk for people living in areas with higher unemployment or higher use of public transportation.94 A 2008 study of Washington, DC, found that while poor air quality and worsened asthma went handin-hand in areas where Medicaid enrollment was high, the areas with the highest Medicaid enrollment did not always have the strongest association of high air pollution and asthma attacks.95 However, two other recent studies in France have found no association with lower income and asthma attacks.96 Scientists have speculated that there are three broad reasons why disparities may exist. First, groups may face greater exposure to pollution because of factors ranging from racism to class bias to housing market dynamics and land costs. For example, pollution sources may be located near disadvantaged communities, increasing exposure to harmful pollutants. Second, low social position may make some groups more susceptible to health threats because of factors related to their disadvantage. Lack of access to health care, grocery stores and good jobs; poorer job opportunities; dirtier workplaces or higher traffic exposure are among the factors that could handicap groups and increase the risk of harm. Finally, existing health conditions, behaviors, or traits may 36 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS predispose some groups to greater risk. For example, diabetics are among the groups most at risk from air pollutants, and the elderly, African Americans, Mexican Americans and people living near a central city have higher incidence of diabetes.97 Communities of color also may be more likely to live in counties with higher levels of pollution. Non-Hispanic Blacks and Hispanics were more likely to live in counties that had worse problems with particle pollution, researchers found in a 2011 analysis. NonHispanic Blacks were also more likely to live in counties with worse ozone pollution. Income groups, by contrast, differed little in these exposures. However, since few rural counties have monitors, the primarily older, non-Hispanic white residents of those counties lack information about the air quality in their communities.98 Unemployed people, those with low income or low education and non-Hispanic Blacks were found to be more likely to live in areas with higher exposures to particle pollution in a 2012 study. However, the different racial/ethnic and income groups were often breathing very different kinds of particles; the different composition and structure of these particles may have different health impacts.99 Highways May Be Especially Dangerous for Breathing Being in heavy traffic, or living near a road, may be even more dangerous than being in other places in a community. Growing evidence shows that the vehicle emissions coming directly from those highways may be higher than in the community as a whole, increasing the risk of harm to people who live or work near busy roads. The number of people living “next to a busy road” may include 30 to 45 percent of the urban population in North America, according to the most recent review of the evidence. In January 2010, the Health Effects Institute published a major review of the evidence by a panel of expert scientists. The panel looked at over 700 studies from around the world, examining the health effects. They concluded that traffic pollution causes asthma attacks in children and may cause a wide range of other effects including: the onset of childhood asthma, impaired lung function, premature death and death from cardiovascular diseases, and cardiovascular morbidity. The area most affected, they concluded, was roughly 0.2 to 0.3 miles (300 to 500 meters) from the highway.100 Children and teenagers are among the most vulnerable—though not the only ones at risk. A Danish study found that long-term exposure to traffic air pollution may increase the risk of developing chronic obstructive pulmonary disease (COPD). They found that those most at risk were people who already had asthma or diabetes.101 Studies have found increased risk of premature death from living near a major highway or an urban road.102 Another study found an increase in risk of heart attacks from being in traffic, whether driving or taking public transportation.103 Urban women in a Boston study experienced decreased lung function associated with traffic-related pollution.104 Support national, state and local efforts to clean up sources of pollution. Your life and the life of someone you love may depend on it. 37 LUNG.org How to Protect Yourself from Ozone and Particle Pollution To minimize your exposure to ozone and particle pollution: Pay attention to forecasts for high air pollution days to know when to take precautions; ■■ Avoid exercising near high-traffic areas; ■■ Avoid exercising outdoors when pollution levels are high, or substitute an activity that requires less exertion; ■■ Do not let anyone smoke indoors and support measures to make all places smokefree; and ■■ Reduce the use of fireplaces and wood-burning stoves. Bottom line: Help yourself and everyone else breathe easier. Support national, state and local efforts to clean up sources of pollution. Your life and the life of someone you love may depend on it. ■■ AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS 1 Ozone and particle pollution are the most widespread, but they aren’t the only serious air pollutants. Others include carbon monoxide, lead, nitrogen dioxide, and sulfur dioxide, as well as scores of toxins such as mercury, arsenic, benzene, formaldehyde, and acid gases. However, the monitoring networks are not as widespread nationwide for the other pollutants. 2 U.S. Environmental Protection Agency. Integrated Science Assessment of Ozone and Related Photochemical Oxidants (Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-10/076F, 2013. 3 Mar TF, Koenig JQ. Relationship between visits to emergency departments for asthma and ozone exposure in greater Seattle, Washington. Ann Allergy Asthma Immunol. 2009; 103: 474-479. Villeneuve PJ, Chen L, Rowe BH, Coates F. Outdoor air pollution and emergency department visits for asthma among children and adults: A case-crossover study in northern Alberta, Canada. Environ Health Global Access Sci Source. 2007; 6: 40. 4 Medina-Ramón M, Schwartz J. Who is more vulnerable to die from ozone air pollution? Epidemiology. 2008; 19: 672-679. 5 Thaller EI, Petronell SA, Hochman D, Howard S, Chhikara RS, Brooks EG. Moderate Increases in Ambient PM2.5 and Ozone Are Associated With Lung Function Decreases in Beach Lifeguards. J Occp Environ Med. 2008; 50: 202-211; Sawyer K, Brown J, Hazucha M, Bennett WD. The effect of exercise on nasal uptake of ozone in healthy human adults. J Appl Physiol. 2007;102: 1380-1386; Hu SC, Ben-Jebria A, Ultman JS. Longitudinal distribution of ozone absorption in the lung: Effects of respiratory flow. J Appl Physiol. 1994; 77: 574-583. 6 Horstman DH, Ball BA, Brown J, Gerrity T, Folinsbee LJ. Comparison of pulmonary responses of asthmatic and nonasthmatic subjects performing light exercise while exposed to a low level of ozone. Toxicol Ind Health. 1995; 11: 369-385; Kreit JW, Gross KB, Moore TB, Lorenzen TJ, D’Arcy J, Eschenbacher WL. Ozone-induced changes in pulmonary function and bronchial responsiveness in asthmatics. J Appl Physiol. 1989; 66: 217-222; Medina-Ramón M, Zanobetti A, Schwartz J. The Effect of Ozone and PM10 on Hospital Admissions for Pneumonia and Chronic Obstructive Pulmonary Disease: a national multicity study. Am J Epidemiol. 2006; 163(6):579-588. 7 Peel JL, Metzger KB, Klein M, Flanders WD, Mulholland JA, Tolbert PE. Ambient air pollution and cardiovascular emergency department visits in potentially sensitive groups. Am J Epidemiol. 2007; 165: 625-633; Medina-Ramón and Schwartz, 2008; Medina-Ramón M, Zanobetti A, Schwartz J, 2006. 8 Medina-Ramón and Schwartz, 2008; Stafoggia M, Forastiere F, Faustini A, Biggeri A, Bisanti L, et al. Susceptibility factors to ozone-related mortality: A population-based case-crossover analysis. Am J Respir Crit Care Med. 2010; 182: 376-384; Jerrett M, Burnett RT, Pope CA III, Ito K, Thurston G, Krewski D, Shi Y, Calle E, Thun M. Long-term ozone exposure and mortality. N Engl J Med. 2009;360: 1085-1095; Alexeeff SE, Litonjua AA, Suh H, Sparrow D, Vokonas PS, Schwartz J. Ozone exposure and lung function: Effect modified by obesity and airways hyperresponsiveness in the VA Normative Aging Study. Chest. 2007; 132: 1890-1897; McDonnell WF, Stewart PW, Smith MV. Prediction of ozone-induced lung function responses in humans. Inhal Toxicol. 2010; 22: 160-168. Lin S, Liu X, Le LH, Hwang SA. Chronic exposure to ambient ozone and asthma hospital admissions among children. Environ Health Perspect. 2008; 116: 1725-1730; Burra TA, Moineddin R, Agha MM, Glazier RH. Social disadvantage, air pollution, and asthma physician visits in Toronto, Canada. Environ Res. 2009; 109: 567-574. 9 Thaller, et al., 2008. 10 Bell ML, McDermott A, Zeger SL, Samet JM, Dominici F. Ozone and short-term mortality in 95 US urban communities, 1987-2000. JAMA. 2004; 292:2372-2378. Gryparis A, Forsberg B, Katsouyanni K, et al. Acute Effects of Ozone on Mortality from the “Air Pollution and Health: a European approach” project. Am J Respir Crit Care Med. 2004; 170: 1080-1087. Bell ML, Dominici F, and Samet JM. A Meta-Analysis of Time-Series Studies of Ozone and Mortality with Comparison to the National Morbidity, Mortality, and Air Pollution Study. Epidemiology. 2005; 16:436-445. Levy JI, Chermerynski SM, Sarnat JA. Ozone Exposure and Mortality: an empiric Bayes metaregression analysis. Epidemiology. 2005; 16:458-468. Ito K, De Leon SF, Lippmann M. Associations Between Ozone and Daily Mortality: analysis and meta-analysis. Epidemiology. 2005; 16:446-429. 11 Zanobetti A, Schwartz J. Mortality displacement in the association of ozone with mortality: an analysis of 48 cities in the United States. Am J Respir Crit Care Med. 2008; 177:184-189; Katsouyanni K, Samet JM, Anderson HR, Atkinson R, Le Tertre A, et al. Air pollution and health: A European and North American approach (APHENA). Boston, MA: Health Effects Institute, 2009; Samoli E, Zanobetti A, Schwartz J, Atkinson R, Le Tertre A, et al. The temporal pattern of mortality responses to ambient ozone in the APHEA project. J Epidemiol Community Health. 2009; 63: 960-966; Stafoggia M, et al, 2010. 12 Gent JF, Triche EW, Holford TR, Belanger K, Bracken MB, Beckett WS, Leaderer BP. Association of Low-Level Ozone and Fine Particles with Respiratory Symptoms in Children with Asthma. JAMA. 2003; 290:1859-1867; Desqueyroux H, Pujet JC, Prosper M, Squinazi F, Momas I. Short-Term Effects of Low-Level Air Pollution on Respiratory Health of Adults Suffering from Moderate to Severe Asthma. Environ Res. 2002; 89:29-37; Burnett RT, Brook JR, Yung WT, Dales RE, Krewski D. Association between Ozone and Hospitalization for Respiratory Diseases in 16 Canadian Cities. Environ Res. 1997; 72:24-31; MedinaRamón M, Zanobetti A, Schwartz J. The Effect of Ozone and PM10 on Hospital Admissions for Pneumonia and Chronic Obstructive Pulmonary Disease: a national multicity study. Am J Epidemiol. 2006; 163(6):579-588. 13 Rich DQ, Mittleman MA, Link MS, Schwartz J, Luttmann-Gibson H, Catalano PJ, Speizer FE, Gold DR, Dockery DW. Increased Risk of Paroxysmal Atrial Fibrillation Episodes Associated with Acute Increases in Ambient Air Pollution. Environ Health Perspect. 2006; 114:120-123. 14 Ruidavets J-B, Cournot M, Cassadou S, Giroux M, Meybeck M, Ferrières J. Ozone Air Pollution is Associated with Acute Myocardial Infarction. Circulation. 2005; 111:563-569. 15 Azevedo JM, Gonçalves FL, de Fátima Andrade M. Long-range ozone transport and its impact on respiratory and cardiovascular health in the north of Portugal. Int J Biometeorol. 2011; 55: 187-202; Linares C, Diaz J. Short-term effect of concentrations of fine particulate matter on hospital admissions due to cardiovascular and respiratory causes among the over-75 age group in Madrid, Spain. Public Health. 2010; 124: 28-36; Middleton N, Yiallouros P, Kleanthous S, Kolokotroni O, Schwartz J, et al. A 10-year time-series analysis of respiratory and cardiovascular morbidity in Nicosia, Cyprus: The effect of short-term changes in air pollution and dust storms. Environ Health. 2008; 7: 39; Lee JT, Kim H, Cho YS, Hong YC, Ha EH, Park H. Air pollution and hospital admissions for ischemic heart diseases among individuals 64+ years of age residing in Seoul, Korea. Arch Environ Health. 2003; 58: 617-623; Wong TW, Lau TS, Yu TS, Neller A, Wong SL, Tam W, Pang SW. Air pollution and hospital admissions for respiratory and cardiovascular diseases in Hong Kong. Occup Environ Med. 1999; 56: 679-683. 16 Jerrett M, et al., 2009. 17 Lin S, Liu X, Le LH, and Hwang S-A. Chronic exposure to ambient ozone and asthma hospital admissions among children. Environ Health Perspect. 2008; 116:1725-1730. 18 Islam T, McConnell R, Gauderman WJ, Avol E, Peters JM, and Gilliland F, Ozone, oxidant defense genes, and risk of asthma during adolescence. Am J Respir Crit Care Med. 2009; 177(4):388-395. 38 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS 19 Salam MT, Millstein J, Li YF, Lurmann FW, Margolis HG, Gilliland FD. Birth outcomes and prenatal exposure to ozone, carbon monoxide, and particulate matter: Results from the Children’s Health Study. Environ Health Perspect. 2005; 113: 1638-1644; Morello-Frosch R, Jesdale BM, Sadd JL, Pastor M. Ambient air pollution exposure and full-term birth weight in California. Environ Health. 2010; 9: 44; Hansen CA, Barnett AG, Pritchard G. The effect of ambient air pollution during early pregnancy on fetal ultrasonic measurements during mid-pregnancy. Environ Health Perspect. 2008; 116: 362-369; Mannes T, Jalaludin B, Morgan G, Lincoln D, Sheppeard V, Corbett S. Impact of ambient air pollution on birth weight in Sydney, Australia. Occup Environ Med. 2005; 62: 524-530. 20 Parker JD, Akinbami LJ, Woodruff TJ. Air Pollution and Childhood Respiratory Allergies in the United States. Environ Health Perspect. 2009; 117:140-147. 21 U.S. EPA., 2013. 22 U.S. EPA. Integrated Science Assessment for Particulate Matter (Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-08/139F, 2009. Available at http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=216546. 23 U.S. EPA. Air Quality Criteria for Particulate Matter, October 2004. Available at http://cfpub2.epa.gov/ncea/cfm/recordisplay. cfm?deid=87903. 24 U.S. EPA, 2009. 25 Mar TF, Larson TV, Stier RA, Claiborn C, Koenig JQ. An analysis of the association between respiratory symptoms in subjects with asthma and daily air pollution in Spokane, Washington. Inhal Toxicol. 2004; 16: 809-815; Peel JL; Tolbert PE; Klein M; Metzger KB, Flanders WD, Knox T; Mulholland JA, Ryan PB, Frumkin H. Ambient air pollution and respiratory emergency department visits. Epidemiology. 2005; 16: 164-174. 26 Barnett AG, Williams GM, Schwartz J, Best TL, Neller AH, Petroeschevsky AL, Simpson RW. The effects of air pollution on hospitalizations for cardiovascular disease in elderly people in Australian and New Zealand cities. Environ Health Perspect. 2006; 114: 1018-1023. 27 Peel JL, Metzger KB, Klein M, Flanders WD, Mulholland JA, Tolbert PE. Ambient air pollution and cardiovascular emergency department visits in potentially sensitive groups. Am J Epidemiol. 2007; 165: 625-633. Pope CA III, Dockery DW. Health Effects of Fine Particulate Air Pollution: Lines that Connect. J Air Waste Mange Assoc. 2006; 56: 709-742. 28 Zanobetti A, Schwartz J. Are Diabetics More Susceptible to the Health Effects of Airborne Particles? Am J Respir Crit Care Med. 2001; 164: 831-833. National Research Council. Research Priorities for Airborne Particulate Matter: IV. Continuing Research Progress. Washington, DC: The National Academies Press, 2004. 29 Ostro B, Broadwin R, Green S, Feng WY, Lipsett M. Fine particulate air pollution and mortality in nine California counties: results from CALFINE. Environ Health Perspect. 2006: 114: 29-33; Ostro B, Feng WY, Broadwin R, Malig B, Green S, Lipsett M. The Impact of Components of Fine Particulate Matter on Cardiovascular Mortality in Susceptible Subpopulations. Occup Environ Med. 2008; 65(11): 750-6. 30 U.S. EPA, 2009. 31 Miller, 2007; O’Neill MS, Veves A, Zanobetti A, Sarnat JA, Gold DR, Economides PA, Horton ES, Schwartz J. Diabetes Enhances Vulnerability to Particulate Air Pollution-Associated Impairment in Vascular Reactivity and Endothelial Function. Circulation. 2005; 111: 2913-2920; 32 Correia AW, Pope CA III, Dockery DW, Wang Y, Ezzati M, Domenici F. Effect of Air Pollution Control on Life Expectancy in the United States: An Analysis of 545 U.S. Counties for the Period from 2000 to 2007. Epidemiology. 2013; 24(1): 23-31. 33 Lepeule J, Laden F, Docker D, Schwartz J. Chronic Exposure to Fine Particles and Mortality: An Extended Follow-up of the Harvard Six Cities Study from 1974 to 2009. Environ Health Perspect. 2012; 120: 965-970. 34 Schwartz J, Coull B, Laden F, Ryan L. The Effect of Dose and Timing of Dose on the Association between Airborne Particles and Survival. Environ Health Perspect. 2008; 116: 64-69. 35 Zanobetti A, Schwartz J, Samoli E, Gryparis A, Tuoloumi G, Peacock J, Anderson RH, Le Tertre A, Bobros J, Celko M, Goren A, Forsberg B, Michelozzi P, Rabczenko D, Perez Hoyos S, Wichmann HE, Katsouyanni K. The Temporal Pattern of Respiratory and Heart Disease Mortality in Response to Air Pollution. Environ Health Perspect. 2003; 111:1188-1193; Dominici F, McDermott A, Zeger SL, Samet JM. Airborne Particulate Matter and Mortality: Timescale Effects in Four US Cities. Am J Epidemiol. 2003; 157: 1055-1065. 36 Shi L, Zanobetti A, Kloog I, Coull BA, Koutrakis P, Melly SJ, Schwartz JD. Low-concentration PM2.5 and mortality: estimating acute and chronic effects in a population-based study. Environ Health Perspect. 2016; 124:46–52; http://dx.doi.org/10.1289/ ehp.1409111 37 Dominici F, McDermott A, Zeger SL, Samet JM. On the Use of Generalized Additive Models in Time-Series Studies of Air Pollution and Health. Am J Epidemiol. 2002; 156: 193-203. 38 Hong Y-C, Lee J-T, Kim H, Ha E-H, Schwartz J, Christiani DC. Effects of Air Pollutants on Acute Stroke Mortality. Environ Health Perspect. 2002; 110: 187-191. 39 Tsai SS, Goggins WB, Chiu HF, Yang CY. Evidence for an Association Between Air Pollution and Daily Stroke Admissions in Kaohsiung, Taiwan. Stroke. 2003; 34: 2612-6. 40 Wellenius GA, Schwartz J, Mittleman MA. Air Pollution and Hospital Admissions for Ischemic and Hemorrhagic Stroke Among Medicare Beneficiaries. Stroke. 2005; 36: 2549-2553. 41 Pope and Dockery, 2006. 42 D’Ippoliti D, Forastiere F, Ancona C, Agabity N, Fusco D, Michelozzi P, Perucci CA. Air Pollution and Myocardial Infarction in Rome: a case-crossover analysis. Epidemiology. 2003; 14: 528-535. Zanobetti A, Schwartz J. The Effect of Particulate Air Pollution on Emergency Admissions for Myocardial Infarction: a multicity case-crossover analysis. Environ Health Perspect. 2005; 113: 978-982. 43 Ghio AJ, Kim C, Devlin RB. Concentrated Ambient Air Particles Induce Mild Pulmonary Inflammation in Healthy Human Volunteers. Am J Respir Crit Care Med. 2000; 162(3 Pt 1): 981-988. 44 Metzger KB, Tolbert PE, Klein M, Peel JL, Flanders WD, Todd K, Mulholland JA, Ryan PB, Frumkin H. Ambient Air Pollution and Cardiovascular Emergency Department Visits in Atlanta, Georgia, 1993-2000. Epidemiology. 2004; 15: 46-56. 45 Tsai, et al., 2003. 46 Wellenius GA, Schwartz J, Mittleman MA. Particulate Air Pollution and Hospital Admissions for Congestive Heart Failure in Seven United States Cities. Am J Cardiol. 2006; 97 (3): 404-408; Wellenius GA, Bateson TF, Mittleman MA, Schwartz J. Particulate Air Pollution and the Rate of Hospitalization for Congestive Heart Failure among Medicare Beneficiaries in Pittsburgh, Pennsylvania. Am J Epidem. 2005; 161: 1030-1036. 39 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS 47 Van Den Eeden SK, Quesenberry CP Jr, Shan J, Lurmann F. Particulate Air Pollution and Morbidity in the California Central Valley: a high particulate pollution region. Final Report to the California Air Resources Board, 2002. 48 Lin M, Chen Y, Burnett RT, Villeneuve PJ, Kerwski D. The Influence of Ambient Coarse Particulate Matter on Asthma Hospitalization in Children: case-crossover and time-series analyses. Environ Health Perspect. 2002; 110: 575-581. 49 Norris G, YoungPong SN, Koenig JQ, Larson TV, Sheppard L, Stout JW. An Association Between Fine Particles and Asthma Emergency Department Visits for Children in Seattle. Environ Health Perspect. 1999; 107: 489-493. 50 Tolbert PE, Mulholland JA, MacIntosh DD, Xu F, Daniels D, Devine OJ, Carlin BP, Klein M, Dorley J, Butler AJ, Nordenberg DF, Frumkin H, Ryan PB, White MC. Air Quality and Pediatric Emergency Room Visits for Asthma in Atlanta, Georgia. Am J Epidemiol. 2000; 151: 798-810. 51 Slaughter JC, Lumley T, Sheppard L, Koenig JQ, Shapiro, GG. Effects of Ambient Air Pollution on Symptom Severity and Medication Use in Children with Asthma. Ann Allergy Asthma Immunol. 2003; 91: 346-353. 52 Thaller, et al., 2008. 53 Dockery DW, Pope CA III, Xu X, Spengler JD, Ware JH, Fay ME, Ferris BG, Speizer FE. An Association Between Air Pollution and Mortality in Six U.S. Cities. N Engl J Med. 1993; 329: 1753-1759. Pope CA, Thun MJ, Namboodiri MM, Dockery DW, Evans JS, Speizer FE, Heath CW. Particulate Air Pollution as a Predictor of Mortality in a Prospective Study of U.S. Adults. Am J Respir Crit Care Med. 1995; 151: 669-674. 54 Zanobetti A, Schwartz J. The effect of fine and coarse particulate air pollution on mortality: A national analysis. Environ Health Perspect. 2009; 117: 1-40 2009; Krewski D; Jerrett M; Burnett RT; Ma R; Hughes E; Shi Y; Turner MC; Pope AC III; Thurston G; Calle EE; Thun MJ. Extended follow-up and spatial analysis of the American Cancer Society study linking particulate air pollution and mortality. Report Nr. 140 (Cambridge, MA: Health Effects Institute, 2009); Franklin M, Zeka A, Schwartz J. Association between PM2.5 and all-cause and specific cause mortality in 27 U.S. communities. J Expo Sci Environ Epidemiol. 2007; 18: 1005-1011. 2007; Lepeule et al, 2012; Pope CA III, Burnett RT, Thun MJ, Calle EE, Krewski D, Ito K, Thurston GD. Lung Cancer, Cardiopulmonary Mortality, and Long-Term Exposure to Fine Particulate Air Pollution. JAMA. 2002; 287(9): 1132-1141. 55 Pope CA III. Epidemiology of Fine Particulate Air Pollution and Human Health: biological mechanisms and who’s at risk? Environ Health Perspect. 2000; 108: 713-723. 56 Thurston GD, Ahn J, Cromar KR, Shao Y, Reynolds H, et al. Ambient Particulate Matter Air Pollution Exposure and Mortality in the NIH-AARP Diet and Health Cohort. Environ Health Perspect. 2015 Advanced Publication; Lepeule J, Laden F, Douglas Dockery D, and Schwartz J. Chronic Exposure to Fine Particles and Mortality: An Extended Follow-up of the Harvard Six Cities Study from 1974 to 2009. Environ Health Perspect. 2012; 120: 965–970. 57 Shi, et al., 2016. 58 Hamra GB, Guha N, Cohen A, Laden F, Raaschou-Nielsen O, Samet JM, Vineis P, Forastiere F, Saldiva P, Yorifuji T, and Loomis D. Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Meta-Analysis. Environ Health Perspect. 2014: 122: 906-911. 59 Lin S, Munsie JP, Hwang SA, Fitzgerald E, Cayo MR. Childhood Asthma Hospitalization and Residential Exposure to State Route Traffic. Environ Res. 2002; 88: 73-81. 60 Gauderman WJ, Vora H, McConnell R, Berhane K, Gilliland GF, Thomas D, Lurmann F, Avol E, Küenzli N, Jarrett M, Peters J. Effect of Exposure to Traffic on Lung Development from 10 to 18 Years of Age: a cohort study. Lancet. 2007; 369: 571-577. 61 Gauderman WJ, Gilliland GF, Vora H, Avol E, Stram D, McConnell R, Thomas D, Lurmann F, Margolis HG, Rappaport EB, Berhane K, Peters JM. Association between Air Pollution and Lung Function Growth in Southern California Children: results from a second cohort. Am J Respir Crit Care Med. 2002; 166: 76-84. 62 Gauderman WJ, Avol E, Gilliland F, Vora H, Thomas D, Berhane K, McConnell R, Kuenzli N, Lurmann F, Rappaport E, Margolis H, Bates D, Peters J. The effect of air pollution on lung development from 10 to 18 years of age. N Engl J Med. 2004; 351: 1057-1067. 63 Gehring U, Wijga AH, Hoek G, Bellander T, et al. Exposure to air pollution and development of asthma and rhinoconjunctivitis throughout childhood and adolescence: a population-based birth cohort study. Lancet Respiratory Medicine. 2015; 3 (12): 933942. 64 Churg, A Brauer, M, Avila-Casado, MdC, Fortoul TI, Wright JL. Chronic Exposure to High Levels of Particulate Air Pollution and Small Airway Remodeling. Environ Health Perspect. 2003; 111: 714-718. 65 Pope CA III, Burnett RT, Thurston GD, Thun MJ, Calle EE, Krewski D, Godleski JJ. Cardiovascular Mortality and Year-round Exposure to Particulate Air Pollution: epidemiological evidence of general pathophysiological pathways of disease. Circulation. 2004; 109: 71-77. 66 Bell ML, Ebisu K, Belanger K. Ambient Air Pollution and low birth weight in Connecticut and Massachusetts. Environ Health Perspect. 2007; 115: 118-24; Ritz B, Wilhelm M, Zhao Y. Air pollution and infant death in southern California, 2989-2000. Pediatrics. 2006; 118: 493-502; Woodruff TJ, parker JD, Schoendorf KC. Fine particulate matter (PM 2.5) air pollution and selected causes of postneonatal infant mortality in California. Environ Health Perspect. 2006; 114: 785-790. 67 Miller KA, Siscovick DS, Shepard L, Shepherd K, Sullivan JH, Anderson GL, Kaufman JD. Long-Term Exposure to Air Pollution and Incidence of Cardiovascular Events in Women. N Engl J Med. 2007; 356: 447-458. 68 Rao X, Patel P, Puett R and Rajogpalan S. Air Pollution as a Risk Factor for Type 2 Diabetes. Toxicological Sciences. 2015; 143 (2): 231-241; Eze IC, Hemkens LG, Bucher HC, Hoffman B, et al. Association between Ambient Air Pollution and Diabetes Mellitus in Europe and North America: Systematic Review and Meta-Analysis. Environ Health Perspect. 2015; 123 (5): 381-389. 69 U.S. EPA, 2009. 70 U.S. EPA, 2009. 71 U.S. EPA, 2009. 72 U.S. EPA, 2009. 73 Thurston GD, Burnett RT, Turner MC, Shi Y, Krewski D, Lall R, Ito K, Jerrett M, Gapstur SM, Diver WR, Pope CA III. Ischemic Heart Disease Mortality and Long-Term Exposure to Source-Related Components of U.S. Fine Particle Air Pollution. Environ Health Perspect; Advance Publication as of 2 Dec 2015. http://dx.doi.org/10.1289/ehp.1509777 74 Bell ML, Ebisu K, Leaderer BP, Gent JF, Lee HJ, Koutrakis P, Wang Y, Dominici F, Peng RD. Associations of PM2.5 constituents and sources with hospital admissions: analysis of four counties in Connecticut and Massachusetts (USA) for persons ≥ 65 years of age. Environ Health Perspect. 2014: 122: 138–144; http://dx.doi.org/10.1289/ehp.1306656 40 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 HEALTH EFFECTS 75 Ebisu K, Bell ML. Airborne PM2.5 Chemical Components and Low Birth Weight in the Northeastern and Mid-Atlantic Regions of the United States. Environ Health Perspect. 2012; 120: 1746–1752; http://dx.doi.org/10.1289/ehp.1104763 76 Levy JI, Diez D, Dou Y, Barr CD, Dominici F. A Meta-Analysis and Multisite Time-Series Analysis of the Differential Toxicity of Major Fine Particulate Matter Constituents. Am J Epidemiology. 2012; 175(11): 1091-1099. doi:10.1093/aje/kwr457; Dai L, Zanobetti A, Koutrakis P, Schwartz JD. Associations of Fine Particulate Matter Species with Mortality in the United States: A Multicity Time-Series Analysis. Environ Health Perspect. 2014; 122(8): 837-842. doi:10.1289/ehp.1307568. 77 Cassee FR, Héroux M-E, Gerlofs-Nijland ME, Kelly FJ. Particulate matter beyond mass: recent health evidence on the role of fractions, chemical constituents and sources of emission. Inhalation Toxicology. 2013; 25(14): 802-812. doi:10.3109/08958378 .2013.850127. 78 Dietert RR, Etzel RA, Chen D, et al. Workshop to Identify Critical Windows of Exposure for Children’s Health: immune and respiratory systems workgroup summary. Environ Health Perspect. 2000; 108 (supp 3): 483-490. 79 World Health Organization: The Effects of Air Pollution on Children’s Health and Development: a review of the evidence E86575. 2005. Available at http://www.euro.who.int/document/E86575.pdf . 80 WHO, 2005. 81 American Academy of Pediatrics Committee on Environmental Health, Ambient Air Pollution: health hazards to children. Pediatrics. 2004; 114: 1699-1707. Statement was reaffirmed in 2010. 82 Gauderman et al., 2004. 83 Galizia A, Kinney PL. Year-round Residence in Areas of High Ozone: association with respiratory health in a nationwide sample of nonsmoking young adults. Environ Health Perspect. 1999; 107: 675-679. 84 Peters JM, Avol E, Gauderman WJ, Linn WS, Navidi W, London SJ, Margolis H, Rappaport E, Vora H, Gong H, Thomas DC. A Study of Twelve Southern California Communities with Differing Levels and Types of Air Pollution. II. Effects on Pulmonary Function. Am J Respir Crit Care Med. 1999; 159: 768-775. 85 Gauderman WJ, Urman R, Avol E, Berhane K, McConnell R, Rapport E, Chang R, Lurmann F and Gilliand F. Association of Improved Air Quality with Lung Development in Children. N Eng J Med. 2015; 372: 905-913. 86 Bayer-Oglesby L, Grize L, Gassner M, Takken-Sahli K, Sennhauser FH, Neu U, Schindler C, Braun-Fahrländer C. Decline of Ambient Air Pollution Levels and Improved Respiratory Health in Swiss Children. Environ Health Perspect. 2005; 113: 16321637. 87 Institute of Medicine. Toward Environmental Justice: Research, Education, and Health Policy Needs. Washington, DC: National Academy Press, 1999; O’Neill MS, Jerrett M, Kawachi I, Levy JI, Cohen AJ, Gouveia N, Wilkinson P, Fletcher T, Cifuentes L, Schwartz J et al. Health, Wealth, and Air Pollution: Advancing Theory and Methods. Environ Health Perspect. 2003: 111: 18611870; Finkelstein MM; Jerrett M; DeLuca P; Finkelstein N; Verma DK, Chapman K, Sears MR. Relation Between Income, Air Pollution And Mortality: A Cohort Study. CMAJ. 2003; 169: 397-402; Ostro B, Broadwin R, Green S, Feng W, Lipsett M. Fine Particulate Air Pollution and Mortality in Nine California Counties: Results from CALFINE. Environ Health Perspect. 2005: 114: 29-33; Zeka A, Zanobetti A, Schwartz J. Short term effects of particulate matter on cause specific mortality: effects of lags and modification by city characteristics. Occup Environ Med. 2006: 62: 718-725. 88 American Lung Association. Urban Air Pollution and Health Inequities: A Workshop Report. Environ Health Perspect. 2001: 109 (suppl 3): 357-374. 89 Zeka A, Zanobetti A, Schwartz J. Individual-Level Modifiers of the Effects of Particulate Matter on Daily Mortality. Am J Epidemiol. 2006: 163: 849-859. 90 Ostro et al., 2006; Ostro et al., 2008. 91 Bell ML, Dominici F. Effect Modification by Community Characteristics on the Short-term Effects of Ozone Exposure and Mortality in 98 US Communities. Am J Epidemiol. 2008; 167: 986-997. 92 Apelberg BJ, Buckley TJ, White RH. Socioeconomic and Racial Disparities in Cancer Risk from Air Toxics in Maryland. Environ Health Perspect. 2005: 113: 693-699. 93 Zeger SL, Dominici F, McDermott A, Samet J. Mortality in the Medicare Population and Chronic Exposure to Fine Particulate Air Pollution in Urban Centers (2000-2005). Environ Health Perspect. 2008: 116: 1614-1619. 94 Bell and Dominici, 2008. 95 Babin S, Burkom H, Holtry R, Tabernero N, Davies-Cole J, Stokes L, Dehaan K, Lee D. Medicaid Patient Asthma-Related Acute Care Visits And Their Associations with Ozone and Particulates in Washington, DC, from 1994-2005. Int J Environ Health Res. 2008; 18 (3): 209-221. 96 Laurent O, Pedrono G, Segala C, Filleul L, Havard S, Deguen S, Schillinger C, Rivière E, Bard D. Air pollution, asthma attacks, and socioeconomic deprivation: a small-area case-crossover study. Am J Epidemiol. 2008; 168: 58-65; Laurent O, Pedrono G, Filleul L, Segala C, Lefranc A, Schillinger C, Riviere E, Bard D. Influence of Socioeconomic Deprivation on the Relation Between Air Pollution and Beta-Agonist Sales for Asthma. Chest. 2009; 135 (3): 717-716. 97 O’Neill et al., 2003. 98 Miranda ML, Edwards SE, Keating MH, Paul CJ. Making the Environmental Justice Grade: The Relative Burden of Air Pollution Exposure in the United States. Int J Environ Res Public Health. 2011; 8: 1755-1771. 99 Bell ML, Ebisu K. Environmental Inequality in Exposures to Airborne Particulate Matter Component in the United States. Environ Health Perspect. 2012; 120: 1699–1704. 100 Health Effects Institute Panel on the Health Effects of Traffic-Related Air Pollution, Traffic-Related Air Pollution: A Critical Review of the Literature on Emissions, Exposure, and Health Effects. Health Effects Institute: Boston, 2010. Available at www.healtheffects.org. 101 Andersen ZJ, Hvidberg M, Jensen SS, Ketzel M, Loft S, Sørensen M, Tjønneland A, Overvad K, and Raaschou-Nielsen O. Chronic Obstructive Pulmonary Disease and Long-Term Exposure to Traffic-related Air Pollution: A Cohort Study. Am J Respir Crit Care Med. 2011: 183: 455-461. 102 Finklestein MM, Jerrett M., Sears M.R. Traffic Air Pollution and Mortality Rate Advancement Periods. Am J Epidemiol. 2004; 160: 173-177; Hoek G, Brunkreef B, Goldbohn S, Fischer P, van den Brandt. Associations between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study. Lancet. 2002; 360: 1203-1209. 103 Peters A, von Klot S, Heier M, Trentinaglia I, Cyrys J, Hormann A, Hauptmann M, Wichmann HE, Lowel H. Exposure to Traffic and the Onset of Myocardial Infarction. N Engl J Med. 2004; 351: 1721-1730. 104 Suglia SF, Gryparis A, Schwartz J, and Wright RJ. Association between Traffic-Related Black Carbon Exposure and Lung Function among Urban Women. Environ Health Perspect. 2008; 116 (10): 1333-1337. 41 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 METHODOLOGY Statistical Methodology: The Air Quality Data Data Sources The data on air quality throughout the United States were obtained from the U.S. Environmental Protection Agency’s Air Quality System (AQS), formerly called Aerometric Information Retrieval System (AIRS) database. The American Lung Association contracted with Dr. Allen S. Lefohn, A.S.L. & Associates, Helena, Montana, to characterize the hourly averaged ozone concentration information and the 24-hour averaged PM2.5 concentration information for the three-year period for 2012-2014 for each monitoring site. Design values for the annual PM2.5 concentrations by county for the period 2012-2014 came from data posted on August 19, 2015, at EPA’s website at http://www3.epa.gov/ airtrends/pdfs/PM25_DesignValues_20122014_FINAL_08_19_15.xlsx. On December 18, 2014, and on March 31, 2015, EPA made additional updates to the information at http://www3.epa.gov/pmdesignations/2012standards/regs.htm. Ozone Data Analysis The 2012, 2013, and 2014 AQS hourly ozone data were used to calculate the daily 8-hour maximum concentration for each ozone-monitoring site. The hourly averaged ozone data were downloaded on September 11, 2015. The data were considered for a three-year period for the same reason that the EPA uses three years of data to determine compliance with the ozone standard: to prevent a situation in any single year, where anomalies of weather or other factors create air pollution levels, which inaccurately reflect the normal conditions. The highest 8-hour daily maximum concentration in each county for 2012, 2013, and 2014, based on the EPA-defined ozone season, was identified. The current national ambient air quality standard for ozone is 70 parts per billion (ppb) measured over eight hours. The EPA’s Air Quality Index reflects the 70 ppb standard. A.S.L. & Associates prepared a table by county that summarized, for each of the three years, the number of days the ozone level was within the ranges identified by the EPA based on the EPA Air Quality Index: 8-hour Ozone Concentration Air Quality Index Levels 0 – 54 ppb n Good (Green) 55 – 70 ppb n Moderate (Yellow) 71 – 85 ppb n Unhealthy for Sensitive Groups (Orange) 86 – 105 ppb n Unhealthy (Red) 106 – 200 ppb n Very Unhealthy (Purple) >201 ppb n Hazardous (Maroon) The goal of this report was to identify the number of days that 8-hour daily maximum concentrations occurred within the defined ranges, not just those days that would fall under the requirements for attaining the national ambient air quality standards. Therefore, no data capture criteria were applied to eliminate monitoring sites or to require a number of valid days for the ozone season. Unlike the form of the previous 0.075 ppm 8-hour average ozone standard that was established in 2008, the daily maximum 8-hour average concentration for a given day is derived from the highest of the 17 consecutive 8-hour averages beginning with the 8-hour period from 7:00 a.m. to 3:00 p.m. and ending with the 8-hour period from 11:00 p.m. to 7:00 a.m. the following day (i.e., the continuous 8-hour averages running from 7:00 a.m. to 11:00 p.m.). All valid days of data within the ozone season were used in the analysis. However, for computing an 8-hour average, at least 75 percent of the hourly concentrations (i.e., 6-8 hours) had to be available for the 8-hour period. In addition, an 8-hour daily maximum average 42 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 METHODOLOGY was identified if valid 8-hour averages were available for at least 75 percent of possible hours in the day (i.e., at least 13 of the possible 17 8-hour averages). Because the EPA includes days with inadequate data if the standard value is exceeded, our data capture methodology included the site’s 8-hour value if at least one valid 8-hr period were available and it was 71 ppb or higher. Following receipt of the above information, the American Lung Association identified the number of days each county, with at least one ozone monitor, experienced air quality designated as orange (Unhealthy for Sensitive Groups), red (Unhealthy), or purple (Very Unhealthy). Short-Term Particle Pollution Data Analysis A.S.L. & Associates identified the maximum daily 24-hour AQS PM2.5 concentration for each county in 2012, 2013, and 2014 with monitoring information. The 24-hour PM2.5 data were downloaded on August 20, 2015. In addition, hourly averaged PM2.5 concentration data were characterized into 24-hour average PM2.5 values by the EPA and provided to A.S.L. & Associates. Using these results, A.S.L. & Associates prepared a table by county that summarized, for each of the three years, the number of days the maximum of the daily PM2.5 concentration was within the ranges identified by the EPA based on the EPA Air Quality Index, as adopted by the EPA on December 14, 2012: 24-hour PM2.5 Concentration Air Quality Index Levels 0.0 mg/m3 to 12.0 mg/m3 n Good (Green) 12.1 mg/m3 to 35.4 mg/m3 35.5 mg/m to 55.4 mg/m 3 55.5 mg/m to 150.4 mg/m 3 n Moderate (Yellow) n Unhealthy for Sensitive Groups (Orange) 3 150.5 mg/m to 250.4 mg/m 3 n Unhealthy (Red) 3 3 greater than or equal to 250.5 mg/m3 n Very Unhealthy (Purple) n Hazardous (Maroon) All previous data collected for 24-hour average PM2.5 were characterized using the AQI thresholds listed above. The goal of this report was to identify the number of days that the maximum in each county of the daily PM2.5 concentration occurred within the defined ranges, not just those days that would fall under the requirements for attaining the national ambient air quality standards. Therefore, no data capture criteria were used to eliminate monitoring sites. Both 24-hour averaged PM data, as well as hourly averaged PM data averaged over 24 hours were used. Included in the analysis are data collected using only FRM and FEM methods, which reported hourly and 24-hour averaged data. As instructed by the Lung Association, A.S.L. & Associates included the exceptional and natural events that were identified in the database and identified for the Lung Association the dates and monitoring sites that experienced such events. Some data have been flagged by the state or local air pollution control agency to indicate that they had raised issues with EPA about those data. Following receipt of the above information, the American Lung Association identified the number of days each county, with at least one PM2.5 monitor, experienced air quality designated as orange (Unhealthy for Sensitive Groups), red (Unhealthy), purple (Very Unhealthy) or maroon (Hazardous). 43 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 METHODOLOGY Description of County Grading System Ozone and short-term particle pollution (24-hour PM2.5) The grades for ozone and short-term particle pollution (24-hour PM2.5) were based on a weighted average for each county. To determine the weighted average, the Lung Association followed these steps: 1. First, assigned weighting factors to each category of the Air Quality Index. The number of orange days experienced by each county received a factor of 1; red days, a factor of 1.5; purple days, a factor of 2; and maroon days, a factor of 2.5. This allowed days where the air pollution levels were higher to receive greater weight. 2. Next, multiplied the total number of days within each category by their assigned factor, and then summed all the categories to calculate a total. 3. Finally, divided the total by three to determine the weighted average, since the monitoring data were collected over a three-year period. The weighted average determined each county’s grades for ozone and 24-hour PM2.5. ■■ ■■ ■■ All counties with a weighted average of zero (corresponding to no exceedances of the standard over the three-year period) were given a grade of “A.” For ozone, an “F” grade was set to generally correlate with the number of unhealthy air days that would place a county in nonattainment for the ozone standard. For short-term particle pollution, fewer unhealthy air days are required for an F than for nonattainment under the PM2.5 standard. The national air quality standard is set to allow two percent of the days during the three years to exceed 35 µg/m3 (called a “98th percentile” form) before violating the standard. That would be roughly 21 unhealthy days in three years. The grading used in this report would allow only about one percent of the days to be over 35 µg/m3 (called a “99th percentile” form) of the PM2.5. The American Lung Association supports using the tighter limits in a 99th percentile form as a more appropriate standard that is intended to protect the public from short-term spikes in pollution. Grading System Grade Weighted Average Approximate Number of Allowable Orange/Red/Purple/Maroon days A 0.0 None B 0.3 to 0.9 1 to 2 orange days with no red C 1.0 to 2.0 3 to 6 days over the standard: 3 to 5 orange with no more than 1 red OR 6 orange with no red D 2.1 to 3.2 7 to 9 days over the standard: 7 total (including up to 2 red) to 9 orange with no red F 3.3 or higher 9 days or more over the standard: 10 orange days or 9 total including at least 1 or more red, purple or maroon Weighted averages allow comparisons to be drawn based on severity of air pollution. For example, if one county had nine orange days and no red days, it would earn a weighted average of 3.0 and a D grade. However, another county which had only eight orange days but also two red days, which signify days with more serious air pollution, would receive a F. That second county would have a weighted average of 3.7. Note that this system differs significantly from the methodology the EPA uses to determine violations of both the ozone and the 24-hour PM2.5 standards. The EPA determines whether a county violates the standard based on the fourth maximum daily 8-hour ozone reading each year averaged over three years. Multiple days of unhealthy air beyond the highest four in each year are not considered. By contrast, the system used in this report recognizes when a community’s air quality repeatedly results in unhealthy air throughout the three years. Consequently, some counties will receive 44 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 METHODOLOGY grades of “F” in this report, showing repeated instances of unhealthy air, while still meeting the EPA’s 2015 ozone standard. The American Lung Association’s position is that the evidence shows that the 2015 ozone standard, although stronger than the 2008 standard, still fails to adequately protect public health. Counties were ranked by weighted average. Metropolitan areas were ranked by the highest weighted average among the counties within a given Metropolitan Statistical Area as of 2013 as defined by the White House Office of Management and Budget (OMB). Year-Round Particle Pollution (Annual PM2.5) Since no comparable Air Quality Index exists for year-round particle pollution (annual PM2.5), the grading was based on the 2012 National Ambient Air Quality Standard for annual PM2.5 of 12 µg/m3. Counties that EPA listed as being at or below 12 µg/m3 were given grades of “Pass.” Counties EPA listed as being at or above 12.1 µg/m3 were given grades of “Fail.” Where insufficient data existed for EPA to determine a design value, those counties received a grade of “Incomplete.” EPA officially recognizes that data collected in all Illinois and Florida counties, and most Tennessee counties, had quality control issues that meant that available data could not be considered for development of an official design value. For short-term and annual particle pollution, those counties received a grade of “Incomplete.” Design value is the calculated concentration of a pollutant based on the form of the national ambient air quality standard and is used by EPA to determine whether or not the air quality in a county meets the standard. Counties were ranked by design value. Metropolitan areas were ranked by the highest design value among the counties within a given Metropolitan Statistical Area as of 2013 as defined by the OMB. The Lung Association received critical assistance from members of the National Association of Clean Air Administrators. With their assistance, all state and local agencies were provided the opportunity to review and comment on the data in draft tabular form. The Lung Association reviewed all discrepancies with the agencies and, if needed, with Dr. Lefohn at A.S.L. & Associates. Questions about the annual PM design values were discussed with EPA; however, the Lung Association made final decisions to grade counties as “Incomplete” where EPA considered PM2.5 data to have inadequate quality assurance. The American Lung Association wishes to express its continued appreciation to the state and local air directors for their willingness to assist in ensuring that the characterized data used in this report are correct. Calculations of Populations-at-Risk Presently county-specific measurements of the number of persons with chronic conditions are not generally available. In order to assess the magnitude of chronic conditions at the state and county levels, we have employed a synthetic estimation technique originally developed by the U.S. Census Bureau. This method uses age-specific national and state estimates of self-reported conditions to project disease prevalence to the county level. The exception to this is poverty, for which estimates are available at the county level. Population Estimates The U.S. Census Bureau estimated data on the total population of each county in the United States for 2014. The Census Bureau also estimated the age-specific breakdown of the population and how many individuals were living in poverty by county. These estimates are the best information on population demographics available between decennial censuses. Poverty estimates came from the Census Bureau’s Small Area Income and Poverty Estimates (SAIPE) program. The program does not use direct counts or estimates from 45 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 METHODOLOGY sample surveys, as these methods would not provide sufficient data for all counties. Instead, a model based on estimates of income or poverty from the Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS) is used to develop estimates for all states and counties. Prevalence Estimates Chronic Obstructive Pulmonary Disease, Cardiovascular Disease, Asthma and Diabetes. In 2014, the Behavioral Risk Factor Surveillance System (BRFSS) survey found that approximately 21.6 million (8.4 percent) of adults residing in the United States and 9.2 percent of children from thirty-seven states and Washington, D.C. reported currently having asthma. Among adults in the Unites States in 2014, 16.1 million (6.6 percent) had ever been diagnosed with chronic obstructive pulmonary disease (COPD), 20.9 million (7.8 percent) had ever been diagnosed with cardiovascular disease, and 25.4 million (8.4 percent) had ever been diagnosed with diabetes. The prevalence estimate for pediatric asthma is calculated for those younger than 18 years. Local area prevalence of pediatric asthma is estimated by applying 2014 state prevalence rates, or if not available, the national rate from the BRFSS to pediatric county-level resident populations obtained from the U.S. Census Bureau web site. Pediatric asthma data from the 2014 BRFSS were available for thirty-seven states and Washington, D.C., from the 2013 BRFSS for one state, from the 2012 BRFSS for two states, and from the 2011 BRFSS for one state, and national data were used for the ten states1 that had no data available. Data from earlier years were not used due to changes in the 2011 survey methodology. The prevalence estimate for COPD, cardiovascular disease, adult asthma and diabetes is calculated for those aged 18-44 years, 45-64 years and 65 years and older. Local area prevalence for these diseases is estimated by applying age-specific state prevalence rates from the 2014 BRFSS to age-specific county-level resident populations obtained from the U.S. Census Bureau web site. Cardiovascular disease included ever having been diagnosed with a heart attack, angina or coronary heart disease, or stroke. Limitations of Estimates. Since the statistics presented by the BRFSS and SAIPE are based on a sample, they will differ (due to random sampling variability) from figures that would be derived from a complete census or case registry of people in the U.S. with these diseases. The results are also subject to reporting, non-response and processing errors. These types of errors are kept to a minimum by methods built into the survey. Additionally, a major limitation of the BRFSS is that the information collected represents self-reports of medically diagnosed conditions, which may underestimate disease prevalence since not all individuals with these conditions have been properly diagnosed. However, the BRFSS is the best available source for information on the magnitude of chronic disease at the state level. The conditions covered in the survey may vary considerably in the accuracy and completeness with which they are reported. Local estimates of chronic diseases are scaled in direct proportion to the base population of the county and its age distribution. No adjustments are made for other factors that may affect local prevalence (e.g., local prevalence of cigarette smokers or occupational exposures) since the health surveys that obtain such data are rarely conducted on the county level. Because the estimates do not account for geographic differences in the prevalence of chronic and acute diseases, the sum of the estimates for each of the counties in the United States may not exactly reflect the national or state estimates derived from the BRFSS. 1 2013: Arizona. 2012: North Dakota and Wyoming. 2011: Iowa. National: Alaska, Arkansas, Colorado, Delaware, Florida, Idaho, Minnesota, South Carolina, South Dakota, and Virginia. 46 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 METHODOLOGY References Irwin, R. Guide to Local Area Populations. U.S. Bureau of the Census, Technical Paper Number 39 (1972). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System, 2014. Population Estimates Branch, U.S. Census Bureau. Annual Estimates of the Resident Population by Selected Age Groups and Sex for Counties: April 1, 2010 to July 1, 2014. Office of Management and Budget. Revised Delineations of Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Combined Statistical Areas, and Guidance on Uses of the Delineations of These Areas. OMB Bulletin 13-01 February 28, 2013. U.S. Census Bureau. Small Area Income and Poverty Estimates. State and County Data, 2014. 47 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S State Table Notes A full explanation of the sources of data and methodology is in Methodology. Notes for all state data tables Notes for all state grades tables. 1. Total Population is based on 2014 U.S. Census and represents the atrisk populations in counties with ozone or PM2.5 pollution monitors; it does not represent the entire state’s sensitive populations. 1. Not all counties have monitors for either ozone or particle pollution. If a county does not have a monitor, that county’s name is not on the list in these tables. The decision about monitors in the county is made by the state and the U.S. Environmental Protection Agency, not by the American Lung Association. 2. Those 18 & under and 65 & over are vulnerable to ozone and PM2.5. Do not use them as population denominators for disease estimates—that will lead to incorrect estimates. 3. Pediatric asthma estimates are for those under 18 years of age and represent the estimated number of people who had asthma in 2014 based on the state rates when available or national rates when not (Behavioral Risk Factor Surveillance System, or BRFSS), applied to county population estimates (U.S. Census). 4. Adult asthma estimates are for those 18 years and older and represent the estimated number of people who had asthma during 2014 based on state rates (BRFSS) applied to county population estimates (U.S. Census). 5. COPD estimates are for adults 18 and over who had ever been diagnosed with chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema, based on state rates (BRFSS) applied to county population estimates (U.S. Census). 6. Cardiovascular disease estimates are for adults 18 and over who have been diagnosed within their lifetime, based on state rates (BRFSS) applied to county population estimates (U.S. Census). CV disease includes coronary heart disease, stroke, and heart attack. 7. Diabetes estimates are for adults 18 and over who have been diagnosed within their lifetime based on state rates (BRFSS) applied to county population estimates (U.S. Census). 8. Poverty estimates include all ages and come from the U.S. Census Bureau’s Small Area Income and Poverty Estimates program. The estimates are derived from a model using estimates of income or poverty from the Annual Social and Economic Supplement and the Current Population Survey, 2014. 9. Adding across rows does not produce valid estimates. Adding the atrisk categories (asthma, COPD, poverty, etc.) will double-count people who fall into more than one category. 48 LUNG.org 2. INC (Incomplete) indicates that monitoring is underway for that pollutant in that county, but that the data are incomplete for all three years. Those counties are not graded or received an Incomplete. For particle pollution, some states collected data, but experienced laboratory quality issues that meant the data could not be used for assessing pollution levels. 3. DNC (Data Not Collected) indicates that data on that particular pollutant is not collected in that county. 4. The Weighted Average (Wgt. Avg) was derived by adding the three years of individual level data (2012-2014), multiplying the sums of each level by the assigned standard weights (i.e., 1=orange, 1.5=red, 2.0=purple and 2.5=maroon) and calculating the average. Grades are assigned based on the weighted averages as follows: A=0.0, B=0.3-0.9, C=1.0-2.0, D=2.1-3.2, F=3.3+. 5. The Design Value is the calculated concentration of a pollutant based on the form of the National Ambient Air Quality Standard and is used by EPA to determine whether the air quality in a county meets the standard. The numbers refer to micrograms per cubic meter, or µg/ m3. Design values for the annual PM2.5 concentrations by county for the period 2012-2014 are as posted on August 19, 2015, at EPA’s website at http://www3.epa.gov/airtrends/values.html. The 2012-2014 design values were compared to the 2012 National Ambient Air Quality Standard for Annual PM2.5, particularly to the EPA’s assessment of data quality required, as discussed on EPA’s website at http://www.epa. gov/pmdesignations/2012standards/regs.htm. Many design values are missing because state data did not meet quality requirements. 6. The annual average National Ambient Air Quality Standard for PM2.5 is 12 µg/m3 as of December 14, 2012. Counties with design values of 12 or lower received a grade of “Pass.” Counties with design values of 12.1 or higher received a grade of “Fail.” AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S ALABAMA American Lung Association in Alabama www.lung.org/alabama AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Baldwin 200,111 44,346 37,385 Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 5,852 14,800 16,591 20,322 21,407 25,696 Clay 13,552 2,925 2,631 Colbert 54,543 11,844 10,099 1,563 4,060 4,540 5,544 5,851 9,022 DeKalb 71,065 17,553 11,159 2,316 5,101 5,505 6,523 6,992 16,856 Elmore 80,977 18,600 11,358 2,455 5,965 6,247 7,186 7,831 10,867 Etowah 103,531 22,830 17,919 Houston 104,193 24,736 16,790 Jefferson 660,793 Madison 350,299 78,612 48,012 10,375 26,043 27,432 31,474 34,440 48,750 Mobile 415,123 99,811 60,326 13,172 30,119 31,858 37,033 40,119 80,016 Montgomery 226,189 54,262 30,192 7,161 16,428 16,881 19,197 21,004 48,844 Morgan 119,607 27,640 19,062 3,648 8,781 9,552 11,333 12,164 17,665 Russell Shelby Sumter Talladega Tuscaloosa Totals 49 152,855 94,375 386 1,010 1,148 1,419 1,489 2,592 3,013 7,685 8,447 10,162 10,811 19,291 3,264 7,570 8,179 20,173 48,545 50,991 9,717 10,397 20,643 58,886 64,018 125,778 59,608 15,066 7,469 1,988 4,260 4,340 4,888 5,377 12,309 206,655 50,446 26,848 13,166 2,600 2,147 81,322 18,149 13,058 202,212 42,566 23,722 2,962,946 684,841 LUNG.org 432,552 6,657 14,978 15,658 17,852 19,596 19,610 343 1,006 1,069 1,256 1,350 4,692 2,395 6,031 6,548 7,762 8,334 17,499 5,618 15,246 14,741 16,014 17,863 34,553 90,380 217,630 229,728 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 266,567 289,045 514,683 S TAT E TA B L E S ALABAMA American Lung Association in Alabama www.lung.org/alabama HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Baldwin Clay Wgt. Avg. Grade Orange Red Purple 4 0 0 1.3 C DNC DNC DNC DNC DNC Annual Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0.0 A 8.8 PASS 0 8.6 PASS 0 0 0.0 A Colbert 6 0 0 2.0 C 0 0 0 0.0 A 8.9 PASS DeKalb 5 0 0 1.7 C 0 0 0 0.0 A 9.3 PASS Elmore 0 Etowah 0 0 0 0.0 A 0 0 0 0.0 A 9.4 PASS Houston 0 0 0 0.0 A 0 0 0 0.0 A 8.6 PASS 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Jefferson 22 4 0 9.3 F 0 0 0 0.0 A 11.3 PASS Madison 14 0 0 4.7 F 0 0 0 0.0 A 9.0 PASS Mobile 9 0 0 3.0 D 0 0 0 0.0 A 8.7 PASS Montgomery 0 0 0 0.0 A 0 0 0 0.0 A 9.9 PASS Morgan 6 0 0 2.0 C 0 0 0 0.0 A 8.9 PASS Russell 2 0 0 0.7 B 0 0 0 0.0 A 10.7 PASS Shelby 8 0 0 2.7 D 0 0 0 0.0 A 9.4 PASS Sumter Talladega Tuscaloosa 50 INC INC INC INC INC DNC DNC DNC DNC DNC 0 0 0 0.0 A LUNG.org DNC DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 DNC DNC 9.6 PASS 9.2 PASS S TAT E TA B L E S ALASK A American Lung Association in Alaska www.lung.org/alaska AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Anchorage Municipality 301,010 74,964 26,719 Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 6,908 18,046 9,397 12,634 15,450 29,207 Denali Borough 1,921 362 164 33 126 74 97 119 133 Fairbanks North Star Borough 99,357 23,924 7,913 2,205 5,999 2,938 3,875 4,764 9,011 Juneau City and Borough 32,406 7,165 3,436 Kenai Peninsula Borough 57,477 13,276 8,163 1,223 3,568 2,216 3,209 3,847 6,472 Matanuska-Susitna Borough 97,882 26,766 9,372 2,466 5,706 3,190 4,360 5,310 10,243 Totals 51 590,053 146,457 LUNG.org 55,767 660 2,028 1,154 1,585 1,928 2,500 13,496 35,473 18,968 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 25,760 31,417 57,5662 S TAT E TA B L E S ALASK A American Lung Association in Alaska www.lung.org/alaska HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Borough Orange Red Purple Anchorage Municipality Wgt. Avg. Grade Orange Red Purple INC INC INC INC INC Denali Borough 0 0 0 Fairbanks North Star Borough 0 0 0 0 0.0 A A 0 1 Annual Wgt. Avg. Grade 0 0.5 B DNC DNC DNC DNC DNC Design Value Pass/ Fail 5.8 PASS DNC DNC 26 25 3 23.2 F 11.1 PASS Juneau City and Borough DNC DNC DNC DNC DNC 4 0 0 1.3 C 6.7 PASS Kenai Peninsula Borough DNC DNC DNC DNC DNC 0 2 0 1.0 C 0.0 INC 17 1 0 6.2 F 6.8 Matanuska-Susitna Borough 52 INC INC LUNG.org INC INC INC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 PASS S TAT E TA B L E S ARIZONA American Lung Association in Arizona www.lung.org/arizona AT-RISK GROUPS Lung Diseases County Apache Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 71,828 21,019 9,665 2,292 4,897 3,493 4,089 5,101 23,458 Cochise 127,448 28,533 25,391 3,112 9,447 7,330 9,132 10,901 22,879 Coconino 137,682 30,047 15,252 3,277 10,477 6,640 7,283 9,299 27,154 Gila 53,119 10,829 14,147 1,181 3,986 3,496 4,619 5,356 12,683 La Paz 20,231 3,527 7,298 Maricopa 385 1,554 1,493 2,095 2,312 4,545 4,087,191 1,023,993 565,934 111,682 295,891 205,053 237,992 295,957 687,643 Mohave 203,361 37,964 54,755 4,141 15,600 13,593 17,918 20,790 41,178 Navajo 108,101 30,243 17,061 3,298 7,472 5,562 Pima Pinal Santa Cruz Yavapai Yuma Totals 53 1,004,516 219,804 178,188 23,973 75,342 55,393 6,704 8,209 30,157 67,134 81,125 183,590 401,918 97,940 72,449 10,682 29,151 21,629 26,477 31,703 66,073 46,695 13,230 7,369 1,443 3,211 2,399 2,896 3,546 10,966 218,844 38,026 61,595 203,247 53,182 35,366 6,684,181 1,608,337 LUNG.org 1,064,470 4,147 17,020 15,121 20,058 23,248 33,589 5,800 14,416 10,446 12,736 15,158 44,112 175,414 488,465 351,647 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 419,132 512,705 1,188,027 S TAT E TA B L E S ARIZONA American Lung Association in Arizona www.lung.org/arizona HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Apache Wgt. Avg. Grade Orange Red Purple DNC DNC DNC DNC DNC Annual Wgt. Avg. Grade INC INC INC INC INC Design Value Pass/ Fail INC INC Cochise 15 0 0 5.0 F 0 0 0 0.0 A 7.0 PASS Coconino 23 0 0 7.7 F INC INC INC INC INC INC INC Gila 42 0 0 14.0 F DNC DNC DNC DNC DNC DNC DNC La Paz 20 0 0 6.7 F INC INC INC INC INC INC INC 122 5 0 43.2 F PASS Maricopa Mohave Navajo Pima Pinal Santa Cruz DNC DNC DNC DNC DNC 9 0 0 3.0 D 13 0 0 4.3 F 43 0 0 14.3 F DNC DNC DNC DNC DNC 8 4 1 5.3 F 11.0 0 0 0 0.0 A INC INC DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC 5.8 PASS PASS 8 0 0 2.7 D 8.6 4 3 0 2.8 D 9.3 PASS Yavapai 16 0 0 5.3 F INC INC INC INC INC INC INC Yuma 26 3 0 10.2 F 1 1 0 0.8 B 7.4 PASS 54 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S ARK ANSAS American Lung Association in Arkansas www.lung.org/arkansas AT-RISK GROUPS Lung Diseases County Total Population Under 18 Pediatric Asthma 3,735 Clark 22,576 4,327 3,625 399 1,567 1,540 2,175 49,548 13,813 6,002 1,273 3,169 3,141 120,768 28,864 13,581 2,660 7,919 7,307 17,534 3,574 2,936 1,944 Poverty 455 1,433 1,566 2,223 2,194 4,707 Jackson 1,381 1,930 20,948 4,935 3,844 97,322 20,369 21,105 1,281 Diabetes Ashley Garland 395 Cardiovascular Disease 18,594 Faulkner 3,250 Adult Asthma COPD Arkansas Crittenden 4,285 65 & Over 2,146 4,285 4,267 4,339 13,323 9,904 10,056 17,140 1,877 6,870 7,773 11,267 10,960 17,929 329 1,239 1,295 1,812 3,864 7,904 1,541 1,917 Phillips 19,930 5,427 3,245 500 1,297 1,389 1,954 1,941 6,950 Polk 20,225 437 Pope 63,201 14,424 9,075 1,329 4,261 4,227 5,861 5,867 10,868 Pulaski Union Washington Totals 55 392,702 4,739 93,241 4,393 52,987 40,227 9,613 6,677 220,792 55,947 23,661 1,112,271 265,099 LUNG.org 156,298 142 575 679 1,805 Newton 8,592 1,388 26,425 1,594 26,289 992 961 1,574 2,317 36,038 2,250 36,399 4,399 61,892 886 2,744 2,929 4,099 4,087 9,184 5,156 14,129 12,849 17,398 17,666 41,097 24,429 74,298 73,958 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 102,251 102,601 200,947 S TAT E TA B L E S ARK ANSAS American Lung Association in Arkansas www.lung.org/arkansas HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple DNC DNC Wgt. Avg. Grade Orange Red Purple Arkansas DNC DNC DNC Ashley DNC DNC DNC DNC DNC 0 0 0 0 Annual Wgt. Avg. Grade 0 0.0 0 0.0 A A Design Value Pass/ Fail 9.5 PASS 9.2 PASS 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC 10 3 0 4.8 F 1 0 0 0.3 B 9.8 PASS Faulkner DNC DNC DNC DNC DNC INC INC INC INC INC INC INC Garland DNC DNC DNC DNC DNC Jackson DNC Clark Crittenden Newton Phillips Polk Pope Pulaski Union Washington 56 DNC 2 DNC 0 DNC 0 0.7 DNC B DNC DNC DNC DNC DNC 4 0 0 1.3 C DNC DNC DNC DNC DNC 21 0 0 7.0 F DNC DNC DNC DNC DNC 16 1 LUNG.org 0 5.8 F 0 0 0 0.0 A 9.7 PASS 0 0 0 0.0 A 9.3 PASS DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC 0 0 0 0.0 A INC INC INC INC INC 9.8 PASS INC INC 1 0 0 0.3 B 0 0 0 0.0 A 9.8 PASS 0 0 0 0.0 A 9.2 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 11.1 PASS PASS S TAT E TA B L E S CALIFORNIA American Lung Association in California www.lung.org/california AT-RISK GROUPS Lung Diseases County Alameda Amador Butte Total Population Under 18 65 & Over Pediatric Asthma 1,610,921 344,898 200,666 45,230 Cardiovascular Disease 30,551 97,985 59,868 36,742 5,627 9,207 224,241 Adult Asthma COPD 38,209 Diabetes Poverty 87,508 127,579 197,984 498 2,521 1,946 3,078 4,137 4,313 4,007 13,931 9,207 13,976 19,374 48,151 Calaveras 44,624 7,913 11,198 701 2,995 2,357 3,740 5,025 6,057 Colusa 21,419 5,995 2,810 531 1,202 768 1,143 1,635 3,030 Contra Costa 1,111,339 260,433 158,199 El Dorado 183,087 38,231 32,882 Fresno 965,974 Glenn 278,941 23,069 66,867 43,593 65,030 93,318 115,466 3,387 11,648 8,290 12,675 17,853 20,715 107,886 24,709 27,955 7,469 4,154 52,769 31,650 46,170 66,992 261,387 662 1,606 1,064 1,604 2,261 4,723 Humboldt 134,809 26,233 20,780 2,324 8,448 5,437 8,137 11,518 27,609 Imperial 179,091 51,111 21,523 4,527 9,863 6,046 8,897 12,791 40,162 Inyo 18,410 3,785 3,932 335 1,175 872 1,362 1,854 2,533 Kern 874,589 257,512 86,198 22,811 47,274 27,545 39,611 58,509 206,604 Kings 150,269 41,383 13,678 Lake Los Angeles 64,184 13,089 13,234 10,116,705 2,303,617 1,233,007 3,666 8,273 4,636 6,575 9,814 33,174 1,159 4,694 4,106 3,019 204,057 603,091 366,048 6,441 15,387 534,609 778,287 1,863,025 Madera 154,548 42,597 19,741 3,773 8,665 5,416 Marin 260,750 53,374 50,588 4,728 16,685 12,099 18,668 25,944 22,272 Mariposa Mendocino 17,682 2,945 4,336 87,869 19,238 16,628 8,020 11,473 32,542 261 1,199 931 1,470 1,985 2,830 1,704 5,457 3,874 5,975 8,233 16,256 Merced 266,353 79,812 27,837 Monterey 431,344 113,960 51,584 10,095 24,453 14,871 21,793 31,512 70,259 Napa 141,667 30,884 23,822 2,736 8,726 5,910 8,978 12,562 12,317 98,893 17,582 23,179 1,557 6,578 5,015 7,892 10,677 11,193 Nevada Orange Placer Plumas 3,145,515 721,973 413,596 371,694 85,109 66,239 18,606 3,201 4,595 7,070 14,286 8,424 12,209 17,828 64,585 63,953 188,600 118,364 174,642 252,466 400,252 7,539 22,720 15,850 24,301 33,714 30,490 284 1,255 979 1,548 2,087 2,556 Riverside 2,329,271 613,655 307,271 54,358 132,989 83,667 124,150 177,332 392,706 Sacramento 1,482,026 361,087 189,691 31,985 86,971 54,148 San Benito San Bernardino 2,112,619 575,325 218,318 San Diego 79,792 115,236 264,955 58,267 15,642 6,640 1,386 3,321 2,050 2,993 4,400 8,162 3,263,431 728,756 414,831 114,602 122,915 50,963 118,259 69,775 100,603 148,690 422,405 64,554 195,372 119,112 174,704 252,410 467,248 San Francisco 852,469 San Joaquin 715,597 199,024 84,210 17,630 39,987 24,581 36,051 52,309 145,167 San Luis Obispo 279,083 50,639 48,977 10,152 56,596 34,269 50,349 72,203 101,313 4,486 17,852 11,905 18,081 25,139 38,048 San Mateo 758,581 162,800 111,206 14,421 46,668 30,259 45,154 64,579 56,580 Santa Barbara 440,668 98,643 61,583 Santa Clara 57 1,894,605 437,810 231,573 LUNG.org 8,738 26,314 16,318 24,219 34,331 73,600 38,782 112,853 69,129 101,089 147,416 159,553 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S CALIFORNIA (cont.) American Lung Association in California www.lung.org/california AT-RISK GROUPS Lung Diseases County Total Population Under 18 Santa Cruz 271,804 54,682 36,624 4,844 16,880 10,546 15,538 22,490 42,076 Shasta 179,804 38,807 34,600 3,438 11,206 7,973 12,318 16,924 26,016 Siskiyou 43,628 8,865 65 & Over Pediatric Asthma 9,885 785 Adult Asthma COPD 2,806 Cardiovascular Disease 2,130 3,351 Diabetes 4,527 Poverty 9,076 Solano 431,131 98,923 58,276 8,763 25,972 16,550 24,508 35,389 51,638 Sonoma 500,292 103,224 83,449 9,144 31,354 21,215 32,136 45,258 55,742 Stanislaus 531,997 145,429 64,423 12,882 29,928 18,489 27,190 39,304 95,456 Sutter 95,847 Tehama 63,067 15,151 11,237 Tulare Tuolumne 25,261 13,891 2,238 5,502 3,576 5,371 1,342 3,803 2,667 7,574 14,485 4,097 5,673 11,358 458,198 144,776 47,624 12,824 24,029 14,258 20,711 30,178 127,305 53,831 9,024 12,626 799 3,600 2,707 4,257 5,739 7,177 Ventura 846,178 204,568 115,000 18,121 50,182 32,154 47,741 68,698 95,912 Yolo 207,590 45,073 23,860 Totals 58 38,629,264 9,113,908 LUNG.org 4,968,418 3,993 12,361 7,153 10,336 15,046 39,493 807,320 2,287,182 1,418,710 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 2,089,046 3,016,715 6,221,343 S TAT E TA B L E S CALIFORNIA American Lung Association in California www.lung.org/california HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Alameda 13 Annual Wgt. Avg. Grade Design Value Pass/ Fail PASS 1 0 4.8 F 7 0 0 2.3 D 9.4 Amador 31 1 0 10.8 F DNC DNC DNC DNC DNC DNC DNC Butte 39 1 0 13.5 F 2 1 0 1.2 C 9.0 PASS Calaveras 18 1 0 6.5 F 1 0 0 0.3 B 8.0 PASS Colusa Contra Costa 0 0 0 0.0 A 8 1 0 3.2 D 2 3 1 2.8 D 3 0 0 1.0 C 7.2 PASS 7.0 PASS El Dorado 112 8 0 41.3 F DNC DNC DNC DNC DNC DNC DNC Fresno 221 59 1 103.8 F 77 38 0 44.7 F 15.4 FAIL Glenn Humboldt 2 0 0 0.7 B DNC DNC 0 0 0 0.0 A INC INC Imperial 77 5 0 28.2 F 17 3 0 7.2 F 14.3 FAIL Inyo 13 0 0 4.3 F 5 13 1 8.8 F 7.5 PASS Kern 245 62 1 113.3 F 69 50 1 48.7 F 19.7 FAIL Kings 118 9 0 43.8 F 68 36 0 40.7 F 16.8 FAIL 3 0 0 1.0 C 0 0 0 0.0 A 4.0 PASS Los Angeles 198 81 4 109.2 F 21 2 0 8.0 F 12.3 FAIL Madera 146 18 0 57.7 F 51 18 0 26.0 F 15.9 FAIL Lake Marin Mariposa Mendocino Merced 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A 83 0 2 28.7 F 0 0 0 0.0 A 90 3 0 31.5 F 3 0 0 1.0 C DNC DNC DNC DNC DNC 9.8 PASS DNC DNC 0 0 0 0.0 A INC INC 43 11.7 5 0 16.8 F PASS Monterey 0 0 0 0.0 A 0 0 0 0.0 A 6.1 PASS Napa 2 0 0 0.7 B 1 0 0 0.3 B INC INC Nevada 69 2 0 24.0 F 1 1 0 0.8 B 6.9 PASS Orange 23 2 Placer 69 7 0 8.7 F 10 1 0 3.8 F 10.5 PASS 0 26.5 F 5 7 1 5.8 F 7.3 PASS DNC DNC DNC DNC DNC 25 1 0 8.8 F 14.1 FAIL 262 106 0 140.3 F 29 3 0 11.2 F 14.6 FAIL Sacramento 99 11 1 39.2 F 14 0 0 4.7 F 9.8 PASS San Benito 17 0 0 5.7 F 0 0 0 0.0 A 5.1 PASS 222 141 12 152.5 F 7 2 0 3.3 F 12.8 FAIL 81 1 0 27.5 F 6 3 0 3.5 F 10.6 PASS Plumas Riverside San Bernardino San Diego San Francisco 0 0 0 0.0 A 3 0 0 1.0 C 8.6 PASS San Joaquin 54 3 0 19.5 F 42 10 0 19.0 F 14.0 FAIL San Luis Obispo 49 1 0 16.8 F 10 0 0 3.3 F 11.6 PASS San Mateo 59 1 0 0 0.3 B LUNG.org 3 0 0 1.0 C AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 8.8 PASS S TAT E TA B L E S CALIFORNIA (cont.) American Lung Association in California www.lung.org/california HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Santa Barbara 10 Santa Clara Santa Cruz 4.3 11 0 0 3.7 F 8 2 1 0 0 0.3 B 33 0 13 0 0 4.3 F 0 0 Siskiyou 2 0 0 0.7 B 2 2 Solano 7 0 0 2.3 D 8 0 0 2.7 D 9.6 PASS Sonoma 0 0 0 0.0 A 0 0 0 0.0 A INC INC Sutter 0 0 Pass/ Fail 0 Stanislaus 0 Design Value 2 Shasta F Annual Wgt. Avg. Grade 0.0 A 8.8 PASS 0 3.7 F 10.0 PASS 0 11.0 F 5.9 PASS 0 0.0 A 6.3 PASS 0 1.7 C 7.5 PASS 103 10 1 40.0 F 69 19 0 32.5 F 14.0 FAIL 26 1 0 9.2 F 3 0 0 1.0 C 8.2 PASS 42 1 0 14.5 F DNC DNC DNC DNC DNC DNC DNC 239 55 1 107.8 F 21 12 0 13.0 F 17.2 FAIL Tuolumne 31 0 0 10.3 F DNC DNC DNC DNC DNC DNC DNC Ventura 54 2 0 19.0 F 1 0 0 0.3 B 9.3 PASS Tehama Tulare Yolo 60 9 0 0 3.0 D LUNG.org 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 6.6 PASS S TAT E TA B L E S COLOR ADO American Lung Association in Colorado www.lung.org/colorado AT-RISK GROUPS Lung Diseases County Total Population Under 18 Adams 480,718 133,050 45,998 12,261 29,160 12,591 17,856 22,596 61,384 Arapahoe 618,821 151,631 73,513 13,973 39,157 18,410 26,459 32,863 68,849 Boulder 313,333 63,524 38,268 Chaffee Clear Creek 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 5,854 20,933 9,615 13,809 17,162 40,299 18,363 2,903 4,218 268 1,288 791 1,195 1,379 2,114 9,187 1,412 1,647 130 652 377 550 670 769 Denver 663,862 138,446 72,177 12,758 44,000 18,444 26,403 32,919 103,412 Douglas 314,638 89,176 31,258 El Paso 663,519 166,360 76,173 15,330 41,657 19,089 27,426 34,064 78,363 Garfield 57,461 Gunnison 15,725 2,819 1,765 Jackson Jefferson La Plata 14,885 8,218 18,946 8,939 12,613 16,111 11,740 6,165 1,372 3,574 1,668 2,370 260 1,082 467 2,994 5,777 665 835 2,216 1,396 249 292 23 96 58 86 101 232 558,503 116,545 81,934 10,740 37,019 19,087 27,756 33,917 45,482 53,989 10,447 7,677 963 3,648 1,824 2,644 3,245 5,549 Larimer 324,122 66,316 45,174 6,111 21,566 10,288 15,005 18,227 40,447 Mesa 148,255 33,252 25,046 3,064 9,603 5,138 Moffat 12,928 Montezuma 25,772 5,844 4,924 539 1,664 979 1,463 1,717 4,157 Park 16,345 2,724 2,652 251 1,145 671 964 1,201 1,525 Pitkin 17,626 2,874 2,742 265 1,236 647 939 1,151 1,228 Pueblo 3,353 1,662 161,875 37,565 27,611 309 803 408 7,632 9,032 22,155 3,462 10,380 5,631 588 728 1,439 8,374 9,894 29,845 Rio Blanco 6,707 1,647 916 152 424 212 309 377 700 San Miguel 7,840 1,480 818 136 535 249 348 450 774 Weld Totals 61 277,670 74,773 30,891 4,768,655 6,890 17,005 7,821 11,220 13,968 28,515 1,121,275 583,521 103,326 305,571 143,401 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 206,677 255,603 556,971 S TAT E TA B L E S COLOR ADO American Lung Association in Colorado www.lung.org/colorado HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Wgt. Avg. Grade Design Value Pass/ Fail Adams 23 1 0 8.2 F 2 0 0 0.7 B INC INC Arapahoe 41 2 0 14.7 F 0 0 0 Boulder 47 5 0 18.2 F 3 0 0 0.0 A INC INC 1.0 C INC INC Chaffee INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Clear Creek INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Denver 16 2 0 6.3 F 5 1 0 2.2 D INC INC Douglas 64 5 0 23.8 F 1 0 0 0.3 B INC INC El Paso 30 0 0 10.0 F 0 0 0 0.0 A INC INC Garfield 47 0 0 15.7 F 0 0 0 0.0 A INC INC Gunnison 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC Jackson 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Jefferson 95 8 0 35.7 F DNC DNC DNC DNC DNC DNC DNC La Plata 0 0 0 0.0 A INC INC Larimer 86 7 0 32.2 F 1 0 0 0.3 B INC INC Mesa 10 0 0 3.3 F 4 0 0 1.3 C INC INC Moffat 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Montezuma 7 0 0 2.3 D 2 0 0 0.7 B 0 0 0 0.0 A 5.7 PASS Park INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Pitkin INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Pueblo Rio Blanco San Miguel Weld 62 DNC DNC DNC DNC DNC 11 4 1 6.3 F INC INC INC INC INC 29 2 LUNG.org 0 10.7 F 0 0 0 0.0 A 1 0 0 0.3 B DNC DNC DNC DNC DNC 3 0 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 1.0 C INC INC 8.8 PASS DNC DNC INC INC S TAT E TA B L E S CONNECTICUT American Lung Association in Connecticut www.lung.org/connecticut AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Fairfield 945,438 Hartford Diabetes Poverty 223,021 135,792 21,351 66,025 36,189 53,156 65,060 83,132 897,985 194,947 140,291 18,663 64,138 35,654 52,726 63,882 106,078 Litchfield 184,993 35,970 34,130 3,444 13,467 8,231 12,448 15,141 14,015 Middlesex 164,943 31,948 29,191 New Haven 861,277 181,733 134,181 New London 273,676 55,534 43,923 5,317 19,891 11,113 16,457 19,936 28,868 Tolland 151,367 28,022 21,234 2,683 11,329 5,884 8,518 10,410 10,253 Windham 116,998 24,255 17,181 2,322 8,482 4,621 6,774 8,300 11,570 Totals 63 3,596,677 775,430 LUNG.org 555,923 Adult Asthma COPD Cardiovascular Disease 3,059 12,058 7,133 10,711 12,996 12,636 17,398 62,041 34,207 74,236 257,431 143,032 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 50,490 61,119 108,729 211,280 256,844 375,281 S TAT E TA B L E S CONNECTICUT American Lung Association in Connecticut www.lung.org/connecticut HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Design Value Pass/ Fail Fairfield 46 18 0 24.3 F 2 0 0 0.7 B 9.3 PASS Hartford 25 2 0 9.3 F 0 0 0 0.0 A 8.2 PASS Litchfield 11 0 0 3.7 F 0 0 0 0.0 A 5.3 PASS Middlesex 29 5 0 12.2 F DNC DNC DNC DNC DNC DNC DNC New Haven 34 10 0 16.3 F 3 0 0 1.0 C 8.5 PASS New London 14 7 0 8.2 F 1 0 0 0.3 B INC INC Tolland 33 2 0 12.0 F DNC DNC DNC DNC DNC DNC DNC Windham 13 0 0 4.3 F DNC DNC DNC DNC DNC DNC DNC 64 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S DELAWARE American Lung Association in Delaware www.lung.org/delaware AT-RISK GROUPS Lung Diseases County Total Population Under 18 Kent 171,987 40,517 26,765 New Castle 552,778 122,577 76,043 11,295 37,443 26,774 36,253 44,611 65,642 Sussex 210,849 41,153 51,099 Totals 935,614 65 204,247 LUNG.org 65 & Over 153,907 Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 3,734 11,438 8,417 11,702 14,114 23,484 3,792 14,918 12,555 19,395 22,006 28,907 18,821 63,799 47,746 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 67,351 80,731 118,033 S TAT E TA B L E S DELAWARE American Lung Association in Delaware www.lung.org/delaware HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Kent 18 4 0 8.0 New Castle 28 2 0 Sussex 19 4 0 66 LUNG.org Annual Wgt. Avg. Grade Design Value Pass/ Fail PASS F 0 0 0 0.0 A 8.2 10.3 F 7 1 0 2.8 D 9.9 PASS 8.3 F 0 0 0 0.0 A 8.4 PASS AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S DISTRICT OF COLUMBIA American Lung Association in the District of Columbia www.lung.org/districtofcolumbia AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty District of Columbia 658,893 115,305 74,754 16,788 63,688 30,022 33,768 43,525 114,790 Totals 67 658,893 115,305 LUNG.org 74,754 16,788 63,688 30,022 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 33,768 43,525 114,790 S TAT E TA B L E S DISTRICT OF COLUMBIA American Lung Association in the District of Columbia www.lung.org/districtofcolumbia HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple District of Columbia 68 27 4 LUNG.org 0 Wgt. Avg. Grade Orange Red Purple 11.0 F 3 0 Annual Wgt. Avg. Grade 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 1.0 C Design Value Pass/ Fail 9.4 PASS S TAT E TA B L E S FLORIDA American Lung Association in Florida www.lung.org/florida AT-RISK GROUPS Lung Diseases County Total Population Under 18 Alachua 256,380 46,309 31,958 Baker Bay Brevard Broward 27,093 6,716 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 4,267 16,877 13,659 16,546 18,450 52,756 3,497 619 178,985 38,603 28,888 1,669 1,464 1,820 2,065 4,826 3,557 11,429 10,491 13,384 15,066 27,165 556,885 104,014 125,991 9,585 36,681 37,427 50,085 55,920 79,657 1,869,235 402,472 286,752 37,088 119,739 108,635 137,585 155,369 268,418 Citrus 139,377 20,948 49,065 1,930 9,326 11,064 15,828 17,270 27,449 Collier 348,777 63,659 102,403 5,866 22,492 24,774 34,598 37,790 49,211 Columbia 67,857 14,787 11,709 1,363 4,311 4,037 Duval 897,698 205,398 114,661 Escambia 310,659 64,735 48,842 5,965 19,917 17,867 22,639 25,378 44,320 Flagler 102,408 1,708 Highlands Hillsborough Holmes 18,533 29,082 98,236 17,496 33,219 Lake 315,690 Lee 679,513 127,041 178,665 Leon 283,988 54,106 32,296 62,516 82,193 7,333 28,166 82,373 71,393 19,650 3,993 3,717 144,755 25,388 43,484 6,679 60,139 68,086 159,748 10,176 11,194 11,775 1,612 6,295 7,337 10,494 11,368 18,898 1,316,298 305,655 172,861 Indian River Liberty 18,927 56,518 48,691 5,206 5,843 13,604 88,554 100,056 217,968 368 1,267 1,212 1,580 1,766 4,743 2,340 9,466 10,586 14,815 16,245 21,098 5,761 20,146 21,390 11,707 43,970 46,612 29,356 32,284 42,954 63,928 70,317 107,493 4,986 18,514 14,737 17,656 19,754 62,734 8,360 1,590 989 147 554 464 563 640 1,544 Manatee 351,746 68,467 89,663 6,309 22,639 23,918 32,684 36,071 49,017 Marion 339,167 63,759 94,731 5,875 21,833 23,707 32,858 36,026 58,576 Martin 153,392 25,790 45,010 2,377 10,168 11,270 15,684 17,262 18,091 2,662,874 548,396 404,884 50,535 171,887 153,512 193,583 217,844 535,148 196,512 43,605 29,615 4,018 12,409 11,084 13,996 15,723 23,680 Miami-Dade Okaloosa Orange Osceola Palm Beach 1,253,001 284,693 134,966 310,211 77,709 39,510 1,397,710 272,643 317,620 26,235 78,952 64,646 77,830 88,231 222,654 7,161 18,907 16,270 20,146 22,715 59,222 25,124 90,158 90,854 121,795 134,806 204,862 Pasco 485,331 99,359 109,019 Pinellas 938,098 160,063 215,386 14,750 62,964 64,014 85,590 95,502 139,881 Polk 634,638 13,351 50,100 St. Lucie 291,028 60,468 65,644 5,572 18,511 18,784 25,220 27,955 49,752 Santa Rosa 163,422 36,937 23,775 3,404 10,356 9,333 11,758 13,320 17,564 Sarasota 396,962 59,426 134,638 5,476 26,591 30,908 43,939 47,951 42,343 Seminole 442,516 94,876 63,493 8,743 28,426 25,318 31,749 35,943 51,782 Volusia 507,531 91,546 117,965 8,436 33,506 34,135 45,809 50,910 87,670 Wakulla Totals 69 144,887 123,821 9,156 31,013 31,407 42,114 46,714 70,125 39,361 38,061 55,636 112,539 31,432 6,549 4,139 603 2,046 1,794 2,223 2,533 4,185 18,177,415 3,723,132 3,394,151 343,087 1,167,953 1,108,186 1,442,029 1,610,005 2,963,452 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S FLORIDA American Lung Association in Florida www.lung.org/florida HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Alachua 0 0 Baker 0 0 0 Bay 1 0 0 0.3 Brevard 1 0 Broward 2 0 Citrus 0 0.0 A Annual Wgt. Avg. Grade Design Value Pass/ Fail INC INC INC INC INC INC INC A DNC DNC B DNC DNC DNC DNC DNC DNC DNC 0 0.3 B INC INC INC INC INC INC INC 0 0.7 B INC INC INC INC INC INC INC 0.0 DNC DNC DNC DNC INC INC INC INC INC INC INC Collier 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Columbia 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Duval 4 0 0 1.3 C INC INC INC INC INC INC INC Escambia 9 0 0 3.0 D INC INC INC INC INC INC INC Flagler 2 0 0 B DNC DNC Highlands 0 0 0 0.0 A DNC DNC DNC DNC DNC Hillsborough DNC DNC DNC DNC DNC DNC DNC DNC 0 F INC A DNC DNC DNC DNC DNC DNC DNC Indian River 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Lake 4 0 0 C DNC DNC Lee 0 0 0 0.0 A INC INC INC INC INC INC INC Leon 0 0 0 0.0 A INC INC INC INC INC INC INC Liberty 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Manatee 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC DNC DNC DNC DNC DNC DNC DNC Miami-Dade 3 0 0 1.0 C INC INC INC INC INC INC INC Okaloosa 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Orange 8 0 0 2.7 D INC INC INC INC INC INC INC Osceola 1 0 0.3 DNC DNC DNC DNC DNC DNC DNC Palm Beach 5 0 0 1.7 C INC INC INC INC INC INC INC Pasco 2 0 0.7 DNC DNC DNC DNC DNC DNC DNC 0 A INC INC 0 0 0.0 DNC INC INC Martin 0 DNC INC DNC 0 0.0 DNC INC DNC 0 DNC INC DNC 0 1.3 INC DNC 0 0 6.0 DNC Holmes Marion 18 0.7 B B Pinellas 5 0 0 1.7 C INC INC INC INC INC INC INC Polk 5 0 INC INC St. Lucie 1 2.2 D INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC Sarasota 8 0 0 2.7 D INC INC INC INC INC INC INC Seminole 4 0 0 1.3 C INC INC INC INC INC INC INC Volusia 2 0 0 0.7 B INC INC INC INC INC INC INC Wakulla 0 0 DNC DNC LUNG.org 0.0 C INC 4 0 0 1.3 INC Santa Rosa 70 0 INC A DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 DNC DNC S TAT E TA B L E S GEORGIA American Lung Association in Georgia www.lung.org/georgia AT-RISK GROUPS Lung Diseases County Total Population Under 18 Bibb 153,905 38,774 21,564 3,947 9,548 8,737 10,644 13,851 41,742 Chatham 283,379 62,857 38,523 6,399 18,215 16,102 19,112 24,829 48,234 Chattooga 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 24,939 5,635 4,104 574 1,607 1,522 1,910 2,469 4,944 Clarke 120,938 21,305 11,757 2,169 8,119 6,284 6,580 8,590 41,889 Clayton 267,542 75,592 22,170 Cobb 730,981 179,960 77,367 18,319 45,524 39,797 46,155 61,362 93,604 Columbia 139,257 36,153 16,415 3,680 8,538 7,652 9,095 12,004 13,098 Coweta 135,571 34,838 16,818 3,546 8,356 7,599 9,145 12,053 16,804 Dawson DeKalb Dougherty Douglas 7,695 15,801 13,302 14,846 19,932 60,123 22,957 5,005 4,116 509 1,500 1,465 1,880 2,427 2,671 722,161 171,308 74,744 17,438 45,416 39,008 44,607 59,228 144,818 92,407 22,999 12,527 2,341 5,746 5,174 6,227 8,103 28,119 138,776 37,351 14,287 3,802 8,386 7,376 8,590 11,435 19,423 Floyd 96,063 22,550 15,039 2,295 6,106 5,687 7,050 9,113 19,408 Fulton 996,319 231,063 103,948 23,521 63,043 53,816 61,287 81,222 168,027 Glynn 82,175 18,979 14,543 75,362 24,873 52,254 44,707 6,511 8,375 15,666 Gwinnett 877,922 Hall 190,761 50,615 25,990 5,152 11,615 10,570 12,827 16,684 31,582 Henry 213,869 57,870 22,345 5,891 12,909 11,433 13,390 17,828 29,088 Houston 149,111 38,294 17,495 3,898 9,166 8,135 9,606 12,655 25,310 Lowndes 113,523 28,190 12,509 2,870 7,009 5,872 6,636 8,666 26,225 Murray 244,347 1,932 5,271 5,098 50,566 67,987 116,888 39,410 9,962 5,223 1,014 2,443 2,233 2,706 3,545 7,283 Muscogee 200,887 48,785 24,158 4,966 12,547 10,914 12,729 16,655 42,237 Paulding 148,987 41,478 14,082 4,222 8,875 7,685 Pike Richmond 17,784 4,431 2,593 451 201,368 47,758 25,278 87,754 Sumter 31,232 7,485 4,632 Walker 68,218 Washington 20,635 4,599 3,308 Totals 71 15,469 1,048 8,817 11,778 15,777 1,302 1,702 2,405 4,862 12,693 11,214 13,244 17,336 49,562 Rockdale Wilkinson 22,500 1,112 11,192 2,290 11,334 5,420 4,983 6,047 7,969 14,983 762 1,969 1,801 2,202 2,849 9,996 1,575 4,395 4,194 5,289 6,843 13,348 468 1,336 1,267 1,588 2,063 5,734 9,326 2,115 1,668 215 603 591 761 982 2,130 6,378,157 1,588,267 705,091 161,678 395,520 345,270 401,350 530,536 1,111,118 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S GEORGIA American Lung Association in Georgia www.lung.org/georgia HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Pass/ Fail Bibb 6 0 0 2.0 C Chatham 0 0 0 0.0 A Chattooga 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Clarke 4 0 0 1.3 C 0 0 0 0.0 A 9.8 PASS 0 0 0 0.0 A 10.3 PASS 0 0 0 0.0 A Clayton DNC DNC DNC DNC DNC 9.3 PASS 1 0 3 1 0 1.5 C DNC DNC DNC DNC DNC DNC DNC Coweta 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC Dawson 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC 3 0 F DeKalb Dougherty Douglas Floyd Fulton 12 14 6.2 F 1 0 0 0.3 B 10.9 PASS Columbia Cobb 4.5 1 0 0 0.3 B Design Value DNC DNC DNC DNC DNC 9 0 0 3.0 D DNC DNC DNC DNC 21 5 0 9.5 10.0 PASS 0 0 0 0.0 A 9.9 8 0 0 2.7 D INC INC DNC DNC DNC DNC DNC PASS DNC DNC DNC 0 0 0 0.0 A 10.3 PASS F 0 0 0 0.0 A INC INC Glynn 0 0 0 0.0 A 0 0 0 0.0 A INC INC Gwinnett 8 1 9.5 Hall Henry 1 0 3.2 D DNC DNC DNC DNC DNC 13 1 6 8.0 F 0 DNC 0 0 DNC 0 0.3 0 DNC 0.0 DNC B A DNC PASS 8.9 PASS DNC DNC Houston DNC DNC DNC DNC DNC 0 0 0 0.0 A 9.2 PASS Lowndes DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.7 PASS Murray 3 Muscogee 1 0 0 0.3 B 1 0 0 0.3 B 10.2 PASS Paulding 5 0 0 1.7 C 0 0 0 0.0 A 8.7 PASS Pike 8 Richmond Rockdale Sumter 0 0 1.0 0 1 3.2 C D 4 0 0 1.3 C 24 0 2 0 0 0 0.0 DNC DNC DNC DNC DNC DNC LUNG.org DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC Wilkinson DNC DNC A Washington DNC DNC DNC DNC DNC DNC DNC DNC F Walker 72 DNC 9.0 DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 10.0 PASS DNC DNC DNC DNC 0 0 0 0.0 0 0 0 0.0 A 9.7 PASS 1 0 0 0.3 B 10.6 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 A DNC DNC 10.3 PASS PASS S TAT E TA B L E S HAWAII American Lung Association in Hawaii www.lung.org/hawaii AT-RISK GROUPS Lung Diseases County Total Population Under 18 Hawaii 194,190 42,750 34,035 Honolulu 991,788 213,585 157,132 34,203 72,556 28,878 53,700 73,295 93,994 Kauai Maui Totals 73 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 6,846 14,062 6,079 11,575 15,624 34,598 70,475 15,722 12,279 2,518 5,084 2,195 4,179 5,642 8,570 163,019 36,387 24,682 1,419,472 308,444 LUNG.org 228,128 5,827 11,753 4,835 49,394 103,455 41,988 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 9,126 12,525 21,103 78,579 107,086 158,265 S TAT E TA B L E S HAWAII American Lung Association in Hawaii www.lung.org/hawaii HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Hawaii Honolulu Wgt. Avg. Grade Orange Red Purple DNC DNC DNC DNC DNC 2 0 1.7 C Design Value Pass/ Fail 12.1 FAIL 0 0 0 0.0 A 5.6 PASS Kauai DNC DNC DNC DNC DNC 0 0 0 0.0 A 5.1 PASS Maui DNC DNC DNC DNC DNC 1 0 0 0.3 B 5.4 PASS 74 0 0 0 0.0 A 2 Annual Wgt. Avg. Grade LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S IDAHO American Lung Association in Idaho www.lung.org/idaho AT-RISK GROUPS Lung Diseases County Total Population Under 18 Ada 426,236 107,136 53,556 Bannock Benewah Butte Franklin Lemhi Shoshone Totals 75 83,347 22,305 65 & Over Pediatric Asthma 10,653 9,118 2,025 1,933 Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 9,873 27,713 15,300 22,046 22,955 48,083 2,055 5,314 2,914 187 610 410 4,243 4,329 14,116 659 655 1,418 2,622 670 513 62 168 111 177 176 385 13,021 4,426 1,772 408 746 436 659 663 1,393 7,726 1,408 2,111 12,390 2,446 2,692 554,460 140,416 LUNG.org 73,230 130 543 394 225 856 573 12,939 35,951 20,137 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 666 639 1,392 919 914 2,310 29,370 30,331 69,097 S TAT E TA B L E S IDAHO American Lung Association in Idaho www.lung.org/idaho HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Wgt. Avg. Grade Ada 10 1 0 3.8 Bannock DNC DNC DNC DNC Benewah DNC DNC DNC DNC DNC Butte Franklin F DNC DNC DNC DNC DNC DNC 1 2 0 1.3 C Design Value Pass/ Fail DNC DNC 7.9 PASS INC INC INC INC INC INC INC A DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 DNC DNC DNC DNC DNC 23 11 0 13.2 F INC INC Lemhi DNC DNC DNC DNC DNC 42 23 10 32.2 F 12.1 FAIL Shoshone DNC DNC DNC DNC DNC 35 2 0 12.7 F 13.1 FAIL 76 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S ILLINOIS American Lung Association in Illinois www.lung.org/illinois AT-RISK GROUPS Lung Diseases County Adams Champaign Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 66,988 15,096 12,538 1,258 4,729 3,293 4,707 5,922 9,185 207,133 39,683 22,918 3,308 15,234 8,350 10,618 13,701 43,210 Clark 16,180 3,688 3,020 307 1,140 801 1,146 1,445 2,213 Cook 5,246,456 1,185,994 679,385 98,865 371,006 225,921 301,824 388,591 883,001 DuPage Effingham Hamilton 932,708 218,703 125,530 18,231 65,508 41,875 56,888 73,557 72,895 34,320 8,117 5,776 677 8,296 1,851 1,678 2,394 1,628 2,293 154 587 423 2,911 3,987 614 770 1,149 Jersey 22,571 4,867 3,977 406 1,618 1,113 1,574 1,998 2,505 Jo Daviess 22,254 4,302 5,469 359 1,633 1,261 1,881 2,335 2,352 Kane 527,306 142,661 61,903 11,892 35,270 21,752 29,050 37,703 55,787 Lake 705,186 McHenry 307,283 76,740 37,263 6,397 21,226 13,513 18,200 23,768 20,905 McLean 174,061 38,428 19,922 3,203 12,378 7,131 9,269 11,989 23,326 Macon 108,350 24,223 19,387 2,019 7,674 5,266 7,466 9,432 17,003 Macoupin 179,315 86,045 14,948 46,453 10,010 8,701 48,311 30,391 40,855 53,138 64,993 834 3,328 2,336 3,338 4,217 5,868 Madison 266,560 59,304 41,772 4,944 18,950 12,469 17,282 22,065 34,436 Peoria 187,319 44,655 28,149 3,722 13,021 8,387 11,545 14,711 30,408 Randolph 32,869 6,411 5,668 Rock Island 146,063 St. Clair 265,729 64,091 36,748 5,343 18,467 11,816 16,111 20,734 49,691 Sangamon 198,997 45,734 30,926 3,812 14,025 9,283 12,883 16,469 29,897 Will 685,419 182,746 76,430 15,234 46,168 28,279 37,510 48,960 54,720 Winnebago Totals 77 32,330 25,751 534 2,416 1,618 2,265 2,877 3,949 288,542 68,785 45,114 10,497,043 2,457,734 LUNG.org 1,384,070 2,695 10,373 7,053 9,963 12,594 23,015 5,734 20,096 13,334 18,549 23,664 47,864 204,878 735,554 457,291 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 615,830 793,549 1,482,359 S TAT E TA B L E S ILLINOIS American Lung Association in Illinois www.lung.org/illinois HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Adams 4 1 Wgt. Avg. Grade Orange Red Purple 0 1.8 C Annual Wgt. Avg. Grade DNC DNC DNC DNC DNC Design Value Pass/ Fail DNC DNC Champaign 9 0 0 3.0 D INC INC INC INC INC INC INC Clark 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC Cook 42 10 0 19.0 F INC INC INC INC INC INC INC DuPage 10 0 0 3.3 F INC INC INC INC INC INC INC Effingham 8 1 0 3.2 D DNC DNC DNC DNC DNC DNC DNC Hamilton 22 3 0 8.8 F INC INC INC INC INC INC INC Jersey 24 5 1 11.2 F INC INC INC INC INC INC INC Jo Daviess 12 0 0 4.0 F DNC DNC DNC DNC DNC DNC DNC Kane 7 2 0 3.3 F INC INC INC INC INC INC INC Lake 32 8 0 14.7 F DNC DNC DNC DNC DNC DNC DNC McHenry 12 1 0 4.5 F INC INC INC INC INC INC INC McLean 18 0 0 6.0 F INC INC INC INC INC INC INC Macon 10 0 0 3.3 F INC INC INC INC INC INC INC Macoupin 11 0 0 3.7 F DNC DNC DNC DNC DNC DNC DNC Madison 47 7 0 19.2 F INC INC INC INC INC INC INC Peoria 21 0 0 7.0 F INC INC INC INC INC INC INC Randolph 26 2 0 9.7 F INC INC INC INC INC INC INC 1 0 0 0.3 B INC INC INC INC INC INC INC St. Clair 30 3 0 11.5 F INC INC INC INC INC INC INC Sangamon 13 0 0 4.3 F INC INC INC INC INC INC INC Rock Island Will 4 0 0 1.3 C INC INC INC INC INC INC INC Winnebago 8 0 0 2.7 D INC INC INC INC INC INC INC 78 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S INDIANA American Lung Association in Indiana www.lung.org/indiana AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Allen 365,918 96,233 47,894 Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 7,679 29,031 23,294 24,261 28,220 54,597 Bartholomew 80,217 19,474 11,958 1,554 6,523 5,362 5,715 6,563 9,338 Boone 61,915 16,736 7,805 1,335 4,855 3,999 4,156 4,864 4,409 Brown 14,962 2,917 3,159 233 1,275 1,215 1,389 1,551 1,908 Carroll 19,923 4,629 3,528 369 1,631 1,445 1,602 1,810 2,137 Clark 114,262 Delaware 117,074 22,177 18,704 Dubois Elkhart 26,320 16,338 42,345 10,191 6,748 2,100 9,451 7,718 1,770 10,226 8,019 8,126 9,407 11,945 8,511 9,723 23,985 813 3,437 2,979 3,232 3,696 3,312 201,971 56,403 26,951 4,501 15,655 12,676 13,325 15,419 27,469 Floyd 76,179 17,644 11,056 1,408 6,277 5,265 5,577 6,456 8,644 Greene 32,726 7,397 5,888 Hamilton 302,623 86,169 31,564 590 2,700 2,399 2,664 3,008 4,989 6,876 23,370 18,284 18,307 21,823 14,813 Hancock 71,978 17,371 10,896 1,386 5,847 4,978 5,338 6,140 4,907 Hendricks 156,056 40,484 19,237 3,230 12,448 9,965 10,248 12,027 9,634 Henry 48,995 10,220 8,811 815 4,140 3,610 3,985 4,505 7,012 Howard 82,982 19,077 14,968 Huntington 36,706 8,208 5,829 655 3,052 2,584 2,783 3,188 3,768 Jackson 43,705 10,596 6,669 846 3,550 2,971 3,188 3,655 6,379 Johnson Knox 147,538 37,522 20,426 37,938 8,060 6,337 Lake 490,228 119,843 71,483 LaPorte 111,444 24,502 17,586 Madison 130,069 28,692 22,039 Marion 934,243 232,996 105,443 Monroe 143,339 23,103 16,311 1,522 6,817 5,992 6,663 7,502 13,655 2,994 11,829 9,603 10,103 11,689 14,711 643 3,203 2,668 2,893 3,289 6,141 9,563 39,744 33,026 1,955 9,316 7,854 35,100 40,472 85,233 8,439 9,676 18,671 2,289 10,850 9,224 10,069 11,429 20,564 18,592 75,854 57,704 1,843 13,116 8,871 57,825 68,523 194,803 8,537 10,173 30,812 Montgomery 38,146 8,902 6,346 Morgan 69,693 16,441 10,505 1,312 5,698 4,903 5,251 6,056 7,917 Perry 19,454 4,062 3,236 Porter Posey St. Joseph 167,076 38,145 23,991 25,540 5,829 4,128 267,618 64,271 38,315 710 3,127 2,685 2,931 3,332 4,544 324 1,648 1,399 1,516 1,729 2,754 3,044 13,842 11,455 12,082 14,000 16,369 465 2,105 1,847 2,005 2,297 2,703 5,128 21,864 17,733 18,710 21,598 44,228 Shelby 44,579 10,285 6,935 821 3,669 3,149 3,389 3,893 5,142 Spencer 20,801 4,692 3,749 374 1,716 1,539 1,711 1,933 1,908 Tippecanoe 183,074 38,034 18,929 3,035 15,819 10,768 10,303 12,347 37,311 Vanderburgh 182,006 39,960 27,655 3,189 15,256 12,513 13,306 15,302 30,984 Vigo 108,175 22,432 15,738 1,790 9,243 7,261 79 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 7,594 8,773 19,910 S TAT E TA B L E S INDIANA (cont.) American Lung Association in Indiana www.lung.org/indiana AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Wabash 32,252 6,979 6,264 Warrick 61,149 Whitley 33,403 7,811 5,358 Totals 80 5,118,302 15,071 9,857 Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 557 2,693 2,381 2,682 2,994 4,621 1,203 4,925 4,264 4,645 5,296 4,926 623 2,736 2,368 2,568 2,937 3,088 1,229,878 698,634 98,137 418,536 335,968 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 350,730 407,297 770,241 S TAT E TA B L E S INDIANA American Lung Association in Indiana www.lung.org/indiana HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Allen 5.2 Bartholomew Boone Brown 14 1 0 F INC INC INC INC INC 19 1 0 6.8 F INC INC INC INC INC Carroll 10 1 0 3.8 F Clark 17 3 0 7.2 F Delaware Dubois 8 0 0 2.7 D DNC DNC DNC DNC DNC 7 0 Annual Wgt. Avg. Grade 0 2.3 D Design Value Pass/ Fail 10.0 PASS INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0.7 B 9.5 PASS 1 0 0 0.3 B 10.0 PASS 0 0 0 0.0 A 10.9 PASS F 10.5 PASS 8 0 1 3.3 F 16 0 0 5.3 Floyd 23 4 0 9.7 F 0 0 0 0.0 A 10.4 PASS Greene 18 1 0 6.5 F 1 0 0 0.3 B 9.9 PASS Hamilton 13 0 0 4.3 F INC INC INC INC INC INC INC Hancock 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Hendricks 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Elkhart Henry DNC DNC DNC DNC DNC Howard DNC DNC DNC DNC DNC 1 0 0 0.3 B 9.5 PASS INC INC INC INC INC INC INC Huntington 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Jackson 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Johnson 9 0 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC Knox 25 0 0 Lake 16 3 LaPorte 23 3 Madison 9 20 Marion 8.3 F DNC DNC DNC DNC 0 6.8 F 9 1 0 3.5 F 11.5 PASS 3 11.2 F 2 0 0 0.7 B 9.6 PASS 1 0 3.5 F 3 0 0 1.0 C 9.8 PASS 2 0 7.7 F 11 0 0 3.7 F 11.8 PASS 0 1 0 0.5 B Monroe DNC DNC DNC DNC DNC Montgomery DNC DNC DNC DNC DNC Morgan 5 Perry 20 Porter 12 Posey 2 9.6 PASS INC INC INC INC INC INC INC 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC 2 0 7.7 F DNC DNC DNC DNC DNC DNC DNC 5.7 1 2 0 1.3 C 10.3 PASS 2 1 0 0 0.7 B F DNC DNC DNC DNC DNC DNC DNC St. Joseph 17 1 1 6.8 F 6 1 0 2.5 D 9.9 PASS Shelby 16 2 0 6.3 F DNC DNC DNC DNC DNC DNC DNC Spencer DNC DNC DNC DNC DNC 0 0 0 0.0 A 10.5 PASS Tippecanoe DNC DNC DNC DNC DNC 2 0 0 0.7 B 10.0 PASS 0 0 0 0.0 A 10.9 Vanderburgh 81 27 2 LUNG.org 0 10.0 F AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 PASS S TAT E TA B L E S INDIANA (cont.) American Lung Association in Indiana www.lung.org/indiana HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Vigo 11 Annual Wgt. Avg. Grade Design Value Pass/ Fail 0 0 3.7 F 2 0 0 0.7 B 10.6 PASS Wabash 27 1 0 9.5 F DNC DNC DNC DNC DNC DNC DNC Warrick 24 2 0 9.0 F DNC DNC DNC DNC DNC DNC DNC Whitley 82 DNC DNC DNC DNC DNC LUNG.org 4 0 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 1.3 C 9.4 PASS S TAT E TA B L E S IOWA American Lung Association in Iowa www.lung.org/iowa AT-RISK GROUPS Lung Diseases County Total Population Under 18 Black Hawk 132,897 28,512 65 & Over Pediatric Asthma 19,713 1,641 Adult Asthma COPD 8,982 Cardiovascular Disease 5,621 7,969 Diabetes Poverty 9,148 18,419 Bremer 24,721 5,399 4,549 311 1,637 1,134 1,686 1,886 1,734 Clinton 48,051 10,893 8,814 627 3,138 2,263 3,368 3,793 6,050 Delaware 17,398 4,147 3,143 239 1,118 821 1,221 1,380 1,532 Harrison 14,324 3,232 2,738 186 933 691 1,037 1,164 1,540 Johnson Lee Linn 142,287 28,963 14,122 35,286 7,610 6,576 217,751 51,848 31,170 Montgomery 10,421 2,360 2,168 Muscatine 42,903 Palo Alto Polk Pottawattamie Scott Story Van Buren Warren Woodbury Totals 83 10,918 6,448 9,099 2,003 1,950 1,667 9,969 5,251 438 2,337 1,687 2,512 2,828 5,991 2,984 14,252 9,192 13,026 15,049 19,779 136 674 515 628 115,937 53,725 6,673 93,128 22,069 14,601 171,387 41,239 24,642 7,468 1,737 1,551 47,956 12,078 7,126 102,271 26,633 14,114 1,671,283 391,711 LUNG.org 227,208 2,733 1,837 115 593 447 459,862 94,073 16,133 10,058 6,801 8,172 21,391 29,850 17,991 1,270 6,065 4,106 2,374 11,169 7,289 929 6,858 3,524 100 479 367 788 874 1,961 2,643 3,035 4,799 688 757 1,001 24,540 28,982 58,971 5,930 6,793 11,120 10,348 11,962 20,437 4,581 5,452 16,276 561 622 1,063 695 3,069 2,053 2,945 3,388 2,925 1,533 6,501 4,174 22,547 110,356 68,964 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 5,907 6,827 15,151 96,549 112,112 210,140 S TAT E TA B L E S IOWA American Lung Association in Iowa www.lung.org/iowa HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Black Hawk Bremer Clinton Delaware Harrison DNC DNC 2 12 DNC Wgt. Avg. Grade Orange Red Purple DNC DNC 0 0 0.7 B 0 0 F 4.0 DNC DNC DNC DNC DNC 13 0 0 4.3 F 0 0 Annual Wgt. Avg. Grade 0 0.0 A DNC DNC DNC DNC DNC Design Value Pass/ Fail 9.5 PASS DNC DNC 2 0 0 0.7 B 10.6 0 0 0 0.0 A 9.0 PASS DNC DNC DNC DNC DNC DNC PASS DNC Johnson DNC DNC DNC DNC DNC 1 0 0 0.3 B 9.2 PASS Lee DNC DNC DNC DNC DNC 0 0 0 0.0 A 10.8 PASS Linn 4 0 0 1.3 C 2 0 0 0.7 B 9.5 PASS Montgomery 6 0 0 2.0 C 1 0 0 0.3 B 8.3 PASS 13 11.1 Muscatine DNC DNC DNC DNC DNC Palo Alto 3 0 0 1.0 C Polk 0 0 0 0.0 Pottawattamie 0 0.0 8.9 PASS DNC 1 0 0 0.3 B 9.8 PASS C 3 0 0 1.0 C 10.3 PASS DNC DNC 0 0 2.0 Story 0 0 0 0.0 A 0 0 F 0 0 0.7 Woodbury 84 2 B DNC DNC DNC DNC DNC LUNG.org PASS 0 DNC Warren F 0 6 3.3 4.8 A DNC 10 0 8.2 PASS Scott Van Buren 1 1 0 0 0.3 B A DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC 3 0 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 1.0 C DNC DNC 8.4 PASS DNC DNC 9.1 PASS S TAT E TA B L E S K ANSAS American Lung Association in Kansas www.lung.org/kansas AT-RISK GROUPS Lung Diseases County Total Population Under 18 Johnson 574,272 145,456 72,681 12,249 37,515 27,785 34,615 42,948 37,315 Leavenworth Linn 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 78,797 19,148 9,969 1,612 5,219 3,840 4,774 5,931 7,856 9,502 2,217 1,982 187 634 561 754 883 1,388 Neosho 16,416 4,073 3,015 Riley 75,194 13,237 5,964 1,115 5,398 2,808 3,198 4,143 13,379 Sedgwick 508,803 Shawnee 178,406 43,345 28,688 Sumner Trego Wyandotte Totals 85 134,715 65,082 343 1,075 900 1,190 1,410 2,804 11,344 32,694 24,066 30,127 37,183 73,532 3,650 11,784 9,396 12,139 14,646 26,058 23,528 5,858 4,025 493 1,542 1,284 1,676 2,010 3,064 2,902 523 701 44 207 191 260 302 279 161,636 45,817 18,169 3,858 10,130 7,191 8,859 11,064 39,074 1,629,456 414,389 210,276 34,896 106,198 78,021 97,592 120,520 204,749 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S K ANSAS American Lung Association in Kansas www.lung.org/kansas HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Johnson Leavenworth Annual Wgt. Avg. Grade Design Value Pass/ Fail 18 3 0 7.5 F 0 0 0 0.0 A 7.9 PASS 29 2 0 10.7 F DNC DNC DNC DNC DNC DNC DNC Linn INC INC INC INC INC INC INC INC INC INC INC INC Neosho INC INC INC INC INC INC INC INC INC INC INC INC Riley INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Sedgwick 33 2 0 12.0 F 1 0 0 0.3 B 9.5 PASS Shawnee 21 0 0 7.0 F 1 0 0 0.3 B 8.5 PASS Sumner 28 2 0 10.3 F 1 0 0 0.3 B 8.2 PASS Trego 13 0 0 4.3 F DNC DNC DNC DNC DNC DNC DNC Wyandotte 19 1 0 6.8 F 1 0 0 0.3 B 9.4 PASS 86 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S KENTUCKY American Lung Association in Kentucky www.lung.org/kentucky AT-RISK GROUPS Lung Diseases County Bell Boone Total Population Under 18 65 & Over Pediatric Asthma 27,778 5,990 4,793 126,413 34,547 14,148 Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 650 2,601 2,758 2,831 2,846 8,955 3,747 11,073 10,966 10,588 10,883 10,009 Boyd 48,832 10,376 8,736 1,125 4,588 4,913 5,077 5,095 10,705 Bullitt 77,955 Campbell 91,833 20,238 12,664 Carter 27,223 6,142 4,487 Christian 74,250 Daviess 98,275 23,849 15,726 Edmonson 12,013 2,330 2,315 Fayette Greenup Hancock Hardin Henderson Jefferson Jessamine Livingston 310,797 18,002 20,581 65,477 10,605 8,247 36,279 36,308 7,935 6,927 8,753 2,236 1,413 108,266 27,144 13,323 1,953 7,211 7,358 2,195 8,588 8,649 7,279 7,424 9,474 8,524 8,682 11,724 666 2,519 2,649 2,702 2,722 6,322 2,232 6,379 5,871 2,587 8,893 9,336 5,527 5,638 14,868 9,511 9,584 14,370 253 1,153 1,246 1,299 1,299 2,366 7,102 29,368 27,764 26,276 26,964 59,007 861 3,379 3,690 3,869 3,865 5,846 243 779 828 2,944 9,741 9,639 848 854 1,193 9,369 9,581 14,905 46,467 10,876 7,274 1,180 4,263 4,474 4,539 4,587 8,227 760,026 172,157 110,291 18,673 70,389 71,607 71,269 72,313 124,850 50,815 12,587 6,824 1,365 4,583 4,614 4,552 4,632 7,190 9,359 1,920 1,861 McCracken 65,316 Madison 87,340 18,415 11,120 Morgan 13,303 2,506 1,941 Oldham 63,490 16,661 7,458 1,807 5,663 5,752 5,619 5,775 3,211 Perry 27,597 5,929 4,257 Pike 63,034 13,208 10,044 1,433 5,973 6,257 6,333 6,408 16,796 Pulaski 63,825 14,462 11,304 1,569 5,889 6,324 6,548 6,567 16,338 Simpson 17,826 4,300 2,824 Trigg Warren Washington Totals 87 14,303 11,899 208 888 991 1,048 1,047 1,299 14,142 3,068 2,996 120,460 27,073 14,493 11,959 2,752 2,056 2,463,655 565,064 LUNG.org 346,305 1,551 6,081 6,553 1,997 8,235 7,901 6,807 6,818 11,214 7,588 7,745 15,947 272 1,295 1,309 1,294 1,317 3,489 643 2,600 2,714 2,735 2,772 7,401 466 1,618 1,699 1,729 1,744 2,610 333 1,316 1,488 1,595 1,584 2,218 2,937 11,164 10,622 10,127 10,360 20,900 299 1,100 1,177 1,214 1,220 2,284 61,291 227,330 229,148 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 226,696 230,328 413,718 S TAT E TA B L E S KENTUCKY American Lung Association in Kentucky www.lung.org/kentucky HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Pass/ Fail Bell 4 0 0 1.3 C Boone 8 Boyd 9 0 0 3.0 D Bullitt 7 1 0 2.8 D DNC DNC DNC DNC DNC DNC DNC 27 1 1 10.2 F 0 0 0 0.0 A 9.6 PASS Campbell Carter 0 0 2.7 D DNC DNC DNC DNC DNC 0 0 0 0.0 A 9.4 PASS DNC DNC 9.5 PASS 0 0 0 0.0 A 7.9 PASS Christian 13 0 0 4.3 F 0 0 0 0.0 A 9.9 PASS Daviess 20 4 0 8.7 F 0 0 0 0.0 A 10.7 PASS Edmonson 14 1 0 5.2 F DNC DNC DNC DNC DNC DNC DNC Fayette 17 1 0 6.2 F 0 0 0 0.0 A 9.5 PASS Greenup 10 1 0 3.8 F DNC DNC DNC DNC DNC DNC DNC Hancock 17 2 0 6.7 F DNC DNC DNC DNC DNC DNC DNC Hardin 5 0 0 1.7 C 0 0 0 0.0 A Design Value 0 0 0 0.0 A INC INC Henderson 24 4 0 10.0 F 0 0 0 0.0 A 10.6 PASS Jefferson 24 6 1 11.7 F 1 0 0 0.3 B 12.5 FAIL Jessamine 13 0 0 4.3 F DNC DNC DNC DNC DNC DNC DNC Livingston 22 4 0 9.3 F DNC DNC DNC DNC DNC DNC DNC McCracken 19 3 1 8.5 F 0 0 0 0.0 A INC INC 0 0 0 0.0 A 8.5 PASS Madison Morgan Oldham 5 2 0 2.7 D DNC DNC DNC DNC DNC 4 17 0 6 0 1.3 C DNC DNC DNC DNC DNC DNC DNC 1 F DNC DNC 9.3 DNC DNC DNC DNC 3 0 0 1.0 C Pike 2 0 0 0.7 B 4 0 0 1.3 C 8.5 PASS Pulaski 5 0 0 1.7 C 0 0 0 0.0 A 9.2 PASS 5 Simpson INC INC INC INC INC DNC Perry INC INC 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC Trigg 12 1 0 4.5 F DNC DNC DNC DNC DNC DNC DNC Warren 16 0 0 5.3 F 0 0 0 0.0 A INC INC Washington 13 0 0 4.3 F DNC DNC DNC DNC DNC DNC DNC 88 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S LOUISIANA American Lung Association in Louisiana www.lung.org/louisiana AT-RISK GROUPS Lung Diseases Parish Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty Ascension Parish 117,029 32,277 11,934 2,597 6,560 6,253 Bossier Parish 125,064 31,618 16,049 2,544 7,204 6,915 10,350 10,038 17,520 Caddo Parish 252,603 61,350 37,374 4,937 14,769 14,759 22,962 22,101 59,514 Calcasieu Parish 197,204 49,200 27,079 3,959 11,436 11,313 17,315 16,745 35,591 East Baton Rouge Parish 446,042 101,880 55,335 8,199 26,516 24,990 36,691 35,726 80,273 Iberville Parish 33,327 7,246 4,521 9,006 8,865 15,873 583 2,019 2,001 3,032 2,946 5,867 Jefferson Parish 435,716 95,369 65,680 7,675 26,316 26,467 41,146 39,668 68,333 Lafayette Parish 235,644 56,280 26,513 4,529 13,850 13,070 18,904 18,530 34,809 Lafourche Parish 98,020 23,119 13,444 1,860 5,793 5,745 Livingston Parish 135,751 35,732 15,788 2,876 7,732 7,448 10,985 10,729 16,499 Orleans Parish 384,320 78,503 46,513 6,318 23,614 22,398 32,626 31,923 103,855 Ouachita Parish 156,325 39,909 20,847 3,212 8,984 8,762 13,294 12,864 35,619 Pointe Coupee Parish 22,406 5,143 4,069 Rapides Parish 132,488 33,363 19,758 St. Bernard Parish 44,409 11,928 4,371 8,767 8,494 16,903 414 1,336 1,421 2,338 2,226 4,072 2,685 7,659 7,720 12,090 11,626 25,480 960 2,511 2,355 3,345 3,300 7,869 St. Charles Parish 52,745 13,409 6,095 1,079 3,054 3,030 4,501 4,411 6,272 St. James Parish 21,638 5,145 3,261 414 1,278 1,316 2,068 1,994 3,450 St. John the Baptist Parish 43,745 887 11,024 5,519 2,536 2,523 3,809 3,710 8,995 St. Tammany Parish 245,829 60,176 36,596 4,843 14,389 14,789 23,231 22,398 27,292 Tangipahoa Parish 127,049 31,553 16,299 2,539 7,372 7,142 10,710 10,400 27,726 Terrebonne Parish 113,328 28,974 14,292 2,332 6,525 6,407 West Baton Rouge Parish 25,085 6,038 3,017 Totals 89 3,445,767 819,236 LUNG.org 454,354 9,639 9,375 23,321 486 1,475 1,439 2,133 2,084 5,012 65,928 202,930 198,262 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 298,943 290,151 630,145 S TAT E TA B L E S LOUISIANA American Lung Association in Louisiana www.lung.org/louisiana HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Parish Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Design Value Pass/ Fail Ascension Parish 5 1 0 2.2 D DNC DNC DNC DNC DNC DNC DNC Bossier Parish 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC Caddo Parish 5 0 0 1.7 C Calcasieu Parish 1 1 0 0.8 B 10.9 PASS 11 0 0 3.7 F 0 0 0 0.0 A 7.9 PASS East Baton Rouge Parish 20 4 0 8.7 F 1 0 0 0.3 B 9.0 PASS Iberville Parish 17 0 0 5.7 F 0 0 0 0.0 A 9.1 PASS Jefferson Parish 12 0 0 4.0 F 0 0 0 0.0 A 8.2 PASS Lafayette Parish 5 0 0 1.7 C 0 0 0 0.0 A 8.2 PASS Lafourche Parish 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC 0 0 F DNC DNC 0 0 2.7 D Livingston Parish 14 4.7 Orleans Parish 8 Ouachita Parish 0 0 0 0.0 A Pointe Coupee Parish Rapides Parish 15 0 0 5.0 F DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC 8.3 PASS DNC DNC 0 0 0 0.0 A 7.8 PASS St. Bernard Parish 7 0 0 2.3 D 0 0 0 0.0 A 9.4 PASS St. Charles Parish 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC St. James Parish 2 1 0 1.2 C DNC DNC DNC DNC DNC DNC DNC St. John the Baptist Parish 13 0 0 4.3 F DNC DNC DNC DNC DNC DNC DNC St. Tammany Parish 1 0 4.5 F DNC DNC DNC DNC DNC DNC DNC 12 Tangipahoa Parish DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.0 PASS Terrebonne Parish DNC DNC DNC DNC DNC 0 0 0 0.0 A 7.4 PASS West Baton Rouge Parish 3 0 0 0 0.0 A 9.2 90 1 LUNG.org 0 1.5 C AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 PASS S TAT E TA B L E S MAINE American Lung Association in Maine www.lung.org/maine AT-RISK GROUPS Lung Diseases County Total Population Under 18 Androscoggin 107,440 23,671 17,178 Aroostook Cumberland Hancock Kennebec Knox Oxford Penobscot Sagadahoc Washington York Totals 91 69,447 13,004 65 & Over Pediatric Asthma 14,790 287,797 56,288 47,262 54,696 9,497 11,764 121,112 24,081 21,400 39,676 7,304 8,874 Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 2,273 9,775 6,287 7,592 7,589 16,125 1,249 5,870 6,466 4,592 5,720 13,603 5,405 27,018 17,377 20,961 20,968 30,257 912 5,179 3,679 2,312 11,248 7,537 4,695 4,581 6,886 9,253 9,207 16,257 701 3,697 2,662 3,441 3,333 5,315 57,238 11,215 11,075 1,077 5,293 3,713 4,649 4,595 9,083 153,414 28,694 25,384 35,045 6,820 6,845 31,808 6,027 7,002 2,755 14,575 9,269 11,172 11,155 26,330 655 3,249 2,261 2,838 2,796 3,642 579 2,945 2,120 2,733 2,652 5,725 200,710 39,871 36,134 3,829 18,617 12,585 15,516 15,414 22,134 1,158,383 226,472 207,708 21,747 108,061 72,081 88,720 88,009 155,357 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S MAINE American Lung Association in Maine www.lung.org/maine HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Androscoggin Wgt. Avg. Grade Orange Red Purple 0 0 0 0.0 A 0 0.0 A Design Value Pass/ Fail 0 0 0 0.0 A 7.3 PASS 0 6.0 1 0 0.5 B PASS Aroostook 0 Cumberland 9 0 0 3.0 D Hancock 4 Kennebec 1 0 0 0.3 B Knox 5 Oxford 0 0 0 0.0 A 0 0 0 0.0 A 8.0 PASS Penobscot 1 0 0 0.3 B 0 0 0 0.0 A 6.7 PASS Sagadahoc 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 0 0 F DNC DNC Washington York 92 14 0 Annual Wgt. Avg. Grade 0 0 LUNG.org 0 1.3 0 1.7 4.7 C C 0 0 0 0.0 A 8.0 PASS 0 4.4 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 DNC PASS 7.2 PASS DNC DNC DNC S TAT E TA B L E S MARYLAND American Lung Association in Maryland www.lung.org/maryland AT-RISK GROUPS Lung Diseases County Total Population Under 18 Anne Arundel 560,133 126,852 75,250 12,265 36,941 24,568 30,747 43,026 36,632 Baltimore 826,925 Calvert 178,621 65 & Over Pediatric Asthma 130,783 17,270 Adult Asthma COPD 54,881 Cardiovascular Disease 38,039 49,119 Diabetes 67,215 Poverty 78,935 90,613 21,926 11,783 2,120 5,758 4,039 5,083 7,198 6,441 Carroll 167,830 37,721 25,734 3,647 10,833 7,891 10,213 14,168 9,673 Cecil 102,383 24,177 14,091 2,338 6,584 4,581 5,805 8,133 10,751 Charles 154,747 38,481 17,031 3,721 9,952 6,414 7,776 11,166 11,000 Dorchester Frederick Garrett 32,578 6,962 6,425 673 2,107 1,644 2,236 2,989 5,608 243,675 58,275 31,475 5,634 15,728 10,606 13,252 18,673 15,670 29,679 5,864 5,936 567 1,960 1,525 2,071 2,771 3,610 Harford 250,105 57,435 36,443 5,553 16,203 11,377 14,551 20,227 19,664 Howard 309,284 75,985 37,694 7,347 19,854 13,178 16,298 23,113 18,818 Kent Montgomery 19,820 3,361 4,828 325 1,348 1,092 1,535 1,993 2,544 1,030,447 242,404 140,885 23,437 67,001 45,118 56,840 79,275 73,213 Prince George’s 904,430 205,170 101,306 19,837 60,569 37,444 44,981 64,254 91,060 Washington Baltimore City Totals 93 149,573 33,288 23,571 3,219 9,800 6,894 8,926 12,238 19,416 622,793 132,223 76,668 12,784 42,633 26,265 31,912 44,919 139,782 5,495,015 1,248,745 739,903 120,737 362,152 240,676 301,344 421,357 542,817 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S MARYLAND American Lung Association in Maryland www.lung.org/maryland HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Anne Arundel 16 6 0 8.3 F 0 0 Annual Wgt. Avg. Grade 0 0.0 A Design Value Pass/ Fail 9.5 PASS Baltimore 30 1 1 11.2 F 0 0 0 0.0 A 10.0 PASS Calvert 19 1 1 7.5 F DNC DNC DNC DNC DNC DNC DNC Carroll 11 1 0 4.2 F DNC DNC DNC DNC DNC DNC DNC Cecil 28 5 0 11.8 F 1 0 0 0.3 B 9.2 PASS Charles 13 3 0 5.8 F DNC DNC DNC DNC DNC DNC DNC Dorchester 16 3 1 7.5 F 0 0 0 0.0 A INC INC Frederick 14 1 0 5.2 F DNC DNC DNC DNC DNC DNC DNC Garrett 13 1 0 4.8 F 0 0 0 0.0 A 7.6 PASS 25 4 1 11.0 F 0 0 0 0.0 A 10.3 PASS Harford Howard Kent Montgomery DNC DNC DNC DNC DNC 22 7 0 10.8 F 0 0 0 0.0 A INC INC 9.3 PASS 0 0 0 0.0 A 9.1 PASS Prince George’s 27 6 0 12.0 F 0 0 0 0.0 A 9.5 PASS Washington 12 1 0 4.5 F 4 0 0 1.3 C 9.6 PASS 4 1 0 1.8 C 1 0 0 0.3 B 9.8 PASS Baltimore City 94 7 1 0 2.8 D INC INC INC INC INC LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S MASSACHUSETTS American Lung Association in Massachusetts www.lung.org/massachusetts AT-RISK GROUPS Lung Diseases County Total Population Under 18 Barnstable 214,914 34,240 59,848 3,341 21,154 14,428 19,775 22,296 18,801 Berkshire 128,715 2,254 Bristol 554,194 117,153 86,881 11,432 52,757 29,120 35,837 43,379 66,553 Dukes Essex Franklin 17,356 23,101 3,183 65 & Over 26,870 3,435 Pediatric Asthma 311 Adult Asthma COPD 12,589 1,695 Cardiovascular Disease 7,650 1,026 9,918 1,321 Diabetes 11,602 1,556 Poverty 16,037 1,544 769,091 169,071 119,878 16,498 72,422 40,267 49,668 60,078 80,526 70,862 12,919 12,896 1,261 6,960 4,090 5,174 6,168 8,397 Hampden 468,161 105,206 71,445 10,266 43,827 23,924 29,330 35,553 80,178 Hampshire 160,939 25,141 23,708 Middlesex 1,570,315 323,031 220,137 31,522 151,294 79,275 94,920 116,814 134,684 14,599 44,836 692,254 Plymouth 507,022 114,206 82,304 11,145 47,317 27,051 33,773 40,589 42,124 Suffolk 767,254 Totals 95 132,696 108,526 9,949 12,271 20,809 Norfolk Worcester 149,603 2,453 16,472 8,385 84,169 12,949 65,492 77,661 36,358 35,235 39,028 54,227 50,144 43,999 155,184 813,475 178,647 114,684 17,433 76,959 41,485 50,174 61,522 90,611 6,734,552 1,388,197 LUNG.org 1,014,781 135,465 646,599 348,294 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 423,702 516,200 759,447 S TAT E TA B L E S MASSACHUSETTS American Lung Association in Massachusetts www.lung.org/massachusetts HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Wgt. Avg. Grade Barnstable Design Value Pass/ Fail 10 1 0 3.8 F DNC DNC DNC DNC DNC DNC DNC 6 0 0 2.0 C 0 0 0 0.0 A 7.3 PASS Bristol 12 2 0 5.0 F 0 0 0 0.0 A 7.1 PASS Dukes 12 2 0 5.0 F DNC DNC DNC DNC DNC DNC DNC Essex 17 1 0 6.2 F 0 0 0 0.0 A 6.7 PASS Berkshire INC INC INC INC INC INC INC INC INC INC INC INC Hampden 14 0 0 4.7 F 0 0 0 0.0 A 7.8 PASS Hampshire 13 0 0 4.3 F DNC DNC DNC DNC DNC DNC DNC Franklin Middlesex Norfolk Plymouth 5 1 12 0 0 2.2 D INC INC INC INC INC INC INC 0 INC INC 4.0 F INC INC INC INC INC Suffolk 5 Worcester 5 1 0 2.2 D 96 0 LUNG.org 0 1.7 C INC INC INC INC INC 0 0 0 0.0 A INC INC 0 0 0 8.4 0.0 A 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 PASS 7.7 PASS S TAT E TA B L E S MICHIGAN American Lung Association in Michigan www.lung.org/michigan AT-RISK GROUPS Lung Diseases County Total Population Under 18 Allegan 113,847 28,295 17,159 2,896 9,320 7,737 8,730 8,998 12,851 Bay 106,179 22,273 19,434 2,280 9,055 7,753 9,084 9,255 17,614 Benzie Berrien 65 & Over Pediatric Asthma 17,519 3,365 4,181 155,233 34,868 27,670 Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 344 1,502 1,403 1,766 1,773 2,043 3,569 12,992 11,079 12,951 13,195 26,842 Cass 51,608 10,978 10,007 1,124 4,372 3,850 4,598 4,675 7,555 Chippewa 38,321 7,307 6,179 Clinton Genesee Huron 748 3,367 2,698 3,015 3,085 6,623 77,297 17,784 11,842 1,820 6,482 5,340 6,005 6,184 7,616 412,895 96,726 64,751 9,900 34,359 28,345 32,082 32,933 87,632 32,065 6,288 7,515 644 2,740 2,553 3,201 3,219 4,469 Ingham 284,582 57,947 33,936 5,931 24,848 17,969 18,378 18,999 53,518 Kalamazoo 258,818 57,108 34,948 5,845 22,004 16,662 17,809 18,296 47,221 Kent 629,237 158,240 76,985 16,197 51,649 39,548 41,924 43,480 94,696 Lenawee Macomb Manistee 99,047 21,685 16,604 2,220 8,384 6,996 860,112 188,185 133,954 19,262 73,143 60,025 8,019 8,204 13,651 67,470 69,411 104,347 24,420 4,345 5,708 445 2,138 1,973 2,455 2,472 3,822 Mason 28,824 5,960 6,099 610 2,445 2,200 2,687 2,715 4,637 Missaukee 15,037 357 3,487 2,876 1,242 1,095 1,311 1,332 2,389 Monroe 149,824 33,622 23,580 3,441 12,659 10,595 12,007 12,379 15,436 Muskegon 172,344 40,942 26,008 4,191 14,304 11,679 13,091 13,465 33,197 Oakland 1,237,868 273,302 186,302 27,974 105,245 86,168 96,167 99,269 122,452 Ottawa 276,292 68,762 36,545 7,038 22,665 17,547 18,938 19,519 24,462 St. Clair 160,078 35,144 26,683 Schoolcraft Tuscola Washtenaw Wayne Wexford Totals 97 8,171 1,486 3,597 13,575 11,542 13,266 13,639 21,850 1,967 152 711 674 848 855 1,410 54,000 11,565 9,902 1,184 4,583 3,971 4,670 4,766 8,304 356,874 70,355 42,878 7,201 31,447 22,978 23,585 24,444 48,651 1,764,804 425,569 243,711 43,559 146,334 116,394 127,404 131,608 419,820 32,886 7,668 5,778 7,418,182 1,693,256 LUNG.org 1,083,202 785 2,725 2,336 2,731 2,787 6,171 173,314 624,290 501,108 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 554,190 570,959 1,199,279 S TAT E TA B L E S MICHIGAN American Lung Association in Michigan www.lung.org/michigan HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Allegan Bay 38 13 0 Wgt. Avg. Grade Orange Red Purple 19.2 F DNC DNC DNC DNC DNC 0 0 0 0 Annual Wgt. Avg. Grade 0 0.0 0 0.0 A A Design Value Pass/ Fail 8.3 PASS 7.8 PASS Benzie 26 0 0 8.7 F DNC DNC DNC DNC DNC DNC DNC Berrien 36 3 1 14.2 F 0 0 0 0.0 A 8.4 PASS Cass 25 1 2 10.2 F DNC DNC DNC DNC DNC DNC DNC Chippewa 9 0 0 3.0 D 0 0 0 0.0 A 6.2 PASS Clinton 12 2 0 5.0 F DNC DNC DNC DNC DNC DNC DNC Genesee 21 3 0 8.5 F 1 0 0 0.3 B 8.1 PASS Huron 17 3 0 7.2 F DNC DNC DNC DNC DNC DNC DNC Ingham 15 0 0 5.0 F 0 0 0 0.0 A 8.5 PASS Kalamazoo 20 2 0 7.7 F 1 0 0 0.3 B 9.2 PASS Kent 24 1 0 8.5 F 0 0 0 0.0 A 9.5 PASS Lenawee 25 4 0 10.3 F 0 0 0 0.0 A 8.6 PASS Macomb 29 1 1 10.8 F 0 0 0 0.0 A 8.6 PASS Manistee 25 0 0 8.3 F 1 0 0 0.3 B 6.6 PASS Mason 23 3 0 9.2 F DNC DNC DNC DNC DNC DNC DNC 18 0 0 6.0 F PASS Missaukee Monroe DNC DNC DNC DNC DNC 0 0 0 0.0 A 5.7 0 0 0 0.0 A INC INC Muskegon 37 9 0 16.8 F INC INC INC INC INC INC INC Oakland 21 2 0 8.0 F 0 0 0 0.0 A 9.1 PASS Ottawa 25 2 0 9.3 F INC INC INC INC INC INC INC St. Clair 23 0 1 8.3 F 1 0 0 0.3 B 9.1 PASS Schoolcraft 16 3 0 6.8 F DNC DNC DNC DNC DNC DNC DNC Tuscola 15 1 0 5.5 F DNC DNC DNC DNC DNC DNC DNC Washtenaw 25 2 0 9.3 F 0 0 0 0.0 A 9.2 PASS Wayne 27 1 1 10.2 F 9 0 0 3.0 D 11.5 PASS 0 0 1.7 Wexford 98 5 LUNG.org C DNC DNC DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 DNC DNC S TAT E TA B L E S MINNESOTA American Lung Association in Minnesota www.lung.org/minnesota AT-RISK GROUPS Lung Diseases County Total Population Under 18 Diabetes Poverty Anoka 341,864 83,470 40,733 7,692 21,955 11,124 16,650 20,153 25,800 Becker 33,259 8,188 6,426 755 2,096 1,265 2,093 2,378 4,793 Beltrami 45,664 11,615 6,569 1,070 2,887 1,482 2,307 2,721 8,056 Carlton 35,571 8,088 5,782 745 2,315 1,289 2,046 2,386 4,086 Cass 28,559 6,024 6,790 555 1,868 1,227 2,099 2,336 4,434 Crow Wing 63,265 14,055 13,106 1,295 4,109 2,506 4,180 4,725 6,815 Dakota Goodhue Hennepin 412,529 103,094 65 & Over Pediatric Asthma 49,966 46,423 10,615 8,586 1,212,064 269,867 151,476 2,006 2,623 9,500 Adult Asthma COPD 26,284 Cardiovascular Disease 13,345 20,064 24,214 29,892 978 3,001 1,770 2,886 3,309 4,377 24,868 80,231 39,225 185 719 474 58,789 71,063 154,785 Lake 10,680 Lyon 25,665 6,359 3,701 586 1,636 846 1,316 1,553 2,839 Mille Lacs 25,884 6,298 4,652 580 1,643 954 1,553 1,782 3,035 902 1,098 Olmsted 150,287 37,047 21,020 Ramsey 532,655 124,557 68,974 11,478 34,728 17,072 25,841 31,035 85,264 St. Louis 200,949 38,796 34,576 Scott 139,672 Stearns 152,912 34,709 20,633 3,198 10,052 4,973 Washington 249,283 62,752 31,928 5,783 15,805 8,285 12,610 15,101 14,735 Winona Wright Totals 99 40,292 12,952 51,097 9,330 7,708 3,414 9,596 4,981 811 7,698 9,126 14,462 3,575 13,674 7,507 11,947 13,904 32,867 3,713 8,489 4,022 5,796 7,188 7,590 7,578 9,062 19,537 860 3,550 1,762 2,716 3,224 7,400 129,918 37,335 14,603 3,440 7,875 3,923 5,867 7,104 7,700 3,888,200 914,497 LUNG.org 512,804 84,271 252,513 128,032 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 194,847 233,267 439,565 S TAT E TA B L E S MINNESOTA American Lung Association in Minnesota www.lung.org/minnesota HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Anoka Becker Beltrami Carlton Cass Crow Wing Dakota Goodhue Hennepin Pass/ Fail 1 0 2.5 D 0 0 0 0.0 A 7.5 PASS 1 0 0 0.3 B INC INC INC INC INC INC INC DNC DNC DNC DNC DNC 1 0 0 0.3 B DNC DNC DNC DNC DNC 0 0 DNC DNC 0 0 0.0 A DNC 0 DNC 0 0.0 DNC A INC INC INC INC INC 0 0 0.3 B Lake 1 4 0 0 1.3 C Mille Lacs 0 Ramsey Design Value 6 Lyon Olmsted Annual Wgt. Avg. Grade 0 0 0.0 A 3 0 0 1.0 C DNC DNC DNC DNC DNC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC INC INC INC INC INC INC 0 0 0 0.0 A DNC DNC DNC DNC DNC 1 INC 0 INC 0 0.3 B INC INC INC 1 0 0 0.3 B DNC DNC DNC DNC DNC 8.0 PASS DNC DNC 8.7 PASS INC INC 6.8 PASS DNC DNC 1 0 0 0.3 B 7.2 PASS 2 10.0 PASS 0 0 0.7 B St. Louis 1 0 0 0.3 B Scott 3 Stearns 0 0 0 0.0 A 1 0 0 0.3 B 7.0 PASS Washington 0 0 0 0.0 A 2 0 0 0.7 B 8.8 PASS Winona Wright 100 0 0 1.0 C DNC DNC DNC DNC DNC 1 0 LUNG.org 0 0.3 B 0 0 0 0.0 A 7.2 PASS 0 8.6 0 0 0.0 A PASS INC INC INC INC INC INC INC INC INC INC INC INC INC INC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S MISSISSIPPI American Lung Association in Mississippi www.lung.org/mississippi AT-RISK GROUPS Lung Diseases County Bolivar DeSoto Forrest Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 33,768 8,644 4,620 1,007 1,863 1,832 2,666 3,182 10,882 170,913 45,705 20,205 76,330 17,659 9,694 Grenada 21,666 5,145 3,589 Hancock 45,949 10,156 7,972 5,325 9,342 9,072 12,821 15,532 17,112 2,057 4,331 4,051 5,747 6,841 19,236 599 1,226 1,274 1,927 2,287 5,287 1,183 2,663 2,817 4,284 5,097 8,993 Harrison 199,058 48,357 26,343 5,634 11,209 10,991 15,807 18,996 36,288 Hinds 243,729 61,438 29,370 7,158 13,574 13,074 18,464 22,305 55,541 Jackson 141,137 3,981 34,169 20,026 7,973 8,037 11,740 14,108 21,723 Jones 68,290 17,480 10,600 2,037 3,768 3,851 5,771 6,852 16,272 Lauderdale 79,739 19,142 12,042 2,230 4,497 4,539 6,724 8,009 16,466 Lee 85,246 21,986 12,217 2,562 4,700 4,724 6,952 8,305 16,289 Yalobusha 12,276 2,792 2,244 Totals 101 1,178,101 292,673 LUNG.org 158,922 325 703 747 1,155 1,362 2,832 34,099 65,848 65,010 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 94,058 112,876 226,921 S TAT E TA B L E S MISSISSIPPI American Lung Association in Mississippi www.lung.org/mississippi HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Bolivar 8 0 Wgt. Avg. Grade Orange Red Purple 0 2.7 D DeSoto 15 1 0 5.5 Forrest DNC DNC DNC DNC Grenada DNC DNC DNC DNC DNC 0 0 0.3 B 9.6 PASS 1 0 0 0.3 B 10.5 PASS 0 0 0 0.0 A 9.0 PASS 0 0 0 0.0 A 8.8 PASS 0 0 0 0.0 A 9.3 PASS 0 1.3 C Harrison 10 0 0 3.3 F Jones 2 1 0 1.2 C 0 0 5.3 DNC DNC 1 0 16 Pass/ Fail F 4 Jackson DNC DNC DNC DNC DNC Design Value DNC Hancock Hinds Annual Wgt. Avg. Grade F DNC DNC DNC DNC DNC 0 0 0 0.0 A 9.9 PASS 0 9.2 0 0 0.0 A INC INC INC INC INC PASS INC INC Lauderdale 0 0 0 0.0 A INC INC INC INC INC INC INC Lee 2 0 0 0.7 B INC INC INC INC INC INC INC Yalobusha 2 0 0.7 DNC DNC DNC DNC DNC DNC DNC 102 0 LUNG.org B AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S MISSOURI American Lung Association in Missouri www.lung.org/missouri AT-RISK GROUPS Lung Diseases County Total Population Under 18 Andrew 65 & Over Pediatric Asthma 17,379 3,985 3,035 Boone 172,717 35,353 18,114 Buchanan 89,486 20,517 13,098 Callaway Adult Asthma COPD Cardiovascular Disease 100,889 25,229 15,595 Cedar 13,952 3,207 3,354 Clay 233,682 58,398 29,834 Clinton 20,299 4,828 3,504 Greene 3,962 13,551 9,338 10,500 12,242 31,804 2,300 6,755 5,540 285,865 59,990 43,748 541 1,508 1,356 1,683 1,822 2,453 6,724 22,080 17,642 21,197 23,550 56,481 683,191 3,364 8,573 6,931 Jefferson 222,716 5,993 8,707 1,968 1,809 Perry 19,202 4,617 3,195 St. Charles 50,952 16,641 41,102 49,018 54,632 111,130 8,311 9,235 22,445 13,778 16,470 18,296 23,387 221 652 625 796 847 1,353 517 1,423 1,251 1,543 1,679 2,194 379,493 92,357 50,200 10,352 28,216 22,986 27,401 30,523 25,281 Ste. Genevieve 103 29,674 18,389 54,249 14,339 6,734 1,607 3,928 3,203 3,805 4,246 8,376 Monroe Totals 53,465 92,529 6,545 17,228 13,719 16,252 18,196 21,041 117,543 30,014 16,395 Lincoln 164,068 7,769 8,509 10,455 359 1,031 1,031 1,344 1,410 2,946 Jasper St. Louis City 6,667 7,386 15,129 2,828 7,397 6,358 Jackson Taney Poverty 44,750 9,618 6,367 1,078 3,448 2,816 3,370 3,745 5,779 Cass St. Louis Diabetes 447 1,305 1,172 1,454 1,575 1,834 17,914 3,980 3,099 446 1,360 1,230 1,525 1,652 2,310 1,001,876 223,659 165,139 25,068 75,996 65,873 80,823 88,275 93,882 54,230 11,523 10,693 1,292 4,140 3,738 4,697 5,054 9,819 317,419 64,355 36,069 3,855,559 885,470 LUNG.org 552,185 7,213 24,965 18,455 21,213 24,285 88,571 99,246 291,150 238,145 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 285,836 317,159 536,670 S TAT E TA B L E S MISSOURI American Lung Association in Missouri www.lung.org/missouri HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Wgt. Avg. Grade Andrew Boone Buchanan Design Value Pass/ Fail 19 1 0 6.8 F DNC DNC DNC DNC DNC DNC DNC 13 0 0 4.3 F DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0.3 B 10.8 PASS Callaway 11 0 0 3.7 F DNC DNC DNC DNC DNC DNC DNC Cass 19 1 0 6.8 F 0 0 0 0.0 A 10.6 PASS Cedar 19 1 0 6.8 F 0 0 0 0.0 A 8.8 PASS Clay 36 6 0 15.0 F 0 0 0 0.0 A 8.9 PASS Clinton 28 3 0 10.8 F DNC DNC DNC DNC DNC DNC DNC Greene 20 0 0 6.7 F 0 0 0 0.0 A 9.2 PASS Jackson DNC DNC DNC DNC DNC 1 0 0 0.3 B 9.6 PASS Jasper 23 2 0 8.7 F DNC DNC DNC DNC DNC DNC DNC Jefferson 35 3 0 13.2 F 1 0 0 0.3 B 10.0 PASS Lincoln 23 4 0 9.7 F DNC DNC DNC DNC DNC DNC DNC Monroe 10 0 0 3.3 F DNC DNC DNC DNC DNC DNC DNC Perry 24 1 0 8.5 F DNC DNC DNC DNC DNC DNC DNC St. Charles 38 7 0 16.2 F DNC DNC DNC DNC DNC DNC DNC Ste. Genevieve 18 2 0 7.0 F DNC DNC DNC DNC DNC DNC DNC St. Louis 37 9 0 16.8 F 2 0 0 0.7 B 10.9 PASS 0 0 1.7 C 5 0 F Taney St. Louis City 104 5 26 LUNG.org 11.2 DNC DNC DNC DNC DNC 4 0 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 1.3 C DNC DNC 11.0 PASS S TAT E TA B L E S MONTANA American Lung Association in Montana www.lung.org/montana AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty Fergus 11,442 2,329 2,626 166 859 700 832 908 1,640 Flathead 94,924 21,313 16,291 1,518 7,022 5,134 5,831 6,709 12,776 Lewis and Clark 65,856 14,329 10,698 1,021 4,936 3,503 3,930 4,573 7,736 Lincoln Missoula Phillips Powder River 19,125 3,521 4,744 112,684 21,839 15,363 4,192 946 858 1,783 310 420 251 1,449 1,258 1,519 1,655 3,622 1,555 8,935 5,475 5,801 6,945 17,216 67 305 245 289 322 648 22 137 115 138 152 214 Ravalli 41,030 8,309 9,488 Richland 11,576 2,864 1,505 204 845 551 595 715 949 Rosebud Silver Bow Totals 105 9,326 2,723 1,272 34,680 7,104 5,991 406,618 85,587 LUNG.org 69,256 592 3,068 2,548 3,042 3,328 7,013 194 634 439 486 574 1,892 506 2,651 1,876 2,111 2,427 6,575 6,096 30,842 21,844 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 24,573 28,308 60,281 S TAT E TA B L E S MONTANA American Lung Association in Montana www.lung.org/montana HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Fergus 0 Wgt. Avg. Grade Orange Red Purple 0 0 0 A 1 0 Annual Wgt. Avg. Grade 0 0.3 B Design Value Pass/ Fail INC INC Flathead 0 0 0 0.0 A 6 0 0 2.0 C 8.2 PASS Lewis and Clark 0 0 0 0.0 A 11 0 0 3.7 F 8.1 PASS 2 0 0 0.7 B 10.5 PASS 14 9 0 9.2 F 10.5 Lincoln DNC DNC DNC DNC DNC 0 A PASS 0 Phillips 0 0 0 0 A 1 0 0 0.3 B INC INC Powder River 0 0 0 0.0 A 1 0 0 0.3 B INC INC 20 11.2 Ravalli Richland Rosebud Silver Bow 106 DNC 0 0.0 Missoula DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC LUNG.org DNC DNC 25 4 21.8 F 1 0 0 0.3 B PASS 7.4 PASS 2 0 0 0.7 B 5.8 PASS 14 9.9 6 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 7.7 F PASS S TAT E TA B L E S NEBR ASK A American Lung Association in Nebraska www.lung.org/nebraska AT-RISK GROUPS Lung Diseases County Total Population Under 18 Douglas 543,244 140,262 62,463 Hall Knox 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 8,621 31,335 21,963 27,817 34,023 74,169 61,492 16,425 8,707 1,010 3,483 2,609 3,480 4,124 8,834 8,482 2,045 2,019 126 488 443 665 735 1,229 Lancaster 301,795 69,604 36,561 4,278 18,091 12,432 15,727 19,036 40,146 Sarpy 172,193 48,493 17,625 2,981 9,632 6,642 Scotts Bluff Washington Totals 107 36,465 8,950 6,446 20,258 4,825 3,245 1,143,929 290,604 LUNG.org 137,066 550 2,113 1,693 8,265 10,250 8,991 2,366 2,725 5,563 297 1,184 949 1,298 1,541 1,450 17,862 66,327 46,732 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 59,620 72,435 140,382 S TAT E TA B L E S NEBR ASK A American Lung Association in Nebraska www.lung.org/nebraska HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Douglas 4.0 Hall Knox Lancaster Sarpy Scotts Bluff Washington 108 12 0 0 F DNC DNC DNC DNC DNC 13 0 0 4.3 F 0 0 0 0.0 A DNC DNC DNC DNC DNC INC INC INC INC INC DNC DNC DNC DNC DNC LUNG.org 3 0 DNC 0 0 DNC Annual Wgt. Avg. Grade 0 1.0 0 DNC 0.0 DNC C A DNC Design Value Pass/ Fail 9.4 PASS 7.2 PASS DNC DNC 1 0 0 0.3 B 8.2 PASS 3 0 0 1.0 C INC INC 0 0 0 0.0 A 5.3 1 0 0 0.3 B 8.3 PASS AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 PASS S TAT E TA B L E S NEVADA American Lung Association in Nevada www.lung.org/nevada AT-RISK GROUPS Lung Diseases County Churchill Clark Douglas Lyon Washoe White Pine Carson City Totals 109 Total Population Under 18 65 & Over Pediatric Asthma 23,989 5,585 4,310 2,069,681 492,248 275,388 47,536 8,667 11,666 51,789 11,582 10,228 440,078 98,655 64,302 10,034 2,154 1,519 54,522 11,199 10,464 2,697,629 630,090 LUNG.org 377,877 Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 378 1,516 1,432 1,887 1,960 3,107 33,351 127,039 107,052 139,436 145,303 318,965 587 3,309 3,484 4,651 4,827 4,861 785 3,361 3,291 4,364 4,537 7,039 6,684 27,801 24,140 31,627 32,983 67,110 146 643 564 740 771 1,195 759 3,592 3,439 4,546 4,725 9,940 42,690 167,261 143,401 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 187,250 195,105 412,217 S TAT E TA B L E S NEVADA American Lung Association in Nevada www.lung.org/nevada HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Churchill Clark Douglas Lyon 0 93 Wgt. Avg. Grade Orange Red Purple 0 0 0.0 A 7 0 F 34.5 DNC DNC DNC DNC DNC 7 0 0 2.3 D Annual Wgt. Avg. Grade DNC DNC DNC DNC DNC 5 2 0 2.7 D Design Value Pass/ Fail DNC DNC 9.9 PASS INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Washoe 18 0 0 6.0 F 16 7 0 8.8 F 10.0 PASS White Pine 17 0 0 5.7 F DNC DNC DNC DNC DNC DNC DNC Carson City 110 8 0 LUNG.org 0 2.7 D INC INC INC INC INC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 INC INC S TAT E TA B L E S NEW HAMPSHIRE American Lung Association in New Hampshire www.lung.org/newhampshire AT-RISK GROUPS Lung Diseases County Total Population Under 18 Pediatric Asthma 3,429 4,140 Poverty 4,921 5,922 76,115 14,182 13,181 1,367 6,333 4,069 4,760 5,737 8,467 Coos 31,653 5,588 6,892 16,182 4,926 Diabetes Cheshire 15,424 1,135 Cardiovascular Disease 60,305 89,658 11,988 Adult Asthma COPD Belknap Grafton 11,776 65 & Over 538 2,639 1,889 2,306 2,717 4,508 1,486 7,594 4,874 5,705 6,841 9,584 Hillsborough 405,184 87,938 56,271 8,474 32,563 19,876 22,651 27,995 34,507 Merrimack 147,171 2,826 Rockingham Totals 111 29,322 23,655 12,052 7,696 8,957 10,910 13,390 300,621 62,005 45,837 5,975 24,382 15,636 18,188 22,356 18,267 1,110,707 226,235 174,006 21,801 90,489 57,468 66,707 81,477 94,645 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S NEW HAMPSHIRE American Lung Association in New Hampshire www.lung.org/newhampshire HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Belknap 0 0.0 Cheshire 2 0 0 0.7 B Coos 4 0 0 1.3 C Grafton 1 0 0 B Hillsborough 8 0 0 2.7 D Merrimack Rockingham 112 0 0 0.3 A 0 0 Annual Wgt. Avg. Grade 0 0.0 A 4 0 0 1.3 C DNC DNC DNC DNC DNC 0 0 0 0.0 A Design Value Pass/ Fail 5.5 PASS 8.8 PASS DNC DNC 6.2 PASS 0 0 0 0.0 A 7.2 PASS 2 0 0 0.7 B 0 0 0 0.0 A 7.5 PASS 12 0 0 4.0 F 0 0 0 0.0 A 8.5 PASS LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S NEW JERSEY American Lung Association in New Jersey www.lung.org/newjersey AT-RISK GROUPS Lung Diseases County Total Population Under 18 Atlantic 275,209 Bergen 933,572 202,136 149,280 19,053 60,322 42,143 62,267 72,967 70,557 Camden 511,038 119,156 72,794 11,232 32,300 21,723 31,489 37,125 65,551 Cumberland 157,389 37,409 21,453 Essex 795,723 192,202 98,394 18,117 49,703 32,033 45,247 53,770 130,059 Gloucester 290,951 66,762 41,118 Hudson 669,115 136,106 71,979 12,829 43,880 25,605 34,698 41,904 117,129 Hunterdon 126,067 26,673 19,795 2,514 8,186 6,072 Mercer 371,537 81,321 51,229 7,665 23,913 15,770 22,625 26,763 41,715 Middlesex 836,297 184,214 112,007 17,364 53,725 34,979 49,900 59,145 67,331 Monmouth 629,279 140,241 98,379 13,219 40,308 28,783 42,437 49,676 51,001 Morris 499,727 111,252 76,865 10,487 32,017 22,642 33,271 38,994 24,782 Ocean 586,301 137,822 128,590 12,991 37,138 28,047 44,483 51,247 68,832 Passaic 508,856 124,026 66,745 11,691 31,708 20,708 29,599 35,062 90,553 Union 552,939 131,992 72,145 12,441 34,673 22,908 32,696 38,708 60,679 Warren Totals 113 60,845 65 & Over 43,515 Pediatric Asthma 5,735 Adult Asthma COPD 17,678 Cardiovascular Disease 12,309 3,526 9,890 6,439 18,166 Diabetes Poverty 21,297 40,761 9,254 10,953 28,287 6,293 18,471 12,588 18,216 21,463 23,626 8,946 10,447 5,742 106,917 22,618 17,095 2,132 6,949 4,976 7,348 8,597 8,747 7,850,917 1,774,775 LUNG.org 1,141,383 167,289 500,860 337,725 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 490,641 578,119 895,352 S TAT E TA B L E S NEW JERSEY American Lung Association in New Jersey www.lung.org/newjersey HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Atlantic 9 3 0 4.5 F 0 0 0 0.0 Bergen 19 0 0 6.3 F 0 0 0 Camden 29 7 0 13.2 F 1 0 0 Cumberland 14 3 0 6.2 F DNC DNC Essex 18 0 0 6.0 F 2 Gloucester 24 4 0 10.0 F Hudson 18 1 0 6.5 F Hunterdon 16 0 0 5.3 Mercer 29 0 0 Middlesex 24 1 Monmouth 17 3 Morris 16 Ocean 22 PASSaic Union Warren 114 Design Value Pass/ Fail A 8.3 PASS 0.0 A 8.8 PASS 0.3 B 9.1 PASS DNC DNC DNC DNC DNC 0 0 0.7 B 9.0 PASS 0 0 0 0.0 A 9.2 PASS 1 0 0 0.3 B 10.6 PASS F DNC DNC DNC DNC DNC DNC DNC 9.7 F 0 0 0 0.0 A 8.8 PASS 0 8.5 F 0 0 0 0.0 A 8.1 PASS 0 7.2 F DNC DNC DNC DNC DNC DNC DNC 1 0 5.8 F 0 0 0 0.0 A 8.7 PASS 2 0 8.3 F 0 0 0 0.0 A 7.8 PASS 7 1 0 2.8 D DNC DNC DNC DNC DNC 3 0 0 1.0 C LUNG.org Wgt. Avg. Grade 0 0 0 0.0 A 8.9 PASS 5 10.5 PASS 0 0 1.7 C 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 8.7 PASS S TAT E TA B L E S NEW MEXICO American Lung Association in New Mexico www.lung.org/newmexico AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Bernalillo 675,551 154,745 95,770 10,323 51,832 28,666 40,878 57,666 124,091 Doña Ana 213,676 54,339 30,240 Diabetes Poverty 3,625 15,937 8,641 12,329 17,177 58,462 Eddy 56,395 14,805 7,864 988 4,128 2,326 3,328 4,692 7,863 Grant 29,096 6,063 7,005 404 2,233 1,563 2,340 3,142 5,437 Lea 69,999 21,264 7,313 1,419 4,899 2,477 3,462 4,957 11,231 Luna 24,673 6,399 5,125 Rio Arriba 39,777 9,668 6,567 427 1,789 1,175 1,743 2,344 7,386 645 2,959 1,803 2,617 3,658 9,503 Sandoval 137,608 33,881 20,844 2,260 10,238 6,007 8,651 12,180 17,264 San Juan 123,785 33,749 16,159 2,251 8,961 4,931 7,018 9,936 25,680 Santa Fe 148,164 1,926 Valencia Totals 115 28,869 29,088 75,817 18,645 11,713 1,594,541 382,427 LUNG.org 237,688 11,638 7,514 1,244 5,636 3,339 25,511 120,250 68,441 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 11,025 15,273 20,700 4,818 6,773 18,156 98,209 137,798 305,773 S TAT E TA B L E S NEW MEXICO American Lung Association in New Mexico www.lung.org/newmexico HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Bernalillo 22 0 0 7.3 F Doña Ana 57 1 0 19.5 F 0 1 0 0.5 Eddy 14 0 0 4.7 F DNC DNC DNC DNC 0 0 0.0 A DNC DNC DNC DNC DNC Grant 0 Lea 3 0 0 1.0 C Luna Rio Arriba Sandoval 4 0 0 1.3 C INC INC INC INC INC 1 0 1.5 Design Value Pass/ Fail 6.5 PASS B 6.2 PASS DNC DNC DNC C 1 0 0 0.3 B DNC DNC 7.8 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0.0 A 16 0 0 5.3 F Santa Fe 1 0 0 0.3 B 0 0 0 0.0 A INC INC Valencia 10 0 0 3.3 F DNC DNC DNC DNC DNC DNC DNC San Juan 116 0 3 Wgt. Avg. Grade LUNG.org 0 0 0 0.0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 A 4.5 PASS S TAT E TA B L E S NEW YORK American Lung Association in New York www.lung.org/newyork AT-RISK GROUPS Lung Diseases County Total Population Under 18 Albany 308,171 58,398 47,255 Bronx Chautauqua 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 5,100 26,837 14,421 18,294 24,769 39,589 1,438,159 366,951 161,607 32,049 116,017 56,886 69,572 96,658 440,989 132,053 27,612 23,893 2,412 11,104 6,604 8,655 11,503 24,433 Chemung 87,770 19,124 14,943 1,670 7,309 4,268 5,553 7,431 15,101 Dutchess 296,579 59,794 45,951 Erie 922,835 190,910 152,635 5,222 25,264 14,255 18,259 24,850 28,417 16,674 78,135 44,527 57,507 77,257 136,135 Essex 38,679 6,695 8,115 585 3,380 2,127 2,835 3,729 4,356 Franklin 51,262 890 Hamilton 10,188 7,619 4,715 713 1,264 4,402 2,397 3,042 4,147 8,393 62 416 301 416 536 537 Herkimer 63,744 13,437 11,993 1,174 5,332 3,255 4,298 5,693 10,279 Jefferson 119,103 29,517 14,532 2,578 9,725 4,747 5,837 7,989 17,009 Kings Madison Monroe New York 2,621,793 611,571 317,555 53,414 217,867 107,096 131,572 181,292 607,086 72,369 14,723 11,473 1,286 6,150 3,489 4,483 6,077 7,962 749,857 160,894 116,048 1,636,268 240,767 234,905 14,052 63,052 34,932 44,689 60,392 103,280 21,028 92,192 151,434 74,580 125,471 280,877 Niagara 213,525 43,441 37,051 3,794 18,071 10,686 13,928 18,687 28,129 Oneida 232,871 49,600 40,681 4,332 19,518 11,420 14,892 19,852 38,971 Onondaga 468,196 102,618 71,673 8,963 39,101 21,769 27,856 37,723 72,873 Orange 376,099 97,713 47,302 8,534 29,857 15,937 19,998 27,625 49,122 Oswego 120,913 26,167 17,500 2,285 10,129 5,597 Putnam Queens 7,115 9,737 22,618 99,487 21,318 14,716 1,862 8,300 4,799 6,152 8,464 6,144 2,321,580 472,945 315,716 41,306 199,166 103,281 129,022 177,022 352,481 Rensselaer 159,774 32,217 24,336 2,814 13,649 7,541 Richmond 473,279 105,141 69,085 9,183 39,406 21,661 27,552 37,548 67,827 Rockland 323,866 7,841 Saratoga 224,921 47,567 35,664 Steuben 98,394 21,977 17,151 Suffolk 89,778 48,094 25,010 14,140 9,614 13,071 19,990 18,216 24,508 46,955 4,154 18,892 10,837 13,960 18,926 15,977 1,919 8,113 4,848 6,345 8,479 16,098 1,502,968 334,242 229,106 29,192 124,640 70,661 90,657 123,247 113,319 Tompkins 104,691 16,173 12,833 1,413 9,671 4,426 5,318 7,341 17,123 Ulster 180,445 33,353 31,326 Wayne 92,051 20,322 15,224 Westchester Totals 117 2,913 15,649 9,140 11,867 15,957 23,615 1,775 7,611 4,513 5,869 7,923 11,678 972,634 222,364 152,132 19,421 80,049 45,536 58,636 79,215 98,067 16,509,051 3,548,230 LUNG.org 2,349,378 309,898 1,393,256 740,675 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 934,203 1,273,120 2,725,430 S TAT E TA B L E S NEW YORK American Lung Association in New York www.lung.org/newyork HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Albany Wgt. Avg. Grade Orange Red Purple 7 0 0 2.3 D Annual Wgt. Avg. Grade 0 0 0 0.0 A Design Value Pass/ Fail 7.3 PASS Bronx 22 0 0 7.3 F 0 0 0 0.0 A 9.3 PASS Chautauqua 17 2 0 6.7 F 0 0 0 0.0 A INC INC Chemung Dutchess Erie INC INC INC INC INC 6 18 0 0 2.0 C 1 0 F 6.5 Essex 6 1 0 2.5 D Franklin 0 0 0 Hamilton 3 0 Herkimer 0 Jefferson 11 Kings Madison 0.0 DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A DNC 0 1.0 C DNC DNC DNC DNC DNC DNC DNC 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 0 0 3.7 F DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC 0 0 DNC DNC 0 0.0 DNC PASS 4.1 PASS A DNC DNC DNC DNC DNC DNC 8.7 A DNC DNC DNC DNC DNC DNC DNC 9.3 PASS DNC DNC Monroe 11 1 0 4.2 F 0 0 0 0.0 A 7.7 PASS New York 11 0 0 3.7 F 0 0 0 0.0 A 10.1 PASS Niagara 11 1 0 4.2 F INC INC INC INC INC INC INC Oneida INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Onondaga 8 0 0 2.7 D 0 0 0 0.0 A 6.7 PASS Orange 0 0 0 0.0 A 0 0 0 0.0 A 7.4 PASS Oswego 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC 0 0 F Putnam Queens Rensselaer 20 6.7 INC INC INC INC INC Richmond 22 2 0 8.3 Rockland 11 1 0 4.2 0 0 0.7 F Westchester 118 A DNC DNC DNC DNC DNC 0.0 A F DNC DNC DNC DNC DNC B DNC DNC DNC DNC DNC 0 0 0 0.0 A Wayne 0.0 0 Steuben Tompkins 0 0 2 Ulster 0 0 Saratoga Suffolk 0 8.2 PASS DNC DNC INC INC DNC DNC DNC DNC 0 0 0 0.0 A 6.0 PASS 17 6 0 8.7 F 0 0 0 0.0 A 7.7 PASS 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC 5 19 DNC DNC DNC DNC DNC DNC DNC 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC 2 0 F DNC DNC LUNG.org 7.3 DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 DNC DNC S TAT E TA B L E S NORTH CAROLINA American Lung Association in North Carolina www.lung.org/northcarolina AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Alamance 155,792 35,618 25,126 Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 4,093 9,386 9,671 12,747 13,512 27,115 Alexander 37,392 7,836 7,069 900 2,317 2,508 3,396 3,533 5,923 Avery 17,773 2,866 3,615 329 1,162 1,241 1,680 1,739 3,041 Buncombe 250,539 48,657 45,342 5,591 15,757 16,524 22,062 23,125 33,936 Caldwell 81,484 17,188 14,531 Carteret 68,811 12,652 14,996 1,454 4,416 4,994 6,918 7,087 9,945 Caswell Catawba Chatham 23,082 4,386 4,517 154,534 35,500 25,004 1,975 5,054 5,432 7,294 7,662 15,102 504 1,472 1,620 2,204 2,294 4,317 4,080 9,331 9,744 12,888 13,672 24,642 68,698 13,914 16,205 1,599 4,302 5,008 7,070 7,122 9,404 Cumberland 326,328 84,051 35,336 9,659 18,704 16,907 20,623 22,977 55,792 Davidson 164,072 37,259 27,527 4,282 9,958 10,550 14,053 14,847 27,440 Davie Duplin Durham Edgecombe 41,434 9,066 7,977 1,042 2,549 2,827 3,860 4,006 5,681 59,882 14,886 9,472 1,711 3,517 3,642 4,809 5,094 16,419 294,460 64,911 32,651 7,459 17,746 16,048 19,526 21,838 46,899 54,933 12,719 9,308 1,462 3,311 3,510 4,685 4,935 13,925 Forsyth 365,298 86,706 52,567 9,964 21,746 21,767 28,141 30,285 69,871 Franklin 62,860 14,487 9,555 1,665 3,798 3,926 5,142 5,508 9,401 Gaston Graham Granville Guilford Haywood Jackson Johnston 211,127 48,786 31,852 8,644 1,832 1,925 5,606 12,706 12,968 16,922 18,124 34,776 211 534 610 853 864 1,754 58,500 12,462 8,937 1,432 3,617 3,730 4,872 5,234 8,664 512,119 116,655 70,643 13,406 30,792 30,139 38,495 41,729 86,041 59,471 10,969 14,108 1,261 3,806 4,396 6,184 6,243 8,961 40,981 7,014 7,262 181,423 47,882 22,252 806 2,628 2,635 3,462 3,641 8,748 5,502 10,445 10,221 12,953 14,201 27,504 Lee 59,662 15,101 8,935 1,735 3,478 3,536 4,622 4,929 10,830 Lenoir 58,485 13,386 10,453 1,538 3,540 3,814 5,140 5,376 12,806 Lincoln 79,829 17,496 12,708 2,011 4,905 5,146 6,789 7,245 12,626 McDowell 44,965 9,307 8,333 1,070 2,798 3,019 4,074 4,255 7,685 Macon 33,875 6,399 8,947 735 2,155 2,585 3,716 3,684 6,061 Martin 23,454 4,850 4,843 557 1,466 1,653 2,280 2,347 4,584 1,012,539 248,710 101,666 28,581 59,222 53,446 64,548 72,888 151,386 Mecklenburg Mitchell 15,311 2,854 3,590 328 979 1,131 1,589 1,607 2,894 Montgomery 27,395 6,342 5,069 729 1,649 1,787 2,423 2,517 5,564 New Hanover Person Pitt 119 216,298 41,940 34,175 39,132 8,527 6,835 175,354 38,449 LUNG.org 19,898 4,820 13,528 13,387 17,339 18,511 37,908 980 2,407 2,584 3,463 3,646 7,236 4,418 10,552 9,468 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 11,517 12,834 39,398 S TAT E TA B L E S NORTH CAROLINA (cont.) American Lung Association in North Carolina www.lung.org/northcarolina AT-RISK GROUPS Lung Diseases County Total Population Under 18 Robeson 134,760 34,916 17,571 Rockingham Rowan Swain 91,696 19,213 65 & Over 16,870 138,630 31,539 22,641 218,568 62,408 24,735 Wake 998,691 Wayne Yancey Totals 120 249,875 Cardiovascular Disease Diabetes Poverty 4,012 7,780 7,608 9,699 10,539 43,106 2,208 8,394 5,706 6,213 8,785 17,540 372 862 922 1,247 1,294 2,716 7,172 12,245 11,961 15,069 16,648 23,279 99,953 28,715 52,560 6,949 7,451 124,456 30,020 18,040 58,240 53,252 64,618 72,962 112,936 799 3,498 3,159 3,903 4,268 12,227 3,450 7,364 7,366 17,614 3,396 4,137 6,877,185 Adult Asthma COPD 3,624 8,383 8,729 11,546 12,230 24,137 14,274 3,234 2,643 Union Watauga Pediatric Asthma 9,536 10,240 28,355 390 1,116 1,289 1,813 1,830 3,590 1,603,213 937,270 184,234 410,926 402,673 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 514,163 557,906 1,122,165 S TAT E TA B L E S NORTH CAROLINA American Lung Association in North Carolina www.lung.org/northcarolina HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Alamance Wgt. Avg. Grade Orange Red Purple DNC DNC DNC DNC DNC 0 0 Annual Wgt. Avg. Grade 0 0.0 A Design Value Pass/ Fail 8.4 PASS Alexander 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Avery 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Buncombe 2 0 0 0.7 B Caldwell 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Carteret 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Caswell 5 0 0 1.7 C Catawba Chatham Cumberland Davidson Davie Duplin DNC DNC DNC DNC DNC 8.8 PASS 0 9.1 PASS 0 0 0.0 A 7.4 PASS 5 0 0 1.7 C 0 0 0 0.0 A 8.9 PASS 0 9.8 PASS DNC DNC DNC DNC DNC 5 1 0 2.2 D DNC DNC DNC DNC DNC Edgecombe 4 1 Franklin 0 0 0 0.0 A 0 0 0 0.0 A 6 1 0 2.5 D Gaston 8.2 PASS 0 1 0 0.5 B Durham Forsyth 0 0 0 0.0 A 0 1.8 C 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A INC INC INC INC INC DNC DNC 7.7 PASS 8.1 PASS INC INC 12 2 0 5.0 F 0 0 0 0.0 A 8.7 PASS 4 1 0 1.8 C DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.5 PASS Graham 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC Granville 4 1 0 1.8 C DNC DNC DNC DNC DNC DNC DNC Guilford 8 1 0 3.2 D 0 0 0 0.0 A 8.5 PASS Haywood 4 0 0 1.3 C 0 0 0 0.0 A 8.7 PASS Jackson 5 0 7.6 Johnston 5 1 0 2.2 D Lee Lenoir Lincoln McDowell 0 0 1.7 C INC INC INC INC INC 1 0 10 1 0 0 0.0 A 0 0 0 0.0 A PASS 7.6 PASS INC INC INC INC INC INC INC 0 0.3 B INC INC INC INC INC INC INC 0 DNC DNC 3.8 F DNC DNC DNC DNC DNC 1 DNC 0 DNC DNC 0 0.3 DNC B 8.7 PASS Macon 0 0 0 0.0 A Martin 1 0 0 0.3 B 0 0 0 0.0 A 7.2 PASS 20 4 0 8.7 F 0 0 0 0.0 A 9.2 PASS 0 0 0 0.0 A INC INC Mecklenburg Mitchell DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC Montgomery 1 1 0 0.8 B 0 0 0 0.0 A 8.0 PASS New Hanover 2 0 0 0.7 B 0 0 0 0.0 A 6.7 PASS Person 7 0 0 2.3 D Pitt 3 1 0 121 LUNG.org 1.5 C DNC DNC DNC DNC DNC 0 0 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 0.0 A DNC DNC 7.7 PASS S TAT E TA B L E S NORTH CAROLINA (cont.) American Lung Association in North Carolina www.lung.org/northcarolina HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Robeson Rockingham Rowan Wgt. Avg. Grade Orange Red Purple DNC DNC DNC DNC DNC 0 0 0.0 A Design Value Pass/ Fail 8.4 PASS 9 0 0 3.0 D DNC DNC DNC DNC DNC DNC DNC 11 1 1 4.8 F 0 0 0 0.0 A 9.1 PASS Swain 0 0 0 0.0 A Union 6 0 1 2.7 D 6 1 0 Wake 0 Annual Wgt. Avg. Grade DNC DNC 0 0 0 0.0 A 10.3 DNC DNC DNC DNC DNC 0 1 0 0.5 B 7.3 PASS Wayne DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.8 PASS 122 1 1 LUNG.org 0 0.8 D DNC DNC DNC DNC DNC 8.0 PASS Watauga Yancey 2.5 0 0 0 0.0 A B DNC DNC DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 PASS DNC DNC S TAT E TA B L E S NORTH DAKOTA American Lung Association in North Dakota www.lung.org/northdakota AT-RISK GROUPS Lung Diseases County Billings Burke Burleigh Cass Dunn McKenzie Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 901 171 160 11 63 37 64 69 69 2,245 525 404 34 149 91 159 168 185 90,503 20,545 13,094 1,337 6,089 3,278 5,409 6,020 7,160 167,005 36,924 18,048 4,399 997 627 2,402 11,425 5,238 8,040 9,573 18,221 65 294 164 271 304 412 10,996 3,229 915 210 674 317 473 589 934 Mercer 8,746 1,952 1,490 127 582 362 619 672 629 Oliver 1,850 417 346 Williams Totals 123 32,130 8,183 3,022 318,775 72,943 LUNG.org 38,106 27 123 80 140 148 194 532 2,087 977 1,476 1,805 2,174 4,746 21,486 10,546 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 16,649 19,348 29,978 S TAT E TA B L E S NORTH DAKOTA American Lung Association in North Dakota www.lung.org/northdakota HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Billings Wgt. Avg. Grade Orange Red Purple 0 0 0 0.0 A 0 0.0 A Design Value Pass/ Fail 0 0 0 0.0 A 4.5 PASS 0 5.6 0 0 0.0 A PASS Burke 0 Burleigh 0 0 0 0.0 A 1 0 0 0.3 B 5.7 PASS Cass 0 0 0 0.0 A 1 0 0 0.3 B 6.4 PASS Dunn 0 0 0 0.0 A 1 0 0 0.3 B 4.8 PASS McKenzie 0 0 0 0.0 A 1 0 0 0.3 B 4.6 PASS Mercer 0 0 0 0.0 A 1 0 0 0.3 B 5.3 PASS Oliver 0 0 0 0.0 A 2 0 0 0.7 B 5.2 PASS Williams 124 0 Annual Wgt. Avg. Grade INC INC INC INC INC LUNG.org INC INC INC INC INC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 INC INC S TAT E TA B L E S OHIO American Lung Association in Ohio www.lung.org/ohio AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Allen 105,040 24,507 16,715 2,555 8,738 6,614 8,156 9,380 17,839 Ashtabula 99,175 22,375 17,231 2,332 8,307 6,590 8,317 9,504 20,547 Athens 64,713 10,084 7,350 1,051 6,002 3,719 4,029 4,854 16,630 Diabetes Poverty Butler 374,158 90,879 49,325 9,474 30,879 22,239 26,342 31,016 52,128 Clark 136,554 3,250 Clermont 201,560 48,781 28,204 Clinton Cuyahoga Delaware 31,178 24,452 11,391 9,006 11,423 12,960 24,315 5,085 16,616 12,484 15,091 17,700 22,370 41,835 10,041 6,376 1,047 3,451 2,624 3,221 3,731 5,584 1,259,828 271,080 207,118 28,259 107,221 82,026 101,553 116,813 241,829 189,113 52,173 21,797 5,439 14,948 10,777 12,608 15,064 8,952 Fayette 28,800 6,925 4,746 722 2,369 1,838 2,296 2,631 4,440 Franklin 1,231,393 291,522 133,768 30,390 102,988 68,640 77,062 92,814 208,629 Geauga 94,295 22,760 16,993 2,373 7,717 6,382 8,199 9,335 7,299 Greene 163,820 33,939 25,557 Hamilton 806,631 187,730 114,279 Jefferson Knox Lake Lawrence 67,694 13,233 3,538 14,117 10,428 12,673 14,662 20,447 19,570 67,366 49,264 13,224 1,379 5,877 4,751 59,121 69,068 138,939 6,099 6,887 13,050 61,167 14,252 9,997 1,486 5,086 3,887 4,825 5,531 8,724 229,230 47,994 41,204 5,003 61,623 13,821 10,541 15,638 1,441 5,175 4,032 25,814 4,179 14,038 10,681 19,805 22,596 20,156 5,055 5,777 10,643 Licking 169,390 Lorain 304,216 69,289 49,658 Lucas 435,286 101,087 63,487 10,538 36,348 26,834 32,427 37,748 87,923 Madison 40,085 19,594 13,107 15,195 22,272 7,223 25,461 19,732 24,538 28,239 43,499 43,918 9,333 6,099 973 3,768 2,751 3,278 3,859 4,890 Mahoning 233,204 47,735 44,613 4,976 20,021 16,100 20,615 23,298 42,601 Medina 176,029 41,406 27,307 4,316 14,601 11,335 14,010 16,247 12,230 Miami 103,900 24,078 17,967 2,510 8,635 6,794 Montgomery 533,116 119,832 88,606 12,492 44,797 34,233 42,532 48,703 101,914 Noble Portage 14,363 2,612 3,414 161,882 31,203 23,726 8,563 9,765 10,920 272 1,258 1,117 1,503 1,667 1,888 3,253 14,233 10,294 12,284 14,370 21,810 Preble 41,586 9,727 7,135 1,014 3,446 2,733 3,447 3,940 5,340 Scioto 77,258 17,002 12,974 375,736 Summit 541,943 117,662 87,731 12,266 46,020 35,256 43,573 50,251 71,490 Trumbull 205,175 43,014 39,709 4,484 17,492 14,206 18,280 20,624 34,593 Warren 221,659 57,356 28,881 5,979 17,894 13,231 15,811 18,655 12,441 Wood Totals 125 66,476 8,590 31,729 24,969 6,204 7,099 20,049 Stark Washington 82,402 1,772 6,531 4,990 31,511 35,886 54,744 61,213 12,306 11,788 1,283 5,279 4,251 5,446 6,154 9,307 129,590 26,828 18,013 9,046,093 2,046,231 LUNG.org 1,372,275 2,797 11,210 7,837 213,310 760,603 568,285 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 9,212 10,787 16,448 692,219 802,808 1,416,880 S TAT E TA B L E S OHIO American Lung Association in Ohio www.lung.org/ohio HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Allen Ashtabula Athens Annual Wgt. Avg. Grade Design Value Pass/ Fail 25 1 0 8.8 F 0 0 0 0.0 A INC INC 10 2 0 4.3 F DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.2 PASS Butler 35 4 0 13.7 F 0 0 0 0.0 A 11.2 PASS Clark 28 1 0 9.8 F 0 0 0 0.0 A 10.2 PASS Clermont 18 5 1 9.2 F DNC DNC DNC DNC DNC DNC DNC Clinton 13 4 0 6.3 F DNC DNC DNC DNC DNC DNC DNC Cuyahoga 30 8 0 14.0 F 7 0 0 2.3 D 12.4 FAIL Delaware 19 1 0 6.8 F DNC DNC DNC DNC DNC DNC DNC Fayette 13 1 0 4.8 F DNC DNC DNC DNC DNC DNC DNC Franklin 32 2 1 12.3 F 0 0 0 0.0 A 10.3 PASS Geauga 18 2 0 7.0 F DNC DNC DNC DNC DNC DNC DNC Greene 13 1 0 4.8 F 0 0 0 0.0 A 9.7 PASS Hamilton 34 5 0 13.8 F 1 0 0 0.3 B 11.7 PASS Jefferson 18 0 0 6.0 F 1 0 0 0.3 B 10.9 PASS Knox 9 1 0 3.5 F DNC DNC DNC DNC DNC DNC DNC Lake 35 6 1 15.3 F 0 0 0 0.0 A 8.7 PASS 9 1 0 3.5 F 0 0 0 0.0 A 9.2 PASS Licking 16 2 0 6.3 F DNC DNC DNC DNC DNC DNC DNC Lorain 12 2 0 5.0 F 0 0 0 0.0 A 9.1 PASS Lucas 25 3 0 9.8 F 0 0 0 0.0 A 10.1 PASS Madison 12 1 0 4.5 F DNC DNC DNC DNC DNC DNC DNC 8 2 0 3.7 F 0 0 0 0.0 A 10.5 PASS Medina 11 1 0 4.2 F 0 0 0 0.0 A INC INC Miami 16 1 0 5.8 F DNC DNC DNC DNC DNC DNC DNC Montgomery 19 1 0 6.8 F 1 0 0 0.3 B INC INC 0 0 2.3 D Lawrence Mahoning Noble 7 Portage 6 1 0 2.5 D Preble Scioto Stark Summit 13 1 0 4.8 F DNC DNC DNC DNC DNC 24 1 0 8.5 F 1 1 0 0.8 B DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A INC INC 0 0 0 0.0 A 9.4 0 0 0 0.0 A 9.0 PASS 1 0 0 0.3 B 11.7 0 0 0 0.0 A PASS PASS 10.7 PASS Trumbull 17 2 0 6.7 F 0 0 0 0.0 A 9.8 PASS Warren 16 2 0 6.3 F DNC DNC DNC DNC DNC DNC DNC Washington 10 0 0 3.3 F DNC DNC DNC DNC DNC DNC DNC Wood 13 1 0 4.8 F DNC DNC DNC DNC DNC DNC DNC 126 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S OKLAHOMA American Lung Association in Oklahoma www.lung.org/oklahoma AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty Adair 22,186 5,943 3,219 Bryan 44,486 10,540 7,502 1,233 3,306 2,808 3,767 4,157 8,258 Caddo 29,317 7,313 4,578 Canadian 129,582 34,287 15,604 695 1,589 1,343 1,778 2,007 5,975 856 2,149 1,832 2,439 2,731 6,399 4,012 9,340 7,266 9,432 10,800 9,811 Carter 48,821 12,456 7,640 1,458 3,552 3,047 4,059 4,544 7,870 Cherokee 48,341 11,160 7,321 1,306 3,627 2,923 3,873 4,316 9,584 Cleveland 269,908 60,279 32,201 7,054 20,521 15,042 19,409 22,131 32,649 Comanche 125,033 30,318 13,787 3,548 9,276 6,648 8,530 9,763 21,256 Cotton 6,150 1,468 1,119 172 457 419 566 628 1,081 Creek 70,632 17,069 11,936 1,997 5,229 4,648 6,228 6,955 10,966 Dewey 4,914 1,284 952 150 353 332 453 495 595 Jefferson 6,292 1,523 1,225 178 464 439 597 657 1,411 Kay 45,478 11,428 8,228 1,337 3,314 2,980 4,034 4,437 8,040 Lincoln 34,619 8,504 5,887 Love 9,773 2,462 1,788 995 2,551 2,306 3,091 3,460 5,089 288 712 647 877 965 1,204 McClain 37,313 9,624 5,471 1,126 2,709 2,302 3,045 3,444 3,788 McCurtain 33,050 8,485 5,618 Mayes 40,816 9,926 6,988 1,162 3,014 2,688 3,608 4,019 7,085 Oklahoma 766,215 195,960 95,761 993 2,396 2,132 2,867 3,184 6,805 22,932 55,829 43,220 56,267 64,037 134,346 Osage 47,981 10,937 8,861 1,280 3,613 3,332 4,497 4,996 7,670 Ottawa 32,105 7,984 5,795 934 2,347 2,083 2,820 3,093 6,863 Pittsburg 44,626 9,910 8,091 1,160 3,383 3,019 4,069 4,503 9,134 Pottawatomie 71,811 17,463 11,209 2,044 5,305 4,459 5,932 6,627 11,971 Sequoyah 41,358 9,964 7,001 1,166 3,064 2,713 3,636 4,054 11,377 Tulsa Totals 127 629,598 160,865 81,791 18,825 45,889 36,355 47,508 54,012 91,246 2,640,405 657,152 LUNG.org 359,573 76,901 193,990 154,982 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 203,381 230,011 420,473 S TAT E TA B L E S OKLAHOMA American Lung Association in Oklahoma www.lung.org/oklahoma HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Wgt. Avg. Grade Adair 5.5 DNC Bryan 15 1 0 F DNC DNC DNC Pass/ Fail DNC DNC DNC DNC DNC DNC DNC DNC DNC Caddo 14 0 0 4.7 F DNC DNC DNC DNC DNC DNC DNC Canadian 19 0 0 6.3 F DNC DNC DNC DNC DNC DNC DNC Carter INC INC INC INC INC DNC Design Value INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Cherokee 17 0 0 5.7 F DNC DNC DNC DNC DNC DNC DNC Cleveland 22 1 0 7.8 F INC INC INC INC INC INC INC Comanche 13 1 0 4.8 F INC INC INC INC INC INC INC Cotton INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Creek 22 2 0 8.3 F DNC DNC DNC DNC DNC DNC DNC Dewey 17 0 0 5.7 F INC INC INC INC INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC 23 1 0 8.2 F 2 0 0 0.7 B INC INC Jefferson Kay Lincoln INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Love INC INC INC INC INC INC INC INC INC INC INC INC DNC DNC McClain McCurtain 15 1 0 5.5 F DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC Mayes 25 3 0 9.8 F DNC DNC DNC DNC DNC DNC DNC Oklahoma 45 3 0 16.5 F 0 0 0 0.0 A 9.3 PASS Osage INC INC INC INC INC DNC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Ottawa 16 2 0 6.3 F DNC DNC DNC DNC DNC DNC DNC Pittsburg 15 0 0 5.0 F 3 0 0 1.0 C 9.7 PASS INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Sequoyah 15 2 0 6.0 F 0 0 0 0.0 A 9.7 PASS Tulsa 48 5 1 19.2 F 0 0 0 0.0 A 9.3 PASS Pottawatomie 128 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S OREGON American Lung Association in Oregon www.lung.org/oregon AT-RISK GROUPS Lung Diseases County Total Population Under 18 Clackamas 394,972 87,767 65 & Over Pediatric Asthma 63,796 6,367 Adult Asthma COPD 31,114 Cardiovascular Disease 18,081 26,225 Diabetes Poverty 28,765 37,450 Columbia 49,459 11,059 8,476 802 3,870 2,323 3,409 3,726 5,880 Crook 20,998 295 Deschutes Harney Jackson 4,065 5,078 170,388 36,354 31,170 7,126 1,445 1,604 210,287 44,070 42,394 1,674 1,119 1,749 1,864 3,809 2,637 13,513 8,032 11,930 12,947 22,298 105 564 367 3,197 16,671 10,195 567 607 1,489 15,443 16,626 37,566 Josephine 83,599 16,350 20,760 1,186 6,640 4,445 7,004 7,437 16,921 Klamath 65,455 14,068 12,570 1,021 5,164 3,128 4,694 5,075 14,092 Lake 7,838 1,449 1,799 105 634 414 639 685 1,429 Lane 358,337 68,413 62,334 4,963 29,455 16,575 24,260 26,412 64,722 Linn 119,356 27,658 20,648 2,006 9,270 5,408 Marion 326,110 82,929 46,969 6,016 24,845 13,499 19,329 21,223 56,064 Multnomah 776,712 153,407 92,605 11,129 64,521 31,980 43,516 48,669 141,562 Umatilla Washington Totals 129 76,705 19,825 10,824 562,998 136,994 66,765 3,230,340 705,853 LUNG.org 487,792 1,438 5,812 3,161 7,983 8,678 22,559 4,511 4,962 13,041 9,938 43,915 22,526 30,967 34,562 69,403 51,207 257,663 141,253 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 202,226 222,240 508,285 S TAT E TA B L E S OREGON American Lung Association in Oregon www.lung.org/oregon HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Wgt. Avg. Grade Clackamas 0.7 DNC Columbia Crook Deschutes Harney Jackson 2 0 0 DNC 0 DNC 0 0 0 0.0 DNC 0 DNC 0 0.0 B DNC A DNC DNC DNC DNC DNC DNC A DNC DNC DNC DNC DNC 2 0 0 0.7 B 2.5 D 9.1 PASS F 10.8 C 8.8 PASS DNC 9 2 0 4.0 F 10.2 PASS DNC 17 9 0 10.2 F 11.0 PASS 16 0 0 5.3 F 9.2 PASS DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC Marion 1 Multnomah 1 0 0 0.3 B Umatilla 2 Washington 1 0 0 0.3 B LUNG.org 0 DNC DNC 4.0 Lake 130 1 PASS 1.2 DNC 0.7 6 9.9 1 DNC 0 DNC DNC DNC DNC DNC DNC DNC 0 DNC 0 F DNC 2 DNC 0 0.3 3.7 DNC 1 Klamath 0 0 DNC 7 DNC DNC DNC DNC DNC Lane 2 DNC Pass/ Fail 2 Josephine Linn 8 DNC Design Value B B PASS INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC 3 0 0 1.0 C 7.4 PASS 1 INC 0 0 0.3 B 7 0 0 2.3 D AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 INC 7.7 PASS S TAT E TA B L E S PENNSYLVANIA American Lung Association in Pennsylvania www.lung.org/pennsylvania County AT-RISK GROUPS Lung Diseases Total Population Under 18 Adams 65 & Over Pediatric Asthma 101,714 20,992 18,585 Allegheny Cardiovascular Disease 2,272 7,880 5,748 1,231,255 234,334 213,797 Armstrong Adult Asthma COPD 25,367 98,074 67,737 Diabetes Poverty 8,260 9,483 10,492 96,403 110,810 157,151 67,785 13,378 13,643 1,448 5,266 4,024 5,862 6,693 9,259 Beaver 169,392 33,322 33,352 Berks 413,691 Blair 125,955 25,897 24,360 Bradford 94,534 3,607 13,206 9,923 14,411 16,465 19,507 65,745 10,233 31,466 21,689 30,615 35,402 57,336 2,803 9,732 7,144 10,387 11,828 18,367 61,784 13,674 12,088 1,480 4,657 3,549 5,174 5,903 7,884 Bucks 626,685 Cambria 137,732 26,637 28,067 2,883 10,762 8,093 11,833 13,452 20,177 Centre 158,742 24,519 19,759 2,654 13,612 7,498 10,070 11,738 24,881 Chester 512,784 120,430 74,595 13,037 38,846 26,607 36,983 43,241 36,496 Clearfield 81,191 133,940 15,135 104,520 14,499 15,324 1,638 48,332 6,447 35,032 4,684 49,519 6,746 57,530 7,729 40,794 12,401 Cumberland 243,762 49,471 41,555 5,355 19,120 13,167 18,734 21,531 20,894 Dauphin 271,453 61,041 41,504 6,608 20,802 14,200 19,886 23,109 35,668 Delaware 562,960 126,171 84,703 13,658 43,259 29,115 40,683 47,277 59,610 Elk 31,194 6,177 6,380 669 2,415 1,887 2,753 3,148 3,220 Erie 278,443 60,762 43,925 6,578 21,504 14,614 20,567 23,797 43,476 Franklin 152,892 3,798 Greene 35,088 27,810 37,843 7,217 6,456 Indiana 87,706 16,086 15,030 42,519 11,492 8,298 13,697 17,932 781 3,015 2,089 2,962 3,416 5,718 1,741 7,068 4,739 39,907 12,004 4,603 16,616 11,939 6,732 7,721 13,966 Lackawanna 212,719 Lancaster 533,320 128,671 87,385 13,929 39,794 27,486 39,175 44,979 54,499 19,690 31,412 Lawrence 88,771 18,187 17,697 Lebanon 136,359 31,262 25,025 3,384 10,246 7,418 10,748 12,252 14,442 Lehigh 357,823 81,411 57,273 8,813 27,255 18,673 26,404 30,471 44,744 Luzerne 318,829 62,535 60,424 6,769 25,000 18,093 26,159 29,868 48,547 Lycoming 116,508 24,194 20,424 2,619 9,054 6,378 9,120 10,469 17,789 Mercer 114,884 23,309 22,800 2,523 8,886 6,615 9,651 10,977 15,793 Monroe 166,314 35,344 25,067 3,826 12,943 9,058 12,586 14,757 21,663 Montgomery 816,857 179,572 133,847 19,439 62,699 43,906 62,133 71,843 56,743 Northampton 300,654 62,183 52,220 Perry 1,969 6,839 5,160 17,253 7,529 8,576 11,441 6,731 23,396 16,535 23,584 27,136 29,019 45,634 10,082 7,245 1,091 3,499 2,492 3,500 4,079 3,919 Philadelphia 1,560,297 346,345 195,315 37,492 122,144 72,745 98,912 115,524 389,485 Somerset 76,218 13,972 15,521 1,512 6,034 4,543 6,622 7,547 9,641 Tioga 42,274 8,432 8,290 913 3,291 2,413 3,514 3,996 6,551 Washington 208,187 41,114 39,403 4,451 16,271 12,025 17,347 19,885 21,640 Westmoreland 359,320 67,688 74,239 7,327 28,187 21,694 31,687 36,135 35,717 York 440,755 98,721 70,142 10,687 33,703 23,481 33,082 38,359 44,232 11,250,686 2,394,346 1,843,422 259,191 872,809 600,489 849,590 980,512 1,472,506 Totals 131 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S PENNSYLVANIA American Lung Association in Pennsylvania www.lung.org/pennsylvania HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Adams 11 Annual Wgt. Avg. Grade 0 0 3.7 F 4 0 0 1.3 Design Value Pass/ Fail C 10.0 PASS Allegheny 39 5 0 15.5 F 18 1 0 6.5 F 13.0 FAIL Armstrong 22 2 0 8.3 F 0 0 0 0.0 A 10.6 PASS Beaver 25 3 0 9.8 F 0 0 0 0.0 A 11.3 PASS Berks 15 0 0 5.0 F 17 0 0 5.7 F 10.6 PASS 13 2 0 5.3 F 4 0 0 1.3 C 11.7 PASS Blair Bradford Bucks Cambria Centre Chester Clearfield Cumberland INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC 29 2 0 10.7 F 15 0 0 5.0 F 10.4 PASS 9 1 0 3.5 F 2 0 0 0.7 B 11.6 PASS 3 0 0 1.0 C 9.1 PASS 21 7 1 0 2.8 D 3 0 8.5 F 2 0 0 0.7 B 9.9 PASS 5 1 0 2.2 D DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 14 0 0 4.7 F 10.4 PASS Dauphin 10 0 0 3.3 F 12 0 0 4.0 F INC INC Delaware 27 1 0 9.5 F 3 0 0 1.0 C 12.3 FAIL Elk 6 1 0 2.5 D DNC DNC DNC DNC DNC DNC DNC Erie 16 3 0 6.8 F 1 0 0 0.3 B 11.4 PASS Franklin 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Greene 17 0 0 5.7 F DNC DNC DNC DNC DNC DNC DNC Indiana 20 3 0 8.2 F DNC DNC DNC DNC DNC DNC DNC 5 0 0 1.7 C 0 0 0 0.0 A INC INC Lancaster 15 1 0 5.5 F 25 1 0 8.8 F 11.6 PASS Lawrence 14 1 0 5.2 F DNC DNC DNC DNC DNC DNC DNC Lebanon 14 0 0 4.7 F 17 0 0 5.7 F 12.7 FAIL Lehigh 12 4.5 DNC DNC DNC DNC DNC DNC Lackawanna 1 0 F DNC Luzerne 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC Lycoming 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC 5 0 F Mercer Monroe 27 11.5 0 0 0.0 A 10.1 PASS 0 0 0 0.0 A 8.7 PASS Montgomery 16 0 0 5.3 F 4 0 0 1.3 C 9.3 PASS Northampton 10 1 0 3.8 F 13 0 0 4.3 F 10.5 PASS 0 0 2.0 Perry Philadelphia 3 0 0 1.0 C 0 6 33 4 0 0 0 1.0 Somerset 3 Tioga 4 0 13.0 C F C 0 1.3 C DNC DNC DNC DNC DNC 7 0 0 2.3 D DNC DNC 11.5 PASS DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC Washington 23 0 0 7.7 F 0 0 0 0.0 A 11.5 PASS Westmoreland 17 2 0 6.7 F 0 0 0 0.0 A 10.1 PASS York 15 1 0 5.5 F 4 0 0 1.3 C 10.7 PASS 132 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S RHODE ISLAND American Lung Association in Rhode Island www.lung.org/rhodeisland AT-RISK GROUPS Lung Diseases County Total Population Under 18 Kent 165,128 31,962 28,684 Providence 631,974 133,247 89,684 14,857 53,731 27,452 38,101 44,446 110,850 Washington 126,653 22,817 22,692 Totals 923,755 133 188,026 LUNG.org 65 & Over 141,060 Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 3,564 14,434 8,110 11,560 13,457 15,259 2,544 11,244 6,305 20,964 79,409 41,867 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 9,010 10,439 12,453 58,671 68,342 138,562 S TAT E TA B L E S RHODE ISLAND American Lung Association in Rhode Island www.lung.org/rhodeisland HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Kent 13 0 0 4.3 F 0 0 0 0.0 A Providence 18 1 0 6.5 F 1 0 0 0.3 Washington 14 3 0 6.2 F 0 0 0 0.0 134 LUNG.org Wgt. Avg. Grade AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 Design Value Pass/ Fail 5.2 PASS B 7.4 PASS A INC INC S TAT E TA B L E S SOUTH CAROLINA American Lung Association in South Carolina www.lung.org/southcarolina AT-RISK GROUPS Lung Diseases County Abbeville Total Population Under 18 65 & Over Pediatric Asthma 24,965 5,371 4,833 Aiken 164,753 36,412 Anderson 192,810 44,900 32,819 Berkeley 198,205 Charleston 381,015 77,013 55,173 48,401 28,861 24,307 Cherokee 56,024 13,403 8,532 Chesterfield 46,125 10,602 7,362 Colleton 37,771 8,692 7,016 Darlington 67,799 15,650 11,203 Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 495 1,635 1,601 2,145 2,560 5,178 3,355 10,723 10,192 13,408 16,153 26,875 4,138 12,359 11,690 15,340 18,502 31,752 4,460 12,550 10,781 13,345 16,543 26,592 7,097 25,423 22,204 28,023 34,245 62,336 1,235 3,565 3,269 4,207 5,125 12,295 977 2,973 2,798 3,626 4,424 11,991 801 2,429 2,382 3,177 3,811 8,566 1,442 4,362 4,123 5,379 6,527 16,800 Edgefield 26,553 5,139 4,214 474 1,793 1,660 2,132 2,613 4,122 Florence 139,231 33,670 20,819 3,103 8,830 8,044 10,321 12,584 26,454 Greenville 482,752 113,304 68,832 10,441 30,915 27,591 35,024 42,878 69,140 Lexington 277,888 65,761 39,526 Oconee 75,192 15,316 16,232 6,855 8,094 12,986 2,180 8,959 120,368 Richland 401,566 88,251 45,505 8,132 26,234 21,387 25,894 32,191 59,816 Spartanburg 293,542 69,467 44,189 6,401 18,744 17,070 21,904 26,703 50,359 York 245,346 60,687 32,152 5,592 15,476 13,774 17,289 21,398 35,172 3,231,905 735,696 469,904 67,795 208,844 186,719 237,458 290,326 520,540 135 LUNG.org 18,329 1,411 4,989 5,024 Pickens Totals 23,657 6,060 17,765 16,082 20,432 25,118 37,932 8,078 7,047 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 10,858 22,174 S TAT E TA B L E S SOUTH CAROLINA American Lung Association in South Carolina www.lung.org/southcarolina HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Abbeville 1 0 0 0.3 Aiken 0 0 0 Anderson 4 1 0 1.8 Berkeley 0 0 0 A Charleston 0 0 0 0.0 A 0.0 0.0 B Annual Wgt. Avg. Grade Design Value Pass/ Fail DNC DNC DNC DNC DNC DNC DNC A DNC DNC C DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0.3 B DNC DNC 8.4 PASS Cherokee 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC Chesterfield 1 1 0 0.8 B 0 0 0 0.0 A 8.1 PASS Colleton 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Darlington 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC Edgefield 0 0 0 0.0 Florence DNC DNC DNC DNC Greenville Lexington A 0 0 0 0.0 A 8.8 PASS DNC 0 0 0 0.0 A 9.1 PASS 1 0 0 0.3 B DNC DNC DNC DNC DNC 1 0 0 0.3 B 1 0 0 0.3 B 9.4 PASS 9.7 PASS Oconee 0 0 0 0.0 A INC INC INC INC INC INC INC Pickens 0 0 DNC DNC Richland 3 0 0 1.0 C Spartanburg 4 0 0 1.3 C York 3 136 0 0 LUNG.org 0 0.0 1.0 A C DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 DNC DNC 9.5 PASS 9.3 PASS DNC DNC S TAT E TA B L E S SOUTH DAKOTA American Lung Association in South Dakota www.lung.org/southdakota AT-RISK GROUPS Lung Diseases County Total Population Under 18 6,551 65 & Over Pediatric Asthma 3,482 604 Adult Asthma COPD 2,032 Cardiovascular Disease 1,230 1,782 Diabetes Poverty 1,872 4,230 Brookings 33,314 Brown 38,408 9,113 6,151 840 2,197 1,656 2,744 2,664 4,375 Codington 27,938 6,805 4,339 627 1,582 1,198 1,969 1,928 2,848 Custer 8,445 1,428 2,162 132 520 479 879 803 876 Jackson 3,274 Meade 1,118 437 26,951 6,479 3,698 103 162 121 198 194 1,097 597 1,536 1,106 1,753 1,757 2,712 Minnehaha 182,882 45,888 22,271 4,229 10,280 7,200 11,072 11,354 20,429 Pennington 108,242 25,953 16,684 2,392 6,166 4,631 Union Totals 137 15,029 3,817 2,330 444,483 107,152 LUNG.org 61,554 7,586 7,436 14,908 352 836 652 1,072 1,054 937 9,874 25,311 18,274 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 29,056 29,061 52,412 S TAT E TA B L E S SOUTH DAKOTA American Lung Association in South Dakota www.lung.org/southdakota HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Brookings 0.3 1 0 0 B Annual Wgt. Avg. Grade Design Value Pass/ Fail PASS 1 0 0 0.3 B 8.2 Brown DNC DNC DNC DNC DNC 0 0 0 0.0 A 7.0 PASS Codington DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.4 PASS Custer 3 0 0 1.0 C Jackson 0 0 0 Meade 1 0 0 0.3 Minnehaha 6 0 0 2.0 C Pennington Union 138 0.0 A B DNC DNC DNC DNC DNC 0 0 0 0.0 A LUNG.org 0 0 0 0.0 A 3.4 PASS 0 4.6 0 0 0.0 A DNC DNC DNC DNC DNC PASS DNC DNC 1 0 0 0.3 B 8.3 PASS 0 6.7 PASS 0 0 0.0 A 1 0 0 0.3 B AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 9.1 PASS S TAT E TA B L E S TENNESSEE American Lung Association in Tennessee www.lung.org/tennessee AT-RISK GROUPS Lung Diseases County Anderson Blount Claiborne Davidson Total Population Under 18 65 & Over Pediatric Asthma 75,528 15,894 14,264 Adult Asthma COPD Cardiovascular Disease 1,548 5,322 6,803 126,339 26,626 23,289 Diabetes Poverty 7,570 8,448 11,583 2,593 8,892 11,294 12,494 13,983 18,270 31,592 6,201 5,839 604 2,262 2,840 3,126 3,505 7,248 668,347 144,015 74,039 14,026 46,208 51,058 49,941 59,351 128,113 DeKalb 19,268 4,346 3,366 423 1,330 1,677 1,840 2,068 3,797 Dyer 37,935 9,133 6,273 889 2,563 3,180 3,456 3,901 7,324 Hamilton Jefferson Knox 351,220 74,326 56,199 52,677 10,932 7,239 24,593 29,825 31,837 36,234 54,383 10,043 1,065 448,644 96,283 64,963 3,724 4,729 5,263 5,867 9,061 9,377 31,219 36,762 38,300 44,097 77,218 Lawrence 42,274 10,541 7,402 1,027 2,828 3,555 3,925 4,393 9,080 Loudon 50,771 10,065 12,455 McMinn 52,626 11,417 9,829 1,112 3,676 4,675 5,195 5,799 8,943 Madison 98,178 22,625 14,646 2,203 6,705 8,083 8,543 9,777 19,635 Maury 85,515 20,161 12,766 1,964 5,804 7,086 7,521 8,599 13,026 Meigs 11,701 2,399 2,322 Montgomery 189,961 51,694 16,301 980 3,654 4,886 5,765 6,233 6,802 234 831 1,081 1,217 1,351 2,400 5,035 12,139 12,682 11,831 14,375 25,803 Putnam 74,165 15,773 12,029 Roane 52,748 10,441 11,185 1,017 3,788 5,019 5,729 6,319 9,418 Rutherford Sevier 288,906 72,318 27,796 95,110 20,102 16,849 1,536 5,180 6,114 6,509 7,392 14,844 7,043 19,067 20,873 20,055 24,082 41,601 1,958 6,683 8,411 938,803 239,364 109,047 Sullivan 157,047 31,271 31,921 3,046 11,238 14,508 16,365 18,127 28,608 Sumner 172,706 42,052 25,278 4,096 11,603 14,165 15,007 17,179 19,349 Williamson 205,226 57,574 23,828 5,607 13,093 16,018 16,468 19,232 11,420 Wilson 125,376 30,387 18,188 2,959 8,439 10,400 11,020 12,630 12,458 Totals 139 4,452,663 23,312 61,830 71,635 9,219 10,367 16,582 Shelby 1,035,940 610,117 100,892 302,673 357,358 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 72,201 84,747 211,505 370,397 428,057 768,471 S TAT E TA B L E S TENNESSEE American Lung Association in Tennessee www.lung.org/tennessee HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Anderson 3 1 Wgt. Avg. Grade Orange Red Purple 0 1.5 C Annual Wgt. Avg. Grade DNC DNC DNC DNC DNC Design Value Pass/ Fail DNC DNC Blount 8 0 0 2.7 D INC INC INC INC INC INC INC Claiborne 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC 2 0 F INC INC 1 0 1.8 C DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC Davidson DeKalb Dyer 20 4 7.7 DNC DNC DNC DNC DNC INC INC INC INC INC Hamilton 8 2 0 3.7 F 0 0 0 0.0 A 9.6 PASS Jefferson 8 2 1 4.3 F DNC DNC DNC DNC DNC DNC DNC 13 2 1 6.0 F INC INC INC INC INC INC INC Knox Lawrence Loudon McMinn DNC DNC DNC DNC DNC 13 2 0 5.3 F INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC Madison DNC DNC DNC DNC DNC INC INC INC INC INC INC INC Maury DNC DNC DNC DNC DNC INC INC INC INC INC INC INC Meigs INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Montgomery DNC DNC DNC DNC DNC INC INC INC INC INC INC INC Putnam DNC DNC DNC DNC DNC INC INC INC INC INC Roane DNC DNC DNC DNC DNC Rutherford Sevier INC INC INC INC INC 3 2 0 2.0 C 1 0 0 0.3 B INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC Shelby 28 5 1 12.5 F INC INC INC INC INC INC INC Sullivan 9 1 0 3.5 F INC INC INC INC INC INC INC Sumner 28 2 0 10.3 F INC INC INC INC INC INC INC 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC 2 0 DNC DNC Williamson Wilson 140 8 14 LUNG.org 5.7 F DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 DNC DNC S TAT E TA B L E S TEXAS American Lung Association in Texas www.lung.org/texas AT-RISK GROUPS Lung Diseases County Total Population Under 18 Bell 329,140 91,323 32,494 Bexar Bowie Brazoria Brewster Cameron Collin Dallas 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 6,431 15,514 11,702 16,678 23,504 45,622 1,855,866 485,751 209,357 34,205 90,282 71,191 103,824 145,494 331,898 93,275 22,229 14,412 1,565 4,759 4,094 338,124 90,770 36,759 6,242 8,535 17,526 6,392 16,403 13,114 19,209 27,147 32,543 9,173 1,802 1,784 420,392 132,864 52,210 127 499 456 714 961 1,262 9,356 19,035 15,603 23,271 31,998 143,568 885,241 240,553 86,046 16,939 42,680 33,492 48,492 69,316 62,032 2,518,638 676,575 243,840 47,642 121,044 92,895 133,218 189,558 480,160 Denton 753,363 196,521 65,706 13,838 36,579 27,662 39,256 56,571 64,947 Ellis 159,317 43,073 18,923 El Paso 833,487 235,582 94,071 16,589 39,384 31,156 45,551 63,576 190,846 Galveston 314,198 77,464 40,120 Gregg Harris Harrison Hidalgo 3,033 7,753 6,375 9,473 13,295 17,299 5,455 15,840 13,209 19,763 27,664 44,194 123,204 31,767 17,463 2,237 6,099 5,139 4,441,370 1,205,210 409,083 7,759 10,662 21,713 84,866 212,318 161,275 229,868 328,434 759,184 67,336 16,774 10,002 1,181 3,391 2,914 4,435 6,093 11,071 831,073 279,329 86,220 19,669 36,156 28,161 40,905 56,889 275,840 Hood 53,921 11,117 12,980 Hunt 88,493 21,145 13,589 1,489 4,531 3,937 252,235 Johnson 157,456 41,568 20,748 2,927 7,753 6,517 9,801 13,621 20,492 Kaufman 111,236 30,756 13,117 2,166 5,363 4,401 6,536 9,166 15,114 McLennan 243,441 60,396 32,655 4,253 12,117 9,903 14,742 20,319 46,019 Montgomery 518,947 138,889 62,529 9,780 25,375 20,952 31,196 43,761 55,864 Nueces Orange Parker Polk Randall Rockwall Smith 33,856 4,208 48,195 12,629 7,808 356,221 89,967 46,356 83,433 20,585 12,579 12,820 10,623 6,021 8,270 17,603 Jefferson Navarro 59,755 783 2,946 2,909 4,715 6,205 6,562 15,883 22,047 50,051 889 2,398 2,126 3,287 4,469 9,567 6,335 17,699 14,569 21,719 30,140 58,798 1,450 4,227 3,664 5,597 7,694 13,175 123,164 30,105 18,221 2,120 6,285 5,485 8,388 11,604 11,997 46,079 9,439 9,175 665 2,494 2,313 3,649 4,903 7,687 128,220 31,183 17,391 87,809 24,343 10,375 218,842 54,448 33,970 2,196 6,451 5,335 7,977 11,027 12,181 1,714 5,222 4,241 3,506 7,336 5,944 3,834 10,997 9,458 14,433 19,662 38,908 Tarrant 1,945,360 526,956 198,779 Travis 1,151,145 265,211 97,085 18,675 57,617 41,916 58,297 84,066 188,959 Victoria Webb Totals 141 91,081 23,515 13,273 266,673 90,675 23,076 19,945,148 5,370,269 LUNG.org 2,096,052 37,106 93,711 73,574 106,743 151,493 291,534 1,656 4,516 3,843 5,829 7,993 14,135 6,385 11,485 8,627 12,253 17,360 85,109 378,154 960,762 752,096 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 1,090,945 1,540,830 3,449,404 S TAT E TA B L E S TEXAS American Lung Association in Texas www.lung.org/texas HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Wgt. Avg. Grade Bell DNC Bexar Bowie Brazoria Brewster Cameron 14 1 0 5.2 F 32 6 0 13.7 F DNC DNC DNC DNC DNC 24 0 8 1 0 0 0.0 DNC DNC DNC Pass/ Fail DNC DNC PASS 0 0 0 0.0 A 8.5 0 0 0 0.0 A 10.2 PASS F DNC DNC DNC DNC DNC A DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0.0 A INC INC INC INC INC INC INC Collin 46 3 0 16.8 F DNC DNC DNC DNC DNC DNC DNC Dallas 43 7 0 17.8 F 1 0 0 0.3 B 10.7 PASS Denton 71 6 0 26.7 F DNC DNC DNC DNC DNC DNC DNC Ellis 17 1 1 6.8 F 0 0 0 0.0 A 9.6 PASS El Paso 22 0 0 7.3 F 9 5 0 5.5 F 11.0 PASS Galveston 13 0 0 4.3 F INC INC INC INC INC INC INC Gregg 11 0 0 3.7 F DNC DNC DNC DNC DNC DNC DNC Harris 49 9 2 22.2 F 1 0 0 0.3 B 11.6 PASS Harrison 11 0 0 3.7 F 0 0 0 0.0 A 9.5 PASS Hidalgo 0 0 12.7 DNC Design Value 0 0 0 0.0 A 0 0 0 0.0 A INC INC Hood 23 3 0 9.2 F DNC DNC DNC DNC DNC DNC DNC Hunt 9 1 0 3.5 F DNC DNC DNC DNC DNC DNC DNC Jefferson 24 2 1 9.7 F DNC DNC DNC DNC DNC DNC DNC Johnson 29 0 1 10.3 F DNC DNC DNC DNC DNC DNC DNC Kaufman 9 1 0 3.5 F DNC DNC DNC DNC DNC DNC DNC McLennan 8 1 0 3.2 D DNC DNC DNC DNC DNC DNC DNC 0 0 DNC DNC 1 0 2.5 D Montgomery 22 7.3 F Navarro 6 Nueces 3 0 0 1.0 C Orange 8 DNC DNC DNC DNC DNC DNC DNC DNC DNC 3 0 0 1.0 C DNC DNC DNC 10.1 PASS 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC 24 2 0 9.0 F DNC DNC DNC DNC DNC DNC DNC 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Randall 15 0 0 5.0 F DNC DNC DNC DNC DNC DNC DNC Rockwall 20 1 1 7.8 F DNC DNC DNC DNC DNC DNC DNC Smith 11 0 0 3.7 F DNC DNC DNC DNC DNC DNC DNC Tarrant 70 10 2 29.7 F 2 0 0 0.7 B 10.3 PASS Travis 10 4.3 0 0 0 0.0 A 9.4 PASS Parker Polk 2 0 Victoria 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Webb 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 142 LUNG.org F AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S UTAH American Lung Association in Utah www.lung.org/utah AT-RISK GROUPS Lung Diseases County Box Elder Cache Carbon Daggett Davis Duchesne Garfield Salt Lake Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 51,518 16,875 6,294 1,138 3,024 1,359 2,325 2,774 5,947 118,343 36,806 10,196 20,660 5,548 3,161 1,117 257 237 329,692 109,941 30,154 20,380 6,983 2,228 2,482 7,088 2,718 4,171 5,154 16,303 374 1,320 621 1,104 1,295 3,178 17 75 39 74 84 88 7,413 19,155 7,918 12,587 15,517 23,606 471 1,168 505 843 1,014 2,328 5,024 1,273 957 86 328 168 314 361 589 1,091,742 309,309 104,910 20,855 68,208 28,129 44,485 55,027 128,385 San Juan 15,251 4,908 1,820 Tooele 61,598 21,247 5,285 1,433 3,519 1,454 2,290 2,844 4,956 Uintah 36,867 12,467 3,346 Utah 331 903 407 693 832 4,366 841 2,126 873 1,385 1,706 3,512 560,974 195,605 40,251 13,188 31,749 11,802 17,516 21,978 69,472 Washington 151,948 43,049 29,710 2,903 9,498 4,699 Weber 240,475 70,164 26,702 4,731 14,854 6,374 10,490 12,731 29,322 Totals 143 2,705,589 834,432 LUNG.org 265,251 56,261 163,015 67,065 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 8,975 10,082 19,330 107,253 131,400 311,382 S TAT E TA B L E S UTAH American Lung Association in Utah www.lung.org/utah HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Box Elder 20 0 0 6.7 F 6 1 Annual Wgt. Avg. Grade 0 2.5 D Design Value Pass/ Fail 7.7 PASS Cache 6 0 0 2.0 C 38 14 0 19.7 F 9.2 PASS Carbon 10 0 0 3.3 F DNC DNC DNC DNC DNC DNC DNC Daggett INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Davis 10 0 0 3.3 F 13 0 0 4.3 F 8.2 PASS Duchesne 25 22 5 22.7 F INC INC INC INC INC INC INC Garfield 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Salt Lake 33 1 0 11.5 F 44 11 0 20.2 F 9.3 PASS 0 0 1.3 C San Juan 4 DNC DNC DNC DNC DNC DNC DNC Tooele 11 1 0 4.2 F 3 0 0 1.0 C 6.2 PASS Uintah 41 24 18 37.7 F INC INC INC INC INC INC INC Utah 29 1 0 10.2 F 21 15 0 14.5 F 9.0 PASS Washington 15 0 0 5.0 F 0 0 0 0.0 A INC INC Weber 30 1 0 10.5 F 22 7 0 10.8 F 9.3 PASS 144 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S VERMONT American Lung Association in Vermont www.lung.org/vermont AT-RISK GROUPS Lung Diseases County Bennington Chittenden Rutland Totals 145 Total Population Under 18 65 & Over Pediatric Asthma 36,445 7,099 7,736 160,531 30,073 21,176 60,086 11,028 11,662 257,062 48,200 LUNG.org 40,574 Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 576 3,292 2,015 2,504 2,532 5,035 2,442 15,013 7,342 8,097 9,127 16,626 895 5,525 3,252 3,952 4,079 7,774 3,914 23,830 12,609 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 14,552 15,737 29,435 S TAT E TA B L E S VERMONT American Lung Association in Vermont www.lung.org/vermont HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Bennington Chittenden Rutland 146 Wgt. Avg. Grade Orange Red Purple 2 0 0 0.7 B 0 0 0 0.0 A DNC DNC DNC DNC DNC LUNG.org Annual Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0.0 A 6.3 PASS 0 0 0 0.0 A 6.6 3 0 0 1.0 C 8.6 PASS AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 PASS S TAT E TA B L E S VIRGINIA American Lung Association in Virginia www.lung.org/virginia AT-RISK GROUPS Lung Diseases County Total Population Under 18 Albemarle 104,489 21,923 17,254 2,020 7,123 5,501 7,177 8,424 8,982 Arlington 226,908 38,935 21,043 Caroline 65 & Over Pediatric Asthma Cardiovascular Disease Diabetes Poverty 3,588 15,955 9,936 11,560 14,025 19,117 29,778 6,990 4,497 Charles City Adult Asthma COPD 644 1,967 1,522 1,973 2,326 3,206 7,023 1,112 1,498 102 516 451 612 714 919 Chesterfield 332,499 81,199 42,573 7,483 21,635 16,224 20,575 24,476 27,051 1,137,538 271,243 130,491 24,995 74,372 53,831 66,978 80,162 75,137 Fauquier 68,248 16,338 10,185 1,506 4,494 3,589 4,674 5,522 4,980 Frederick 82,377 19,398 12,518 1,788 5,440 4,251 5,526 6,515 6,233 Giles 16,815 3,489 3,355 Fairfax 322 1,158 970 1,310 1,523 2,254 Hanover 101,918 23,180 15,969 2,136 6,818 5,469 7,155 8,435 6,140 Henrico 321,924 75,395 44,341 6,948 21,219 15,886 20,267 24,009 34,985 Loudoun 363,050 106,602 28,589 9,823 21,904 14,808 17,642 21,441 14,077 Madison 13,157 2,768 2,698 255 905 775 1,053 1,223 1,598 Page 23,848 4,847 4,714 447 1,651 1,382 1,863 2,169 3,991 Prince Edward 23,074 3,804 3,559 351 1,651 1,170 1,481 1,746 4,822 Prince William 446,094 125,131 36,956 11,531 27,408 18,485 22,066 26,772 31,917 Roanoke 93,785 19,500 18,395 1,797 6,451 5,367 7,224 8,409 7,498 Rockbridge 22,327 3,874 5,413 357 1,612 1,431 1,983 2,287 2,884 Rockingham 78,171 17,505 14,048 1,613 5,256 4,255 5,660 6,611 8,906 139,992 37,524 12,749 3,458 8,773 6,117 7,415 8,964 7,952 Stafford Wythe Alexandria City Bristol City 29,121 5,863 5,725 150,575 26,741 15,232 540 2,020 1,683 2,265 2,638 4,493 2,464 10,548 6,894 17,184 3,429 3,412 8,206 9,911 14,266 316 1,192 974 1,309 1,521 3,696 Hampton City 136,879 29,768 18,743 2,743 9,202 6,742 8,539 10,125 20,149 Lynchburg City 79,047 15,777 11,100 1,454 5,404 3,691 4,609 5,444 17,175 Norfolk City 245,428 49,895 24,401 4,598 16,620 10,578 12,512 15,089 49,728 Roanoke City 99,428 21,936 14,770 2,021 6,675 5,054 6,501 7,675 19,938 Salem City 25,483 5,069 4,349 Suffolk City 86,806 21,651 11,256 Virginia Beach City 450,980 102,990 55,493 Totals 147 4,953,946 467 1,762 1,372 1,797 2,107 2,393 1,995 5,609 4,209 5,349 6,354 11,668 9,491 29,827 21,219 26,451 31,519 37,886 1,163,876 595,326 107,251 325,169 233,837 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 291,730 348,139 454,041 S TAT E TA B L E S VIRGINIA American Lung Association in Virginia www.lung.org/virginia HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Albemarle Wgt. Avg. Grade Orange Red Purple 2 0 0 0.7 B Annual Wgt. Avg. Grade 0 0 0 0.0 A Design Value Pass/ Fail 7.6 PASS Arlington 20 4 0 8.7 F 0 0 0 0.0 A 9.0 PASS Caroline 10 0 0 3.3 F DNC DNC DNC DNC DNC DNC DNC Charles City 10 1 0 3.8 F 0 0 0 0.0 A 7.9 PASS Chesterfield 6 0 0 2.0 C 0 0 0 0.0 A INC INC 19 2 1 8.0 F 1 0 0 0.3 B 8.4 PASS Fauquier 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Frederick 3 0 0 1.0 C 1 0 0 0.3 B 9.2 PASS Giles 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Hanover 4 2 0 2.3 D DNC DNC DNC DNC DNC DNC DNC Henrico 5 3 0 3.2 D 0 0 0 0.0 A 8.3 PASS Loudoun 7 0 0 2.3 D 0 0 0 0.0 A 8.7 PASS Madison 5 Page 3 0 0 1.0 C Prince Edward 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Prince William 7 0 0 2.3 D DNC DNC DNC DNC DNC DNC DNC Roanoke 3 0 0 1.0 C INC INC INC INC INC INC INC Rockbridge 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Rockingham 2 0 0 0.7 B 0 0 0 0.0 A 8.6 PASS Stafford 7 0 0 2.3 D DNC DNC DNC DNC DNC DNC DNC 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC Fairfax Wythe Alexandria City Bristol City Hampton City 0 0 1.7 C INC INC INC INC INC DNC DNC DNC DNC DNC 7 1 0 2.8 D DNC DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC 7.8 PASS 8.6 PASS 0 0 0 0.0 A 7.5 PASS Lynchburg City DNC DNC DNC DNC DNC 0 0 0 0.0 A 7.6 PASS Norfolk City DNC DNC DNC DNC DNC 0 0 0 0.0 A 7.9 PASS Roanoke City DNC DNC DNC DNC DNC INC INC INC INC INC INC INC Salem City DNC DNC DNC DNC DNC Suffolk City Virginia Beach City 148 5 0 0 1.7 DNC DNC DNC DNC LUNG.org 0 0 0 0.0 A 8.6 PASS C DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.0 PASS AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S WASHINGTON American Lung Association in Washington www.lung.org/washington AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty Chelan 74,588 18,077 13,024 1,181 5,273 3,654 4,863 5,497 10,298 Clallam 72,715 12,836 19,539 838 5,639 4,292 6,260 6,713 11,518 Clark King 451,008 113,811 62,050 2,079,967 435,969 253,231 7,434 31,314 20,634 25,966 30,320 44,213 28,476 151,837 95,642 115,015 136,509 230,750 Kitsap 254,183 53,039 40,823 Pierce 831,928 199,866 105,373 Skagit 120,365 Snohomish 759,583 176,088 91,715 11,502 54,094 34,736 42,185 50,529 73,930 Spokane 484,318 Thurston 265,851 58,836 40,416 3,843 19,224 12,762 16,272 18,766 31,197 Whatcom 208,351 42,077 32,158 2,748 15,390 10,060 12,753 14,566 31,842 Yakima 247,687 73,891 31,719 4,826 16,075 10,398 12,998 14,992 50,044 5,850,544 1,320,429 784,126 86,247 419,590 271,308 335,794 393,454 713,311 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 Totals 149 27,109 108,830 22,546 71,532 3,464 18,716 12,593 16,232 18,691 27,550 13,055 58,493 37,511 1,771 7,108 8,707 34,828 6,093 22,933 46,000 54,142 106,432 8,208 29,042 9,198 33,531 18,627 76,910 S TAT E TA B L E S WASHINGTON American Lung Association in Washington www.lung.org/washington HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Chelan Wgt. Avg. Grade Orange Red Purple DNC DNC DNC DNC DNC Clallam 0 0 0 0.0 A Clark 1 0 0 B King 8 0 0 2.7 D Kitsap 0.3 DNC DNC DNC DNC DNC 1 2 Annual Wgt. Avg. Grade 0 1.3 C DNC DNC DNC DNC DNC 2 0 0 0.7 B Design Value Pass/ Fail INC INC DNC DNC INC INC 6 0 0 2.0 C 6.6 PASS 0 INC INC 0 0 0.0 A Pierce 0 0 0 0.0 A 11 0 0 3.7 F 7.5 PASS Skagit 0 0 0 0.0 A INC INC INC INC INC INC INC Snohomish DNC DNC DNC DNC DNC Spokane 0 Thurston 1 0 Whatcom 0 0 0 0.0 A Yakima 150 DNC 0 DNC 0 A 0 0.3 B DNC LUNG.org 0.0 DNC DNC 7 1 0 2.8 D 7.8 PASS 3 0 0 1.0 C 7.9 INC INC INC INC INC PASS INC INC 0 0 0 0.0 A INC INC 16 8.9 2 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 6.3 F PASS S TAT E TA B L E S WEST VIRGINIA American Lung Association in West Virginia www.lung.org/westvirginia AT-RISK GROUPS Lung Diseases County Total Population Under 18 Diabetes Poverty Berkeley 110,497 26,725 14,685 2,516 9,326 10,928 10,805 10,988 14,356 Brooke 23,530 4,179 5,063 393 2,139 2,716 2,906 2,910 3,416 Cabell 97,109 19,524 16,488 Gilmer 65 & Over Pediatric Asthma 8,618 1,189 1,283 Adult Asthma COPD Cardiovascular Disease 1,838 8,552 9,970 10,325 10,282 20,377 112 820 908 906 904 1,851 Greenbrier 35,450 6,910 7,566 651 3,155 4,033 4,324 4,333 7,308 Hancock 30,112 561 Harrison Kanawha Marion Marshall Monongalia 5,961 6,069 32,416 6,508 6,345 103,463 16,535 11,147 Raleigh 78,241 16,620 14,220 Totals 151 3,612 3,640 3,841 3,667 16,769 20,670 21,490 21,644 31,400 56,803 11,306 10,295 1,064 5,025 6,053 6,318 6,319 9,920 43,328 8,322 8,451 Wood 3,418 68,761 14,750 12,329 1,389 5,986 7,369 7,666 7,716 9,412 190,223 38,945 34,502 Ohio Tucker 2,678 6,927 1,182 1,572 86,237 18,171 16,019 971,715 196,827 LUNG.org 166,034 613 2,872 3,626 3,817 3,844 4,820 1,557 9,574 9,714 9,267 9,198 21,601 783 3,870 4,785 5,046 5,055 7,506 1,565 6,812 8,294 111 636 826 1,711 7,541 9,365 18,531 85,755 102,675 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 8,677 8,692 13,163 889 892 1,152 9,798 9,858 14,609 105,847 106,274 164,732 S TAT E TA B L E S WEST VIRGINIA American Lung Association in West Virginia www.lung.org/westvirginia HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Berkeley Brooke 1 0 0 0.3 DNC DNC DNC DNC B DNC Annual Wgt. Avg. Grade Design Value Pass/ Fail 1 0 0 0.3 B 10.4 PASS 0 0 0 0.0 A 11.1 PASS Cabell 8 1 0 3.2 D Gilmer 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Greenbrier 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC 0 0 F Hancock Harrison Kanawha 16 5.3 DNC DNC DNC DNC DNC 15 0 0 5.0 F 0 0 0 0.0 A 9.8 PASS 0 0 0 0.0 A 10.0 0 0 0 0.0 A 9.1 PASS PASS 0 0 0 0.0 A 10.2 PASS Marion DNC DNC DNC DNC DNC 0 0 0 0.0 A 9.7 PASS Marshall DNC DNC DNC DNC DNC 0 0 0 0.0 A 11.1 PASS Monongalia Ohio Raleigh 7 0 0 2.3 D 12 1 0 4.5 F DNC DNC DNC DNC DNC Tucker 2 Wood 8 0 0 2.7 D 152 0 LUNG.org 0 0.7 B 0 0 0 0.0 A 8.8 PASS 1 10.4 0 DNC 0 0 DNC 0 0.3 0 DNC 0.0 DNC B A DNC 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 PASS INC INC DNC DNC 9.8 PASS S TAT E TA B L E S WISCONSIN American Lung Association in Wisconsin www.lung.org/wisconsin AT-RISK GROUPS Lung Diseases County Ashland Brown Columbia Dane Total Population Under 18 65 & Over Pediatric Asthma 16,103 3,645 2,810 256,670 62,432 33,496 Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 370 1,274 685 1,005 1,197 2,303 6,339 20,213 9,653 13,477 16,540 29,879 56,615 12,671 9,150 1,287 4,518 2,381 3,426 4,133 4,866 516,284 108,748 61,557 11,042 42,739 18,624 25,615 31,642 67,242 Dodge 88,574 18,373 14,429 1,865 7,225 3,753 5,400 6,512 8,158 Door 27,766 4,660 7,340 473 2,292 1,464 2,297 2,629 3,016 Eau Claire 101,564 20,839 14,291 2,116 8,399 3,802 5,417 6,540 13,916 Fond du Lac 101,759 22,324 16,881 2,267 8,158 4,270 6,194 7,430 9,698 9,127 1,878 1,987 191 730 425 650 755 1,519 Forest Grant 51,829 10,526 8,460 1,069 4,258 2,062 3,018 3,588 7,043 Jefferson 84,395 Kenosha Kewaunee La Crosse Manitowoc 18,870 12,652 168,068 40,577 21,004 20,444 4,501 3,859 118,011 24,041 17,407 6,772 3,405 4,120 13,296 6,334 4,848 5,881 8,594 8,739 10,813 25,089 457 1,621 908 1,348 1,595 1,807 2,441 9,749 4,551 6,522 7,853 14,121 80,160 16,960 14,908 1,722 6,439 3,594 5,294 6,298 8,558 Marathon 135,780 31,796 21,609 Milwaukee 956,406 Outagamie 182,006 43,921 23,942 Ozaukee 1,916 87,470 233,769 19,244 116,067 15,314 3,228 10,695 5,558 23,735 75,542 33,895 8,023 9,654 13,287 47,083 57,835 205,183 4,459 14,362 6,939 9,677 11,892 17,857 1,954 5,587 6,975 3,837 6,696 4,276 Racine 195,163 46,606 28,785 4,732 15,346 7,831 11,122 13,525 24,966 Rock 161,188 38,494 24,323 3,908 12,662 6,388 9,159 11,059 23,554 Sauk 63,379 14,580 10,781 1,480 4,999 2,643 3,870 4,615 7,429 Sheboygan 115,290 26,246 18,698 2,665 9,151 4,811 6,945 8,360 10,165 Taylor 20,540 4,865 3,751 494 1,595 895 1,323 1,570 2,363 Vilas 21,398 3,602 6,213 366 1,747 1,172 1,876 2,122 3,126 Walworth 103,527 22,702 15,862 2,305 8,347 4,174 Waukesha 395,118 88,374 65,101 8,973 31,487 16,920 24,367 29,402 22,536 4,134,634 945,244 590,677 95,974 330,591 160,974 228,261 277,358 554,299 Totals 153 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 5,980 7,222 13,748 S TAT E TA B L E S WISCONSIN American Lung Association in Wisconsin www.lung.org/wisconsin HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Ashland Wgt. Avg. Grade Orange Red Purple 1 0 0 0.3 B Annual Wgt. Avg. Grade 0 0 0 0.0 A Design Value Pass/ Fail 5.2 PASS Brown 13 1 0 4.8 F 3 0 0 1.0 C 8.5 PASS Columbia 14 1 0 5.2 F DNC DNC DNC DNC DNC DNC DNC Dane 9 2 0 4.0 F 1 0 0 0.3 B 9.3 PASS Dodge 18 1 0 6.5 F 0 0 0 0.0 A 8.4 PASS Door 19 4 0 8.3 F DNC DNC DNC DNC DNC DNC DNC Eau Claire Fond du Lac Forest Grant 2 0 0 0.7 B 0 0 0 0.0 A 7.9 PASS 16 1 0 5.8 F DNC DNC DNC DNC DNC DNC DNC 4 0 0 1.3 C 0 0 0 0.0 A INC INC DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.7 PASS Jefferson 18 1 0 6.5 F DNC DNC DNC DNC DNC DNC DNC Kenosha 42 9 0 18.5 F 0 0 0 0.0 A 9.0 PASS Kewaunee 12 4 0 6.0 F DNC DNC DNC DNC DNC DNC DNC La Crosse Manitowoc Marathon 2 0 0 0.7 B 23 3 5 0 10.2 0 0 1.0 0 0 0 0.0 A F DNC DNC DNC DNC DNC C DNC DNC DNC DNC DNC 8.2 PASS DNC DNC DNC DNC Milwaukee 27 9 0 13.5 F 1 0 0 0.3 B 10.3 PASS Outagamie 13 1 0 4.8 F 2 0 0 0.7 B 8.4 PASS Ozaukee 27 6 0 12.0 F 0 0 0 0.0 A 7.9 PASS Racine INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Rock 17 0 0 5.7 F DNC DNC DNC DNC DNC DNC DNC Sauk 8 1 0 3.2 D 0 0 0 0.0 A 7.4 PASS 42 8 0 18.0 F DNC DNC DNC DNC DNC DNC DNC Sheboygan Taylor Vilas 2 0 0 0.7 B 2 0 0 0.7 B 0 0 0 0.0 A 0 0 0 0.0 A 6.8 PASS 5.1 PASS Walworth 19 1 0 6.8 F DNC DNC DNC DNC DNC DNC DNC Waukesha 10 1 0 3.8 F 0 0 0 0.0 A 10.2 PASS 154 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 S TAT E TA B L E S WYOMING American Lung Association in Wyoming www.lung.org/wyoming AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Cardiovascular Disease Diabetes Poverty Albany 37,811 6,236 3,708 536 2,640 1,740 1,761 2,074 8,547 Big Horn 11,930 3,014 2,287 259 747 663 Campbell 48,320 13,540 3,434 1,163 2,907 1,984 2,118 2,512 3,391 Carbon 15,854 3,783 2,184 325 1,010 798 946 1,019 1,851 Converse 14,097 3,478 1,987 299 889 714 857 917 1,299 147 464 406 514 528 602 893 2,538 2,122 2,606 2,714 5,558 Crook 7,248 1,706 1,303 Fremont 40,703 10,393 6,607 Goshen 13,514 2,710 2,766 Laramie 96,389 22,699 13,776 841 851 1,251 233 905 796 1,004 1,016 1,762 1,950 6,167 4,870 5,762 6,173 10,165 Natrona 81,624 19,512 10,469 1,676 5,197 3,982 4,619 5,040 8,262 Park 28,989 Sheridan 30,032 6,481 5,492 557 1,972 1,696 2,118 2,180 2,890 Sublette 10,057 207 Sweetwater 45,010 12,168 4,275 1,045 2,746 1,974 2,190 2,494 4,346 Teton 22,930 4,372 2,805 376 1,552 1,151 1,305 1,451 1,751 Uinta 20,904 6,228 2,309 535 1,228 934 1,082 1,193 2,081 Weston Totals 155 5,933 2,413 5,823 1,272 510 1,931 640 1,707 500 2,164 591 2,195 644 3,049 675 7,201 1,553 1,300 133 473 406 507 523 901 532,613 126,219 LUNG.org 71,797 10,844 34,006 26,443 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 30,984 33,524 58,381 S TAT E TA B L E S WYOMING American Lung Association in Wyoming www.lung.org/wyoming HIGH OZONE DAYS 2012–2014 HIGH PARTICLE POLLUTION DAYS 2012–2014 24-Hour County Orange Red Purple Albany Big Horn Wgt. Avg. Grade Orange Red Purple 6 0 0 2.0 C INC INC INC INC INC Campbell 6 1 0 2.5 D Carbon 0 0 0 0.0 A Annual Wgt. Avg. Grade 0 0 0 0.0 A INC INC INC INC INC 0 1 0 0.5 B INC INC INC INC INC INC INC INC INC INC INC Crook INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC 4 0 0 1.3 C 2 0 0 0.7 B 7.4 PASS Laramie Natrona DNC DNC DNC DNC DNC 0 0.3 B 4.8 PASS INC INC INC INC INC Goshen 0 Pass/ Fail Converse Fremont 1 Design Value INC INC INC INC INC INC INC INC INC 5 0 0 1.7 C 0 0 0 0.0 A 2 0 0 0.7 B 1 0 0 0.3 B 4.8 PASS 0 0 0 0.0 A 4.4 0 0 0 0.0 A 7.2 PASS 5 6 0 4.7 F INC Park DNC DNC DNC Sheridan DNC DNC DNC DNC DNC 4 1 0 0 0.3 B 1 0 0 0.3 B 5.5 PASS Teton 2 0 0 0.7 B 1 0 0 0.3 B 5.2 PASS Uinta 1 156 1.3 0 0.3 C PASS Sweetwater 0 0 DNC Sublette Weston 0 DNC 4.7 PASS B INC INC INC INC INC LUNG.org INC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2016 We will breathe easier when the air in every American community is clean and healthy. We will breathe easier when people are free from the addictive grip of tobacco and the debilitating effects of lung disease. We will breathe easier when the air in our public spaces and workplaces is clear of secondhand smoke. We will breathe easier when children no longer battle airborne poisons or fear an asthma attack. Until then, we are fighting for air. About the American Lung Association The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease, through research, education and advocacy. The work of the American Lung Association is focused on four strategic imperatives: to defeat lung cancer; to improve the air we breathe; to reduce the burden of lung disease on individuals and their families; and to eliminate tobacco use and tobaccorelated diseases. For more information about the American Lung Association, a holder of the Better Business Bureau Wise Giving Guide Seal, or to support the work it does, call 1-800-LUNGUSA (1-800-586-4872) or visit: www.Lung.org.