?g?lgCAN STATE AI Assocmm OF THE 8 EMBARG Embargoed until April 19, 2017 at 12:01 AM. (Eastern Time) Acknowledgments The American Lung Association “State of the Air® 2017” 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, M.A., who directed the project, analyzed data, wrote the text, and coordinated print and web presentations; Lyndsay Moseley Alexander, Laura Kate Bender and Diana Van Vleet who integrated the Healthy Air Campaign with this report; Zach Jump, M.A., 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, M.D., and Al Rizzo, M.D., 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 Valerie Wojs, who managed content production online; Laura Lavelle, Thomas Venhuizen and Corey Clark who developed social sharing and digital engagement strategy; Kim Lacina, Allison MacMunn, Gregg Tubbs and Erin Meyer 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. Hardworking 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. D E O G R A B EM 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; 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 also appreciate the assistance of the Association of Air Pollution Control Agencies, whose members also assisted in the review of the data from their states. 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 any of these agencies do. The American Lung Association assumes sole responsibility for the content of the American Lung Association “State of the Air® 2017.” American Lung Association National Headquarters 55 W. Wacker Drive, Suite 1150 Chicago, IL 60601 Advocacy Office 1331 Pennsylvania Avenue, NW, Suite 1725 North Washington, DC 20004 Phone: 1 (800) 586-4872 Fax: (202) 452-1805 www.stateoftheair.org www.Lung.org Copyright ©2017 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 2017 Contents The State of the Air 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Rankings People at Risk in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 D E O G R A B EM Most-Polluted Cities in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . 15 Most-Polluted Counties in the U.S. . . . . . . . . . . . . . . . . . . . . . . 18 Cleanest Cities in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Cleanest Counties in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Health Effects of Ozone and Particle Pollution . . . . . . . . . . . . . . . . . 32 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 State Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 3 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 STATE OF THE AIR 2017 The State of the Air 2017 The “State of the Air 2017” found continued improvement in air quality in 2013-2015 in ozone and year-round particle pollution, but an unrelenting increase in dangerous spikes in particle pollution. These trends demonstrate the continued need to support and enforce the Clean Air Act to protect the nation from unhealthy air. The “State of the Air 2017” report shows that cleaning up pollution continues successfully in much of the nation. In the 25 cities with the worst ozone and year-round particle pollution, the majority saw improvements from last year. Many again reached their lowest levels ever of these widespread air pollutants. 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, many cities reported their highest number of unhealthy days since the report began, including some that experienced extreme weather events. “State of the Air 2017” shows that more than four in 10 people had unhealthy air quality in their communities. The “State of the Air 2017” 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 2017” report looks at levels of ozone and particle pollution found in official monitoring sites across the United States in 2013, 2014 and 2015. The report uses the most current quality-assured nationwide data available for these analyses. D E O G R A B EM Overall Trends Four in 10 people live where the air is unhealthy. Still, this represents a major improvement: Onequarter fewer people now live where the air quality hit unhealthy levels. 4 LUNG.org 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 2016” report covered data from 2012, 2013 and 2014.1 The “State of the Air 2017” found continued improvement in air quality in 2013-2015 in ozone and year-round particle pollution, but an unrelenting increase in dangerous spikes in particle pollution. The number of people exposed to unhealthy levels of air pollution dropped to more than 125 million people, from 166 million in the years covered in the 2016 report (2012-2014). 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. Nearly four in 10 people (38.9 percent) in the United States live in counties that have unhealthful levels of either ozone or particle pollution. More than 125 million Americans live in 204 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. Still, this represents a major improvement: One-quarter fewer people now live where the air quality hit unhealthy levels in 2013-2015 than in the 2016 report. In last year’s report, covering 2012-2014, more than 166 million Americans lived in counties with unhealthful levels of air pollution. AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 STATE OF THE AIR 2017 More than 18 million people (5.6 percent) live in 12 counties with unhealthful levels of all three: ozone and short-term and year-round particle pollution. This is nearly 1.9 million fewer people than in the 2016 report when approximately 6.3 percent were exposed. However, we continue to lack data on particle pollution in all or parts of two states. Los Angeles improved over last year and again had its best ozone report in the history of the “State of the Air.” Los Angeles remains the city with the worst ozone pollution as it has for nearly the entire history of the report. Bakersfield, CA, maintains its rank as the city with the worst short-term particle pollution, while Visalia-Porterfield-Hanford, CA, moved for the first time to rank as the most-polluted city for year-round particle pollution. The “State of the Air 2017” report shows the sustained success of the Clean Air Act, continuing to clean up pollution in much of the nation, as it nearly completes its fifth decade of service. Many cities reported fewer days of high ozone and lower levels of year-round particle pollution. Several cities again reported their cleanest years ever during this period, while others had their worst periods of air pollution. Thanks to the provisions in the Clean Air Act, the United States has continued to reduce ozone and particle pollution as well as other pollutants for decades. Figure 1 from 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. D E O G R A B EM Comparison of Growth Areas and Emissions, 1970–2015 260% 240% 246% Gross Domes c Product 220% 200% 180% 184% Vehicle Miles Traveled 160% 140% Popula on 120% 100% 80% 60% 57% 40% 44% 20% 28% 0% Energy Consump on CO2 Emissions –20% –40% –60% –80% –71% 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 15 Figure 1: Air pollution emissions continue to drop steadily since 1970 thanks to the Clean Air Act. As the economy continues to grow, emissions that cause ozone and particle pollution continue to drop. Source: U.S. EPA, Air Trends: Air Quality National Summary, 2017. The Clean Air Act must remain intact and enforced to enable the nation to continue to protect all Americans from the dangers of air pollution. This law has driven improvements in air quality for 47 years, as shown in Figure 1. Since first issued in 2000, the “State of the Air” reports have also documented these improvements, as shown in trend charts for counties and cities available at www.stateoftheair.org. The nation must ensure that the Clean Air Act’s tools remain in place, funded and followed. The “State of the Air 2017” report adds to the evidence that a changing climate in making it harder to protect human health. 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 many that experienced wildfire smoke. 5 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 STATE OF THE AIR 2017 As climate change continues, cleaning up these pollutants will become ever more challenging. Climate change poses many threats to human health, including worsened air quality and extreme weather events. The nation must continue to reduce emissions that worsen climate. Ozone Pollution Twenty of the 25 cities with the worst ozone pollution reduced the number of highozone days they experienced each year, improving over the previous report. Twelve experienced their best ozone seasons ever during 2013-2015, reaching their lowest weighted average number of days of unhealthy levels each year. Los Angeles remains at the top of this list as it has for all but one of the 18 reports. Los Angeles also continues its success at cleaning up ozone, dropping its average number of unhealthy days to its lowest level ever. Also experiencing their fewest high-ozone days on average were 10 other cities among the 25 most polluted by ozone. They include Bakersfield, CA; Visalia-PortervilleHanford, CA; Modesto-Merced, CA; Sacramento, CA; Las Vegas; Dallas-Fort Worth; El Centro, CA; San Jose-San Francisco; Philadelphia; and Chico, CA. Nine others improved, though not reaching their lowest level: Fresno-Madera, CA; Phoenix; Denver-Aurora, CO; El Centro, CA; Fort Collins, CO; El Paso-Las Cruces, TXNM; San Antonio; Hartford, CT; Sheboygan, WI. One city—Redding-Red Bluff, CA—had the same number of unhealthy ozone days on average in this year’s report. D E O G R A B EM Four cities suffered more high-ozone days on average than in last year’s report: San Diego; Houston; Salt Lake City; and Baton Rouge, LA. These comparisons are all based on the Air Quality Index adopted with the 2015 ozone standard. Although EPA has yet to designate any places for cleanup based on that standard, it remains the current official national ambient air quality standard. Regional differences. Cities in the West and Southwest continue to dominate the most ozone-polluted list. California retains its historic challenge with seven of the 10 most polluted metropolitan areas in that state and 11 of the worst 25. California’s weather and geography complicate the strong effort the state continues to make to reduce emissions. The Southwest continues to fill most of the remaining slots, with nine of the 25 most ozone-polluted cities. Texas has four cities in the 25 most-polluted list: Houston, Dallas-Fort Worth, El Paso and San Antonio. Colorado has two: Denver and Fort Collins. Arizona, Nevada and Utah each have one. The Northeast also has three metro areas on the list, two of which cover parts of multiple states: New York City, Philadelphia, and Hanford, CT. The Midwest has only Sheboygan, WI. in the 25 mostpolluted list. The only southern city to remain on the list is Baton Rouge, LA. Those changes reflect changes seen in the past two reports, where increased oil and gas extraction especially in the Southwest and cleanup of power plants in the eastern U.S. have shifted the cities that experienced the greatest number of unhealthy air days. 6 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 STATE OF THE AIR 2017 Year-round Particles Twelve cities improved to their lowest levels of year-round particle pollution. Fifteen of the 25 cities with the highest year-round particle pollution reduced their levels, including 12 that reached or matched their lowest levels ever in 2013-2015. The 10 most polluted remain the only metropolitan areas in the nation that fail to meet the official national limits on annual fine particle pollution. Eight of the 25 cities suffered higher annual particle pollution levels, including Visalia-Porterfield-Hanford, CA, the city that ranked as the most polluted for yearround levels. In addition to Visalia, three other California cities—Bakersfield; San Jose-San Francisco; and San Luis Obispo—and two other cities in the western states— Medford-Grants Pass, OR, and Fairbanks, AK—had worse year-round levels. The two remaining cities with higher year-round average levels were in the east: JohnstownSomerset, PA and New York City metro area. San Luis Obispo reached its worst level ever. Two cities in the list of the 25 most-polluted maintained the same level as in the 2016 report: Cleveland and Houston. Regional differences. Much of the eastern and middle parts of the country have improved significantly since the report first started to track these fine particles. Much of that improvement came from reducing emissions from coal-fired power plants, as well as benefiting from nationwide cleanup of diesel engines. However, the western states’ burden of so much wildfire smoke and high inversions seems to have moved from just being a short-term problem to adding to the burden year-round. Cities in California’s San Joaquin valley were hit hard, as were other locations where particle pollution is usually limited to short spikes, including Fairbanks, AK, and Medford-Grants Pass, OR. D E O G R A B EM Data remain missing in all of Illinois, most of Tennessee and parts of Maine. That means that millions of people, including in large cities Chicago, Memphis and St. Louis (which is missing suburban counties in Illinois), cannot know how much particulate matter they are breathing. Short-Term Particle Pollution Bakersfield, CA retains its ranking as the most polluted city for spikes in particle pollution in this report, as it had in the 2016 report and in four other reports since 2010. Unfortunately, Bakersfield suffered more unhealthy days on average in this year’s report. Eight cities suffered their highest number of spikes in particle pollution since the reporting began. Fifteen of the 25 most-polluted cities had more days with higher episodes of particle pollution, including eight that suffered their most days since the report started and one that maintained its worst report ever. Cities recording their worst short-term particle episodes in 2013-2015 concentrated in the western states: Visalia-Porterfield-Hanford, CA; Fairbanks, AK; San Jose-San Francisco; Reno, NV; El Centro, CA; Lancaster, PN; Anchorage, AK; and Bend-RedmondPrineville, OR, marking that city’s first time on this list. Seven other western cities recorded more unhealthy days than in the previous report: Bakersfield, CA; Salt Lake City, UT; Logan, UT-ID; Los Angeles; Sacramento, CA; SeattleTacoma, WA; and Medford-Grants Pass, OR. Fortunately, eight cities improved with fewer days of spikes in particle levels in 2013-2015 than in 2012-2014. Six of these are western cities: Fresno-Madera, CA; Modesto-Merced, CA; Missoula, MT; Yakima, WA; Eugene, OR; and Phoenix, AZ. Two cities in Pennsylvania also improved: Harrisburg-York-Lebanon; and notably, Pittsburgh. Pittsburgh, which had been ranked the most polluted city in the same category in the 2008 report, experienced its fewest unhealthy days ever in 2013-2015. 7 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 STATE OF THE AIR 2017 Philadelphia and South Bend, IN recorded the same number of days in this year’s report as in last year’s report. However, as noted above, that kept South Bend stuck at its worst average number of unhealthy particle pollution days. Regional differences. Locations with many days of spikes shows the burden of concentrated smoke from wildfires, brushfires and wood-burning devices. For example, Reno, NV, suffered wildfires, and Logan, UT-ID; Eugene, OR, and Fairbanks and Anchorage, AK, rely heavily on wood burning devices for heat. Wildfires have increased, in part, from drought and heat enhanced by climate change. Inversions trap particles in place behind mountains and ridgelines. For example, inversions in the San Joaquin Valley in California and in the Wasatch Ridge in Utah contributed to high pollution days in both states. Cleanest Cities Six cities ranked on all three cleanest cities lists in 2013-2015. These cities had zero high ozone or high particle pollution days, and were among the 25 cities with the lowest year-round particle levels. Five have repeated their ranking on this list, but Wilmington, NC, joins this list for the first time. Listed alphabetically below, these six cities are: Burlington-South Burlington, VT Honolulu, HI Cape Coral-Fort Myers-Naples, FL Palm Bay-Melbourne-Titusville, FL Elmira-Corning, NY Wilmington, NC D E O G R A B EM Eleven 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: Bangor, ME North Port Sarasota, FL Casper, WY Orlando-Deltona-Daytona Beach, FL Colorado Springs, CO Pueblo-Canon City, CO Farmington, NM Sierra Vista-Douglas, AZ Homosassa Springs, FL Syracuse-Auburn, NY Lakeland Winter Haven, FL Twenty-three other cities 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 Greenville-Washington, NC Brunswick, GA Harrisonburg-Staunton-Waynesboro, VA Charlottesville, VA Jackson-Vicksburg-Brookhaven, MS Columbia-Orangeburg-Newberry, SC La Crosse-Onalaska, WI-MN Des Moines-Ames-West Des Moines, IA McAllen-Edinburg, TX Dothan-Enterprise-Ozark, AL Monroe-Ruston-Bastrop, LA Eau Claire-Menomonie, WI Rome-Summerville, GA Fayetteville-Springdale-Rogers, AK-MO Savannah-Hinesville-Statesboro, GA Florence, SC Springfield-Branson, MO Florence-Muscle Shoals, AL Tuscaloosa, AL Gadsden, AL Waterloo-Cedar Falls, IA Gainesville-Lake City, FL 8 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 STATE OF THE AIR 2017 Two cities ranked on both lists for ozone and year-round particle pollution levels. Fargo-Wahpeton, ND-MN and Salinas, CA 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 2017” shows that, even with ongoing improvement, too many people in the United States live where the air is unhealthy for them to breathe. People at Risk Nearly four in 10 people (38.9 percent) in the United States live in counties that have unhealthful levels of either ozone or particle pollution. More than 125 million Americans live in 204 counties where they breathe unhealthful levels of air pollution in the form of either ozone or short-term or year-round levels of particles. This represents a major improvement: One-quarter fewer people now live where the air quality hit unhealthy levels in 2013-2015 than in the 2016 report. In last year’s report, covering 2012-2014, more than 166 million Americans lived in counties with unhealthful levels of air pollution. This improvement reflects continued progress in reducing harmful air pollution under the Clean Air Act. Progress would have been greater if climate change had not helped to create conditions that can worsen air quality. D E O G R A B EM More than 18 million people in the U.S. live in counties where the outdoor air failed all three tests. More than one-third (36 percent) of the people in the United States live in areas with unhealthy levels of ozone pollution, but that is far fewer in 2013-2015 than in the previous report. Approximately 116.5 million people live in 161 counties that earned an F for ozone this year’s report, a significant drop from the approximately 162.9 million who lived in counties earning an F in 2012-2014. Nearly 19.9 million people (6.2 percent) suffered from unhealthy year-round levels of particle pollution in 2013-2015. These people lived in 18 counties where the annual average concentration of particle pollution was too high. Although still too high, fewer people face those dangerous year-round concentrations during this period than in last year’s report. That report covered 2012-2014 when approximately 22.8 million people lived where monitors recorded unhealthy levels of year-round particle pollution. More than 13 percent of people in the United States—more than 43 million—live in an area with too many days with unhealthful levels of particle pollution. Slightly fewer people lived where those episodes of unhealthy spikes in particle pollution in 20132015, despite many cities reaching their worst number of spikes since the report began. The total population exposed to unhealthy air dropped slightly to 43.03 million, down from 44.97 million in the 2016 report. Some counties with large populations had fewer high days, so they no longer received an F, while smaller population counties had more high pollution days. Those shifts resulted in slight changes to the population totals. More than 18 million people (5.6 percent) live in 12 counties with unhealthful levels of all three: ozone and short-term and year-round particle pollution. This is nearly 1.9 million fewer people than in the 2016 report when approximately 6.3 percent were exposed. However, data on particle pollution remains missing in all or parts of three states. With the risks from airborne pollution so great, the 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. Because of the missing data on particle pollution in Illinois, Tennessee and Maine, the numbers of people living in counties that fail all three tests may be actually higher. 9 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 STATE OF THE AIR 2017 Older and Younger—Nearly 16.7 million adults age 65 and over and more than 29.5 million children under 18 years old live in counties that received an F for at least one pollutant. More than 2.3 million seniors and more than 4.3 million children live in counties failing all three tests. People with Asthma—Nearly 2.5 million children and nearly 8.3 million adults with asthma live in counties of the United States that received an F for at least one pollutant. Nearly 322,000 children and close to 1.1 million adults with asthma live in counties failing all three tests. Chronic Obstructive Pulmonary Disease (COPD)—More than 5.1 million people with COPD live in counties that received an F for at least one pollutant. More than 575,000 people with COPD live in counties failing all three tests. Lung Cancer—More than 68,000 people with lung cancer live in counties that received an F for at least one pollutant. More than 8,000 people with lung cancer live in counties failing all three tests. Cardiovascular Disease—More than 7.1 million people with cardiovascular diseases live in counties that received an F for at least one pollutant; more than 88,000 people live in counties failing all three tests. Diabetes—Nearly 3.3 million people with diabetes live in counties that received an F for either short-term or year-round particle pollution; more than 1.3 million live in counties failing both tests. Having diabetes increases the risk of harm from particle pollution. D E O G R A B EM Poverty—More than 17.7 million people with incomes meeting the federal poverty definition live in counties that received an F for at least one pollutant. Nearly 3.2 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. What Needs to Be Done Our nation has made significant strides in cleaning up our air, as the progress in the 18 years of this report has shown. Stopping or retreating cannot be an option. Our nation’s historic, legal commitment to protect the health of millions of Americans requires more work to reduce the burden of air pollution. 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 leaders must support steps to improve the air we breathe so that it does not cause or worsen lung disease. The American Lung Association urges our nation’s leaders to stand up for public health and take these important steps to improve the air we all breathe. Protect the Clean Air Act Congress must make certain that the Clean Air Act remains strong, fully implemented and enforced. 10 LUNG.org Our nation’s continued air quality improvement shown in the “State of the Air 2017” report is possible only 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. Congress wrote the Clean Air Act to set up science-based, technology-fostering steps to protect public health by reducing pollution. Under the Clean Air Act, Congress directed that the EPA and each state take steps to clean up the air. As the “State of the Air 2017” report documents, those steps have reduced ozone and particle pollution in much of the nation. Unfortunately, some in Congress seek changes to the Clean Air Act that would dismantle key provisions of the law and threaten progress made over nearly five decades. To protect the lives and health of millions of Americans, Congress must protect the Clean Air Act—making certain it remains strong, fully implemented and enforced. AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 STATE OF THE AIR 2017 Fight Climate Change by Reducing Carbon Pollution from Power Plants Power plants comprise the largest stationary source of carbon pollution in the United States. The electric sector contributed 30 percent of all energy-related carbon dioxide (CO2) emissions in 2014.2 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 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 American Lung Association calls on governors to direct their states to develop strong plans to reduce carbon pollution from power plants and protect public health. In 2015, EPA adopted the Clean Power Plan, a flexible, practical tool kit 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 courts hear the case. D E O G R A B EM Even before the lower court released its decision on the Clean Power Plan, President Trump issued an Executive Order directing EPA Administrator Scott Pruitt to roll back the plan. However, the Lung Association and others will continue to fight to secure reductions in carbon dioxide emissions from power plants and other sources. Retain the Clean Vehicle Emissions Standards. Transportation produces more than one quarter of the nation’s greenhouse gases that worsen climate change.3 In 2012, EPA and the National Highway Traffic Safety Administration announced new standards for reducing greenhouse gas emissions from cars, SUVs and light-duty trucks in model years 2017-2025. The emissions standards would reduce 2 billion metric tons of carbon dioxide emissions over the lifetime of the vehicles and would improve fuel efficiency. EPA committed to doing an interim review after the initial phase was in place to see if the longer-term standards for 2012-2025 should still be in place. In January 2017, EPA announced that it had completed its mid-term review and that these emissions standards were appropriate and achievable by the automobile industry for model years 2022-2025. However, in March 2017, EPA Administrator Scott Pruitt and Transportation Secretary Elaine Chao announced the reconsideration of the final determination and reopened EPA’s review. The Lung Association opposed the decision to reopen the review, as EPA had taken an extensive, in-depth examination with public comments before reaching their conclusion. Based on the evidence EPA found before, the Lung Association expects EPA to conclude, again, that the targets should remain in place. Reduce Emissions from Existing and New Oil and Gas Operations Oil and gas production wells, processing plants, transmission pipelines and storage units have long emitted harmful gases including methane, volatile organic compounds and other pollutants. As noted earlier, this report found high levels of unhealthy ozone in places where oil and gas production has expanded in the last few years. In May 2016, EPA adopted health-protective standards to reduce harmful emissions of these gases from new and modified sources within the oil and natural gas industry. 11 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 STATE OF THE AIR 2017 However, that action did not affect emissions from the existing oil and gas infrastructure. In November 2016, EPA requested essential information from the oil and gas industry about the location and size of their facilities. Gathering this information is a required step for EPA to eventually limit harmful emissions from these existing sources. The industry objected and, unfortunately, in March 2017, the EPA withdrew its request to the updated information on their facilities, with the explanation that the administrator needed to review the request. The Lung Association calls on the administrator to move forward and set strong pollution control standards for existing oil and gas operations. 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. Improve the Air Pollution Monitoring Network The grades in this report come from information from the nationwide air pollutionmonitoring 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. D E O G R A B EM 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. Communities that have expanded oil and gas extraction operations need more monitoring. The President has proposed to cut EPA’s budget by 31 percent, including dramatic cuts for state air pollution grants that fund monitoring. 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. Here’s how to speak up and step up: Speak up for Healthy Air Protections. Send a message to Congress and to the White House: Protect the Clean Air Act! Urge the President and Congress to support cleaner, healthier air and oppose measures to block or delay the cleanup of air pollution. The President and all members of Congress should support and protect the Clean Air Act. Tell Congress to support adequate funds for the EPA to implement and enforce the Clean Air Act. EPA works with the states to make sure that the pollution is cleaned up, but they need the resources to do that work. Tell EPA to follow the law to protect your health. EPA is required to follow the Clean Air Act, completing regular reviews of the science and putting in place steps to clean up sources of pollution to provide that protection. That includes taking steps to reduce pollution that causes climate change. You can provide comments to EPA at public hearings or in writing online. Sign up for more information about times when your voice is needed at www.FightingForAir.org. 12 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 STATE OF THE AIR 2017 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 locally. Participate in state and local efforts to clean up air pollution and address climate change. To find your local air pollution control agency, go to www.4cleanair.org. 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. 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. D E O G R A B EM 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 A complete discussion of the sources of data and the methodology is included in Methodology. 2 U.S. Environmental Protection Agency. Inventory of Greenhouse Gas Emissions and Sinks: 1990-2014. Washington, DC: U.S. EPA, 2016. EPA 430-R-16-002. 3 EPA, 2016. 13 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS People at Risk from Short-Term Particle Pollution (24-Hour PM2.5) Chronic Diseases Age Groups Number In Counties where Adult Pediatric Lung CV 65 and Total of the Grades were: Asthma Asthma COPD Cancer Disease Diabetes Poverty Under 18 Over Population Counties Grade A (0.0) 5,992,655 1,802,928 4,289,711 53,062 5,519,300 6,813,373 12,296,314 19,154,928 12,637,796 85,841,453 288 Grade B (0.3-0.9) 2,487,361 710,302 1,707,641 22,079 2,257,763 2,798,334 5,296,773 8,482,854 5,136,291 36,961,630 111 Grade C (1.0-2.0) 1,497,678 418,793 1,017,268 13,031 1,354,796 1,698,140 3,133,628 5,062,225 3,014,053 21,607,181 54 Grade D (2.1-3.2) 1,034,136 260,265 627,358 8,067 847,006 1,130,589 2,203,289 3,452,500 2,064,381 15,344,010 23 Grade F (3.3+) 2,758,254 821,980 1,571,574 20,540 2,256,027 3,140,522 6,585,074 10,434,818 5,634,316 43,036,931 69 National Population in Counties with PM2.5 Monitors 15,156,120 4,405,144 10,236,303 129,977 13,557,088 17,166,636 32,430,455 51,249,670 31,374,325 223,082,364 636 People at Risk from Year-Round Particle Pollution (Annual PM2.5) Chronic Diseases Age Groups D E O G R A B EM Number In Counties where Adult Pediatric Lung CV 65 and Total of the Grades were: Asthma Asthma COPD Cancer Disease Diabetes Poverty Under 18 Over Population Counties Pass Fail 11,727,392 3,421,296 1,215,259 7,938,618 100,393 10,429,084 13,115,687 24,212,629 38,997,449 23,983,876 170,682,208 349,400 673,296 9,220 1,011,474 1,495,671 3,455,844 4,738,182 2,612,834 468 19,870,106 18 National Population in Counties with PM2.5 Monitors 15,156,120 4,405,144 10,236,303 129,977 13,557,088 17,166,636 32,430,455 51,249,670 31,374,325 223,082,364 636 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) 2,135,734 592,588 1,591,631 2,084,164 4,515,103 7,034,893 4,934,132 31,578,049 218 Grade B (0.3-0.9) 1,866,933 547,662 1,429,515 1,831,132 4,001,141 6,187,522 4,137,336 27,423,560 159 Grade C (1.0-2.0) 2,625,700 740,239 1,949,579 2,496,364 4,762,756 8,192,247 5,655,800 36,787,108 167 Grade D (2.1-3.2) 1,752,575 487,238 1,199,321 1,527,279 3,307,983 5,233,129 3,456,203 23,537,106 62 Grade F (3.3+) 7,629,719 2,304,667 4,743,298 6,576,087 16,529,442 27,566,927 15,417,092 116,502,119 161 16,218,750 4,732,885 11,069,317 14,726,495 33,546,429 54,859,943 34,098,150 238,804,343 803 National Population in Counties with Ozone Monitors Note: The State of the Air 2017 covers the period 2013-2015. The Appendix provides a full discussion of the methodology. 14 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS People at Risk In 25 U.S. Cities Most Polluted by Short-Term Particle Pollution (24-hour PM2.5) 2017 Rank1 Metropolitan Statistical Areas Total Population2 Under 183 65 and Pediatric Adult Over3 Asthma.4,6 Asthma5,6 Lung CV COPD7 Cancer8 Disease9 Diabetes10 Poverty11 1 Bakersfield, CA 882,176 257,727 88,992 18,417 47,777 23,732 384 36,297 57,322 185,990 2 Visalia-Porterville-Hanford, CA 610,828 185,471 63,293 13,253 32,579 16,291 266 24,985 39,208 154,039 2 Fresno-Madera, CA 1,129,859 322,159 132,448 23,021 62,047 31,883 490 49,778 77,435 274,927 4 Modesto-Merced, CA 806,843 226,215 95,841 16,165 44,619 23,071 350 36,214 56,432 171,672 5 Fairbanks, AK 99,631 24,116 8,349 2,045 7,139 2,756 56 3,943 4,891 7,671 6 San Jose-San Francisco-Oakland, CA 8,713,914 1,877,655 1,214,016 134,173 526,751 280,172 3,779 448,510 696,765 933,311 7 Salt Lake City-Provo-Orem, UT 2,467,709 757,422 231,853 53,789 154,727 60,714 653 90,218 115,839 255,652 8 Logan, UT-ID 133,857 41,508 12,489 3,008 8,322 3,200 38 4,693 5,854 19,910 9 Los Angeles-Long Beach, CA 18,679,763 4,383,662 2,376,130 313,246 1,099,027 571,985 10 Reno-Carson City-Fernley, NV 605,706 131,049 102,549 7,661 38,311 33,137 356 39,626 49,111 81,422 11 El Centro, CA 180,191 51,119 22,442 3,653 9,934 5,187 78 8,178 12,647 41,685 12 Lancaster, PA 536,624 128,793 89,727 14,397 41,751 28,456 353 38,439 42,053 55,725 13 Missoula, MT 66 5,905 6,350 17,461 14 Sacramento-Roseville, CA 1,102 132,685 204,433 379,600 14 Anchorage, AK 16 Yakima, WA 17 Pittsburgh-New Castle-Weirton, PA-OH-WV 17 Seattle-Tacoma, WA 19 Medford-Grants Pass, OR 20 Philadelphia-Reading-Camden, PA-NJ-DE-MD 21 South Bend-Elkhart-Mishawaka, IN-MI 21 Harrisburg-York-Lebanon, PA 23 Eugene, OR 24 25 114,181 22,154 16,172 1,404 8,203 4,628 2,544,026 593,452 374,195 42,407 150,701 81,902 399,790 101,387 38,009 8,596 27,941 8,096 902,929 1,409,515 2,928,894 11,714 223 17,279 21,498 D E O G R A B EM 248,830 138 34,981 74,063 32,662 4,838 16,416 10,504 13,029 14,296 46,794 2,648,605 509,215 497,830 56,223 218,112 4,602,591 1,000,111 626,375 65,324 339,697 158,026 1,748 213,287 232,472 327,752 216,668 2,557 263,773 293,479 297,312 60,886 65,587 5,714 26,407 14,726 482,638 21,709 28,402 58,695 7,183,479 1,592,239 1,085,893 162,777 525,438 349,693 725,065 178,459 113,087 13,523 56,107 43,911 4,605 470,916 511 54,707 542,896 62,712 916,171 109,079 1,247,235 272,926 209,814 30,509 99,682 68,539 820 92,638 101,485 126,887 362,895 68,799 64,973 6,456 33,296 16,555 204 23,240 31,518 67,777 Phoenix-Mesa-Scottsdale, AZ 4,574,531 1,127,596 670,488 122,981 324,484 214,829 2,233 264,628 340,926 727,788 Bend-Redmond-Prineville, OR 196,898 41,110 38,464 3,858 17,521 9,377 17,982 26,721 167 111 13,392 Notes: 1. Cities are ranked using the highest weighted average for any county within that Combined Metropolitan Statistical Area or Metropolitan Statistical Area. 2. Total Population represents the at-risk populations for all counties within the respective Combined Metropolitan Statistical Area 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 2015 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 2015 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. Lung cancer estimates are the number of new cases diagnosed in 2013 . 9. 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). 10. 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). 11. Poverty estimates come from the U.S. Census Bureau and are for all ages. 15 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS People at Risk In 25 U.S. Cities Most Polluted by Year-Round Particle Pollution (Annual PM2.5) 2017 Rank1 Metropolitan Statistical Areas Total Population2 Under 183 65 and Pediatric Adult Over3 Asthma.4,6 Asthma5,6 Lung CV COPD7 Cancer8 Disease9 Diabetes10 Poverty11 154,039 1 Visalia-Porterville-Hanford, CA 610,828 185,471 63,293 13,253 32,579 16,291 266 24,985 39,208 2 Bakersfield, CA 882,176 257,727 88,992 18,417 47,777 23,732 384 36,297 57,322 185,990 3 Fresno-Madera, CA 1,129,859 322,159 132,448 23,021 62,047 31,883 490 49,778 77,435 274,927 4 San Jose-San Francisco-Oakland, CA 696,765 933,311 5 Los Angeles-Long Beach, CA 6 7 8 8,713,914 1,877,655 1,214,016 134,173 526,751 280,172 3,779 448,510 18,679,763 4,383,662 2,376,130 313,246 1,099,027 571,985 8,096 902,929 1,409,515 2,928,894 Modesto-Merced, CA 806,843 226,215 95,841 16,165 44,619 23,071 350 36,214 56,432 171,672 El Centro, CA 180,191 51,119 22,442 3,653 9,934 5,187 78 8,178 12,647 41,685 Pittsburgh-New Castle-Weirton, PA-OH-WV 2,648,605 509,215 497,830 56,223 218,112 158,026 1,748 213,287 232,472 327,752 9 Cleveland-Akron-Canton, OH 3,493,596 756,784 597,001 54,482 274,623 222,765 2,401 263,764 312,145 497,987 10 San Luis Obispo-Paso RoblesArroyo Grande, CA 281,401 50,837 51,231 3,633 17,910 10,097 122 16,633 25,113 38,448 11 Medford-Grants Pass, OR 297,312 60,886 65,587 5,714 26,407 14,726 167 21,709 28,402 58,695 11 Philadelphia-Reading-Camden, PA-NJ-DE-MD 7,183,479 1,592,239 1,085,893 162,777 525,438 349,693 4,605 470,916 542,896 916,171 13 Indianapolis-Carmel-Muncie, IN 2,372,530 583,997 313,675 43,916 184,825 139,575 1,738 171,702 200,542 329,297 13 Louisville/Jefferson County— Elizabethtown—Madison, KY-IN 13 Johnstown-Somerset, PA 16 Houston-The Woodlands, TX 17 Fairbanks, AK 18 Detroit-Warren-Ann Arbor, MI 18 Altoona, PA 20 Lancaster, PA 20 Cincinnati-Wilmington-Maysville, OH-KY-IN 22 Birmingham-Hoover-Talladega, AL 1,360,082 312,528 22 Harrisburg-York-Lebanon, PA 1,247,235 272,926 22 New York-Newark, NY-NJ-CT-PA 23,723,696 5,178,719 3,461,559 25 Erie-Meadville, PA 364,529 78,960 61,087 D E O G R A B EM 1,504,559 346,616 219,919 35,200 133,941 130,160 211,933 40,095 44,363 4,482 17,358 12,999 1,365 133,904 6,855,069 1,829,561 703,418 144,776 382,312 248,754 99,631 24,116 8,349 2,045 7,139 2,756 5,319,913 1,196,787 801,027 92,712 424,024 314,167 125,593 25,939 24,852 2,900 10,102 7,381 82 10,174 536,624 128,793 89,727 14,397 41,751 28,456 353 2,216,735 531,163 311,427 42,406 176,287 145,299 209,403 41,245 103,803 110,714 209,814 30,509 99,682 68,539 140 150,903 200,814 18,031 19,502 29,615 3,705 381,501 552,311 988,741 3,943 4,891 7,671 3,379 372,872 436,925 847,421 11,031 18,616 38,439 42,053 55,725 1,650 160,014 188,672 287,495 56 933 116,412 141,142 222,890 820 101,485 126,887 92,638 505,108 1,708,629 1,001,947 14,302 1,340,765 1,727,386 3,178,139 8,827 29,248 19,931 240 26,881 29,464 57,949 Notes: 1. Cities are ranked using the highest weighted average for any county within that Combined Metropolitan Statistical Area or Metropolitan Statistical Area. 2. Total Population represents the at-risk populations for all counties within the respective Combined Metropolitan Statistical Area 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 2015 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 2015 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. Lung cancer estimates are the number of new cases diagnosed in 2013 . 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. 16 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS People at Risk In 25 Most Ozone-Polluted Cities 2017 Rank1 Metropolitan Statistical Areas 1 Los Angeles-Long Beach, CA 2 Bakersfield, CA 3 Fresno-Madera, CA 4 Visalia-Porterville-Hanford, CA 5 Phoenix-Mesa-Scottsdale, AZ 6 Modesto-Merced, CA 7 San Diego-Carlsbad, CA 8 Sacramento-Roseville, CA 9 New York-Newark, NY-NJ-CT-PA 10 11 Total Population2 Under 183 65 and Pediatric Adult Over3 Asthma.4,6 Asthma5,6 18,679,763 4,383,662 2,376,130 313,246 882,176 257,727 88,992 18,417 1,129,859 322,159 132,448 23,021 COPD7 CV Disease8 1,099,027 571,985 8,096 47,777 23,732 384 57,322 62,047 31,883 490 77,435 Poverty9 1,409,515 610,828 185,471 63,293 13,253 32,579 16,291 266 39,208 4,574,531 1,127,596 670,488 122,981 324,484 214,829 2,233 340,926 806,843 226,215 95,841 16,165 44,619 23,071 350 56,432 3,299,521 728,037 431,999 52,024 197,708 102,514 1,433 250,288 2,544,026 593,452 374,195 42,407 150,701 81,902 1,102 204,433 23,723,696 5,178,719 3,461,559 505,108 1,708,629 1,001,947 14,302 1,727,386 Las Vegas-Henderson, NV-AZ 2,362,015 543,472 358,944 33,670 149,068 120,361 1,367 179,273 Denver-Aurora, CO 3,418,876 802,008 408,996 68,001 237,472 108,795 1,453 169,116 12 Houston-The Woodlands, TX 6,855,069 1,829,561 703,418 144,776 382,312 248,754 3,705 552,311 13 Dallas-Fort Worth, TX-OK 7,538,055 1,990,630 826,555 157,759 422,482 282,033 4,071 625,563 14 El Centro, CA 180,191 51,119 22,442 3,653 9,934 5,187 78 12,647 15 Fort Collins, CO 333,577 67,793 47,570 5,748 24,144 11,356 142 17,585 16 El Paso-Las Cruces, TX-NM Redding-Red Bluff, CA 18 D E O G R A B EM 84,514 17 1,053,267 288,219 129,282 23,423 61,859 39,643 538 242,841 53,749 47,109 3,841 14,771 8,761 105 22,350 San Jose-San Francisco-Oakland, CA 8,713,914 1,877,655 1,214,016 134,173 526,751 280,172 3,779 696,765 19 San Antonio-New Braunfels, TX 2,384,075 612,614 296,086 48,477 134,762 91,254 1,286 202,041 20 Salt Lake City-Provo-Orem, UT 2,467,709 757,422 231,853 53,789 154,727 60,714 653 115,839 21 Hartford-West Hartford, CT 1,483,187 305,454 239,202 35,791 123,794 60,395 936 109,140 22 Baton Rouge, LA 830,480 197,739 105,468 17,303 51,764 45,903 579 76,252 22 Philadelphia-Reading-Camden, PA-NJ-DE-MD 7,183,479 1,592,239 1,085,893 162,777 525,438 349,693 4,605 542,896 24 Sheboygan, WI 115,569 26,084 19,254 1,917 8,460 4,412 69 7,810 25 Chico, CA 225,411 45,348 39,543 3,240 13,978 7,812 98 19,274 Notes: 1. Cities are ranked using the highest weighted average for any county within that Combined Metropolitan Statistical Area or Metropolitan Statistical Area. 2. Total Population represents the at-risk populations for all counties within the respective Combined Metropolitan Statistical Area 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 2015 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 2015 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. 17 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS People at Risk in 25 Counties Most Polluted by Short-Term Particle Pollution (24-hour PM2.5) At-Risk Groups 2017 Rank1 County ST Total Population2 Under 183 High PM2.5 Days in Unhealthy Ranges, 2013–2015 65 and Pediatric Adult Lung Over3 Asthma4,6 Asthma5,6 COPD7 Cancer8 CV Disease8 Diabetes9 Poverty10 Weighted Avg.11 Grade12 1 Kern CA 882,176 257,727 88,992 18,417 47,777 23,732 384 36,297 57,322 185,990 52.7 F 2 Fresno CA 974,861 279,544 112,074 19,976 53,384 27,289 423 42,457 66,139 241,669 41.2 F 2 Kings CA 150,965 41,435 14,146 2,961 8,357 4,026 66 6,015 9,555 30,117 41.2 F 4 Stanislaus CA 538,388 146,063 67,324 10,437 30,189 15,817 233 25,049 38,935 103,646 29.8 F 5 Fairbanks North AK Star Borough 99,631 24,116 8,349 2,045 7,139 2,756 56 3,943 4,891 7,671 25.8 F 6 Madera CA 154,998 42,615 20,374 3,045 8,663 4,595 67 7,321 11,296 33,258 24.7 F 7 San Joaquin CA 726,106 199,894 87,579 14,284 40,454 21,053 315 33,228 51,852 124,606 22.8 F 8 Salt Lake UT 1,107,314 311,386 109,258 22,113 72,084 28,671 293 42,720 54,993 117,311 21.7 F 9 Cache UT 120,783 37,123 10,685 2,636 7,531 2,768 32 4,057 5,140 18,657 20.2 F 10 Merced CA 268,455 80,152 28,517 5,727 14,430 7,254 117 11,165 17,497 68,026 19.5 F 11 Shoshone ID 12,432 2,464 2,772 209 909 576 6 892 988 2,577 16.8 F 12 Utah UT 575,205 198,953 42,066 14,129 33,832 12,002 152 17,123 21,908 70,537 15.5 F 13 Lemhi ID 7,735 1,398 2,193 119 574 398 4 642 694 1,347 14.3 F 14 Riverside CA 2,361,026 612,848 320,086 43,793 134,810 71,829 1,024 114,813 177,144 377,244 14.0 F 15 Douglas NV 47,710 8,500 12,234 497 3,145 3,277 28 4,072 4,863 4,459 13.3 F 16 Franklin ID 13,074 4,385 1,804 372 791 432 6 636 714 1,253 12.7 F CA 459,863 144,036 49,147 10,292 24,222 12,265 200 18,970 29,653 123,922 12.5 F MT 41,373 8,214 9,904 521 2,901 2,193 24 3,088 3,060 6,129 12.5 F CA 18,409 3,149 4,729 225 1,206 785 8 1,395 2,065 2,503 11.3 F 17 Tulare 17 Ravalli 19 Plumas 20 Weber D E O G R A B EM UT 243,645 70,325 27,606 4,994 15,725 6,546 64 10,045 12,791 29,768 11.0 F 20 Santa Cruz CA 274,146 54,183 38,794 3,872 16,944 8,989 119 14,364 22,322 40,480 11.0 F 22 Los Angeles CA 10,170,292 2,279,839 1,277,335 162,912 606,055 312,736 4,407 490,888 767,731 1,675,802 10.5 F 23 Inyo CA 8 1,227 9.7 F 23 Lincoln 25 Washoe 18,260 3,769 4,044 269 1,139 706 1,827 2,222 MT 19,052 3,491 4,903 221 1,360 1,072 11 1,523 1,499 3,817 9.7 F NV 446,903 99,275 67,548 5,804 28,100 23,194 263 27,431 34,367 61,017 9.5 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 2015 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 2015 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. Lung cancer estimates are the number of new cases diagnosed in 2013 . 9. 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). 10. 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). 11. Poverty estimates come from the U.S. Census Bureau and are for all ages. 12. The Weighted Average was derived by counting the number of days in each unhealthful range (orange, red, purple, maroon) in each year (2013-2015), 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. 13. 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+. 18 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS People at Risk In 25 Counties Most Polluted by Year-Round Particle Pollution (Annual PM2.5) At-Risk Groups 2017 Rank1 County ST Total Population2 Under 183 65 and Pediatric Adult Over3 Asthma4,6 Asthma5,6 Lung COPD7 Cancer8 CV Disease9 Diabetes10 Poverty11 PM2.5 Annual, 2013–2015 Design Pass/ Value12 Grade13 1 Kings CA 150,965 41,435 14,146 2,961 8,357 4,026 66 6,015 9,555 30,117 22.2 Fail 2 Kern CA 882,176 257,727 88,992 18,417 47,777 23,732 384 36,297 57,322 185,990 20.8 Fail 3 Tulare CA 459,863 144,036 49,147 10,292 24,222 12,265 200 18,970 29,653 123,922 17.6 Fail 4 Fresno CA 974,861 279,544 112,074 19,976 53,384 27,289 423 42,457 66,139 241,669 15.4 Fail 5 Madera CA 154,998 42,615 20,374 3,045 8,663 4,595 67 7,321 11,296 33,258 15.2 Fail 6 Plumas CA 18,409 3,149 4,729 225 1,206 785 8 1,395 2,065 2,503 14.9 Fail 7 San Joaquin CA 726,106 199,894 87,579 14,284 40,454 21,053 315 33,228 51,852 124,606 14.2 Fail 8 Riverside CA 2,361,026 612,848 320,086 43,793 134,810 71,829 1,024 114,813 177,144 377,244 14.1 Fail 9 Stanislaus CA 538,388 146,063 67,324 10,437 30,189 15,817 233 25,049 38,935 103,646 13.8 Fail 10 Shoshone ID 12,432 2,464 2,772 209 909 576 6 892 988 2,577 13.7 Fail 11 Imperial CA 180,191 51,119 22,442 3,653 9,934 5,187 78 8,178 12,647 41,685 13.1 Fail 12 Lemhi ID 7,735 1,398 2,193 119 574 398 4 642 694 1,347 12.7 Fail 13 Allegheny PA 1,230,459 233,675 217,210 26,121 102,088 69,398 807 93,646 102,520 145,454 12.6 Fail 14 Merced CA 268,455 80,152 28,517 5,727 14,430 7,254 117 11,165 17,497 68,026 12.5 Fail 15 Cuyahoga OH 1,255,921 268,170 210,832 19,306 99,147 79,368 861 93,526 110,646 224,256 12.4 Fail 16 Los Angeles CA 10,170,292 2,279,839 1,277,335 162,912 606,055 312,736 4,407 490,888 767,731 1,675,802 12.3 Fail D E O G R A B EM 17 San Luis Obispo CA 281,401 50,837 51,231 3,633 17,910 10,097 122 16,633 25,113 38,448 12.1 Fail 17 Hawaii HI 196,428 43,217 35,851 4,291 15,151 6,892 99 10,359 13,874 35,294 12.1 Fail 19 San Bernardino CA 2,128,133 572,173 228,666 40,886 119,170 59,986 923 92,725 146,418 394,031 12.0 Pass OR 212,567 44,332 44,244 4,160 18,855 10,252 119 14,926 19,715 40,427 11.8 Pass 20 Philadelphia PA 1,567,442 346,932 198,475 38,782 127,499 74,034 1,024 94,862 106,183 385,781 11.8 Pass 22 Lincoln MT 19,052 3,491 4,903 221 1,360 1,072 11 1,523 1,499 3,817 11.7 Pass 20 Jackson 22 Marion IN 939,020 234,220 108,060 17,613 73,292 52,169 686 63,121 75,137 189,323 11.7 Pass 22 Jefferson KY 763,623 171,811 113,444 18,636 70,483 70,948 727 70,423 78,758 115,246 11.7 Pass 22 Cambria PA 136,411 26,377 28,534 2,949 11,114 8,324 90 11,550 12,488 19,450 11.7 Pass 22 Washington PA 208,261 41,143 40,169 4,599 16,954 12,373 137 17,016 18,497 20,501 11.7 Pass 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. Lung cancer estimates are the number of new cases diagnosed in 2013 . 9. 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). 10. 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). 11. Poverty estimates come from the U.S. Census Bureau and are for all ages. 12. 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). 13. 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. 19 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS People at Risk in 25 Most Ozone-Polluted Counties At-Risk Groups 2017 Rank1 County ST Total Population2 Under 183 1 San Bernardino CA 2,128,133 2 Riverside CA 2,361,026 612,848 3 Los Angeles CA 10,170,292 2,279,839 4 Kern CA 882,176 257,727 5 Fresno CA 974,861 6 Tulare CA 7 Madera CA 8 Kings 9 572,173 65 and Pediatric Adult Over3 Asthma4,6 Asthma5,6 228,666 High Ozone Days in Unhealthy Ranges, 2013–2015 COPD7 CV Disease8 Poverty9 Weighted Avg.10 Grade11 394,031 142.3 F F 40,886 119,170 59,986 92,725 320,086 43,793 1,277,335 162,912 134,810 71,829 114,813 377,244 122.0 606,055 312,736 490,888 1,675,802 108.3 88,992 F 18,417 47,777 23,732 36,297 185,990 100.5 F 279,544 112,074 19,976 53,384 27,289 42,457 241,669 92.8 F 459,863 154,998 144,036 49,147 10,292 24,222 12,265 18,970 123,922 92.5 F 42,615 20,374 3,045 8,663 4,595 7,321 33,258 46.8 CA F 150,965 41,435 14,146 2,961 8,357 4,026 6,015 30,117 44.5 Maricopa AZ F 4,167,947 1,030,669 592,961 112,410 295,494 193,792 237,849 667,637 34.7 F 10 Uintah UT 37,928 12,923 3,410 918 2,262 889 1,322 3,733 34.0 F 11 Merced CA 268,455 80,152 28,517 5,727 14,430 7,254 11,165 68,026 33.3 F 12 San Diego CA 3,299,521 728,037 431,999 52,024 197,708 102,514 161,074 445,948 31.2 F 13 El Dorado CA 184,452 37,919 34,393 2,710 11,424 6,776 11,581 16,634 31.0 F 14 Stanislaus CA 538,388 146,063 67,324 10,437 30,189 15,817 25,049 103,646 30.0 F 15 Sacramento CA 1,501,335 361,617 198,168 25,840 87,748 46,278 73,651 250,325 26.0 F 16 Nevada CA 98,877 17,428 24,201 1,245 6,422 4,090 7,193 12,137 25.7 F 17 Fairfield CT 948,053 220,906 137,799 25,884 76,395 36,729 51,524 83,612 24.0 F 18 Clark NV 2,114,801 498,564 290,001 29,147 130,554 103,810 121,424 321,755 23.8 F 19 Jefferson CO 565,524 116,627 85,287 9,889 40,386 20,708 29,549 44,068 23.7 F 20 Harris TX 4,538,028 1,224,413 428,697 96,889 252,264 158,961 240,522 744,712 23.3 F 21 Tarrant TX 1,982,498 533,475 208,355 42,215 110,194 72,657 111,992 255,993 23.2 F 21 Denton TX 780,612 201,646 70,965 15,957 44,046 27,885 42,057 61,186 23.2 F 23 Imperial CA 180,191 51,119 22,442 3,653 9,934 5,187 8,178 41,685 22.5 F 24 Duchesne UT 20,862 7,230 2,283 513 1,236 517 802 2,247 21.3 F 25 Larimer CO 333,577 67,793 47,570 5,748 24,144 11,356 16,259 39,648 19.7 F D E O G R A B EM 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 2015 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 2015 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 (2013-2015), 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+. 20 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS Cleanest U.S. Cities for Short-Term Particle Pollution (24-hour PM2.5)1 Metropolitan Statistical Area Population Metropolitan Statistical Area Population Albany-Schenectady, NY 1,173,891 Metropolitan Statistical Area Population Greenville-Washington, NC 223,493 St. George, UT Alexandria, LA 154,484 Gulfport-Biloxi-Pascagoula, MS 389,255 Syracuse-Auburn, NY Asheville-Brevard, NC 480,051 Harrisonburg-Staunton-Waynesboro, VA 251,352 Tampa-St. Petersburg-Clearwater, FL Homosassa Springs, FL 141,058 Texarkana, TX-AR Hot Springs-Malvern, AR 130,603 Tulsa-Muskogee-Bartlesville, OK Houma-Thibodaux, LA 212,297 Tuscaloosa, AL 239,908 Huntsville-Decatur-Albertville, AL 763,287 Urban Honolulu, HI 998,714 Jackson-Vicksburg-Brookhaven, MS 670,061 Valdosta, GA La Crosse-Onalaska, WI-MN 136,985 Virginia Beach-Norfolk, VA-NC Lafayette-Opelousas-Morgan City, LA 627,146 Waterloo-Cedar Falls, IA 170,612 Lake Charles-Jennings, LA 237,044 Wilmington, NC 277,969 Lakeland-Winter Haven, FL 650,092 Lansing-East Lansing-Owosso, MI 540,895 Lexington-Fayette—Richmond— Frankfort, KY 723,849 Lima-Van Wert-Celina, OH 219,831 Atlanta—Athens-Clarke County— Sandy Springs, GA 6,365,108 Augusta-Richmond County, GA-SC 590,146 Austin-Round Rock, TX 2,000,860 Bangor, ME 152,692 Beckley, WV 122,507 Bellingham, WA 212,284 Birmingham-Hoover-Talladega, AL 1,360,082 Bowling Green-Glasgow, KY 221,915 Brunswick, GA 116,003 Buffalo-Cheektowaga, NY 1,213,152 Burlington-South Burlington, VT 217,042 Cape Coral-Fort Myers-Naples, FL Casper, WY 1,059,287 D E O G R A B EM 82,178 Charleston-Huntington-Ashland, WV-OH-KY 693,726 Charlotte-Concord, NC-SC 2,583,956 Charlottesville, VA 229,514 Chattanooga-Cleveland-Dalton, TN-GA-AL 950,005 Colorado Springs, CO 697,856 Columbia-Orangeburg-Newberry, SC 937,288 Columbus-Auburn-Opelika, GA-AL 504,865 Columbus-Marion-Zanesville, OH 2,424,831 Corpus Christi-Kingsville-Alice, TX 526,068 Des Moines-Ames-West Des Moines, IA 782,390 Dothan-Enterprise-Ozark, AL 248,947 Eau Claire-Menomonie, WI 210,133 Edwards-Glenwood Springs, CO 129,487 Elmira-Corning, NY 184,702 Erie-Meadville, PA 364,529 Evansville, IN-KY 315,693 Farmington, NM 118,737 Fayetteville-Lumberton-Laurinburg, NC 546,215 Fayetteville-Springdale-Rogers, AR-MO 513,559 Florence, SC 206,448 Florence-Muscle Shoals, AL 146,950 Fort Smith, AR-OK 280,241 Gadsden, AL 103,057 Gainesville-Lake City, FL 345,511 Goldsboro, NC 124,132 Grand Island, NE Greensboro—Winston-Salem— High Point, NC 85,066 1,642,506 Longview-Marshall, TX 284,527 Lynchburg, VA 259,950 McAllen-Edinburg, TX Milwaukee-Racine-Waukesha, WI 906,099 2,046,692 Mobile-Daphne-Fairhope, AL 619,104 Monroe-Ruston-Bastrop, LA 253,407 Montgomery, AL 373,792 Morgantown-Fairmont, WV 195,101 New Orleans-Metairie-Hammond, LA-MS North Port-Sarasota, FL 1,493,205 977,491 Oklahoma City-Shawnee, OK 1,430,327 Orlando-Deltona-Daytona Beach, FL 3,129,308 Owensboro, KY 117,463 Palm Bay-Melbourne-Titusville, FL 568,088 Parkersburg-Marietta-Vienna, WV-OH 153,444 Pensacola-Ferry Pass, FL-AL 515,832 Pittsfield, MA 127,828 Pueblo-Cañon City, CO 210,283 Richmond, VA 1,271,334 Rochester-Batavia-Seneca Falls, NY 1,175,724 Rome-Summerville, GA 121,426 Saginaw-Midland-Bay City, MI 382,598 Salisbury, MD-DE San Antonio-New Braunfels, TX 395,300 2,384,075 Santa Maria-Santa Barbara, CA 444,769 Savannah-Hinesville-Statesboro, GA 532,048 Scranton—Wilkes-Barre—Hazleton, PA 558,166 Sierra Vista-Douglas, AZ 126,427 Springfield-Branson, MO 541,991 Springfield-Greenfield Town, MA 702,583 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 2006 NAAQS. 21 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 155,602 738,746 2,975,225 149,769 1,151,172 142,875 1,828,187 RANKINGS Top 25 Cleanest U.S. Cities for Year-Round Particle Pollution (Annual PM2.5)1 Rank2 Design Value3 Metropolitan Statistical Area Population 1 4.1 Cheyenne, WY 1 4.1 Farmington, NM 97,121 3 4.6 Casper, WY 4 4.8 Kahului-Wailuku-Lahaina, HI 164,726 5 5.3 Bismarck, ND 129,517 6 5.4 Urban Honolulu, HI 998,714 7 5.6 Palm Bay-Melbourne-Titusville, FL 568,088 8 5.7 Colorado Springs, CO 697,856 8 5.7 Elmira-Corning, NY 184,702 10 5.8 Pueblo-Cañon City, CO 210,283 11 5.9 Cape Coral-Fort Myers-Naples, FL 1,059,287 12 6.0 Miami-Fort Lauderdale-Port St. Lucie, FL 6,654,565 13 6.1 North Port-Sarasota, FL 14 6.2 Redding-Red Bluff, CA 14 6.2 Homosassa Springs, FL 14 6.2 Orlando-Deltona-Daytona Beach, FL 17 6.3 Salinas, CA 433,898 17 6.3 Burlington-South Burlington, VT 217,042 19 6.4 Fargo-Wahpeton, ND-MN 256,634 19 6.4 Yuma, AZ 204,275 19 6.4 Bangor, ME 152,692 19 6.4 Syracuse-Auburn, NY 738,746 23 6.5 Lakeland-Winter Haven, FL 650,092 23 6.5 Sierra Vista-Douglas, AZ 126,427 23 6.5 Wilmington, NC 277,969 118,737 82,178 977,491 D E O G R A B EM 242,841 141,058 3,129,308 Notes: 1 This list represents cities with the lowest levels of annual PM2.5 air pollution. 2. Cities are ranked by using the highest design value for any county within that metropolitan area. 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). 22 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS Cleanest U.S. Cities for Ozone Air Pollution1 Metropolitan Statistical Area Population Metropolitan Statistical Area Population Bellingham, WA 212,284 Johnson City-Kingsport-Bristol, TN-VA 507,768 Blacksburg-Christiansburg-Radford, VA 181,747 La Crosse-Onalaska, WI-MN 136,985 Brownsville-Harlingen-Raymondville, TX 444,059 Lincoln-Beatrice, NE 345,478 Brunswick, GA 116,003 McAllen-Edinburg, TX 906,099 217,042 Missoula, MT 114,181 Monroe-Ruston-Bastrop, LA 253,407 Burlington-South Burlington, VT Cape Coral-Fort Myers-Naples, FL 1,059,287 Cedar Rapids-Iowa City, IA 432,538 New Bern-Morehead City, NC 195,124 Charleston-North Charleston, SC 744,526 Ocala, FL 343,254 Charlottesville, VA 229,514 Palm Bay-Melbourne-Titusville, FL 568,088 Columbia-Moberly-Mexico, MO 226,174 Peoria-Canton, IL 413,717 Columbia-Orangeburg-Newberry, SC 937,288 Quincy-Hannibal, IL-MO 116,296 Decatur, IL 107,303 Rapid City-Spearfish, SD 168,961 Des Moines-Ames-West Des Moines, IA 782,390 Roanoke, VA 314,560 Dothan-Enterprise-Ozark, AL 248,947 Rochester-Austin, MN 252,989 Eau Claire-Menomonie, WI 210,133 Rome-Summerville, GA 121,426 Elmira-Corning, NY 184,702 Salinas, CA 433,898 Savannah-Hinesville-Statesboro, GA 532,048 D E O G R A B EM Fairbanks, AK 99,631 Fargo-Wahpeton, ND-MN 256,634 Sebring, FL Fayetteville-Springdale-Rogers, AR-MO 513,559 Sioux City-Vermillion, IA-SD-NE 183,033 Florence, SC 206,448 Sioux Falls, SD 251,854 Florence-Muscle Shoals, AL 146,950 Springfield-Branson, MO 541,991 Fort Wayne-Huntington-Auburn, IN 626,124 Springfield-Jacksonville-Lincoln, IL 314,212 Gadsden, AL 99,491 103,057 Steamboat Springs-Craig, CO 37,067 Gainesville-Lake City, FL 345,511 Tallahassee-Bainbridge, FL-GA 405,098 Greenville-Washington, NC 223,493 Terre Haute, IN 171,019 Harrisonburg-Staunton-Waynesboro, VA 251,352 Tuscaloosa, AL 239,908 Hickory-Lenoir, NC 407,499 Urban Honolulu, HI 998,714 Idaho Falls-Rexburg-Blackfoot, ID 235,829 Utica-Rome, NY 295,600 Ithaca-Cortland, NY 153,420 Waterloo-Cedar Falls, IA 170,612 Jackson-Vicksburg-Brookhaven, MS 670,061 Williamsport-Lock Haven, PA 155,489 Jefferson City, MO 151,145 Wilmington, NC 277,969 Notes: 1. This list represents cities with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on 2015 NAAQS. 23 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Brevard FL Palm Bay-Melbourne-Titusville, FL Clay AL Broward FL Miami-Fort Lauderdale-Port St. Lucie, FL Colbert AL Florence-Muscle Shoals, AL Citrus FL Homosassa Springs, FL DeKalb AL Huntsville-Decatur-Albertville, AL Escambia FL Pensacola-Ferry Pass, FL-AL Etowah AL Gadsden, AL Hillsborough FL Tampa-St. Petersburg-Clearwater, FL Houston AL Dothan-Enterprise-Ozark, AL Lee FL Cape Coral-Fort Myers-Naples, FL Jefferson AL Birmingham-Hoover-Talladega, AL Orange FL Orlando-Deltona-Daytona Beach, FL Madison AL Huntsville-Decatur-Albertville, AL Palm Beach FL Miami-Fort Lauderdale-Port St. Lucie, FL Mobile AL Mobile-Daphne-Fairhope, AL Pinellas FL Tampa-St. Petersburg-Clearwater, FL Montgomery AL Montgomery, AL Polk FL Lakeland-Winter Haven, FL Morgan AL Huntsville-Decatur-Albertville, AL Sarasota FL North Port-Sarasota, FL Russell AL Columbus-Auburn-Opelika, GA-AL Seminole FL Orlando-Deltona-Daytona Beach, FL Shelby AL Birmingham-Hoover-Talladega, AL Volusia FL Orlando-Deltona-Daytona Beach, FL Talladega AL Birmingham-Hoover-Talladega, AL Chatham GA Savannah-Hinesville-Statesboro, GA Tuscaloosa AL Tuscaloosa, AL Clarke Arkansas AR GA Atlanta—Athens-Clarke County—Sandy Springs, GA Ashley Garland Jackson Polk Union Washington Cochise Mohave Pima San Benito D E O G R A B EM AR AR Hot Springs-Malvern, AR AR AR AR AR Fayetteville-Springdale-Rogers, AR-MO AZ Sierra Vista-Douglas, AZ AZ Las Vegas-Henderson, NV-AZ AZ Tucson-Nogales, AZ CA San Jose-San Francisco-Oakland, CA Santa Barbara CA Santa Maria-Santa Barbara, CA Sonoma CA San Jose-San Francisco-Oakland, CA Ventura CA Los Angeles-Long Beach, CA Yolo CA Sacramento-Roseville, CA Arapahoe CO Denver-Aurora, CO El Paso CO Colorado Springs, CO Garfield CO Edwards-Glenwood Springs, CO La Plata CO Montezuma CO Pueblo CO Pueblo-Cañon City, CO Rio Blanco CO Hartford CT Hartford-West Hartford, CT Litchfield CT New York-Newark, NY-NJ-CT-PA District of Columbia DC Washington-Baltimore-Arlington, DC-MD-VAWV-PA Kent DE Philadelphia-Reading-Camden, PA-NJ-DE-MD Sussex DE Salisbury, MD-DE Alachua FL Gainesville-Lake City, FL Clayton GA Atlanta—Athens-Clarke County—Sandy Springs, GA Cobb GA Atlanta—Athens-Clarke County—Sandy Springs, GA DeKalb GA Atlanta—Athens-Clarke County—Sandy Springs, GA Floyd GA Rome-Summerville, GA Fulton GA Atlanta—Athens-Clarke County—Sandy Springs, GA Glynn GA Brunswick, GA Gwinnett GA Atlanta—Athens-Clarke County—Sandy Springs, GA Hall GA Atlanta—Athens-Clarke County—Sandy Springs, GA Houston GA Macon-Bibb County—Warner Robins, GA Lowndes GA Valdosta, GA Muscogee GA Columbus-Auburn-Opelika, GA-AL Paulding GA Atlanta—Athens-Clarke County—Sandy Springs, GA Richmond GA Augusta-Richmond County, GA-SC Walker GA Chattanooga-Cleveland-Dalton, TN-GA-AL Washington GA Honolulu HI Urban Honolulu, HI Kauai HI Black Hawk IA Delaware IA Lee IA Palo Alto IA Polk IA Van Buren IA Dubois IN Waterloo-Cedar Falls, IA Des Moines-Ames-West Des Moines, IA 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 2017 RANKINGS Cleanest Counties for Short-Term Particle Pollution (24-hour PM2.5)1 (cont.) County State MSAs and Respective CSA2 County Greene IN Spencer IN Vanderburgh IN Evansville, IN-KY Johnson KS Kansas City-Overland Park-Kansas City, MO-KS Bell KY Boyd KY Charleston-Huntington-Ashland, WV-OH-KY 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 Henderson KY Evansville, IN-KY Madison KY Lexington-Fayette—Richmond—Frankfort, KY McCracken KY Paducah-Mayfield, KY-IL Perry Pulaski Warren State MSAs and Respective CSA2 Montgomery MD Washington-Baltimore-Arlington, DC-MD-VAWV-PA Prince George's MD Washington-Baltimore-Arlington, DC-MD-VAWV-PA Penobscot ME Bangor, ME Allegan MI Grand Rapids-Wyoming-Muskegon, MI Bay MI Saginaw-Midland-Bay City, MI Berrien MI South Bend-Elkhart-Mishawaka, IN-MI Chippewa MI Ingham MI Lansing-East Lansing-Owosso, MI Lenawee MI Detroit-Warren-Ann Arbor, MI Missaukee MI Washtenaw MI Detroit-Warren-Ann Arbor, MI Dakota MN Minneapolis-St. Paul, MN-WI Scott MN Minneapolis-St. Paul, MN-WI Wright MN Minneapolis-St. Paul, MN-WI Cedar MO Greene MO Springfield-Branson, MO Grenada MS Hancock MS Gulfport-Biloxi-Pascagoula, MS Harrison MS Gulfport-Biloxi-Pascagoula, MS Hinds MS Jackson-Vicksburg-Brookhaven, MS Jackson MS Gulfport-Biloxi-Pascagoula, MS Alamance NC Greensboro—Winston-Salem—High Point, NC Buncombe NC Asheville-Brevard, NC Caswell NC Catawba NC Hickory-Lenoir, NC Cumberland NC Fayetteville-Lumberton-Laurinburg, NC Davidson NC Greensboro—Winston-Salem—High Point, NC Duplin NC Durham NC Raleigh-Durham-Chapel Hill, NC Forsyth NC Greensboro—Winston-Salem—High Point, NC Gaston NC Charlotte-Concord, NC-SC Guilford NC Greensboro—Winston-Salem—High Point, NC Haywood NC Asheville-Brevard, NC Jackson NC Johnston NC Raleigh-Durham-Chapel Hill, NC Martin NC Mecklenburg NC Charlotte-Concord, NC-SC Mitchell NC Montgomery NC New Hanover NC Wilmington, NC Pitt NC Greenville-Washington, NC Rowan NC Charlotte-Concord, NC-SC Swain NC D E O G R A B EM KY KY KY Bowling Green-Glasgow, KY Calcasieu Parish LA Lake Charles-Jennings, LA Iberville Parish LA Baton Rouge, LA Jefferson Parish LA New Orleans-Metairie-Hammond, LA-MS Lafayette Parish LA Lafayette-Opelousas-Morgan City, LA Ouachita Parish LA Monroe-Ruston-Bastrop, LA Rapides Parish LA Alexandria, LA St. Bernard Parish LA New Orleans-Metairie-Hammond, LA-MS Tangipahoa Parish LA New Orleans-Metairie-Hammond, LA-MS Terrebonne Parish LA Houma-Thibodaux, LA West Baton Rouge Parish LA Baton Rouge, LA Berkshire MA Pittsfield, MA Bristol MA Boston-Worcester-Providence, MA-RI-NH-CT Essex MA Boston-Worcester-Providence, MA-RI-NH-CT Hampden MA Springfield-Greenfield Town, MA Plymouth MA Boston-Worcester-Providence, MA-RI-NH-CT Suffolk MA Boston-Worcester-Providence, MA-RI-NH-CT Worcester MA Boston-Worcester-Providence, MA-RI-NH-CT Anne Arundel MD Washington-Baltimore-Arlington, DC-MD-VAWV-PA Baltimore MD Washington-Baltimore-Arlington, DC-MD-VAWV-PA Dorchester MD Washington-Baltimore-Arlington, DC-MD-VAWV-PA Garrett MD Harford MD Washington-Baltimore-Arlington, DC-MD-VAWV-PA Kent MD 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. 25 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Wayne NC Goldsboro, NC Trumbull OH Youngstown-Warren, OH-PA Hall NE Grand Island, NE Oklahoma OK Oklahoma City-Shawnee, OK Scotts Bluff NE Sequoyah OK Fort Smith, AR-OK Belknap NH Boston-Worcester-Providence, MA-RI-NH-CT Tulsa OK Tulsa-Muskogee-Bartlesville, OK Grafton NH Armstrong PA Pittsburgh-New Castle-Weirton, PA-OH-WV Hillsborough NH Boston-Worcester-Providence, MA-RI-NH-CT Erie PA Erie-Meadville, PA Rockingham NH Boston-Worcester-Providence, MA-RI-NH-CT Lackawanna PA Scranton—Wilkes-Barre—Hazleton, PA Atlantic NJ Philadelphia-Reading-Camden, PA-NJ-DE-MD Monroe PA New York-Newark, NY-NJ-CT-PA Bergen NJ New York-Newark, NY-NJ-CT-PA Westmoreland PA Pittsburgh-New Castle-Weirton, PA-OH-WV Gloucester NJ Philadelphia-Reading-Camden, PA-NJ-DE-MD Kent RI Boston-Worcester-Providence, MA-RI-NH-CT Mercer NJ New York-Newark, NY-NJ-CT-PA Washington RI Boston-Worcester-Providence, MA-RI-NH-CT Middlesex NJ New York-Newark, NY-NJ-CT-PA Chesterfield SC Morris NJ New York-Newark, NY-NJ-CT-PA Edgefield SC Augusta-Richmond County, GA-SC Passaic NJ New York-Newark, NY-NJ-CT-PA Florence SC Florence, SC Warren NJ New York-Newark, NY-NJ-CT-PA Lexington SC Columbia-Orangeburg-Newberry, SC San Juan NM Farmington, NM Richland SC Columbia-Orangeburg-Newberry, SC NY Albany-Schenectady, NY Spartanburg SC Greenville-Spartanburg-Anderson, SC NY New York-Newark, NY-NJ-CT-PA Brown SD NY Hamilton TN Chattanooga-Cleveland-Dalton, TN-GA-AL NY Buffalo-Cheektowaga, NY McMinn TN Chattanooga-Cleveland-Dalton, TN-GA-AL NY Bexar TX San Antonio-New Braunfels, TX NY New York-Newark, NY-NJ-CT-PA Bowie TX Texarkana, TX-AR NY Rochester-Batavia-Seneca Falls, NY Ellis TX Dallas-Fort Worth, TX-OK NY New York-Newark, NY-NJ-CT-PA Galveston TX Houston-The Woodlands, TX NY Syracuse-Auburn, NY Harrison TX Longview-Marshall, TX NY New York-Newark, NY-NJ-CT-PA Hidalgo TX McAllen-Edinburg, TX Queens NY New York-Newark, NY-NJ-CT-PA Nueces TX Corpus Christi-Kingsville-Alice, TX Richmond NY New York-Newark, NY-NJ-CT-PA Travis TX Austin-Round Rock, TX Steuben NY Elmira-Corning, NY Washington UT St. George, UT Suffolk NY New York-Newark, NY-NJ-CT-PA Albemarle VA Charlottesville, VA Allen OH Lima-Van Wert-Celina, OH Arlington Athens OH VA Washington-Baltimore-Arlington, DC-MD-VAWV-PA Butler OH Cincinnati-Wilmington-Maysville, OH-KY-IN Bristol City VA Johnson City-Kingsport-Bristol, TN-VA Clark OH Dayton-Springfield-Sidney, OH Charles City VA Richmond, VA Franklin OH Columbus-Marion-Zanesville, OH Chesterfield VA Richmond, VA Greene OH Dayton-Springfield-Sidney, OH Fairfax Lake OH Cleveland-Akron-Canton, OH VA Washington-Baltimore-Arlington, DC-MD-VAWV-PA Lawrence OH Charleston-Huntington-Ashland, WV-OH-KY Hampton City VA Virginia Beach-Norfolk, VA-NC Lorain OH Cleveland-Akron-Canton, OH Henrico VA Richmond, VA Mahoning OH Youngstown-Warren, OH-PA Loudoun VA Washington-Baltimore-Arlington, DC-MD-VAWV-PA Medina OH Cleveland-Akron-Canton, OH Lynchburg City VA Lynchburg, VA Portage OH Cleveland-Akron-Canton, OH Norfolk City VA Virginia Beach-Norfolk, VA-NC Preble OH Page VA Scioto OH Charleston-Huntington-Ashland, WV-OH-KY Rockingham VA Harrisonburg-Staunton-Waynesboro, VA Albany Bronx Chautauqua Erie Essex Kings Monroe New York Onondaga Orange D E O G R A B EM 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. 26 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS Cleanest Counties for Short-Term Particle Pollution (24-hour PM2.5)1 (cont.) County State MSAs and Respective CSA2 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 Skagit 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 La Crosse WI La Crosse-Onalaska, WI-MN Milwaukee WI Milwaukee-Racine-Waukesha, WI Ozaukee WI Milwaukee-Racine-Waukesha, WI Sauk WI Madison-Janesville-Beloit, WI Taylor Vilas Waukesha Brooke Cabell Hancock Harrison Kanawha Marion Marshall D E O G R A B EM WI WI WI Milwaukee-Racine-Waukesha, WI WV Pittsburgh-New Castle-Weirton, PA-OH-WV WV Charleston-Huntington-Ashland, WV-OH-KY WV Pittsburgh-New Castle-Weirton, PA-OH-WV WV WV Charleston-Huntington-Ashland, WV-OH-KY WV Morgantown-Fairmont, WV WV Wheeling, WV-OH Monongalia WV Morgantown-Fairmont, WV Raleigh WV Beckley, WV Wood WV Parkersburg-Marietta-Vienna, WV-OH Albany WY Carbon WY Natrona WY Casper, WY Park WY Sublette WY Sweetwater WY Teton 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. 27 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS Top 25 Cleanest Counties for Year-Round Particle Pollution (Annual PM2.5)1 2017 Rank2 County State Design Value3 1 Custer SD 3.2 2 McKenzie ND 3.4 3 Kauai HI 3.9 3 Lake CA 4.0 4 San Juan NM 4.1 4 Laramie WY 4.1 4 Essex NY 4.1 4 Park WY 4.1 9 Campbell WY 4.2 10 Albany WY 4.3 11 Fergus MT 4.5 12 Natrona WY 4.6 13 Jackson SD 4.7 13 Teton WY 4.7 15 Sweetwater WY 4.8 15 Lake MN 4.8 15 Maui HI 4.8 18 Kent RI 4.9 18 Oliver ND 4.9 18 Phillips MT 4.9 18 Billings ND 4.9 22 San Benito CA 5.0 22 Vilas WI 5.0 22 Sublette WY 5.0 22 Belknap NH 5.0 D E O G R A B EM Notes: 1. This list represents counties with the lowest levels of monitored long term 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). 28 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS Cleanest Counties for Ozone Air Pollution1 County State Metropolitan Statistical Area County Denali Borough AK Honolulu HI Urban Honolulu, HI Fairbanks North Star Borough AK Fairbanks, AK Bremer IA Waterloo-Cedar Falls, IA Colbert AL Florence-Muscle Shoals, AL Linn IA Cedar Rapids-Iowa City, IA Etowah AL Gadsden, AL Polk IA Des Moines-Ames-West Des Moines, IA Houston AL Dothan-Enterprise-Ozark, AL Scott IA Davenport-Moline, IA-IL Madison AL Huntsville-Decatur-Albertville, AL Story IA Des Moines-Ames-West Des Moines, IA Morgan AL Huntsville-Decatur-Albertville, AL Van Buren IA Sumter AL Warren IA Des Moines-Ames-West Des Moines, IA Tuscaloosa AL Butte ID Idaho Falls-Rexburg-Blackfoot, ID Newton AR Adams IL Quincy-Hannibal, IL-MO Polk AR Clark IL Washington AR Fayetteville-Springdale-Rogers, AR-MO Effingham IL Colusa CA Hamilton IL Humboldt CA Macon IL Decatur, IL Lake CA Macoupin IL St. Louis-St. Charles-Farmington, MO-IL Marin CA San Jose-San Francisco-Oakland, CA Peoria IL Peoria-Canton, IL Sangamon IL Springfield-Jacksonville-Lincoln, IL Will IL Chicago-Naperville, IL-IN-WI Allen IN Fort Wayne-Huntington-Auburn, IN Delaware IN Indianapolis-Carmel-Muncie, IN Elkhart IN South Bend-Elkhart-Mishawaka, IN-MI Hamilton IN Indianapolis-Carmel-Muncie, IN Hancock IN Indianapolis-Carmel-Muncie, IN Hendricks IN Indianapolis-Carmel-Muncie, IN Huntington IN Fort Wayne-Huntington-Auburn, IN Johnson IN Indianapolis-Carmel-Muncie, IN Knox IN Madison IN Indianapolis-Carmel-Muncie, IN Morgan IN Indianapolis-Carmel-Muncie, IN Shelby IN Indianapolis-Carmel-Muncie, IN Vigo IN Terre Haute, IN Johnson KS Kansas City-Overland Park-Kansas City, MO-KS Trego KS Bell KY Mendocino Monterey Tuscaloosa, AL D E O G R A B EM CA CA Salinas, CA San Francisco CA San Jose-San Francisco-Oakland, CA Santa Cruz CA San Jose-San Francisco-Oakland, CA Sonoma Moffat Montezuma Alachua State Metropolitan Statistical Area CA San Jose-San Francisco-Oakland, CA CO Steamboat Springs-Craig, CO CO FL Gainesville-Lake City, FL FL Jacksonville-St. Marys-Palatka, FL-GA FL Palm Bay-Melbourne-Titusville, FL FL Cape Coral-Fort Myers-Naples, FL Columbia FL Gainesville-Lake City, FL Flagler FL Orlando-Deltona-Daytona Beach, 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 Carter KY Seminole FL Orlando-Deltona-Daytona Beach, FL Morgan KY Wakulla FL Tallahassee-Bainbridge, FL-GA Perry KY Chatham GA Savannah-Hinesville-Statesboro, GA Pike KY Chattooga GA Rome-Summerville, GA Pulaski KY Clarke GA Atlanta—Athens-Clarke County—Sandy Springs, GA Warren KY Bowling Green-Glasgow, KY Columbia GA Augusta-Richmond County, GA-SC Ouachita Parish LA Monroe-Ruston-Bastrop, LA Glynn GA Brunswick, GA Androscoggin ME Portland-Lewiston-South Portland, ME Muscogee GA Columbus-Auburn-Opelika, GA-AL Aroostook ME Paulding GA Atlanta—Athens-Clarke County—Sandy Springs, GA Oxford ME Chippewa MI Becker MN Crow Wing MN Baker Brevard Collier Richmond GA Augusta-Richmond County, GA-SC Sumter GA Notes: 1. This list represents counties with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on 2015 NAAQS. 29 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS Cleanest Counties for Ozone Air Pollution1 (cont.) County State Metropolitan Statistical Area County Goodhue MN Minneapolis-St. Paul, MN-WI Knox NE Hennepin MN Minneapolis-St. Paul, MN-WI Lancaster NE Lincoln-Beatrice, NE Lake MN Belknap NH Boston-Worcester-Providence, MA-RI-NH-CT Mille Lacs MN Minneapolis-St. Paul, MN-WI Sandoval NM Albuquerque-Santa Fe-Las Vegas, NM Olmsted MN Rochester-Austin, MN Santa Fe NM Albuquerque-Santa Fe-Las Vegas, NM St. Louis MN Duluth, MN-WI Albany NY Albany-Schenectady, NY Stearns MN Minneapolis-St. Paul, MN-WI Hamilton NY Washington MN Minneapolis-St. Paul, MN-WI Herkimer NY Utica-Rome, NY Boone MO Columbia-Moberly-Mexico, MO Monroe NY Rochester-Batavia-Seneca Falls, NY Callaway MO Jefferson City, MO Onondaga NY Syracuse-Auburn, NY Cass MO Kansas City-Overland Park-Kansas City, MOKS Steuben NY Elmira-Corning, NY Greene MO Springfield-Branson, MO Tompkins NY Ithaca-Cortland, NY Taney MO Springfield-Branson, MO Lorain OH Cleveland-Akron-Canton, OH Hinds MS Jackson-Vicksburg-Brookhaven, MS Portage OH Cleveland-Akron-Canton, OH Lauderdale MS Summit OH Cleveland-Akron-Canton, OH Fergus MT Caddo OK Columbia OR Portland-Vancouver-Salem, OR-WA Bradford PA Clearfield PA State College-DuBois, PA Lycoming PA Williamsport-Lock Haven, PA Abbeville SC Greenville-Spartanburg-Anderson, SC Aiken SC Augusta-Richmond County, GA-SC Anderson SC Greenville-Spartanburg-Anderson, SC Berkeley SC Charleston-North Charleston, SC Charleston SC Charleston-North Charleston, SC Chesterfield SC Colleton SC Darlington SC Florence, SC Oconee SC Greenville-Spartanburg-Anderson, SC Pickens SC Greenville-Spartanburg-Anderson, SC Richland SC Columbia-Orangeburg-Newberry, SC York SC Charlotte-Concord, NC-SC Brookings SD Custer SD Rapid City-Spearfish, SD Jackson SD Meade SD Rapid City-Spearfish, SD Minnehaha SD Sioux Falls, SD Union SD Sioux City-Vermillion, IA-SD-NE Anderson TN Knoxville-Morristown-Sevierville, TN Claiborne TN DeKalb TN Sevier TN Knoxville-Morristown-Sevierville, TN Sullivan TN Johnson City-Kingsport-Bristol, TN-VA Wilson TN Nashville-Davidson—Murfreesboro, TN Brewster TX Cameron TX Brownsville-Harlingen-Raymondville, TX Hidalgo TX McAllen-Edinburg, TX Albemarle VA Charlottesville, VA Flathead D E O G R A B EM MT Lewis and Clark MT Missoula MT Missoula, MT Phillips MT Powder River MT Richland MT Rosebud Alexander Avery Buncombe Caldwell State Metropolitan Statistical Area MT NC Hickory-Lenoir, NC NC NC Asheville-Brevard, NC NC Hickory-Lenoir, NC Carteret NC New Bern-Morehead City, NC Chatham NC Raleigh-Durham-Chapel Hill, NC Durham NC Raleigh-Durham-Chapel Hill, NC Franklin NC Raleigh-Durham-Chapel Hill, NC Granville NC Raleigh-Durham-Chapel Hill, NC Johnston NC Raleigh-Durham-Chapel Hill, NC Lenoir NC Macon NC Martin NC Montgomery NC New Hanover NC Wilmington, NC Pitt NC Greenville-Washington, NC Swain NC Billings ND Burke ND Burleigh ND Bismarck, ND Cass ND Fargo-Wahpeton, ND-MN McKenzie ND Mercer ND Williams ND Notes: 1. This list represents counties with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on 2015 NAAQS. 30 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 RANKINGS Cleanest Counties for Ozone Air Pollution1 (cont.) County State Metropolitan Statistical Area Caroline VA Richmond, VA Chesterfield VA Richmond, VA Fauquier VA Washington-Baltimore-Arlington, DC-MDVA-WV-PA Frederick VA Washington-Baltimore-Arlington, DC-MDVA-WV-PA Giles VA Blacksburg-Christiansburg-Radford, VA Madison VA Page VA Roanoke VA Rockbridge VA Rockingham VA Wythe VA Chittenden VT Clallam WA Pierce WA Seattle-Tacoma, WA Skagit WA Seattle-Tacoma, WA Thurston Whatcom Ashland Eau Claire Forest La Crosse Taylor Berkeley Gilmer Greenbrier Big Horn Roanoke, VA Harrisonburg-Staunton-Waynesboro, VA Burlington-South Burlington, VT D E O G R A B EM WA Seattle-Tacoma, WA WA Bellingham, WA WI WI Eau Claire-Menomonie, WI WI WI La Crosse-Onalaska, WI-MN WI WV Washington-Baltimore-Arlington, DC-MDVA-WV-PA WV WV WY Campbell WY Fremont WY Teton WY Weston WY Notes: 1. This list represents counties with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on 2015 NAAQS. 31 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 125 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? Air pollu on remains a major danger to the health of children and adults. D E O G R A B EM e M ay ca us PR EM AT UR E de D ve M EA ay lo TH pm ca us en e ta re lh pr ar od m uc v e ha As rm th m a a‚ ac k W Lu he ng ez ca in nc g er an d co Sh ug or hi tn ng es s Ca of rd br io ea Su va th sc s c ep ul a rh Lu bi lit ar ng yt m s o su in e f ec re o dn ns es s, sw el lin g Health risks from: OZONE POLLUTION 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. 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 oxygen Ozone (O3) is a gas molecule composed of three oxygen atoms. 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? 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. The essential raw ingredients for ozone come from nitrogen oxides (NOx); hydrocarbons, also called volatile organic compounds (VOCs); and carbon monoxide (CO). They are 32 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 HEALTH EFFECTS 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 VOCs NOx CO OZONE When gases that come out of tailpipes and smokestacks come in contact with sunlight, they react and form ozone smog. 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. 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. ■■ D E O G R A B EM A major new study found evidence that people with lung cancer faced greater risk from ozone and other outdoor air pollutants. The 2016 study tracked the air pollution levels from 1988 to 2011 that more than 350,000 cancer patients in California experienced. The researchers found that the ozone and other air pollutants shortened their survival.9 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.10 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.11 Newer research has confirmed that ozone increased the risk of premature death even when other pollutants also exist.12 33 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 HEALTH EFFECTS 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.13 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.14 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.15 Several studies around the world have found increased risk of hospital admissions or emergency department visits for cardiovascular disease.16 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. D E O G R A B EM Examining the records from a long-term national database, researchers found a higher risk of death from respiratory diseases associated with increases in ozone.17 ■■ 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.18 ■■ 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.19 ■■ Studies link lower birth weight and decreased lung function in newborns to ozone levels in their community.20 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.21 ■■ Research shows lower level of ozone causes harm. The EPA released their latest complete review of the current research on ozone pollution in February 2013.22 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 experts on the Committee and EPA concluded that ozone pollution posed multiple, serious threats to health. Their findings are highlighted in the box on the next page. 34 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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. D E O G R A B EM 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. 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 35 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 HEALTH EFFECTS trapped in the lungs, while the smallest are so minute that they can pass through the 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 diameter23 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 form 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.”24 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.25 D E O G R A B EM 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;26 ■■ People over 65 years of age;27 ■■ People with lung disease such as asthma and chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema; ■■ People with heart disease28 or diabetes;29 ■■ People with low incomes;30 and ■■ People who work or are active outdoors.31 Diabetics face increased risk at least in part because of their higher risk for cardiovascular disease.32 ■■ People with lung cancer also appear to be at higher risk from particle pollution, according to the 2016 study of more than 350,000 patients in California. Researchers looked at the exposure they experienced between 1988 and 2011 and found that where higher concentrations of particle pollution existed, people with lung cancer had shorter life spans.33 What Can Particles Do to Your Health? Breathing particle pollution may trigger illness, hospitalization and premature death. 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.34 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 36 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 HEALTH EFFECTS 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/m3.35 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.36 These studies add to the growing research that cleaning up air pollution improves life and health. 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.37 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.38 Another study in 2017 looked more closely at Boston and found a similar higher risk of premature death from particle pollution in a city that meets current limits on short-term particle pollution.39 D E O G R A B EM 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;40, 41, 42, 43 ■■ increased mortality in infants and young children;44 ■■ increased numbers of heart attacks, especially among the elderly and in people with heart conditions;45 ■■ inflammation of lung tissue in young, healthy adults;46 ■■ increased hospitalization for cardiovascular disease, including strokes and congestive heart failure;47, 48, 49 ■■ increased emergency room visits for patients suffering from acute respiratory ailments;50 ■■ increased hospitalization for asthma among children;51, 52, 53 and ■■ increased severity of asthma attacks in children.54 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.55 ■■ Year-Round Exposure Breathing high levels of particle pollution day in and day out can also be deadly, as landmark studies in the 1990s conclusively showed56 and as other studies confirmed.57 Chronic exposure to particle pollution can shorten life by one to three years.58 Recent research has confirmed that long-term exposure to particle pollution still kills, even with the declining levels in the U.S. since 2000 59 and even in areas, such as New England, that currently meet the official limit, or standard, for year-round particle pollution.60 37 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 HEALTH EFFECTS In late 2013, the World Health Organization concluded that particle pollution could cause lung cancer. 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.61 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;62, 63 ■■ slowed lung function growth in children and teenagers;64, 65 ■■ development of asthma in children up to age 14;66 ■■ significant damage to the small airways of the lungs;67 ■■ increased risk of death from cardiovascular disease;68 and ■■ increased risk of lower birth weight and infant mortality.69 Research into the health risks of 65,000 women over age 50 found that those who 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.70 ■■ 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.71 D E O G R A B EM Scientists have found links between particle pollution and mental health concerns. A study of 27,000 residents in Seoul, Korea, found that breathing particle pollution over a long time increased the risk of major depressive disorder. The risk was higher for those who also had a chronic disease such as asthma, COPD, or diabetes.72 Older adults suffered more symptoms of depression and anxiety when particle pollution was higher in a large study looking at data from community living groups across the United States. Those who lived in lower socioeconomic situations or who had a history of respiratory illness or heart disease were more likely to have anxiety symptoms.73 The EPA completed their most recent review of the current research on particle pollution in December 2009.74 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 38 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 HEALTH EFFECTS 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.75 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.76 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.77 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. D E O G R A B EM 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. Each particle may have many different components. The building blocks of each can include several biological and chemical components. Bacteria, pollen and other biological ingredients can combine in the particle with chemical agents, such as heavy metals, elemental carbon, dust and secondary species like sulfates and nitrates. These combinations mean that particles can have complex effects on the body.78 Some studies have found different kinds of particles may have greater risk for different health outcomes. For example, one 2015 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.79 ■■ 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.80 ■■ 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.81 Other studies have identified the challenges of exploring all the kinds of particles and their health effects with the limited monitoring across the nation.82 Some particles serve as carriers for other chemicals that are also toxic, and the combination may worsen the impact.83, 84 ■■ The best evidence shows that having less of all types of particles in the air leads to better health and longer lives. 39 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 HEALTH EFFECTS 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.85 In addition, the body’s defenses that help adults fight off infections are still developing in young bodies.86 Children have more respiratory infections than adults, which also seems to increase their susceptibility to air pollution.87 Furthermore, children don’t behave like adults, and their behavior also affects their 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.88 Air Pollution Affects Children Before They Are Born The largest portion of a child’s lungs will grow long after he or she is born. Several studies have found air pollution linked to harm to children while they are still in the womb. A large study in California found that higher particle pollution levels increased the risk of preterm birth.89 Pregnant women exposed to even low levels of particle pollution had higher risk factors for preterm birth in a Boston study.90 Preterm births occurred more frequently when particle pollution spiked, as an Australian study found, even when they controlled for other risk factors.91 D E O G R A B EM 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.92 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.93 A much larger study of 3,300 schoolchildren 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.94 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.” 95 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.96 40 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 HEALTH EFFECTS 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,97 including a workshop the American Lung Association held in 2001 that focused on urban air pollution and health inequities.98 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,99 while others found greater responsiveness for whites and Hispanics, but not African Americans,100 or for African Americans but not other races or ethnic groups.101 Other researchers have found greater risk for African Americans from hazardous air pollutants, including those pollutants that also come from traffic sources.102 Socioeconomic position has been more consistently associated with greater harm from air pollution. Multiple large 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.103 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.104 A 2008 study of Washington, DC, found that while poor air quality and worsened asthma went hand in 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.105 A 2016 study of New Jersey residents found that the risk of dying early from long-term exposure to particle pollution was higher in communities with larger African-American populations, lower home values and lower median income.106 However, two other studies in France have found no association with lower income and asthma attacks.107 D E O G R A B EM 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 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.108 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.109 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.110 41 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 HEALTH EFFECTS 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.111 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.112 Studies have found increased risk of premature death from living near a major highway or an urban road.113 Another study found an increase in risk of heart attacks from being in traffic, whether driving or taking public transportation.114 Urban women in a Boston study experienced decreased lung function associated with traffic-related pollution.115 D E O G R A B EM Adults living closer to the road—within 300 meters—may risk dementia. In 2017, a study of residents of Ontario, Canada, found that those who lived close to heavy traffic had a higher risk of dementia, though not for Parkinson’s disease or multiple sclerosis. Researchers found the strongest association among those who lived closest to the roads (less than 50 meters), who had never moved and who lived in major cities.116 A study of older men in 2011 also found that long-term exposure to traffic pollution increased their risk of having poor cognition.117 How to Protect Yourself from Ozone and Particle Pollution To minimize your exposure to ozone and particle pollution: 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. 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. ■■ 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. 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Traffic-related air pollution and cognitive function in a cohort of older men. Environ Health Perspect 2011.119:682–687. doi:10.1289/ehp.1002767 D E O G R A B EM 47 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 2013-2015 for each monitoring site. Design values for the annual PM2.5 concentrations by county for the period 20132015 came from data posted on July 29, 2016, at the U.S. Environmental Protection Agency’s website at https://www.epa.gov/sites/production/files/2016-07/pm25_ designvalues_20132015_final_07_29_16.xlsx. Ozone Data Analysis The 2013, 2014 and 2015 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 August 11, 2016, following the close of the authorized period for quality review and assurance certification of data. Only the hourly average ozone concentrations derived from FRM and FEM monitors were used in the analysis. 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 2013, 2014 and 2015, based on the EPA-defined ozone season, was identified. D E O G R A B EM 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 in each county occurred within the defined ranges. This approach provided an indication of the level of pollution for all monitored days, not just those days that fell 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. 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. This follows the process EPA uses for the current ozone standard adopted in 2015, but differs from the form used under the previous 0.075 ppm 8-hour 48 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 METHODOLOGY average ozone standard that was established in 2008. 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 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 (i.e., not 75 percent complete) if the standard value is exceeded, our data capture methodology also included the site’s 8-hour value if at least one valid 8-hr period were available and it was 71 ppb or higher. 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. For each day across all sites within a specific county, the highest daily maximum 8-hour average ozone concentration was recorded and then the results were summarized by county for the number of days the ozone levels were within the ranges identified above. 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). D E O G R A B EM Short-Term Particle Pollution Data Analysis A.S.L. & Associates identified the maximum daily 24-hour AQS PM2.5 concentration for each county in 2013, 2014 and 2015 with monitoring information. The 24-hour PM2.5 data were downloaded on August 10, 2016, following the close of the authorized period for quality review and assurance certification of data. 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/m to 12.0 mg/m n Good (Green) 3 3 12.1 mg/m to 35.4 mg/m 3 35.5 mg/m to 55.4 mg/m 3 3 3 55.5 mg/m to 150.4 mg/m 3 n Moderate (Yellow) n Unhealthy for Sensitive Groups (Orange) 3 n Unhealthy (Red) 150.5 mg/m3 to 250.4 mg/m3 n Very Unhealthy (Purple) greater than or equal to 250.5 mg/m3 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. This approach provided an indication of the level of pollution for all monitored days, not just those days that fell 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 49 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 METHODOLOGY 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. For each day across all sites within a specific county, the highest daily maximum 24-h PM2.5 concentration was recorded and then the results were summarized by county for the number of days the concentration levels were within the ranges identified on the chart on the preceding page. 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). 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. D E O G R A B EM 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. ■■ ■■ ■■ 50 LUNG.org 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 2 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 1 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. AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 METHODOLOGY 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 that 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 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. D E O G R A B EM The Lung Association calculates the population at risk from these pollutants based on the population from the entire county where the monitor is located and the largest metropolitan area that contains that county. Not only do people from that county or metropolitan area circulate within the county and the metropolitan area, the air pollution circulates to that monitor through the county and metropolitan area. 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 2015 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 recognized that data collected in all Illinois counties, in some Maine counties and in most Tennessee counties were processed in certain laboratories where quality control issues 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.” 51 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 METHODOLOGY 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 2015 as defined by the OMB. The Lung Association received critical assistance from members of the National Association of Clean Air Agencies and the Association of Air Pollution Control Agencies. 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 agespecific 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. D E O G R A B EM Population Estimates The Lung Association includes the total county population in discussions of populations at risk from exposure to pollution in each county. The Lung Association uses that conservative count based on several factors: the recognized limited number and locations of monitors in most counties and metropolitan areas; the movement of the population both in daily activities, including outdoor activities, such as exercise or work; and the transport of emission from sources into and across the county to reach the monitor. The U.S. Census Bureau estimated data on the total population of each county in the United States for 2015. 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 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 2015, the Behavioral Risk Factor Surveillance System (BRFSS) survey found that approximately 21.6 million (8.9 percent) of adults residing in the United States and 8.5 percent of children from 30 states and Washington, D.C., reported currently having asthma. Among adults in the Unites States in 2015, 15.5 million (6.3 percent) had ever been diagnosed with chronic obstructive pulmonary disease (COPD), 20.4 million (8.4 52 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 METHODOLOGY percent) had ever been diagnosed with cardiovascular disease and 25.6 million (10.4 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 2015 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 website. Pediatric asthma data from the 2015 BRFSS were available for thirty states and Washington D.C., from the 2014 BRFSS for seven states, from the 2013 BRFSS for one state, from the 2012 BRFSS for two states, from the 2011 BRFSS for one state, and national data were used for the nine 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 2015 BRFSS to age-specific county-level resident populations obtained from the U.S. Census Bureau website. Cardiovascular disease included ever having been diagnosed with a heart attack, angina or coronary heart disease, or stroke. Incidence Estimates D E O G R A B EM Lung Cancer. State- and gender-specific lung cancer incidence rates for 2013 were obtained from StateCancerProfiles.gov, a system that provides access to statistics from both the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program and the Center for Disease Control and Prevention's National Program of Cancer Registries. Local area incidence of lung cancer is estimated by applying 2013 age-adjusted and sex-specific incidence rates to 2015 county populations obtained from the U.S. Census Bureau. Thereafter, the incidence estimates for each county within a state are summed to determine overall incidence. Estimates for Nevada are based on 2010 rates. 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 2014: Alabama, Kentucky, Maryland, North Carolina, Tennessee, Washington, West Virginia. 2013: Arizona. 2012: North Dakota and Wyoming. 2011: Iowa. National: Alaska, Arkansas, Colorado, Delaware, Florida, Idaho, South Carolina, South Dakota and Virginia. 53 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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, 2015. StateCancerProfile.gov, 2016. Cancer Incidence by State and Gender, 2013. 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, 2015. 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 15-01 July 15, 2015. U.S. Census Bureau. Small Area Income and Poverty Estimates. State and County Data, 2015. D E O G R A B EM 54 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 2015 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 2015 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 2015 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). 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. 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 are not collected in that county. 4. The Weighted Average (Wgt. Avg) was derived by adding the three years of individual level data (2013-2015), 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+. D E O G R A B EM 6. Lung cancer estimates are for all ages and represent the estimated number of people diagnosed with lung cancer in 2013 based on state rates (StateCancerProfiles.gov) applied to county population estimates (U.S. Census). 7. 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. 8. 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). 9. 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, 2015. 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 2013-2015 are as posted on July 26, 2016 at EPA’s website at https://www.epa.gov/air-trends/air-quality-design-values. The 20132015 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 https://www. epa.gov/pm-pollution/2012-national-ambient-air-quality-standardsnaaqs-particulate-matter-pm. 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.” 10. Adding across rows does not produce valid estimates. Adding the at risk categories (asthma, COPD, poverty, etc.) will double-count people who fall into more than one category. 55 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Baldwin 65 & Over Pediatric Asthma 203,709 44,719 39,062 Adult Asthma COPD Lung Cancer 5,902 15,709 17,599 Cardiovascular Disease Diabetes Poverty 140 19,344 23,202 25,941 Clay 13,555 2,897 2,700 382 1,053 1,194 9 1,322 1,585 2,436 Colbert 54,354 11,698 10,232 1,544 4,217 4,700 37 5,139 6,174 9,732 DeKalb 71,130 17,539 11,383 2,315 5,306 5,730 49 6,101 7,372 14,481 Elmore 81,468 18,601 11,693 2,455 6,234 6,536 56 6,769 8,234 10,609 Etowah 103,057 22,585 18,278 Houston 104,173 24,547 17,147 Jefferson 660,367 Madison 353,089 78,771 49,684 10,396 27,236 28,736 243 29,667 36,236 45,877 Mobile 415,395 99,154 62,039 13,086 31,333 33,139 284 34,686 42,050 75,204 Montgomery 226,519 54,083 31,018 7,137 17,089 17,578 155 18,045 21,919 49,457 Morgan 119,565 27,527 19,529 3,633 9,117 9,914 82 10,564 12,787 19,250 152,511 96,633 2,981 7,961 8,752 71 3,240 7,880 8,515 20,127 50,335 71 52,865 451 Shelby 59,660 15,352 7,574 2,026 4,396 4,501 208,713 50,382 28,101 6,649 15,723 16,505 66,751 13,103 2,553 2,197 Talladega 80,862 17,686 13,396 2,334 6,258 6,803 Tuscaloosa 203,976 42,579 24,553 2,972,695 683,184 LUNG.org 445,219 337 1,043 1,101 5,619 15,992 15,511 90,161 226,882 239,679 115,897 41 4,579 5,584 13,575 143 16,969 20,742 17,558 Sumter 56 9,090 10,969 18,829 54,982 D E O G R A B EM Russell Totals 9,456 11,391 19,146 9 1,164 1,401 4,073 56 7,248 8,773 17,439 140 15,316 18,631 38,704 2,038 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 250,441 303,801 498,208 S TAT E TA B L E S ALABAMA American Lung Association in Alabama www.lung.org/alabama HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Baldwin Clay Wgt. Avg. Grade Orange Red Purple 3 0 0 1.0 C DNC DNC DNC DNC DNC Annual Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0.0 A 8.6 PASS 0 8.4 PASS 0 0 0.0 A Colbert 0 0 0 0.0 A 0 0 0 0.0 A 8.9 PASS DeKalb 1 0 0 0.3 B 0 0 0 0.0 A 9.2 PASS Elmore 1 Etowah 0 0 0 0.0 A 0 0 0 0.0 A 9.2 PASS Houston 0 0 0 0.0 A 0 0 0 0.0 A 8.1 PASS 0 11.0 PASS Jefferson 11 0 0 0 0.3 0 3.7 B F DNC DNC DNC DNC DNC 0 0 0.0 A DNC DNC Madison 0 0 0 0.0 A 0 0 0 0.0 A 8.6 PASS Mobile 7 0 0 2.3 D 0 0 0 0.0 A 8.6 PASS Montgomery 1 0 0 0.3 B 0 0 0 0.0 A 9.3 PASS Morgan 0 0 0 0.0 A 0 0 0 0.0 A 8.9 PASS Russell 2 0 0 0.7 B 0 0 0 0.0 A 10.0 PASS Shelby 4 0 0 1.3 C 0 0 0 0.0 A INC INC Sumter 0 D E O G R A B EM Talladega Tuscaloosa 57 0 0 0.0 A 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 2017 DNC DNC 9.5 PASS 9.0 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 Anchorage Municipality Denali Borough 65 & Over Pediatric Asthma 298,695 73,959 28,001 Adult Asthma COPD Lung Cancer 6,271 21,084 8,706 1,919 352 173 Cardiovascular Disease Diabetes Poverty 166 12,779 15,881 25,305 30 145 64 1 93 122 124 Fairbanks North Star Borough 99,631 24,116 8,349 2,045 7,139 2,756 56 3,943 4,891 7,671 Juneau City and Borough 32,756 7,216 3,594 612 2,372 1,060 18 1,597 1,992 2,542 Kenai Peninsula Borough 58,059 13,343 8,604 1,131 4,123 2,057 32 3,275 3,960 6,488 Matanuska-Susitna Borough 101,095 27,428 10,008 2,326 6,857 3,008 57 4,500 5,618 9,676 Totals 592,155 58 146,414 58,729 12,414 41,720 17,651 331 26,188 32,463 D E O G R A B EM LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 51,806 S TAT E TA B L E S ALASK A American Lung Association in Alaska www.lung.org/alaska HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour Borough Orange Red Purple Anchorage Municipality Wgt. Avg. Grade Orange Red Purple DNC DNC DNC DNC DNC Denali Borough 0 0 0 0.0 A Fairbanks North Star Borough 0 0 0 A 0.0 Juneau City and Borough DNC DNC DNC DNC DNC Kenai Peninsula Borough DNC DNC DNC DNC DNC Matanuska-Susitna Borough INC INC INC INC INC 0 1 Annual Wgt. Avg. Grade 0 0.5 B DNC DNC DNC DNC DNC Design Value 5.7 PASS DNC DNC 26 33 1 25.8 F 11.5 PASS 3 0 0 1.0 C 6.8 PASS INC INC INC INC INC INC INC 20 7.1 PASS 2 0 7.7 F D E O G R A B EM 59 LUNG.org Pass/ Fail AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S ARIZONA American Lung Association in Arizona www.lung.org/arizona AT-RISK GROUPS Lung Diseases County Total Population Under 18 Apache 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer 71,474 20,658 9,977 2,253 4,804 3,242 Cardiovascular Disease Diabetes Poverty 35 4,004 5,188 26,788 Cochise 126,427 28,038 26,125 3,058 9,240 6,964 62 8,939 11,020 20,439 Coconino 139,097 29,757 15,930 3,245 10,261 6,029 68 7,138 9,491 25,133 Gila 53,159 10,845 14,609 1,183 3,977 3,438 26 4,568 5,456 11,089 La Paz 20,152 3,451 7,491 10 2,069 2,342 4,398 Maricopa 376 1,545 1,505 4,167,947 1,030,669 592,961 112,410 295,494 193,792 2,033 237,849 307,832 667,637 Mohave 204,737 37,506 56,716 Navajo 108,277 29,874 17,825 3,258 7,398 5,271 4,091 15,719 13,467 100 17,851 21,373 34,720 53 6,633 8,407 29,810 Pima 1,010,025 218,540 185,865 23,835 74,267 52,701 492 66,528 83,206 184,628 Pinal 406,584 96,927 77,527 10,571 28,991 21,037 200 26,779 33,093 60,151 D E O G R A B EM Santa Cruz Yavapai Yuma Totals 60 46,461 12,919 7,668 1,409 3,167 2,267 222,255 38,024 64,634 204,275 52,433 36,813 6,780,870 1,609,641 1,114,141 LUNG.org 4,147 17,332 15,160 5,719 14,162 9,995 175,556 486,357 334,869 23 2,855 3,620 11,295 108 20,183 24,097 32,978 100 12,659 15,606 41,159 3,310 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 418,057 530,731 1,150,225 S TAT E TA B L E S ARIZONA American Lung Association in Arizona www.lung.org/arizona HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Apache Cochise Wgt. Avg. Grade Orange Red Purple DNC DNC DNC DNC DNC 7 0 0 2.3 D Annual Wgt. Avg. Grade INC INC INC INC INC 0 0 0 0.0 A Design Value Pass/ Fail INC INC 6.5 PASS Coconino 11 0 0 3.7 F INC INC INC INC INC INC INC Gila 20 0 0 6.7 F DNC DNC DNC DNC DNC DNC DNC La Paz 12 0 0 4.0 F INC INC INC INC INC INC INC 101 2 0 34.7 F Maricopa Mohave DNC DNC DNC DNC DNC Navajo 2 Pima 7 0 0 2.3 D Pinal Santa Cruz 61 0 0.7 25 0 0 8.3 DNC DNC DNC DNC B 3 1 4.5 F 10.0 PASS 0 0 0.0 A INC INC DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC 5.5 PASS F 8 0 0 2.7 D 7.7 PASS DNC 7 3 0 3.8 F 9.1 PASS D E O G R A B EM Yavapai Yuma 0 7 0 7 0 20 2 LUNG.org 0 2.3 D 0 7.7 F INC INC INC INC INC 1 1 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 0.8 B INC INC 6.4 PASS 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 415 1,619 1,641 17 1,919 2,167 4,040 Clark 22,633 4,334 3,638 367 1,824 1,666 18 1,823 2,082 4,466 Crittenden 48,963 13,578 6,133 1,151 3,608 3,380 39 3,647 4,267 12,473 Garland 97,177 20,122 21,427 78 9,762 10,867 18,354 Jackson 17,338 14 1,541 Pulaski Union 1,706 7,785 8,111 296 1,405 1,366 7,913 1,563 1,976 133 643 698 15 1,668 1,897 1,764 3,748 4,150 6 866 955 1,894 20,216 4,766 4,438 404 1,562 1,647 16 2,000 2,220 4,869 392,664 92,607 55,006 7,852 30,450 28,558 315 31,092 36,114 74,375 40,144 9,591 6,842 813 3,111 3,095 32 3,542 4,043 7,800 D E O G R A B EM Washington 225,477 56,325 24,743 Totals 911,796 62 1,447 Poverty 20,838 4,889 3,929 Polk 1,443 Cardiovascular Disease Diabetes Ashley 2,948 361 Lung Cancer 18,433 3,488 3,280 Adult Asthma COPD Arkansas Newton 4,255 65 & Over 215,518 LUNG.org 134,360 4,776 16,954 14,630 18,273 70,403 66,239 183 14,926 17,610 36,600 733 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 72,787 83,988 172,769 S TAT E TA B L E S ARK ANSAS American Lung Association in Arkansas www.lung.org/arkansas HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 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 9.1 PASS 8.6 PASS Clark 1 0 0 0.3 B DNC DNC DNC DNC DNC Crittenden 1 0 0 0.3 B 1 0 0 0.3 B 9.4 PASS 0 0 0 0.0 A 9.0 PASS 0 0 0 0.0 A Garland DNC DNC DNC DNC DNC Jackson DNC DNC DNC DNC DNC DNC 8.9 PASS Newton 0 0 0 0.0 A Polk 0 0 0 0.0 A 0 0 0 0.0 A 9.2 PASS Pulaski 4 0 0 1.3 C 1 0 0 0.3 B 10.7 PASS 0 0 0 0.0 A 9.1 PASS Union DNC DNC D E O G R A B EM Washington 63 DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A LUNG.org 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 8.6 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 Total Population Under 18 Alameda 1,638,215 346,302 208,711 Amador 65 & Over Pediatric Asthma 37,001 5,654 9,539 Butte 225,411 45,348 39,543 Adult Asthma COPD Lung Cancer 24,746 99,232 51,297 404 2,475 1,589 3,240 13,978 7,812 Cardiovascular Disease Diabetes 709 Poverty 80,675 126,353 184,716 16 2,803 4,144 4,404 98 12,787 19,274 47,269 Calaveras 44,828 7,795 11,595 557 2,929 1,912 19 3,403 5,033 5,781 Colusa 21,482 5,958 2,889 426 1,198 646 9 1,042 1,611 2,800 Contra Costa 1,126,745 261,320 164,504 18,673 66,864 36,598 El Dorado 184,452 37,919 34,393 Fresno 974,861 Glenn 279,544 112,074 28,017 7,491 4,220 2,710 11,424 6,776 19,976 53,384 27,289 535 1,590 883 488 59,728 92,596 114,123 80 11,581 17,709 16,634 423 42,457 66,139 241,669 12 1,447 2,214 5,105 Humboldt 135,727 26,518 21,791 1,895 8,447 4,603 59 7,444 11,365 27,616 Imperial 180,191 51,119 22,442 3,653 9,934 5,187 78 8,178 12,647 41,685 Inyo Kern D E O G R A B EM 18,260 3,769 4,044 Kings Lake Los Angeles 269 1,139 706 882,176 257,727 88,992 18,417 47,777 23,732 384 36,297 57,322 185,990 150,965 41,435 14,146 2,961 8,357 4,026 66 6,015 9,555 30,117 64,591 13,267 13,778 948 4,025 2,473 10,170,292 2,279,839 1,277,335 162,912 606,055 312,736 Madera 154,998 42,615 20,374 3,045 8,663 4,595 Marin 261,221 53,520 52,327 3,824 16,244 9,837 Mariposa Mendocino 8 1,227 1,827 2,222 17,531 2,875 4,421 205 1,157 744 87,649 18,982 17,382 1,356 5,368 3,203 28 4,282 6,420 13,006 4,407 490,888 767,731 1,675,802 67 7,321 11,296 33,258 113 16,960 25,706 19,100 8 1,316 1,952 2,627 38 5,454 8,187 17,508 Merced 268,455 80,152 28,517 5,727 14,430 7,254 117 11,165 17,497 68,026 Monterey 433,898 114,387 53,530 8,174 24,563 12,728 189 19,992 31,075 63,732 Napa 142,456 30,661 24,821 2,191 8,688 4,953 62 8,241 12,528 13,960 98,877 17,428 24,201 1,245 6,422 4,090 43 7,193 10,664 12,137 Nevada Orange Placer Plumas 3,169,776 716,153 430,447 375,391 84,957 69,332 18,409 3,149 4,729 51,175 188,995 100,412 6,071 22,644 13,266 225 1,206 785 Riverside 2,361,026 612,848 320,086 43,793 134,810 71,829 Sacramento 1,501,335 361,617 198,168 25,840 87,748 46,278 San Benito 58,792 15,631 6,957 1,117 3,316 1,731 San Bernardino 2,128,133 572,173 228,666 40,886 119,170 59,986 San Diego 3,299,521 728,037 431,999 52,024 197,708 102,514 29,633 650 73,651 114,506 250,325 26 2,748 4,328 5,454 923 92,725 146,418 394,031 1,433 161,074 250,288 445,948 726,106 199,894 87,579 14,284 40,454 21,053 315 33,228 51,852 124,606 San Luis Obispo 281,401 50,837 51,231 122 16,633 25,113 38,448 San Mateo 765,135 162,283 114,498 11,596 46,568 25,369 331 41,231 63,775 63,663 Santa Barbara 444,769 99,537 63,670 193 22,203 33,995 66,475 LUNG.org 57,569 1,024 114,813 177,144 377,244 San Joaquin 1,918,044 436,397 239,977 8,286 8 1,395 2,065 2,503 864,816 64 126,593 162 22,400 33,857 32,093 San Francisco Santa Clara 115,963 1,374 160,772 250,372 398,428 3,633 17,910 10,097 7,113 26,618 14,037 31,184 113,823 59,008 376 833 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 46,201 71,392 105,244 93,034 145,834 156,430 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Santa Cruz 274,146 54,183 38,794 3,872 16,944 8,989 119 14,364 22,322 40,480 Shasta 179,533 38,620 35,628 2,760 11,015 6,564 78 11,166 16,752 33,556 Siskiyou 43,554 8,813 10,231 630 2,737 1,734 19 3,039 4,503 9,725 Solano 436,092 99,381 61,524 7,102 25,974 13,988 189 22,587 35,069 50,972 Sonoma 502,146 102,120 87,731 7,297 31,075 17,715 217 29,511 45,011 54,563 Stanislaus 538,388 146,063 67,324 10,437 30,189 15,817 233 25,049 38,935 103,646 Sutter 96,463 Tehama 63,308 15,129 11,481 1,081 3,756 2,197 Trinity 13,069 2,207 3,209 Tulare Ventura Totals 65 14,342 1,799 5,517 3,029 42 158 856 549 459,863 144,036 49,147 10,292 24,222 12,265 4,928 7,539 53,709 8,959 12,976 640 3,523 2,209 850,536 202,649 119,596 14,481 49,997 27,022 213,016 45,741 24,994 38,984,776 9,084,172 5,166,478 LUNG.org 3,269 12,808 6,335 649,133 2,301,495 1,210,079 16,721 27 3,705 5,598 14,073 6 970 1,445 2,523 200 18,970 29,653 123,922 D E O G R A B EM Tuolumne Yolo 25,170 23 3,851 5,703 7,305 369 43,731 67,850 83,389 92 16,906 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 9,602 14,965 35,877 1,921,480 2,987,129 5,866,931 S TAT E TA B L E S CALIFORNIA American Lung Association in California www.lung.org/california HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Alameda 19 0 0 6.3 F 11 0 0 3.7 F Amador 20 0 0 6.7 F DNC DNC DNC DNC DNC Butte 23 1 0 8.2 F 4 1 0 1.8 C 9.3 PASS Calaveras 23 1 0 8.2 F 2 1 1 1.8 C 8.6 PASS Colusa 0 0 0 0.0 A Wgt. Avg. Grade 3 1 0 1.5 C Design Value Pass/ Fail 10.8 PASS DNC DNC 7.6 PASS Contra Costa 13 0 0 4.3 F 3 0 0 1.0 C El Dorado 87 4 0 31.0 F DNC DNC DNC DNC DNC DNC DNC 215 41 1 92.8 F 68 37 0 41.2 F 15.4 FAIL Fresno Glenn 2 Humboldt 0 0 0.7 B DNC DNC 4 0 0 1.3 C INC INC 63 3 0 22.5 F 22 4 0 9.3 F 13.1 9 0 0 3.0 D 6 14 1 9.7 F 7.6 PASS 232 45 1 100.5 F 81 50 1 52.7 F 20.8 FAIL 120 9 0 44.5 F 65 39 0 41.2 F 22.2 FAIL 0 0 0 0.0 A 0 1 0 0.5 B 4.0 PASS Los Angeles 202 78 3 108.3 F 27 3 0 10.5 F 12.3 FAIL Madera 124 11 0 46.8 F 47 18 0 24.7 F 15.2 FAIL Imperial Inyo Kern Kings Lake D E O G R A B EM Marin Mariposa 0 0 0 0.0 A DNC DNC DNC DNC DNC 10.5 PASS Mendocino Merced 0 0 0 0.0 A 49 0 0 16.3 F 0 0 0 0.0 A 94 4 0 33.3 F 5 0 0 1.7 C DNC DNC DNC DNC DNC FAIL 10.0 PASS DNC DNC 2 2 0 1.7 C INC INC 48 12.5 7 0 19.5 F FAIL Monterey 0 0 0 0.0 A 1 0 0 0.3 B 6.3 PASS Napa 2 0 0 0.7 B 2 0 0 0.7 B 11.4 PASS Nevada 74 2 0 25.7 F 1 1 0 0.8 B 5.3 PASS Orange 26 4 0 10.7 F 8 0 0 2.7 D 7.8 PASS Placer 49 5 0 18.8 F 5 6 1 5.3 F 7.8 PASS DNC DNC DNC DNC DNC 31 2 0 11.3 F 14.9 FAIL 243 82 0 122.0 F 36 4 0 14.0 F 14.1 FAIL 72 4 0 26.0 F 23 0 0 7.7 F 10.2 PASS Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco 9 0 0 3.0 D 0 0 0 0.0 A 5.0 PASS 220 126 9 142.3 F 18 0 0 6.0 F 12.0 PASS 92 1 0 31.2 F 4 2 0 2.3 D 10.0 PASS 0 0 0 0.0 A 2 0 0 0.7 B 8.4 PASS San Joaquin 39 2 0 14.0 F 52 11 0 22.8 F 14.2 FAIL San Luis Obispo 21 0 0 7.0 F 7 0 0 2.3 D 12.1 FAIL San Mateo 66 2 0 0 0.7 B LUNG.org 3 0 0 1.0 C AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 7.8 PASS S TAT E TA B L E S CALIFORNIA (cont.) American Lung Association in California www.lung.org/california HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Santa Barbara 8 2 0 3.7 Santa Clara 13 0 0 4.3 Santa Cruz 0 0 0 0.0 16 0 0 5.3 Siskiyou 1 0 0 Solano 4 0 0 Sonoma 0 0 0 0.0 A Shasta F 0 0 0 F 9 2 A 33 0 F 0 0.3 B 1.3 C Annual Wgt. Avg. Grade Design Value Pass/ Fail 0.0 A 7.7 PASS 0 4.0 F 10.2 PASS 0 11.0 F 5.6 PASS 1 0 0.5 B 6.2 PASS 4 2 0 2.3 D INC 14 0 0 4.7 F INC 9.8 PASS 0 0 0 0.0 A INC INC Stanislaus 84 4 0 30.0 F 64 17 0 29.8 F 13.8 Sutter 19 1 0 6.8 F 3 0 0 1.0 C 9.1 PASS 42 1 0 14.5 F DNC DNC DNC DNC DNC Tehama Trinity Tulare Tuolumne Ventura 67 DNC D E O G R A B EM Yolo DNC DNC DNC DNC DNC 226 33 1 29 0 37 1 DNC INC INC INC INC INC INC INC 92.5 F 18 13 0 12.5 F 17.6 FAIL 0 9.7 F DNC DNC DNC DNC DNC DNC DNC 0 12.8 F 0 0 0 0.0 A 4 0 0 1.3 C LUNG.org FAIL 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 9.4 PASS 7.0 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Adams 491,337 135,138 47,987 11,458 32,466 13,882 209 19,244 21,576 61,980 Arapahoe 631,096 153,148 76,968 12,985 43,314 20,195 268 28,436 31,401 57,651 Boulder 319,372 63,682 40,331 136 14,899 16,431 38,046 Chaffee Clear Creek 5,399 23,227 10,580 18,658 2,848 4,366 241 1,409 858 8 1,275 1,329 2,006 9,303 1,472 1,743 125 695 408 4 585 637 880 Denver 682,545 140,671 74,815 11,927 49,657 20,404 290 28,558 31,559 105,275 Douglas 322,387 89,885 33,895 7,621 20,957 9,951 137 13,757 15,563 10,917 El Paso 674,471 167,331 79,908 14,188 46,093 20,905 287 29,453 32,453 72,201 Garfield 58,095 Gunnison 16,067 2,807 1,851 Jackson Jefferson 14,941 6,534 1,267 3,902 1,825 238 1,211 515 2,543 7 2,846 5,909 718 799 1,892 D E O G R A B EM La Plata 1,356 237 296 20 99 61 1 89 94 189 565,524 116,627 85,287 9,889 40,386 20,708 240 29,549 32,231 44,068 54,688 10,531 8,129 893 3,981 1,996 Larimer 333,577 67,793 47,570 5,748 24,144 11,356 Mesa 148,513 33,122 25,879 2,808 10,389 5,551 Moffat 25 12,937 3,317 1,719 281 865 23 2,843 3,105 4,993 142 16,259 17,585 39,648 63 438 6 8,110 8,600 20,326 619 682 1,496 Montezuma 26,168 5,909 5,169 501 1,807 1,067 Park 16,510 2,744 2,844 233 1,215 723 7 1,023 1,136 1,511 17,787 2,772 2,908 235 1,347 707 8 1,008 1,101 1,243 Pitkin Pueblo 163,591 37,836 28,497 3,208 11,311 6,102 11 1,570 1,656 4,994 69 8,917 9,456 31,501 Rio Blanco 6,571 1,561 916 132 452 224 3 319 348 607 San Miguel 7,879 1,444 929 122 579 277 3 382 434 865 Weld Totals 68 285,174 76,551 32,528 4,863,606 1,132,367 LUNG.org 611,069 6,491 18,940 8,642 96,012 338,444 157,371 121 12,144 13,430 31,531 2,067 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 222,301 244,450 539,729 S TAT E TA B L E S COLOR ADO American Lung Association in Colorado www.lung.org/colorado HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Adams 19 0 0 6.3 F 2 0 0 0.7 Arapahoe 21 0 0 7.0 F 0 0 0 Boulder 25 1 0 8.8 F 2 0 0 Chaffee INC INC INC INC INC DNC DNC 32 3 0 12.2 F DNC Denver 8 0 0 2.7 D Douglas 41 3 0 15.2 F El Paso 11 0 0 3.7 Garfield 2 0 0 0.7 Gunnison 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Jackson 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 62 6 0 23.7 F DNC DNC DNC DNC DNC DNC DNC Clear Creek Jefferson Design Value Pass/ Fail B INC INC 0.0 A 6.3 PASS 0.7 B 7.0 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 9 1 0 3.5 F 7.5 PASS 1 0 0 0.3 B 5.5 PASS F 0 0 0 0.0 A 5.7 PASS B 0 0 0 0.0 A INC D E O G R A B EM La Plata Larimer Wgt. Avg. Grade 7 0 0 2.3 D 56 2 0 19.7 F Mesa 1 0 0 0.3 B Moffat 0 0 0 0.0 A INC 0 0 0 0.0 A INC INC 2 6.8 PASS 1 0 1.2 C 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Montezuma 0 0 0 0.0 A Park 5 0 0 1.7 C INC INC INC INC INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Pitkin Pueblo Rio Blanco San Miguel Weld 69 DNC DNC DNC DNC DNC 9 4 1 5.7 F INC INC INC INC INC 19 0 LUNG.org 0 6.3 F 0 0 0 0.0 A 7.4 PASS 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC 2 0 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 0.7 B INC INC 5.8 PASS 8.2 PASS DNC DNC 7.8 PASS 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 Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Fairfield 948,053 220,906 137,799 25,884 76,395 36,729 598 51,524 66,675 83,612 Hartford 895,841 192,728 142,573 22,583 73,932 35,966 565 51,006 64,973 96,763 Litchfield 183,603 35,040 34,949 4,106 15,442 8,423 116 12,149 15,281 13,383 Middlesex 164,063 30,985 29,944 3,631 13,892 7,288 103 10,464 13,197 10,744 New Haven 859,470 178,891 137,053 20,961 71,618 34,597 542 49,032 62,466 112,801 New London 271,863 54,507 44,994 6,387 22,836 11,233 172 15,975 20,290 28,760 Tolland 151,420 27,234 21,691 3,191 13,134 5,907 Windham 116,573 23,768 17,803 2,785 9,752 4,697 Totals 3,590,886 764,059 566,806 89,528 297,001 144,841 96 8,209 10,681 9,593 74 6,602 8,518 12,211 2,265 204,962 262,081 D E O G R A B EM 70 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 367,867 S TAT E TA B L E S CONNECTICUT American Lung Association in Connecticut www.lung.org/connecticut HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Design Value Pass/ Fail Fairfield 51 14 0 24.0 F 2 0 0 0.7 B 9.4 PASS Hartford 23 1 0 8.2 F 0 0 0 0.0 A 7.3 PASS Litchfield 11 0 0 3.7 F 0 0 0 0.0 A 5.2 PASS Middlesex 28 3 0 10.8 F DNC DNC DNC DNC DNC New Haven 28 6 0 12.3 F 3 0 0 1.0 C New London 15 4 0 7.0 F 1 0 0 0.3 B INC INC Tolland 22 0 0 7.3 F DNC DNC DNC DNC DNC DNC DNC 0 0 2.3 D Windham 7 DNC DNC DNC DNC DNC DNC 8.7 PASS DNC DNC D E O G R A B EM 71 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 DNC 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Kent 173,533 40,353 27,752 3,421 12,327 9,164 122 12,038 14,468 23,947 New Castle 556,779 122,224 78,983 10,363 40,396 29,290 391 37,276 46,136 65,503 Sussex 215,622 41,809 53,780 152 19,956 22,909 26,205 Totals 945,934 204,386 160,515 3,545 16,172 13,976 17,330 68,894 52,430 665 69,271 83,513 D E O G R A B EM 72 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 115,655 S TAT E TA B L E S DELAWARE American Lung Association in Delaware www.lung.org/delaware HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Kent New Castle Sussex Wgt. Avg. Grade Orange Red Purple 1 0 0 0.3 B 17 1 0 6.2 F 8 0 0 2.7 D Annual Wgt. Avg. Grade Design Value 0 0 0 0.0 A 8.1 PASS 9 9.6 PASS 1 0 3.5 F 0 0 0 0.0 A 8.4 PASS D E O G R A B EM 73 LUNG.org Pass/ Fail AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Lung Cancer Cardiovascular Disease Diabetes Poverty District of Columbia 672,228 118,107 77,004 10,175 59,002 28,305 375 37,044 46,280 113,185 Totals 375 672,228 118,107 77,004 10,175 59,002 28,305 37,044 46,280 D E O G R A B EM 74 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 113,185 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 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple District of Columbia 3.3 10 0 0 F 0 0 Annual Wgt. Avg. Grade 0 0.0 A Design Value 9.2 PASS D E O G R A B EM 75 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 Pass/ Fail 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 Baker Pediatric Asthma 259,964 46,861 33,506 27,420 Bay 65 & Over 6,769 Broward Lung Cancer 3,973 16,007 11,918 3,636 574 181,635 39,234 29,823 Brevard Adult Asthma COPD 1,567 568,088 105,472 130,247 Poverty 155 15,044 18,257 52,258 1,313 16 3,327 10,763 9,517 1,700 2,073 4,189 108 12,574 15,154 29,301 8,943 34,825 35,230 1,896,425 407,683 296,906 Cardiovascular Disease Diabetes 338 48,315 57,294 75,268 34,567 112,749 98,583 1,128 129,582 156,814 263,607 Citrus 141,058 21,032 50,225 1,783 8,877 10,724 84 15,432 17,779 24,249 Collier 357,305 63,956 107,485 5,423 21,743 24,126 213 34,140 39,548 48,198 Columbia 68,348 14,889 12,005 1,262 4,035 3,664 41 4,882 5,858 12,413 Duval 913,010 207,260 119,785 17,573 53,462 43,566 543 56,074 68,376 142,660 Escambia 311,003 64,885 50,304 5,502 18,556 15,977 186 21,003 25,283 44,835 Flagler 105,392 1,592 D E O G R A B EM Highlands Hillsborough Holmes 18,778 30,717 99,491 17,476 33,952 6,449 7,144 63 1,482 6,037 7,096 1,349,050 311,084 180,904 803 326 1,166 1,091 Indian River 147,919 25,425 45,664 2,156 9,095 10,294 Lake 325,875 5,462 Lee Leon Liberty 64,420 85,204 19,489 11,729 12,213 59 10,196 11,699 22,419 26,376 78,572 64,466 19,324 3,848 3,762 10,072 83,213 101,279 209,040 12 1,468 1,752 4,535 88 14,601 16,934 19,051 20,536 194 28,638 33,475 41,272 701,982 129,382 189,043 10,970 42,657 45,196 418 63,130 73,716 110,398 286,272 54,381 33,957 170 15,951 19,452 59,366 4,611 17,445 12,742 8,331 1,609 1,004 136 510 400 5 508 624 1,422 Manatee 363,369 69,687 94,063 5,909 21,940 23,107 216 32,165 37,697 53,080 Marion 343,254 64,096 97,002 5,435 20,749 22,493 204 31,619 36,781 62,271 Martin 156,283 26,273 46,400 2,228 9,690 10,828 93 15,280 17,805 17,125 2,693,117 552,280 420,642 46,827 161,793 138,709 1,602 181,691 219,597 529,850 198,664 43,993 30,682 3,730 11,671 9,957 119 13,045 15,737 21,966 Miami-Dade Okaloosa Orange Osceola Palm Beach 1,288,126 290,689 141,831 24,647 75,573 57,410 323,993 80,769 41,928 1,422,789 276,718 326,763 6,848 18,388 14,891 23,462 85,823 85,174 768 72,218 88,804 196,882 193 19,170 23,316 59,226 846 116,804 137,780 189,355 Pasco 497,909 101,714 112,844 Pinellas 949,827 159,853 222,148 13,554 59,433 59,907 564 82,129 97,345 127,287 Polk 650,092 387 Santa Rosa 167,040 37,266 24,872 3,160 9,842 8,520 Sarasota 405,549 59,816 140,193 5,072 25,580 30,252 241 43,364 50,014 38,874 Seminole 449,144 95,641 66,050 8,109 26,795 22,857 267 29,808 36,207 51,205 St. Lucie 298,563 61,111 68,766 5,182 17,789 17,857 178 24,544 28,946 48,570 Volusia 517,887 92,727 122,495 7,862 31,901 32,178 308 44,218 52,234 82,326 Wakulla Totals 76 31,535 147,812 6,596 128,029 4,347 18,525,033 3,771,485 3,527,184 LUNG.org 8,624 29,705 29,645 12,533 559 37,680 1,896 35,383 296 40,664 48,023 71,760 47,818 56,748 109,907 100 11,153 13,538 19,681 1,599 19 319,778 1,110,252 1,024,351 11,026 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 2,072 2,532 4,623 1,374,285 1,640,200 2,860,682 S TAT E TA B L E S FLORIDA American Lung Association in Florida www.lung.org/florida HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Pass/ Fail Alachua 0 0 0 0.0 A Baker 0 0 0 Bay 1 0 0 0.3 Brevard 0 0 0 0.0 A 0 0 0 0.0 A 5.6 PASS Broward 2 0 0 0.7 B 0 0 0 0.0 A INC INC Citrus 0.0 0 0 0 0.0 A Design Value A DNC B DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 DNC 0 DNC DNC 0 0.0 DNC A INC INC DNC DNC DNC DNC 6.2 PASS Collier 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Columbia 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Duval 4 0 0 1.3 C Escambia 5 0 0 1.7 C Flagler 0 0 0 0 0 0 0.0 1 0 0 0.3 B 0 0 0 0.0 A 7.7 PASS 7.7 PASS D E O G R A B EM Highlands Hillsborough 10 0.0 3.3 A DNC A DNC DNC DNC DNC DNC 0 0 DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Indian River 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Lake 3 0 0 C DNC DNC DNC A DNC 0 DNC 0.0 DNC 0 DNC 0 DNC Holmes 1.0 F DNC DNC 7.8 PASS DNC Lee 0 0 0 0.0 A 0 0 0 0.0 A 5.9 PASS Leon 0 0 0 0.0 A 0 1 0 0.5 B 8.3 PASS Liberty 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC Manatee Marion DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC DNC DNC DNC DNC DNC DNC Miami-Dade 2 0 0 0.7 B 1 0 0 0.3 B Okaloosa 1 0 0 0.3 B DNC DNC DNC DNC DNC Orange 3 0 0 1.0 C Osceola 1 Palm Beach 3 0 0 1.0 C Pasco 2 Pinellas 4 0 0 1.3 C 0 0 0 0.0 A 6.5 PASS Polk 2 0 0 0 6.5 PASS Santa Rosa 3 0 0 1.0 Sarasota 6 0 0 2.0 C Martin Seminole St. Lucie 0 0 0 0 0 0.0 0 0.3 0 0.7 0.7 A B B B C 0 0 0 0.0 A INC INC INC INC INC Volusia 1 0 0 0.3 B Wakulla 0 77 0 LUNG.org 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 DNC DNC 6.0 PASS DNC DNC 6.2 PASS DNC DNC 5.3 PASS DNC DNC DNC DNC 6.1 PASS 6.1 PASS DNC DNC 6.1 PASS 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Bibb 153,721 38,331 22,157 4,261 10,747 8,295 101 11,020 13,528 39,343 Chatham 286,956 63,320 40,041 7,038 20,576 15,162 189 20,027 24,437 48,579 Chattooga 24,922 5,646 4,126 628 1,807 1,455 Clarke 123,912 21,518 12,223 2,392 9,081 5,512 Clayton 273,955 77,100 23,396 8,570 18,229 12,585 179 16,189 19,824 62,452 Cobb 741,334 182,064 81,302 20,237 52,131 37,970 488 49,492 60,804 83,213 Columbia 144,052 37,251 17,316 4,140 9,969 7,447 95 9,777 12,018 13,355 Coweta 138,427 35,281 17,659 3,922 9,689 7,436 91 9,804 12,086 14,976 Dawson DeKalb Douglas Fulton Glynn Gwinnett Hall 549 1,738 1,461 734,871 173,901 78,499 19,329 51,950 36,932 1,949 2,400 4,781 81 7,032 8,370 42,773 15 1,971 2,435 2,800 482 47,985 58,756 128,675 D E O G R A B EM Dougherty Floyd 23,312 4,936 4,330 17 91,332 22,653 12,926 2,518 6,368 4,841 140,733 37,540 15,015 4,173 9,654 7,098 60 6,420 7,865 25,847 92 9,256 11,392 19,638 96,504 22,599 15,526 2,512 6,893 5,458 64 7,300 8,966 18,060 1,010,562 231,537 108,711 25,736 71,920 50,682 666 65,813 80,451 156,705 83,579 19,122 15,181 2,125 6,058 5,027 895,823 247,554 79,872 27,516 60,468 42,829 55 6,784 8,357 14,999 592 55,273 67,944 112,026 193,535 50,521 27,256 5,615 13,315 10,249 128 13,608 16,702 32,263 217,739 57,991 23,693 6,446 14,976 11,108 143 14,506 17,871 21,377 Houston 150,033 38,453 18,150 4,274 10,384 7,705 99 10,116 12,416 22,510 Lowndes 112,865 28,087 12,987 3,122 7,710 5,316 75 6,935 8,405 28,460 39,565 10,027 5,446 1,115 2,766 2,143 26 2,839 3,494 6,960 Henry Murray Muscogee 200,579 48,646 24,713 5,407 13,983 10,088 133 13,232 16,148 42,678 Paulding 152,238 41,773 15,125 4,643 10,311 7,452 100 Pike Richmond 17,941 4,379 2,688 487 201,793 47,511 26,108 88,856 Sumter 30,779 7,285 4,783 Walker 68,066 Washington 20,816 4,586 3,374 Totals 78 9,155 15,176 1,026 12 5,281 14,261 10,493 Rockdale Wilkinson 22,656 1,280 11,700 2,518 11,539 6,237 4,973 4,853 2,074 58 4,048 45 510 1,525 1,224 6,414 7,916 14,009 20 2,254 2,762 8,970 5,430 6,692 12,485 14 1,636 2,016 4,969 2,095 1,670 233 670 568 6 767 6,467,955 1,599,539 737,512 177,790 451,848 328,152 4,259 428,684 LUNG.org 1,688 133 13,808 16,888 46,401 810 2,179 1,690 1,687 9,678 11,899 13,326 1,367 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 949 1,891 525,480 1,046,595 S TAT E TA B L E S GEORGIA American Lung Association in Georgia www.lung.org/georgia HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Pass/ Fail Bibb 2 0 0 0.7 B Chatham 0 0 0 0.0 A Chattooga 0 0 0 0.0 A DNC DNC DNC DNC DNC Clarke 0 0 0 0.0 A 0 0 0 0.0 A 9.5 PASS 0 0 0 0.0 A 10.0 PASS Clayton DNC DNC DNC DNC DNC 1 0 0 0.3 B Design Value 0 0 0 0.0 A 8.9 PASS DNC DNC Cobb 5 0 0 1.7 C Columbia 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Coweta 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Dawson 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DeKalb Douglas Fulton 9.6 PASS 0 0 0 0.0 A 9.4 PASS 7 9.8 PASS D E O G R A B EM Dougherty Floyd 8 0 0 2.7 D 0 0 0 0.0 A 10.2 PASS DNC DNC DNC DNC DNC 4 0 0 1.3 DNC DNC DNC DNC 17 3 0 7.2 C 0 0 2.3 D DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A 9.9 PASS F 0 0 0 0.0 A 10.5 PASS Glynn 0 0 0 0.0 A 0 0 0 0.0 A 8.0 PASS Gwinnett 6 0 9.0 PASS Hall Henry 1 0 2.5 D DNC DNC DNC DNC DNC 11 1 0 4.2 F 0 DNC 0 0 DNC 0 0.0 0 DNC 0.0 DNC A A DNC 8.4 PASS DNC DNC Houston DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.9 PASS Lowndes DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.5 PASS Murray 1 Muscogee 0 0 0 0.0 A 0 0 0 0.0 A 9.6 PASS Paulding 0 0 0 0.0 A 0 0 0 0.0 A 8.2 PASS Pike 4 Richmond Rockdale Sumter 0 0.8 1 0 1.8 B C 0 0 0 0.0 A 14 0 Walker DNC Washington Wilkinson 79 1 0 0 0 0 0.0 DNC DNC DNC DNC DNC 0 0 0 0.0 A F DNC A DNC DNC DNC DNC DNC DNC DNC DNC 9.5 PASS DNC DNC DNC DNC 0.0 DNC DNC DNC DNC DNC 0 0 0 0.0 A 9.2 PASS DNC 1 0 0 0.3 B 10.0 PASS LUNG.org DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 A DNC 0 DNC DNC DNC DNC 0 DNC DNC DNC DNC DNC 0 DNC DNC 4.7 DNC DNC DNC DNC DNC 9.9 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Hawaii 196,428 43,217 35,851 4,291 15,151 6,892 99 10,359 13,874 35,294 Honolulu 998,714 214,852 161,966 21,333 79,203 33,353 505 47,503 64,243 88,536 Kauai Maui Totals 71,735 16,019 12,902 1,591 5,515 2,500 164,637 36,745 26,166 1,431,514 310,833 236,885 3,649 12,794 5,586 30,864 112,663 48,331 36 3,748 5,026 7,928 83 724 8,155 11,097 17,333 69,765 94,239 D E O G R A B EM 80 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 149,091 S TAT E TA B L E S HAWAII American Lung Association in Hawaii www.lung.org/hawaii HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Hawaii Wgt. Avg. Grade Orange Red Purple DNC DNC DNC DNC DNC Honolulu 0 0 0 0.0 A 2 0 Annual Wgt. Avg. Grade 0 0.7 B Design Value Pass/ Fail 12.1 FAIL 0 0 0 0.0 A 5.4 PASS Kauai DNC DNC DNC DNC DNC 0 0 0 0.0 A 3.9 PASS Maui DNC DNC DNC DNC DNC 1 0 0 0.3 B 4.8 PASS D E O G R A B EM 81 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 65 & Over Pediatric Asthma 434,211 107,568 56,644 Bannock 83,744 Benewah Butte 11,020 624 512 207,478 61,522 26,566 Franklin 13,074 Jerome 22,814 7,115 2,811 Lemhi Shoshone Totals 82 Lung Cancer 9,121 29,849 15,427 1,891 5,594 2,864 9,052 2,003 1,973 170 643 409 2,501 Canyon 22,302 Adult Asthma COPD 4,385 1,804 53 171 107 5,216 13,298 6,883 372 791 432 603 1,434 748 Cardiovascular Disease Diabetes Poverty 205 21,998 25,165 49,369 40 4,112 4,655 18,179 4 634 702 1,614 1 98 6 165 183 394 9,906 11,224 32,329 636 714 1,253 11 1,073 1,224 3,577 7,735 1,398 2,193 119 574 398 4 642 694 1,347 12,432 2,464 2,772 209 909 576 6 892 988 2,577 793,041 209,381 106,295 17,753 53,263 27,843 375 40,057 45,548 D E O G R A B EM LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 110,639 S TAT E TA B L E S IDAHO American Lung Association in Idaho www.lung.org/idaho HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Ada 6 1 0 2.5 D Bannock DNC Benewah DNC DNC DNC DNC DNC Butte 0 DNC Wgt. Avg. Grade Orange Red Purple DNC 0 0 DNC 0.0 DNC A Annual Wgt. Avg. Grade INC INC INC INC INC 3 1 0 1.5 C Design Value Pass/ Fail INC INC 7.3 PASS INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC Canyon DNC DNC DNC DNC DNC Franklin DNC Jerome DNC DNC DNC DNC DNC INC INC INC INC INC INC INC Lemhi DNC DNC DNC DNC DNC 34 6 0 14.3 F 12.7 FAIL Shoshone DNC DNC DNC DNC DNC 43 5 0 16.8 F 13.7 FAIL DNC DNC DNC DNC INC INC INC INC INC INC INC 20 INC 12 0 12.7 F D E O G R A B EM 83 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 INC S TAT E TA B L E S ILLINOIS American Lung Association in Illinois www.lung.org/illinois AT-RISK GROUPS Lung Diseases County Total Population Under 18 Adams Champaign Clark DuPage Effingham 208,861 39,693 23,639 Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty 43 4,879 5,821 8,674 2,935 14,382 8,428 135 10,735 13,579 38,751 3,632 3,029 269 1,024 782 10 1,178 1,408 2,171 5,238,216 1,175,147 692,946 86,906 341,993 224,961 3,377 306,619 381,122 833,241 933,736 216,777 129,486 16,031 60,047 41,707 34,371 Hamilton Pediatric Asthma 67,013 15,213 12,711 1,125 4,300 3,243 15,979 Cook 65 & Over 8,103 5,870 599 2,187 603 58,108 72,050 65,538 1,608 22 8,200 1,815 1,678 134 528 413 2,362 2,852 3,313 5 633 750 1,055 Jersey 22,372 4,762 4,016 352 1,463 1,095 14 1,620 1,954 2,455 Jo Daviess 22,086 4,271 5,552 316 1,460 1,232 14 1,978 2,301 2,060 Kane Lake 530,847 141,342 64,659 10,453 32,725 21,999 344 29,962 37,481 56,882 703,910 456 D E O G R A B EM Macon Macoupin 176,512 88,880 13,054 44,232 30,322 107,303 23,914 19,664 1,769 6,933 5,160 46,045 9,770 8,897 723 3,007 2,302 41,581 52,009 61,899 69 7,683 9,211 18,784 30 3,469 4,148 6,192 Madison 266,209 59,077 42,437 4,369 17,297 12,351 172 17,738 21,641 33,734 McHenry 307,343 75,431 38,883 5,578 19,422 13,535 199 18,604 23,327 24,659 McLean 173,166 38,016 20,468 2,811 11,432 7,115 112 Peoria 186,221 44,415 28,650 3,285 11,867 8,285 120 11,823 14,415 28,269 Randolph Rock Island 32,852 6,300 5,782 146,133 32,595 26,190 466 2,214 1,602 2,410 9,450 6,954 9,355 11,766 18,969 22 2,336 2,826 4,049 94 10,290 12,363 18,596 Sangamon 198,712 45,433 31,830 3,360 12,791 9,198 128 13,260 16,158 29,798 St. Clair 264,052 63,022 37,645 4,661 16,833 11,705 170 16,430 20,263 42,464 Will 687,263 179,235 79,991 13,255 42,712 28,544 445 38,444 48,427 53,883 Winnebago Totals 84 287,078 68,062 46,023 10,487,968 2,432,537 1,418,926 LUNG.org 5,033 18,270 13,182 179,893 676,570 455,721 185 19,061 23,193 41,541 6,771 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 628,146 779,067 1,396,977 S TAT E TA B L E S ILLINOIS American Lung Association in Illinois www.lung.org/illinois HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple 0 Wgt. Avg. Grade Orange Red Purple 0 0.0 A Annual Wgt. Avg. Grade DNC DNC DNC DNC DNC Design Value Pass/ Fail Adams 0 DNC DNC Champaign 1 0 0 0.3 B INC INC INC INC INC INC INC Clark 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Cook 17 1 0 6.2 F INC INC INC INC INC INC INC DuPage 3 0 0 1.0 C INC INC INC INC INC INC INC Effingham 0 0 DNC DNC Hamilton 0 0 0 0.0 A INC INC INC INC INC INC INC Jersey 3 1 0 1.5 C INC INC INC INC INC INC INC Jo Daviess 2 0 0.7 DNC DNC DNC DNC DNC DNC DNC Kane Lake 0 1 0 0.0 A B DNC DNC DNC DNC Macoupin 15 0 0 0 0 22 DNC 0 0.3 B INC INC INC INC INC INC INC 0 DNC DNC D E O G R A B EM Macon Madison 0 5.0 F DNC DNC DNC DNC DNC 0 0.0 A INC INC INC INC INC INC INC 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 0 0 F INC INC 7.3 INC INC INC INC INC McHenry 5 0 0 1.7 C INC INC INC INC INC INC INC McLean 1 0 0 0.3 B INC INC INC INC INC INC INC Peoria 0 0 0 0.0 A INC INC INC INC INC INC INC Randolph 4 0 0 1.3 C INC INC INC INC INC INC INC Rock Island 1 0 INC INC Sangamon 0 0 0 0.0 A INC INC INC INC INC INC INC St. Clair 4 0 0 1.3 C INC INC INC INC INC INC INC Will 0 0 0 0.0 A INC INC INC INC INC INC INC Winnebago 3 0 0 1.0 C INC INC INC INC INC INC INC 85 0 LUNG.org 0.3 B INC INC INC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 INC INC 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 Allen 65 & Over Pediatric Asthma 368,450 96,167 49,434 Adult Asthma COPD Lung Cancer 7,232 28,100 21,417 Cardiovascular Disease Diabetes Poverty 270 26,495 30,756 52,689 Bartholomew 81,162 19,533 12,282 1,469 6,334 4,972 60 6,242 7,129 9,462 Boone 63,344 17,002 8,084 1,279 4,779 3,735 46 4,561 5,364 3,734 Brown 14,977 2,893 3,272 218 1,215 1,145 11 1,489 1,632 1,688 Carroll 19,856 4,508 3,604 339 1,561 1,347 15 1,723 1,925 1,855 Clark 115,371 Delaware 116,852 22,109 18,947 Dubois Elkhart Floyd Hamilton Hendricks 16,811 42,461 10,185 6,962 2,007 9,130 7,129 1,663 9,771 7,248 766 3,296 2,768 85 8,860 10,229 85 11,832 9,213 10,402 24,820 31 3,490 3,961 3,179 203,474 56,889 27,717 4,278 15,101 11,658 149 14,513 16,730 27,906 76,778 17,795 11,459 1,338 6,056 4,879 56 6,060 6,995 8,502 D E O G R A B EM Greene Hancock 26,683 32,441 7,205 5,983 309,697 87,329 33,758 542 2,565 2,222 6,567 23,072 17,116 24 2,847 3,175 4,710 227 20,525 24,634 14,366 72,520 17,226 11,199 1,295 5,665 4,640 53 5,797 6,648 4,272 158,192 40,662 20,089 3,058 12,146 9,245 116 11,296 13,285 8,477 Henry 48,985 10,256 8,982 Howard 82,556 18,761 15,225 1,411 6,489 5,535 60 7,127 7,911 13,724 Huntington 36,630 8,072 5,967 607 2,924 2,386 27 3,005 3,418 3,832 Jackson 44,069 10,778 6,811 810 3,414 2,742 32 3,447 3,929 5,250 Johnson Knox 149,633 37,532 21,118 37,927 8,005 6,383 118,118 73,176 771 3,945 3,337 2,822 11,549 8,924 602 3,067 2,439 8,882 37,969 30,309 36 4,274 4,771 6,636 110 11,099 12,807 11,720 28 3,102 3,494 6,735 Lake 487,865 LaPorte 110,884 24,277 17,940 1,826 8,873 7,209 Madison 129,723 28,550 22,366 2,147 10,340 8,494 95 10,823 12,157 20,636 Marion 939,020 234,220 108,060 17,613 73,292 52,169 686 63,121 75,137 189,323 Monroe 144,705 23,002 16,832 106 1,730 12,779 7,869 357 82 37,867 43,453 79,740 9,068 10,327 16,294 9,570 11,380 30,425 Montgomery 38,227 8,829 6,489 664 3,003 2,491 28 3,166 3,564 4,543 Morgan 69,648 16,261 10,890 1,223 5,462 4,557 51 5,682 6,526 7,814 Perry 19,347 3,996 3,346 14 1,635 1,843 2,341 Porter 167,688 37,980 24,962 300 1,570 1,287 2,856 13,333 10,585 123 13,158 15,182 18,931 Posey 25,512 5,795 4,202 436 2,012 1,715 19 2,151 2,455 2,442 Shelby 44,478 10,203 7,078 767 3,507 2,912 33 3,644 4,170 5,205 Spencer 20,715 4,658 3,820 350 1,630 1,429 15 1,828 2,041 1,931 St. Joseph 268,441 64,242 39,260 4,831 21,028 16,236 196 20,287 23,296 42,922 Tippecanoe 185,826 38,439 19,501 2,891 15,485 9,570 137 11,530 13,844 32,336 Vanderburgh 181,877 39,873 28,248 2,998 14,597 11,442 133 14,364 16,408 30,123 Vigo 107,896 22,180 16,090 1,668 8,853 6,580 86 LUNG.org 80 8,240 9,450 20,027 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 32,138 6,905 6,374 Warrick 61,897 Whitley 33,406 7,743 5,457 Totals 15,119 5,144,668 1,229,980 10,247 718,425 Adult Asthma COPD Lung Cancer 519 2,560 2,213 1,137 4,776 3,992 92,492 403,873 308,133 5,057 5,713 LUNG.org 4,546 25 2,759 3,140 2,598 3,770 381,995 442,441 D E O G R A B EM 87 Poverty 24 2,882 3,160 3,625 45 582 2,622 2,194 Cardiovascular Disease Diabetes AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 741,191 S TAT E TA B L E S INDIANA American Lung Association in Indiana www.lung.org/indiana HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Allen Wgt. Avg. Grade Orange Red Purple 0 0 0 0.0 A Annual Wgt. Avg. Grade 7 1 0 2.8 D Design Value Pass/ Fail 10.2 PASS Bartholomew 3 0 0 1.0 C INC INC INC INC INC INC INC Boone 4 0 1.3 DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC Brown 0 C INC INC INC INC INC Carroll 1 0 0 0.3 B Clark 4 1 0 C Delaware 0 0 0 0.0 A Dubois 1.8 DNC DNC DNC DNC DNC 1 0 0 0.3 B 11.4 PASS 2 0 0 0.7 B 9.7 PASS 0 0 0 0.0 A 10.6 PASS Elkhart 0 0 0 0.0 A 16 0 0 5.3 F 10.4 PASS Floyd 6 0 0 2.0 C 1 0 0 0.3 B 10.0 PASS D E O G R A B EM Greene 3 0 0 1.0 C Hamilton 0 0 0 0.0 A INC INC INC INC INC INC INC Hancock 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Hendricks Henry Howard DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A 1 0 0 0.3 B 9.5 PASS 9.1 PASS INC INC INC INC INC INC INC Huntington 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Jackson 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Johnson 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Knox 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Lake 5 0 0 C LaPorte 8 0 0 2.7 D 2 0 0 0.7 B 9.5 PASS Madison 0 0 0 0.0 A 3 0 0 1.0 C 9.6 PASS Marion 4 10 1 0 3.8 F 11.7 PASS 0 1 0 0.5 B 0 0 1.7 1.3 C Monroe DNC DNC DNC DNC DNC Montgomery DNC DNC DNC DNC DNC 8 2 0 3.7 F 11.0 PASS 9.4 PASS INC INC INC INC INC INC INC Morgan 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Perry 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC Porter 8 0 0 2.7 D Posey 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Shelby 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Spencer St. Joseph Tippecanoe Vanderburgh 88 DNC DNC DNC DNC DNC 3 0 0 1.0 C DNC DNC DNC DNC DNC 13 0 LUNG.org 0 4.3 F 2 2 0 1.7 C 0 0 0 0.0 A 10.0 PASS 10.1 PASS 5 1 0 2.2 D 9.7 PASS 1 0 0 0.3 B 9.8 PASS 0 0 0 0.0 A 10.7 PASS AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S INDIANA (cont.) American Lung Association in Indiana www.lung.org/indiana HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Pass/ Fail Vigo 0 0 0 0.0 A Wabash 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC Warrick 4 0 0 C DNC DNC Whitley 1.3 DNC DNC DNC DNC DNC 2 1 0 1.2 C Design Value 3 DNC 0 DNC DNC 0 1.0 DNC C 10.3 PASS 9.3 PASS D E O G R A B EM 89 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 DNC 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 133,455 28,752 65 & Over Pediatric Asthma 20,236 1,655 Adult Asthma COPD 7,985 Lung Cancer 5,680 Cardiovascular Disease Diabetes 85 7,289 8,473 Poverty 18,161 Bremer 24,722 5,422 4,661 312 1,462 1,149 16 1,548 1,757 1,791 Clinton 47,768 10,950 8,898 630 2,797 2,264 30 3,074 3,522 6,263 Delaware 17,403 4,134 3,170 238 1,010 823 11 1,119 1,288 1,743 Harrison 14,265 3,214 2,800 185 838 696 Johnson Lee 144,251 29,208 15,003 1,681 8,840 5,358 35,089 7,594 6,698 Linn 219,916 52,166 32,289 437 2,088 1,693 3,003 12,826 9,353 10,234 2,280 2,172 131 601 515 Muscatine 43,011 Pottawattamie Scott Story Van Buren Warren Woodbury Totals 90 628 2,450 92 6,265 7,568 24,908 22 2,301 2,633 5,358 1,857 6 716 809 1,339 27 2,445 2,847 D E O G R A B EM Palo Alto Polk 6,676 955 1,089 1,385 140 12,093 14,166 23,524 Montgomery 10,915 9 9,133 2,053 1,974 118 533 450 467,711 117,819 55,946 6,782 26,886 18,343 93,671 22,256 14,930 172,126 41,195 25,490 1,281 5,452 2,371 10,013 96,021 16,276 10,417 7,344 1,697 1,534 48,626 12,180 7,409 297 22,854 4,145 59 7,375 109 937 6,112 3,587 98 427 365 4,871 6 626 701 1,013 27,333 54,557 5,466 6,361 12,293 9,575 11,219 20,823 62 4,132 4,950 15,717 5 508 575 1,154 701 2,785 2,097 31 2,750 3,212 3,641 102,782 26,929 14,335 1,550 5,802 4,192 65 5,397 6,331 13,957 1,687,528 395,040 LUNG.org 234,638 22,738 98,908 69,942 1,071 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 89,112 104,835 212,498 S TAT E TA B L E S IOWA American Lung Association in Iowa www.lung.org/iowa HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Black Hawk DNC DNC DNC DNC 0 Clinton 1 0 0 0.3 B Harrison 0 0.0 DNC Bremer Delaware 0 Wgt. Avg. Grade Orange Red Purple A DNC DNC DNC DNC DNC 1 0 0 0.3 B 0 0 Annual Wgt. Avg. Grade 0 0.0 A DNC DNC DNC DNC DNC Design Value Pass/ Fail 9.0 PASS DNC DNC 3 0 0 1.0 C 10.2 PASS 0 8.7 PASS 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Johnson DNC DNC DNC DNC DNC 2 0 0 0.7 B 8.8 PASS Lee DNC DNC DNC DNC DNC 0 0 0 0.0 A 10.0 PASS Linn 0 0 0 0.0 A 3 0 0 1.0 C 9.3 PASS Montgomery 1 0 0 0.3 B 1 0 0 0.3 B 7.6 PASS 11 10.4 PASS Muscatine DNC DNC DNC DNC DNC 0 0 3.7 F D E O G R A B EM Palo Alto 1 0 0 0.3 B 0 0 0 0.0 A 7.8 PASS Polk 0 0 0 0.0 A 0 0 0 0.0 8.3 PASS DNC DNC DNC DNC DNC 1 0 0 0.3 B 9.0 PASS 0 0 0 0.0 A 5 0 0 1.7 C 10.1 PASS 0 0 0 0.0 Pottawattamie Scott Story Van Buren Warren Woodbury 91 A 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC LUNG.org 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 2017 1.0 C DNC DNC 8.0 PASS DNC DNC 8.4 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 Leavenworth Linn 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer 580,159 145,597 76,022 12,903 37,954 26,585 Cardiovascular Disease Diabetes Poverty 365 33,371 41,203 31,474 79,315 19,050 10,365 1,688 5,263 3,650 9,536 2,198 2,004 195 636 525 51 4,566 5,647 7,817 6 724 844 1,318 Neosho 16,346 4,044 3,030 358 1,067 835 10 1,127 1,330 2,995 Riley 75,247 13,025 6,256 1,154 5,394 2,707 48 2,986 3,925 15,560 Sedgwick 511,574 Shawnee 178,725 43,262 29,471 Sumner Trego Wyandotte Totals 92 134,499 67,228 11,919 32,879 22,839 322 3,834 11,780 8,832 23,535 5,821 4,135 35,402 76,898 112 11,604 13,921 24,840 516 1,540 1,200 2,927 545 707 28,782 48 206 177 15 1,600 1,904 2,701 2 248 286 298 163,369 45,889 18,586 4,067 10,260 6,858 103 8,433 10,532 35,442 1,640,733 413,930 217,804 36,682 106,979 74,210 1,033 93,440 114,993 199,343 D E O G R A B EM LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S K ANSAS American Lung Association in Kansas www.lung.org/kansas HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Johnson Leavenworth Wgt. Avg. Grade Orange Red Purple 0 0 0 0.0 A 4 0 Pass/ Fail 7.7 PASS DNC DNC DNC DNC DNC DNC DNC 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 0 2.7 C 0 0 0 0.0 A Design Value Linn 0 0 1.3 Annual Wgt. Avg. Grade Sedgwick 8 Shawnee 1 0 0 0.3 B 1 0 0 0.3 B 8.0 PASS Sumner 5 0 0 1.7 C 1 0 0 0.3 B 7.8 PASS Trego 0 0 0 0.0 A Wyandotte 1 0 0 B 0.3 D 1 0 0 0.3 B DNC DNC DNC DNC DNC 1 0 0 0.3 B 9.2 PASS DNC DNC 9.2 PASS D E O G R A B EM 93 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S KENTUCKY American Lung Association in Kentucky www.lung.org/kentucky AT-RISK GROUPS Lung Diseases County Total Population Under 18 Bell 65 & Over Pediatric Asthma 27,337 5,809 4,852 Boone 127,712 34,843 14,808 Adult Asthma COPD Lung Cancer 630 2,552 2,718 3,779 11,106 10,927 Cardiovascular Disease Diabetes Poverty 26 2,784 3,050 11,772 122 10,493 12,018 10,304 Boyd 48,325 10,186 8,823 1,105 4,517 4,859 46 5,003 5,463 9,440 Bullitt 78,702 75 Campbell 92,066 20,046 13,096 2,174 8,588 8,562 88 8,414 9,476 12,805 Carter 27,158 6,102 4,620 26 2,685 2,952 5,203 Christian 73,309 Daviess 99,259 24,141 16,079 Edmonson 12,007 2,276 2,407 Fayette Hardin Henderson Jefferson 20,014 66,246 11,116 8,410 37,689 1,947 7,241 7,392 662 2,498 2,635 2,171 6,384 5,498 2,619 8,918 9,312 247 1,150 1,253 7,186 29,741 26,994 7,275 8,195 5,985 Jessamine Livingston 36,068 7,867 7,046 5,242 95 9,442 10,412 14,405 8,692 2,186 1,479 106,439 26,333 13,901 237 771 830 25,619 29,457 2,856 9,563 9,441 763,623 171,811 113,444 18,636 70,483 102 70,948 932 1,189 9,199 10,422 15,424 70,423 78,758 115,246 49 4,565 5,143 9,129 208 872 996 9 1,047 1,129 1,404 Madison 87,824 18,551 11,491 2,012 8,284 7,689 84 7,420 8,436 14,873 McCracken 65,018 62 Morgan 13,275 2,552 1,954 277 1,279 1,280 13 1,259 1,417 3,577 Oldham 64,875 16,641 7,791 1,805 5,765 5,842 63 5,627 6,441 3,688 Perry 27,565 6,064 4,404 26 2,696 2,994 7,675 Pike 61,792 13,066 10,260 1,417 5,786 6,128 59 6,192 6,852 15,082 Pulaski 63,782 14,325 11,539 1,554 5,856 6,331 61 6,528 7,122 14,448 Simpson 18,006 4,378 2,864 Trigg Warren Washington Totals 94 9,316 1,920 1,909 851 44 4,484 4,966 7,688 727 51,961 12,805 7,098 1,389 4,670 4,648 57,637 34 3,843 4,155 5,973 8 46,407 10,857 7,419 1,178 4,223 4,445 13,750 11 1,308 1,415 2,376 300 853 3,331 3,676 7,504 71 D E O G R A B EM Greenup Hancock 314,488 17,953 14,201 12,169 14,233 3,061 3,072 122,851 27,678 15,030 12,063 2,761 2,102 2,474,153 564,673 LUNG.org 356,872 1,540 6,012 6,528 658 2,555 2,682 475 1,619 1,694 332 1,315 1,519 3,002 11,394 10,379 61,249 227,576 226,390 7,355 9,671 17 1,712 1,893 2,820 14 1,618 1,729 2,129 117 299 1,102 1,184 6,767 9,920 11,347 20,992 12 1,213 1,329 1,992 2,361 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 223,628 250,845 398,196 S TAT E TA B L E S KENTUCKY American Lung Association in Kentucky www.lung.org/kentucky HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Bell 0 0 0 0.0 A Boone 2 Boyd 5 0 0 1.7 C Bullitt 4 0 0 1.3 C DNC DNC DNC DNC DNC 13 0 0 4.3 F 0 0 0 0.0 A Campbell 0 0 0.7 B 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A Design Value Pass/ Fail 8.9 PASS DNC DNC 9.1 PASS DNC DNC 9.5 PASS Carter 0 0 0 0.0 A 0 0 0 0.0 A 7.6 PASS Christian 1 0 9.7 PASS Daviess 1 0 0 0.3 B Edmonson 1 0 0 0.3 B Fayette C 0 0 0.3 1.3 B 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A 10.3 PASS DNC DNC 4 0 0 Greenup 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 9.1 PASS Hancock 6 0 0 C DNC DNC D E O G R A B EM 2.0 DNC DNC DNC DNC DNC Hardin 1 0 0 0.3 B 0 0 0 0.0 A 9.8 PASS Henderson 2 0 0 0.7 B 0 0 0 0.0 A 10.3 PASS Jefferson 6 4 0 2 11.7 PASS 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Jessamine Livingston Madison 4.0 F DNC DNC DNC DNC DNC 1.2 C 0 0 0 0.0 A 8.1 PASS 0 0 0 0.0 A INC 1 0 0 Morgan 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Oldham 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC Perry 0 0 0 0.0 A 0 0 0 0.0 A INC INC Pike 0 0 0 0.0 A 3 0 0 1.0 C 8.0 PASS Pulaski 0 0 0 0.0 A 0 0 0 0.0 A 8.7 PASS Simpson 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Trigg 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Warren 0 0 0 0.0 A Washington 2 95 LUNG.org 0 0.7 B 0 McCracken 0 0.3 1 B 0 0 0 0.0 A DNC DNC DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 INC 9.1 PASS DNC DNC 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 Lung Disease Cardiovascular Diabetes Poverty Ascension Parish 119,455 32,905 12,536 2,879 7,071 6,217 83 8,674 10,209 12,695 Bossier Parish 125,175 31,423 16,527 2,750 7,674 6,838 87 9,879 11,416 17,765 Caddo Parish 251,460 61,152 38,375 5,351 15,547 14,636 174 21,587 24,857 54,405 Calcasieu Parish 198,788 49,384 27,852 4,321 12,205 11,288 139 16,419 19,009 34,103 East Baton Rouge 446,753 101,773 57,272 Parish 8,906 28,269 24,506 310 35,101 40,586 80,662 Iberville Parish 33,095 7,047 4,648 617 2,126 1,971 23 2,841 3,307 6,538 Jefferson Parish 436,275 94,962 67,695 8,310 27,857 26,432 304 38,811 44,859 70,484 Lafayette Parish 240,098 57,778 27,678 5,056 14,923 12,910 167 18,189 21,229 39,876 Lafourche Parish 98,325 23,175 13,797 2,028 6,135 5,703 69 8,266 9,598 13,612 D E O G R A B EM Livingston Parish 137,788 36,109 16,505 3,160 8,310 7,428 96 10,560 12,325 18,356 Orleans Parish 389,617 79,432 48,658 6,951 25,384 22,147 270 31,364 36,545 90,849 Ouachita Parish 156,761 39,935 21,430 3,494 9,553 8,692 109 12,628 14,594 34,836 Pointe Coupee Parish 22,251 5,032 4,156 Rapides Parish 132,141 33,075 20,183 440 1,402 1,439 2,894 8,087 7,698 15 2,180 2,502 4,264 92 11,361 13,098 27,768 St. Bernard Parish 45,408 12,355 4,547 1,081 2,703 2,319 32 3,215 3,783 9,179 St. Charles Parish 52,812 13,348 6,346 1,168 3,215 2,989 37 4,226 4,979 6,147 St. James Parish 21,567 5,009 3,347 438 1,349 1,317 15 1,934 2,245 3,902 St. John the Baptist Parish 43,626 10,928 5,681 956 2,666 2,489 30 3,567 4,172 8,829 St. Martin Parish 53,835 13,320 7,326 1,166 3,305 3,098 38 4,472 5,211 9,693 St. Tammany Parish 250,088 60,805 38,533 5,321 15,417 15,091 174 22,189 25,742 31,138 Tangipahoa Parish 128,755 31,859 16,932 2,788 7,924 7,133 90 10,276 11,915 30,092 Terrebonne Parish 113,972 29,354 14,655 2,569 6,910 6,320 West Baton Rouge 25,490 6,258 3,120 Parish Totals 96 3,523,535 836,418 LUNG.org 477,799 80 548 1,570 1,421 73,190 219,602 200,084 9,073 10,567 22,587 18 2,017 2,361 3,754 2,452 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 288,828 335,109 631,534 S TAT E TA B L E S LOUISIANA American Lung Association in Louisiana www.lung.org/louisiana HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour Parish Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Design Value Pass/ Fail Ascension Parish 6 1 0 2.5 D DNC DNC DNC DNC DNC DNC DNC Bossier Parish 5 0 0 1.7 DNC DNC DNC DNC DNC DNC DNC Caddo Parish 1 0 0 0.3 B 1 0 0 0.3 B 10.3 PASS Calcasieu Parish 8 1 0 3.2 D 0 0 0 0.0 A 7.2 PASS F 1 0 0 0.3 B 8.8 PASS C East Baton Rouge Parish 21 4 0 9.0 Iberville Parish 13 0 0 4.3 F 0 0 0 0.0 A 8.7 PASS Jefferson Parish 7 0 0 2.3 D 0 0 0 0.0 A 7.9 PASS Lafayette Parish 2 0 0 0.7 B 0 0 0 0.0 A 7.8 PASS Lafourche Parish 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 0 0 F DNC DNC Livingston Parish 11 3.7 DNC DNC DNC DNC D E O G R A B EM Orleans Parish Ouachita Parish Pointe Coupee Parish Rapides Parish INC INC INC INC INC 0 0 0 0.0 A 8 0 0 2.7 D DNC DNC DNC DNC DNC INC INC INC INC INC 0 0 0 0.0 A DNC DNC DNC DNC DNC 0.0 A 7.4 PASS 9.0 PASS 0 2.0 C 0 0 0 0.0 A St. Charles Parish INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC 1 0 1.2 C DNC DNC DNC DNC DNC DNC DNC 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC 9 1 0 3.5 F DNC DNC DNC DNC DNC DNC DNC St. John the Baptist Parish 5 St. Tammany Parish DNC 0 0 St. Martin Parish DNC 0 6 2 INC INC 0 St. Bernard Parish St. James Parish DNC INC INC Tangipahoa Parish DNC DNC DNC DNC DNC 0 0 0 0.0 A 7.6 PASS Terrebonne Parish DNC DNC DNC DNC DNC 0 0 0 0.0 A 7.2 PASS West Baton Rouge Parish 5 0 0 0 0.0 A 8.9 PASS 97 0 LUNG.org 0 1.7 C AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Aroostook Hancock Knox Penobscot Sagadahoc Washington Totals 98 15,032 9,551 12,084 119,980 23,627 21,154 39,855 7,333 9,143 Oxford York 12,778 289,977 56,068 49,183 54,659 Kennebec Pediatric Asthma Adult Asthma COPD Lung Cancer 107,233 23,468 17,615 2,271 9,491 6,529 68,628 Cumberland 65 & Over 1,237 6,197 4,798 5,426 26,504 18,210 924 5,007 3,874 2,286 10,873 7,728 710 3,595 2,830 57,202 11,150 11,363 1,079 5,145 3,883 152,692 28,318 26,256 35,149 6,793 7,136 31,625 5,998 7,145 2,740 14,095 9,622 657 3,165 2,383 580 2,834 2,230 Cardiovascular Disease Diabetes Poverty 82 7,587 7,883 15,668 52 5,829 5,875 12,342 220 21,155 21,985 30,030 42 4,704 91 9,084 9,366 15,229 4,742 6,136 30 3,460 3,471 4,393 44 4,666 4,739 9,579 116 11,160 11,609 24,822 27 2,865 2,909 3,915 24 2,724 2,735 5,779 D E O G R A B EM 201,169 39,427 37,449 3,815 18,177 13,211 153 15,665 16,055 16,376 1,158,169 224,511 213,560 21,726 105,082 75,298 880 88,899 91,369 144,269 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S MAINE American Lung Association in Maine www.lung.org/maine HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Design Value Pass/ Fail Androscoggin 0 0 0 0.0 A Aroostook 0 0 Cumberland 7 0 0 2.3 D INC INC INC INC INC INC INC Hancock 6 0 INC INC Kennebec 1 0 0 0.3 B INC INC INC INC INC INC INC Knox 6 0 2.0 DNC DNC DNC DNC DNC DNC DNC Oxford 0 0 INC INC INC INC INC INC INC Penobscot 1 0 0 0.3 B Sagadahoc 1 Washington York 99 1 0 0 0 0 0.0 2.0 A C C 0 0.0 A INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC 0 0 0 0.0 A INC 6.4 PASS 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 0 0 F DNC DNC D E O G R A B EM 12 INC LUNG.org 4.0 DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Anne Arundel 564,195 126,843 77,478 12,264 38,806 26,664 325 33,851 44,294 32,769 Baltimore 831,128 179,387 133,926 17,344 57,577 40,725 477 54,155 68,882 73,955 Baltimore City 621,849 131,353 77,919 12,700 43,408 28,201 357 34,916 45,727 135,850 Calvert 90,595 21,516 12,259 2,080 6,168 4,414 Carroll 167,627 37,047 26,540 Cecil 102,382 23,808 14,590 2,302 6,991 4,975 Charles 156,118 38,264 17,904 Dorchester Frederick Garrett 3,582 11,612 8,518 3,700 10,517 7,125 32,384 6,896 6,546 245,322 58,104 32,623 29,460 5,704 6,094 16,659 11,593 552 2,093 1,606 59 6,367 8,371 10,109 90 667 2,245 1,721 5,618 52 5,556 7,420 5,315 97 11,173 14,536 10,235 8,625 11,679 10,943 19 2,441 3,020 5,781 141 14,594 19,310 17,749 17 2,275 2,818 3,921 D E O G R A B EM Harford 250,290 56,808 37,682 5,493 17,181 12,287 144 15,974 20,770 19,384 Howard 313,414 76,590 39,680 7,405 21,083 14,520 181 18,081 24,056 16,350 Kent Montgomery 19,787 3,304 5,013 319 1,438 1,136 11 1,716 2,035 2,723 1,040,116 243,491 146,195 23,542 70,668 49,115 598 62,958 82,042 77,657 Prince George's 909,535 204,375 106,712 19,760 62,662 41,217 523 50,108 66,913 83,988 Washington 149,585 33,184 24,253 Totals 100 5,523,787 1,246,674 LUNG.org 765,414 3,208 10,296 7,382 120,537 379,403 261,199 87 3,178 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 9,831 12,543 16,984 332,622 434,417 523,713 S TAT E TA B L E S MARYLAND American Lung Association in Maryland www.lung.org/maryland HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Anne Arundel Baltimore Wgt. Avg. Grade Orange Red Purple 9 0 0 3.0 D Annual Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0.0 A 9.3 PASS 20 0 0 6.7 F 0 0 0 0.0 A 9.8 PASS Baltimore City 6 0 0 2.0 C 1 0 0 0.3 B 9.6 PASS Calvert 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC Carroll 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC 1 0 0 0 1.3 Cecil 13 4.8 F 0 0 0.3 B Dorchester 3 0 0 1.0 C Frederick 2 0 0 0.7 B DNC DNC DNC DNC DNC 1 0 0 0.3 B 0 0 0 0.0 A 6.6 PASS 13 1 0 4.8 F 0 0 0 0.0 A 9.4 PASS Harford Montgomery Prince George's Washington 101 0 0 0 0.0 A DNC DNC 7.9 PASS DNC D E O G R A B EM Howard Kent DNC DNC DNC DNC DNC 9.4 PASS 4 Garrett C 1 Charles DNC DNC DNC DNC DNC 10 0 0 3.3 F 6 0 0 2.0 C 16 1 0 5.8 F 4 0 0 1.3 C LUNG.org INC INC INC INC INC 0 0 0 0.0 A DNC INC INC 8.8 PASS 0 0 0 0.0 A 8.9 PASS 0 9.4 PASS 0 0 0.0 A 3 0 0 1.0 C AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 9.4 PASS 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Barnstable 214,333 33,534 61,137 4,053 17,645 12,686 Berkshire 127,828 2,707 Bristol 556,772 116,624 89,109 14,095 45,031 25,669 Dukes 17,299 Essex 22,400 3,158 27,597 3,617 382 10,567 1,419 6,708 905 776,043 169,296 123,799 20,461 62,022 35,610 Franklin 70,601 12,653 13,439 1,529 5,860 3,595 Cardiovascular Disease Diabetes Poverty 136 19,120 21,136 16,030 81 9,544 10,858 17,453 353 34,497 40,355 68,378 11 1,282 1,469 1,456 491 47,962 56,131 87,669 45 4,986 5,782 8,221 Hampden 470,690 105,014 72,932 12,692 37,479 21,025 298 28,133 32,860 77,818 Hampshire 161,292 24,587 24,700 102 Middlesex Norfolk 1,585,139 322,638 226,108 696,023 149,465 111,124 2,972 14,134 7,399 38,994 130,333 70,034 18,065 55,890 31,991 1,004 440 9,645 11,270 21,232 91,480 107,969 116,761 43,046 50,370 D E O G R A B EM 48,042 Plymouth 510,393 113,432 85,389 13,710 40,386 23,953 323 32,672 38,155 48,231 Suffolk 778,121 493 Worcester Totals 102 133,727 86,473 16,162 67,807 31,251 818,963 178,270 118,261 21,546 65,911 36,609 6,783,497 1,384,798 1,043,685 LUNG.org 167,368 554,483 307,435 37,909 45,273 144,867 519 48,272 57,168 95,500 4,295 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 408,549 478,798 751,658 S TAT E TA B L E S MASSACHUSETTS American Lung Association in Massachusetts www.lung.org/massachusetts HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Barnstable Berkshire 8 0 Wgt. Avg. Grade Orange Red Purple 0 2.7 D Annual Wgt. Avg. Grade DNC DNC DNC DNC DNC Design Value Pass/ Fail DNC DNC INC INC INC INC INC 0 0 0 0.0 A 6.8 PASS Bristol 9 2 0 4.0 F 0 0 0 0.0 A 6.9 PASS Dukes 4 0 0 1.3 C DNC DNC DNC DNC DNC Essex 14 0 0 4.7 F 0 0 0 0.0 A INC INC INC INC INC INC INC INC INC INC Franklin DNC 6.3 PASS INC INC Hampden 7 0 0 2.3 D Hampshire 6 0 0 2.0 C INC INC INC INC INC INC INC Middlesex 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC 7 1 0 D INC INC Norfolk Worcester 103 INC INC INC INC 7.3 PASS D E O G R A B EM Plymouth Suffolk 2.8 0 0 0 0.0 A DNC INC INC INC INC INC 6 0 0 2.0 C 3 0 0 1.0 C LUNG.org INC 0 0 0 0.0 A INC INC 0 0 0 7.7 PASS 0.0 A 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 6.9 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Allegan 114,625 28,179 17,738 2,183 8,866 6,785 73 8,142 9,463 12,668 Bay 105,659 21,934 19,842 1,699 8,544 6,759 67 8,346 9,546 15,161 Benzie Berrien 17,457 3,257 4,301 154,636 34,521 28,115 252 1,431 1,258 2,674 12,265 9,639 11 1,633 1,811 1,810 98 11,873 13,603 25,854 Cass 51,657 10,899 10,254 844 4,145 3,399 33 4,247 4,817 7,530 Chippewa 38,033 7,100 6,330 550 3,181 2,316 25 2,775 3,242 6,502 Clinton Genesee Huron 77,390 17,667 12,207 1,369 6,127 4,660 410,849 95,474 65,992 7,396 32,345 24,536 31,883 6,218 7,574 49 5,587 6,501 7,632 261 29,550 34,316 83,172 482 2,590 2,254 20 2,911 3,238 3,662 Ingham 286,085 57,692 35,094 4,469 23,751 15,154 182 17,099 20,836 56,310 Kalamazoo 260,263 57,149 36,023 4,427 21,016 14,218 166 16,530 19,732 40,161 Kent 636,369 158,665 79,581 12,291 49,439 34,080 405 39,215 46,957 90,457 D E O G R A B EM Lenawee Macomb 98,573 21,365 17,053 1,655 7,903 6,083 864,840 187,442 137,131 14,521 69,546 52,417 63 7,405 8,546 13,388 549 62,721 73,101 99,879 Manistee 24,461 4,357 5,816 338 2,031 1,750 Mason 28,783 5,963 6,234 462 2,313 1,938 18 2,463 2,768 4,745 Missaukee 14,903 263 10 3,400 2,922 1,170 958 16 2,250 2,510 3,465 1,199 1,359 2,576 Monroe 149,568 33,218 24,353 2,573 11,919 9,249 Muskegon 172,790 40,701 26,801 3,153 13,565 10,150 110 12,149 14,167 26,695 1,242,304 270,694 192,577 20,970 99,794 75,210 789 89,638 104,668 114,976 279,955 69,191 37,983 5,360 21,771 15,170 178 17,716 21,041 23,266 8,173 1,440 2,031 112 678 606 5 785 870 1,273 Oakland Ottawa Schoolcraft St. Clair Tuscola Washtenaw Wayne Wexford 159,875 34,557 27,456 2,677 12,812 10,129 53,777 11,360 10,174 358,880 69,537 44,917 104 LUNG.org 1,116 117,427 138,457 430,851 598 2,580 2,048 130,366 591,847 433,567 34 4,310 4,917 8,200 228 22,065 26,801 48,525 32,780 137,680 99,824 33,003 7,725 5,915 7,434,126 1,682,851 1,112,741 102 12,313 14,186 20,195 880 4,323 3,483 5,387 30,063 19,495 1,759,335 423,146 248,327 Totals 95 11,143 12,913 15,717 21 2,522 2,888 4,827 4,725 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 514,016 603,256 1,169,497 S TAT E TA B L E S MICHIGAN American Lung Association in Michigan www.lung.org/michigan HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Allegan 6.7 17 Bay 2 0 F DNC DNC DNC DNC DNC Benzie 6 Berrien 14 0 0 2.0 C 0 0 F 0 0 2.3 D 4.7 Annual Wgt. Avg. Grade 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A Pass/ Fail 8.1 PASS 7.8 PASS DNC DNC 8.2 PASS Cass 7 Chippewa 0 0 0 0.0 A Clinton 2 Genesee 5 0 0 1.7 C Huron 4 Ingham 1 0 0 0.3 B 0 0 0 0.0 A 8.5 PASS Kalamazoo 3 0 0 1.0 C 1 0 0 0.3 B 9.0 PASS Kent 6 0 0 2.0 C 0 1 0 0.5 B 9.4 PASS 4 0 0 1.3 C 0 0 0 0.0 A 8.4 PASS 0 8.9 PASS 0 0 0.7 0 1.3 B C 15 0 0 5.0 F Manistee 5 0 0 1.7 C Mason 5 0 0 1.7 C 2 0 0 B Missaukee Monroe Muskegon 0 0 0 0.0 A DNC DNC DNC DNC DNC 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 6.1 PASS DNC DNC 8.2 PASS DNC DNC D E O G R A B EM Lenawee Macomb 0 DNC DNC DNC DNC DNC Design Value 0.7 DNC DNC DNC DNC DNC 1 0 0.5 B 1 0 0 0.3 B DNC DNC DNC DNC DNC 6.3 PASS DNC DNC 0 0 0 0.0 A 5.6 PASS 1 0 0 0.3 B INC INC 17 1 0 6.2 F INC INC INC INC INC Oakland 8 0 0 2.7 D 1 0 0 0.3 B Ottawa 7 0 0 2.3 D INC INC INC INC INC INC INC Schoolcraft 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC 19 0 0 6.3 F 1 0 0 0.3 B 0 0 0.3 St. Clair Tuscola 1 B DNC DNC DNC DNC DNC INC INC 9.0 PASS 9.1 PASS DNC DNC Washtenaw 5 0 0 1.7 C 0 0 0 0.0 A 9.2 PASS Wayne 9 0 0 3.0 D 4 0 0 1.3 C 11.4 PASS Wexford 2 105 0 LUNG.org 0 0.7 B DNC DNC DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Anoka 344,151 83,424 42,705 5,248 19,301 11,354 198 16,473 19,048 24,058 Becker 33,386 8,227 6,532 518 1,834 1,277 19 2,020 2,185 3,728 Beltrami 45,672 11,516 6,826 Carlton Crow Wing Dakota 724 2,541 1,509 26 2,252 2,515 7,081 35,569 8,059 5,945 507 2,021 1,304 21 1,991 2,211 3,658 63,428 13,940 13,464 877 3,604 2,552 36 4,072 4,371 6,500 414,686 Goodhue Hennepin 102,866 52,466 46,435 10,438 8,789 6,471 23,088 13,629 238 657 2,628 1,793 1,223,149 271,399 157,112 17,074 70,967 40,122 1,986 2,655 125 623 19,853 22,860 29,191 27 2,805 3,063 4,042 702 57,856 66,595 130,801 Lake 10,631 476 6 Lyon 25,673 6,424 3,787 404 1,428 857 15 1,279 1,435 3,009 25,788 6,154 4,744 387 1,437 966 15 1,505 1,644 3,125 Olmsted 151,436 37,346 21,771 2,349 8,453 5,084 87 7,554 8,523 13,255 Ramsey 538,133 125,750 71,450 7,911 30,770 17,476 Scott 141,660 2,538 40,341 13,602 7,549 81 200,431 38,344 35,413 Stearns 154,708 35,283 21,287 2,220 8,908 5,096 Washington 251,597 62,864 33,651 Winona Wright 50,885 9,338 7,888 1,024 309 25,385 28,983 78,920 4,150 St. Louis 106 823 D E O G R A B EM Mille Lacs Totals 779 2,412 11,947 7,587 5,802 6,891 7,203 115 11,579 12,809 25,821 3,955 13,922 8,474 89 7,441 8,458 19,939 144 12,499 14,289 12,744 587 3,102 1,786 29 2,634 2,960 5,953 131,311 37,511 15,260 2,360 6,963 4,029 76 5,824 6,733 6,629 3,888,729 911,210 LUNG.org 525,347 57,325 221,085 129,523 2,234 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 189,602 216,396 386,681 S TAT E TA B L E S MINNESOTA American Lung Association in Minnesota www.lung.org/minnesota HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Anoka Becker Beltrami 3 0 0 1.0 C 0 0 0 0.0 A DNC DNC DNC DNC DNC Carlton 1 0 Crow Wing 0 0 0 0.0 A Dakota DNC DNC 0 0.3 B DNC DNC DNC 1 0 0 0.3 B 6.8 PASS 2 0 0 0.7 B INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC 2 0 0 0.7 B 0 0 0 0.0 A 7.0 PASS 0 0 0 0.0 A 1 0 0 0.3 B 8.1 PASS Lake 0 1 4.8 PASS Lyon 4 0 0 1.3 C Mille Lacs 0 Olmsted 0 0 0 0.0 A 0.0 A DNC DNC DNC DNC DNC 5.1 PASS Hennepin 0 A Pass/ Fail 0 0 0 0.0 Design Value Goodhue 0 0 0.3 B 1 0 0 0.3 B DNC DNC 6.3 PASS D E O G R A B EM Ramsey Scott 0 Annual Wgt. Avg. Grade 0 0 0.0 A DNC DNC DNC DNC DNC 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 2 0 0 0.7 B 7.3 PASS 3 0 0 1.0 C 9.3 PASS 0 0 0 0.0 A 7.8 PASS St. Louis 0 0 0 0.0 A 1 0 0 0.3 B 7.5 PASS Stearns 0 0 0 0.0 A 0 1 0 0.5 B 6.1 PASS Washington Winona Wright 107 0 0 0 0.0 A DNC DNC DNC DNC DNC 1 0 0 0.3 B LUNG.org 2 0 0 0.7 B INC INC INC INC INC 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 8.4 PASS INC INC 6.6 PASS S TAT E TA B L E S MISSISSIPPI American Lung Association in Mississippi www.lung.org/mississippi AT-RISK GROUPS Lung Diseases County Total Population Under 18 Bolivar DeSoto 65 & Over Pediatric Asthma 33,322 8,403 4,779 173,323 45,833 21,065 17,548 Lung Cancer 747 1,929 1,892 4,073 9,912 9,623 4,495 135 13,634 18,017 17,169 Grenada 21,578 5,133 3,658 456 1,278 1,331 17 1,999 2,572 4,539 Hancock 46,420 905 36 2,827 4,171 Poverty 26 2,762 3,604 11,380 75,944 8,158 1,560 Cardiovascular Disease Diabetes Forrest 10,185 9,980 Adult Asthma COPD 3,005 5,962 4,513 7,867 5,802 19,355 9,574 Harrison 201,410 48,920 27,525 Hinds 242,891 60,755 30,353 5,400 14,123 13,542 187 19,229 25,403 63,361 Jackson 141,425 3,030 110 34,092 20,634 4,348 11,829 11,575 59 8,356 8,445 157 16,684 21,885 43,019 12,307 16,048 22,511 Lauderdale 78,524 18,824 12,320 1,673 4,632 4,689 Lee 85,300 21,934 12,457 1,949 4,920 4,933 66 7,227 9,407 14,640 12,447 2,895 2,301 10 1,204 1,538 2,747 D E O G R A B EM Yalobusha Totals 108 61 6,938 8,991 16,497 1,112,584 274,522 LUNG.org 153,230 257 742 789 24,398 65,043 63,994 864 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 92,458 121,133 224,792 S TAT E TA B L E S MISSISSIPPI American Lung Association in Mississippi www.lung.org/mississippi HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Bolivar 1 DeSoto 0 Wgt. Avg. Grade Orange Red Purple 0 0.3 B 2 0 0 0.7 B Forrest DNC DNC DNC Grenada DNC DNC DNC DNC DNC 0 0.7 DNC Pass/ Fail DNC DNC 1 0 0 0.3 B 9.3 PASS 1 0 0 0.3 B 10.0 PASS 0 0 0 0.0 A 8.1 PASS 0 0 0 0.0 A 8.6 PASS 2 Harrison 7 0 0 2.3 D 0 0 0 0.0 A 8.8 PASS Hinds 0 0 0 0.0 A 0 0 0 0.0 A INC INC Jackson 8 0 0 0 9.2 PASS Lauderdale 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Lee 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 2.7 B DNC DNC DNC DNC DNC Design Value Hancock D 0 0 0.0 A D E O G R A B EM Yalobusha 109 0 DNC Annual Wgt. Avg. Grade LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Boone Buchanan Callaway Cass Cedar Clay Pediatric Asthma 17,296 3,984 3,022 174,974 35,803 18,998 Greene Adult Asthma COPD Lung Cancer 345 1,272 1,174 131 11,594 12,960 29,347 67 7,113 7,733 14,578 44,834 9,507 6,539 822 3,402 2,924 34 3,617 3,954 5,672 101,603 25,189 16,118 2,178 7,325 6,577 76 8,377 9,052 9,241 13,934 3,246 3,352 20,609 4,876 3,628 288,072 60,311 45,016 687,623 165,286 95,014 281 1,012 1,014 5,044 17,111 14,431 176 17,614 19,358 18,212 16 1,809 1,939 2,094 5,216 21,990 18,438 14,295 50,363 216 22,908 24,764 48,993 42,820 514 52,688 57,659 D E O G R A B EM Jefferson 224,124 Monroe Perry St. Charles St. Louis St. Louis City Ste. Genevieve Taney 110 10 1,408 1,458 2,727 422 1,503 1,392 118,596 30,156 16,783 2,608 8,530 7,230 Lincoln Poverty 13 1,521 1,633 1,612 3,096 13,586 10,170 Jasper Totals Cardiovascular Disease Diabetes 89,100 20,210 13,356 1,748 6,634 5,710 235,637 58,322 30,934 Clinton Jackson 65 & Over 53,406 30,911 4,619 16,414 14,345 168 54,696 14,267 6,951 1,234 3,893 3,353 385,590 93,004 52,662 398 1,395 1,271 17,751 19,493 23,221 41 4,105 4,529 6,089 8,583 1,912 1,839 165 633 620 19,183 4,604 3,242 119,421 89 8,946 9,735 18,467 6 838 882 1,182 14 1,637 1,759 2,088 8,043 28,177 24,240 289 29,863 32,763 23,775 1,003,362 223,088 169,017 19,294 74,774 67,336 748 86,170 92,819 101,692 315,685 63,437 36,569 17,919 4,035 3,118 5,486 24,494 19,411 236 22,709 25,343 78,089 349 1,325 1,237 13 1,603 1,726 1,914 54,592 11,646 11,028 1,007 4,102 3,801 41 5,033 5,313 8,483 3,876,012 886,289 LUNG.org 568,097 76,650 287,936 247,496 2,899 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 307,306 334,871 516,897 S TAT E TA B L E S MISSOURI American Lung Association in Missouri www.lung.org/missouri HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Andrew Boone Buchanan Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Design Value Pass/ Fail 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0.3 B 0 0 0 0.0 A 1 0 0 0.3 B 1 0 0 0.3 B 0 0 0 0.0 A 7.9 PASS 1 8.6 PASS 0 0 4.3 0 0 2.0 F Clinton 6 Greene 0 0 0 0.0 A Jackson Jasper Jefferson DNC DNC DNC DNC C DNC DNC DNC DNC DNC DNC 10.5 PASS Cass 13 A 0 0 Clay 0 0.0 0 Callaway Cedar 0 1 0 0 0.3 B DNC DNC DNC DNC DNC 0 0 0 0.0 A 3 0 0 1.0 C DNC DNC 9.4 PASS DNC DNC INC INC 9.1 PASS D E O G R A B EM 2 10 0 0 0.7 B 0 0 F 3.3 DNC DNC DNC DNC DNC 3 0 0 1.0 C DNC DNC 10.6 PASS Lincoln 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Monroe 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Perry 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 1 0 F DNC DNC St. Charles St. Louis 15 5.5 DNC DNC DNC DNC DNC 11 0 0 3.7 F 3 0 0 1.0 C 10.7 PASS St. Louis City 2 0 0 0.7 B 7 1 0 2.8 D 11.0 PASS Ste. Genevieve 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Taney 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 111 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Lung Cancer Cardiovascular Disease Diabetes Poverty Fergus 11,427 2,337 2,685 148 794 587 7 825 817 1,515 Flathead 96,165 21,452 17,068 1,360 6,633 4,416 56 5,933 6,135 13,270 Lewis and Clark 66,418 14,379 11,234 912 4,630 3,002 38 3,992 4,165 7,903 Lincoln Missoula Phillips Powder River 221 1,360 1,072 11 1,523 1,499 3,817 114,181 22,154 16,172 1,404 8,203 4,628 19,052 3,491 4,903 66 5,905 6,350 17,461 4,169 965 865 1,773 302 435 61 282 204 19 129 99 Ravalli 41,373 8,214 9,904 Richland 11,960 3,091 1,504 196 796 466 Rosebud 521 2,901 2,193 9,398 2,763 1,326 175 593 373 1 139 138 185 24 3,088 3,060 6,129 7 594 643 835 5 490 517 1,750 D E O G R A B EM Silver Bow 34,622 7,092 6,107 450 2,442 1,575 Yellowstone 157,048 36,826 24,786 2,335 10,690 6,650 Totals 567,586 7,802 112 2 283 285 673 123,066 LUNG.org 96,989 39,452 25,264 20 2,103 2,181 5,614 91 328 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 8,761 9,193 15,995 33,634 34,983 75,147 S TAT E TA B L E S MONTANA American Lung Association in Montana www.lung.org/montana HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Fergus 0 0 0 0.0 A Flathead 0 0 0 0.0 Lewis and Clark 0 0 0 0.0 DNC DNC DNC DNC Missoula 0 0 0 Phillips 0 0 0 Powder River 0 0 0 0.0 A Lincoln Ravalli DNC Richland Rosebud Silver Bow DNC Design Value 3 0 3.8 F 4.5 PASS A 9 9 0 7.5 F 9.3 PASS A 12 5 0 6.5 F 8.3 PASS DNC 9 12 1 9.7 F 11.7 PASS 0.0 A 9 11 0 8.5 F 10.4 PASS 0.0 A 5 4 0 3.7 F 4.9 PASS DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC LUNG.org Pass/ Fail 7 5 1 0 2.2 D 6.2 PASS 17 9.4 PASS 11 2 12.5 F 4 3 0 2.8 D 7.0 PASS 4 1 0 1.8 C 5.4 PASS 10 9.7 PASS D E O G R A B EM Yellowstone 113 DNC Annual Wgt. Avg. Grade 7 0 6.8 F INC INC INC INC INC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 INC INC 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 Hall 65 & Over Pediatric Asthma 550,064 142,366 64,743 Adult Asthma COPD Lung Cancer 9,416 29,437 20,470 38 3,402 3,973 8,182 8,543 2,077 2,039 137 462 438 5 646 720 1,141 Lancaster 306,468 70,379 38,425 Sarpy 175,692 49,226 18,645 3,256 9,137 6,234 108 8,293 9,997 10,095 Scotts Bluff Washington Totals 36,261 8,957 6,543 20,248 4,864 3,361 1,158,956 294,542 142,658 4,655 17,054 11,578 Poverty 338 27,534 32,882 77,869 61,680 16,673 8,902 1,103 3,241 2,456 Knox Cardiovascular Disease Diabetes 592 1,960 1,615 322 1,105 911 19,480 62,396 43,703 189 15,724 18,567 39,383 22 2,296 2,628 12 1,267 1,482 1,328 713 59,162 70,249 D E O G R A B EM 114 LUNG.org 5,364 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 143,362 S TAT E TA B L E S NEBR ASK A American Lung Association in Nebraska www.lung.org/nebraska HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Douglas Hall Wgt. Avg. Grade Orange Red Purple 2 0 0 0.7 B DNC DNC DNC DNC DNC Knox 0 0 0 0.0 A Lancaster 0 0 0 0.0 A Annual Wgt. Avg. Grade 4 0 0 1.3 C 0 0 0 0.0 A DNC DNC DNC DNC DNC Design Value Pass/ Fail 9.1 PASS 6.8 PASS DNC DNC 1 0 0 0.3 B 7.5 PASS C INC INC Sarpy DNC DNC DNC DNC DNC 3 Scotts Bluff DNC 0 0 0 0.0 A 5.3 PASS Washington DNC DNC DNC DNC DNC 1 0 0 0.3 B 7.5 PASS DNC DNC DNC DNC 0 0 1.0 D E O G R A B EM 115 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S NEVADA American Lung Association in Nevada www.lung.org/nevada AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Carson City 54,521 11,140 10,792 651 3,492 3,226 32 3,913 4,779 8,457 Churchill 24,200 5,626 4,425 329 1,492 1,341 14 1,613 1,978 3,115 Clark 2,114,801 498,564 290,001 29,147 130,554 103,810 1,242 121,424 153,343 321,755 Douglas 47,710 8,500 12,234 497 3,145 3,277 28 4,072 4,863 4,459 Elko 51,935 845 31 Lyon 52,585 11,634 10,816 Washoe White Pine Totals 14,459 5,043 446,903 99,275 67,548 3,058 2,226 680 3,293 3,136 5,804 28,100 23,194 651,286 402,370 38,075 173,759 140,729 3,328 31 3,827 4,647 7,180 6 614 769 1,198 1,647 165,456 208,074 D E O G R A B EM 116 LUNG.org 5,065 263 27,431 34,367 61,017 9,811 2,088 1,511 122 625 518 2,802,466 2,562 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 412,246 S TAT E TA B L E S NEVADA American Lung Association in Nevada www.lung.org/nevada HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Carson City 0.3 Churchill Clark Douglas Elko Lyon 1 0 2 8 10 1 8.3 F INC INC 0 0 0.7 B 0 23.8 F 5 1 0 2.2 D 10.1 PASS DNC DNC DNC DNC DNC 13 10 6 13.3 F INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC 8 0 0 2.0 C 0 0 F 0 0 2.7 D 6.0 DNC DNC DNC DNC DNC Pass/ Fail 5 18 White Pine B Design Value 64 6 Washoe 0 Annual Wgt. Avg. Grade DNC DNC DNC DNC DNC 18 7 0 9.5 F DNC DNC DNC DNC DNC DNC DNC DNC DNC 9.6 PASS DNC DNC D E O G R A B EM 117 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 3,532 50 4,648 5,073 7,064 Coos 31,212 5,412 7,018 21 2,236 2,410 4,792 390 2,554 1,910 1,084 7,546 5,007 Hillsborough 406,678 87,109 58,512 6,283 32,660 20,524 Merrimack 147,994 2,091 Rockingham Totals 28,984 24,880 12,059 40 59 4,079 5,588 4,424 Poverty 75,909 13,972 13,574 1,008 6,283 4,172 16,667 4,872 Cardiovascular Disease Diabetes Cheshire 15,033 845 Lung Cancer 60,641 89,320 12,451 Adult Asthma COPD Belknap Grafton 11,714 65 & Over 6,065 9,245 267 22,154 24,704 31,984 7,973 97 8,834 9,732 11,691 301,777 61,163 47,679 4,412 24,310 16,094 198 17,762 19,803 15,687 1,113,531 223,387 180,781 16,113 90,285 59,212 731 65,301 72,211 85,680 D E O G R A B EM 118 5,217 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S NEW HAMPSHIRE American Lung Association in New Hampshire www.lung.org/newhampshire HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Belknap 0 0.0 Cheshire 1 0 0 0.3 B Coos 7 0 0 2.3 D Grafton 1 0 0 Hillsborough 4 0 0 1.3 C Merrimack 2 0 0 0.7 B INC INC INC INC INC Rockingham 9 0 0 3.0 D 0 0 0 0.0 A 0 0 0.3 A B 0 0 Wgt. Avg. Grade 0 0.0 A 3 1 0 1.5 C DNC DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A Design Value 5.0 PASS 8.8 PASS DNC DNC 6.3 PASS 6.3 PASS INC LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 INC 8.2 PASS D E O G R A B EM 119 Pass/ Fail 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 5,175 Adult Asthma COPD 15,459 Lung Cancer 10,901 Cardiovascular Disease Diabetes 160 Bergen 938,506 201,430 152,403 17,351 53,224 37,421 548 54,597 68,269 65,906 Camden 510,923 118,125 74,538 10,175 28,407 19,173 298 27,507 34,471 65,805 Cumberland 155,854 36,694 21,848 Essex 797,434 191,077 100,634 16,459 43,951 28,153 466 39,512 49,773 131,125 Gloucester 291,479 65,857 42,653 5,673 16,321 11,115 170 16,027 20,133 22,086 Hudson 674,836 136,696 73,318 11,775 39,100 22,716 395 30,321 38,252 117,828 Hunterdon 125,488 25,973 20,477 2,237 7,191 5,243 73 7,794 9,827 6,046 Mercer 371,398 80,663 52,076 6,948 21,047 13,868 217 19,699 24,736 39,354 Middlesex 840,900 183,992 115,274 15,849 47,569 31,018 492 43,846 55,073 69,660 Monmouth 628,715 138,218 100,935 11,906 35,431 25,248 368 37,103 46,557 46,641 Morris 499,509 109,736 78,501 292 29,039 36,453 25,917 Ocean 588,721 138,514 130,156 11,931 32,235 25,767 344 39,159 48,012 63,101 Passaic 510,916 124,017 68,264 10,682 28,014 18,301 299 25,890 32,510 86,457 Union 555,786 131,997 73,670 11,370 30,698 20,137 325 28,577 35,981 58,384 3,161 8,621 5,673 92 15,917 19,885 Poverty 274,219 9,452 28,166 19,849 106,869 22,141 17,629 1,907 6,119 4,382 7,871,553 1,765,207 1,167,176 LUNG.org 152,050 441,554 298,964 37,923 8,040 10,063 24,740 D E O G R A B EM Warren 120 44,800 Pediatric Asthma Atlantic Totals 60,077 65 & Over 62 6,452 8,093 8,040 4,602 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 429,480 538,088 869,013 S TAT E TA B L E S NEW JERSEY American Lung Association in New Jersey www.lung.org/newjersey HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Atlantic 4 1 0 1.8 C 0 0 0 0.0 Bergen 22 0 0 7.3 F 0 0 0 0.0 A 9.1 PASS Camden 18 1 0 6.5 F 1 0 0 0.3 B 10.4 PASS 0 0 1.0 C Cumberland 3 Wgt. Avg. Grade A DNC DNC DNC DNC DNC Pass/ Fail 8.1 PASS DNC DNC Essex 10 0 0 3.3 F 2 0 0 0.7 Gloucester 12 0 0 4.0 F 0 0 0 0.0 A 8.9 PASS Hudson 21 2 0 8.0 F 1 0 0 0.3 B 10.8 PASS Hunterdon 10 0 0 3.3 F DNC DNC DNC DNC DNC Mercer 19 0 0 6.3 F 0 0 0 0.0 A Middlesex 13 1 0 4.8 F 0 0 0 0.0 A 9 2 0 4.0 F DNC DNC DNC DNC DNC 10 0 0 3.3 F 0 0 0 0.0 A 7.1 PASS 15 1 0 5.5 F 1 0 0 0.3 B 7.7 PASS Ocean Passaic Union Warren 121 8.9 PASS DNC 9 0 0 3.0 D DNC DNC DNC DNC DNC 3 0 0 1.0 C LUNG.org DNC 8.6 PASS 8.0 PASS D E O G R A B EM Monmouth Morris B Design Value DNC DNC 0 0 0 0.0 A 8.9 PASS 5 10.4 PASS 0 0 1.7 C 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 8.3 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 Lung Cancer Bernalillo 676,685 153,390 99,360 13,882 51,620 30,839 Doña Ana 214,295 54,119 31,444 4,898 15,811 9,174 Cardiovascular Disease Diabetes Poverty 271 40,308 58,573 126,614 86 12,034 17,463 53,968 Eddy 57,578 15,216 8,022 1,377 4,178 2,504 23 3,272 4,755 7,015 Grant 28,609 5,929 7,226 537 2,238 1,607 11 2,263 3,077 5,753 Lea 71,180 21,611 7,399 1,956 4,891 2,679 29 3,388 5,077 9,875 Luna 24,518 6,385 5,121 578 1,790 1,200 10 1,661 2,296 7,395 39,465 9,489 6,793 Rio Arriba 859 2,956 1,926 16 2,581 3,662 9,486 San Juan 118,737 31,403 16,654 2,842 8,614 5,179 48 6,774 9,836 22,047 Sandoval 139,394 33,821 22,113 3,061 10,410 6,576 56 Santa Fe 148,686 2,577 59 122 31,050 11,852 8,108 11,065 15,447 D E O G R A B EM Valencia Totals 28,477 8,716 12,494 15,572 75,737 18,383 12,106 1,664 5,655 3,590 1,594,884 378,223 LUNG.org 247,288 34,231 120,014 73,384 19,165 30 4,764 6,821 14,643 639 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 96,827 139,501 291,533 S TAT E TA B L E S NEW MEXICO American Lung Association in New Mexico www.lung.org/newmexico HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Bernalillo Doña Ana 7 0 0 2.3 D 47 Eddy 6 Grant Wgt. Avg. Grade Orange Red Purple 1 0 0 0 2.0 16.2 F C INC INC INC INC INC Lea Luna 3 0 0 1.0 C INC INC INC INC INC Rio Arriba 2 San Juan 6 0 0 2.0 C Sandoval 0 0 0 0.0 Santa Fe 0 0 0 5 0 0 1.7 0 0.7 0.0 B A 1 0 0 0.3 B 0 1 0 0.5 B Design Value LUNG.org Pass/ Fail 7.5 PASS 5.6 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 1 1 0 0.8 B 7.8 PASS 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 A INC C DNC DNC DNC DNC DNC INC INC INC INC 4.1 PASS DNC DNC INC D E O G R A B EM Valencia 123 0 Annual Wgt. Avg. Grade AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 INC DNC DNC 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 Bronx 65 & Over Pediatric Asthma 309,381 58,304 48,270 Adult Asthma COPD Lung Cancer 5,820 25,045 14,222 1,455,444 368,977 166,281 Cardiovascular Disease Diabetes Poverty 187 18,365 24,127 36,827 36,829 108,973 56,592 878 Chautauqua 130,779 26,957 24,195 2,691 10,265 6,506 Dutchess 295,754 58,429 47,326 5,832 23,510 14,221 179 18,470 24,379 28,978 Erie 922,578 189,903 154,748 18,955 72,679 43,998 558 57,512 75,126 139,581 Essex 38,478 6,501 8,240 Franklin 50,660 Hamilton Herkimer Jefferson Kings 7,766 649 3,148 2,108 1,003 4,712 684 1,305 63,100 13,267 12,133 117,635 28,751 14,843 4,038 23 2,824 3,617 4,418 2,354 31 68 391 302 1,324 4,915 3,204 2,870 8,938 4,605 8,608 11,130 21,630 3,040 4,017 2,636,735 612,433 325,578 61,129 203,249 105,485 38 4,262 5,493 7,806 72 5,833 7,723 15,718 1,591 133,122 177,651 581,684 749,600 159,513 119,145 15,922 58,648 34,647 1,644,518 240,380 240,185 23,993 141,186 8,234 3 416 523 523 D E O G R A B EM Monroe New York 10,048 79 71,058 95,629 430,291 453 45,035 59,058 107,747 73,158 992 92,935 122,646 280,715 Niagara 212,652 43,176 37,547 4,310 16,742 10,569 129 13,900 18,134 32,421 Onondaga 468,463 101,865 73,407 10,168 36,408 21,602 283 28,054 36,875 66,114 Orange 377,647 97,462 48,796 229 20,341 27,220 44,395 Oswego 120,146 25,897 17,842 2,585 9,349 5,539 73 7,150 9,490 19,996 Putnam 99,042 20,747 15,070 2,071 7,722 4,803 60 6,219 8,298 5,897 Queens 2,339,150 476,985 323,755 9,728 27,867 15,918 47,610 185,952 102,666 1,415 130,999 174,342 320,712 Richmond 474,558 104,847 71,216 10,465 36,723 21,600 287 27,926 36,907 66,586 Rockland 326,037 197 Saratoga 226,249 47,460 36,846 Steuben Suffolk Tompkins Wayne Westchester Totals 124 90,294 49,160 9,013 23,402 14,047 4,737 17,692 10,863 18,331 23,965 44,933 137 14,164 18,634 14,149 97,631 21,597 17,601 2,156 7,504 4,813 59 6,364 8,257 14,745 1,501,587 329,288 234,551 32,867 116,081 70,497 910 91,598 120,920 114,849 104,926 15,703 13,350 1,567 9,018 4,342 64 5,415 7,221 18,480 91,446 20,039 15,562 2,000 7,042 4,489 976,396 221,464 154,130 22,105 74,826 45,276 15,835,304 3,390,971 2,278,848 LUNG.org 338,465 1,241,312 698,426 55 5,894 7,727 11,008 591 58,954 77,491 96,580 9,575 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 896,789 1,186,604 2,535,017 S TAT E TA B L E S NEW YORK American Lung Association in New York www.lung.org/newyork HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Albany Bronx Wgt. Avg. Grade Orange Red Purple 0 0 0 0.0 A 14 0 0 4.7 F Chautauqua 8 0 0 2.7 D Dutchess 3 Erie 9 0 0 3.0 D Essex 1 0 0 0.3 B Franklin 4 0 0 Hamilton 0 0 Herkimer 0 1 Jefferson Kings 0 1.0 1.3 C 0 0 0 0.0 A 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC Design Value 9.4 PASS INC INC DNC DNC 8.6 PASS 4.1 PASS C DNC 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A 8 Pass/ Fail 7.4 PASS DNC D E O G R A B EM Monroe New York 0 Annual Wgt. Avg. Grade 0 0 2.7 D 0 0 0.0 A 9.1 PASS 0 0 0 0.0 A 7.2 PASS 0 11.0 PASS 0 0 0.0 A Niagara 2 0 Onondaga 0 0 0 0.0 A 0 0 0 0.0 A 6.4 PASS Orange 4 0 0 1.3 C 0 0 0 0.0 A 7.2 PASS Oswego 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Putnam 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC 11 0 0 3.7 F 0 0 0 0.0 A 8.1 PASS Richmond 18 2 0 7.0 F 0 0 0 0.0 A INC INC Rockland 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC Saratoga 1 0 0 0.3 B DNC DNC DNC DNC DNC Steuben 0 0 0 0.0 A Queens Suffolk 0 0.7 B 0 DNC INC INC DNC DNC 0 0 0 0.0 A 5.7 PASS 0 0 0 0.0 A 7.5 PASS DNC DNC DNC DNC 22 2 0 8.3 Tompkins 0 0 0 0.0 A DNC Wayne 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 1 0 F DNC DNC Westchester 125 18 LUNG.org 6.5 F INC INC INC INC INC DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 DNC DNC 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 Alamance 65 & Over Pediatric Asthma 158,276 36,006 25,967 Adult Asthma COPD Lung Cancer 4,138 10,049 9,404 Cardiovascular Disease Diabetes Poverty 111 11,839 13,568 29,039 Alexander 37,325 7,735 7,268 889 2,439 2,402 27 3,142 3,539 5,555 Avery 17,689 2,743 3,691 315 1,229 1,186 13 1,554 1,741 2,997 Buncombe 253,178 48,656 47,089 5,591 16,815 15,971 178 20,538 23,256 37,433 Caldwell 81,287 17,004 14,831 1,954 5,301 5,202 57 6,696 7,622 12,963 Carteret 68,879 12,577 15,542 1,445 4,653 4,789 49 6,461 7,177 9,370 Caswell Catawba Chatham 22,941 4,390 4,658 155,056 35,211 25,759 504 1,532 1,542 16 2,029 2,285 4,353 4,046 9,865 9,408 109 11,889 13,637 23,050 70,928 14,114 17,716 1,622 4,698 4,963 50 6,923 7,548 8,111 Cumberland 323,838 82,868 36,625 9,523 19,664 16,254 228 18,698 22,260 59,320 Davidson 164,622 36,952 28,400 4,246 10,520 10,193 116 12,997 14,858 22,977 D E O G R A B EM Davie Duplin Durham Edgecombe Forsyth Franklin Gaston Graham Granville Guilford Haywood Jackson Johnston 41,753 9,023 8,180 1,037 2,703 2,725 29 3,581 4,037 5,080 59,159 14,471 9,762 1,663 3,676 3,487 300,952 65,360 34,465 42 4,424 5,056 14,603 7,511 19,232 15,910 211 18,150 21,740 49,310 54,150 12,476 9,504 1,434 3,433 3,321 38 4,262 4,849 14,742 369,019 87,172 54,419 10,017 23,139 21,137 258 25,965 30,134 64,966 63,710 14,466 9,945 1,662 4,054 3,839 45 4,777 5,532 9,909 213,442 48,942 32,838 5,624 13,524 12,603 150 15,625 18,086 36,243 8,616 1,836 1,961 211 560 575 58,674 12,289 9,341 1,412 3,820 3,628 517,600 117,471 73,066 13,499 32,807 29,322 59,868 11,001 14,384 1,264 4,038 4,188 41,265 7,064 7,473 185,660 48,767 23,545 812 2,801 2,531 5,604 11,240 10,152 6 786 864 1,783 42 4,512 5,230 8,786 362 35,488 41,440 78,783 42 5,752 6,320 10,436 29 3,206 3,634 7,879 131 12,131 14,323 23,887 Lee 59,660 14,874 9,190 1,709 3,680 3,419 42 4,267 4,914 10,044 Lenoir 58,106 13,143 10,623 1,510 3,706 3,626 41 4,695 5,319 13,069 Lincoln 81,035 17,661 13,178 2,030 5,223 5,027 57 6,304 7,283 10,774 Macon 34,201 6,475 9,163 744 2,293 2,453 24 3,478 3,757 5,719 Martin 23,357 547 16 McDowell 44,989 9,263 8,484 1,064 2,945 2,888 Mecklenburg 1,034,070 4,761 251,972 5,018 106,570 28,956 1,537 63,888 1,577 52,936 2,114 2,357 5,213 32 3,744 4,240 8,183 726 59,508 72,056 145,693 Mitchell 15,246 2,815 3,644 323 1,028 1,073 11 1,471 1,620 2,516 Montgomery 27,548 6,329 5,233 727 1,748 1,717 19 2,249 2,529 5,296 New Hanover Person Pitt 126 220,358 42,336 35,679 39,259 8,509 7,046 175,842 38,695 LUNG.org 20,590 4,865 14,586 13,082 978 2,536 2,486 4,447 11,183 9,139 155 16,201 18,628 36,967 28 3,195 3,640 6,317 123 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 10,466 12,467 43,954 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 Rockingham Rowan Swain Union 134,197 34,605 18,170 91,758 19,184 17,184 139,142 31,310 23,306 Wayne Yancey 253,184 105,510 8,857 10,348 39,785 2,205 64 7,694 5,989 5,938 53,124 721 393,069 59,937 72,654 111,299 37 3,581 4,183 11,956 88 383 1,178 1,225 438,984 10 1,160 1,304 2,295 157 14,033 16,727 21,397 803 3,739 3,045 184,962 16,699 98 10,636 12,177 23,342 370 922 889 63,063 8,733 8,725 10,092 22,267 12 1,683 1,849 3,359 4,893 475,422 555,616 1,087,719 D E O G R A B EM LUNG.org Poverty 94 3,428 7,740 7,069 17,587 3,332 4,208 Cardiovascular Disease Diabetes 3,977 8,167 7,318 29,095 52,906 6,990 7,728 974,188 Lung Cancer 7,177 13,169 11,899 124,132 29,833 18,567 6,962,654 1,609,540 Adult Asthma COPD 3,598 8,871 8,407 14,434 3,222 2,727 1,024,198 Watauga 127 Pediatric Asthma 222,742 62,453 25,941 Wake Totals 65 & Over AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S NORTH CAROLINA American Lung Association in North Carolina www.lung.org/northcarolina HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 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 INC INC Alexander 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Avery 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Buncombe 0 0 0 0.0 A Caldwell 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Carteret 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Caswell 1 0 0 0.3 B Catawba Chatham Cumberland Duplin 0 0 0 0.0 A 1 0 0 0.3 B 0 0 0 0.0 A 8.8 PASS 0 8.9 PASS 0 0 0.0 A INC INC INC INC INC DNC DNC DNC DNC DNC 8.5 PASS 0 9.2 PASS INC INC INC INC INC DNC DNC DNC DNC DNC 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A Edgecombe 1 0 0 0.3 B Forsyth 5 0 0 1.7 C 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC Gaston INC INC 0 0 0 0.0 A Durham Franklin 7.7 PASS D E O G R A B EM Davidson Davie DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A INC INC INC INC INC 0 0 0 0.0 A DNC DNC 7.3 PASS 8.3 PASS INC INC 8.5 PASS DNC DNC INC INC Graham 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Granville 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Guilford 2 0 0 0.7 B 0 0 0 0.0 A 8.4 PASS Haywood 2 0 0 0.7 B 0 0 0 0.0 A 8.2 PASS Jackson 2 0 7.3 PASS Johnston 0 0 0 0.0 A Lee 0 0 0.7 B 0 0.0 A 0 0 0 0.0 A 7.3 PASS INC INC INC INC INC INC INC Lenoir 0 0 0 0.0 A INC INC INC INC INC INC INC Lincoln 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC Macon 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 0 0 0 A Martin McDowell Mecklenburg Mitchell INC INC INC INC INC 0 0.0 DNC DNC DNC DNC DNC 13 0 0 4.3 F DNC DNC DNC DNC DNC 0 0 0 0.0 A 6.9 PASS 1 0 0 0.3 B 8.4 PASS 0 0 0 0.0 A 9.0 PASS 0 0 0 0.0 A INC INC Montgomery 0 0 0 0.0 A 0 0 0 0.0 A INC INC New Hanover 0 0 0 0.0 A 0 0 0 0.0 A 6.5 PASS Person 1 0 0 0.3 B Pitt 0 0 0 A 128 LUNG.org 0.0 DNC DNC DNC DNC DNC 0 0 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 0.0 A DNC DNC 7.3 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 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Robeson Wgt. Avg. Grade Orange Red Purple DNC DNC DNC DNC DNC 0 1.0 Pass/ Fail INC INC INC INC INC INC INC DNC DNC 3 Rowan 2 0 0 0.7 B 0 0 0 0.0 A 8.7 PASS Swain 0 0 0 0.0 A 0 0 0 0.0 A 7.6 PASS Union 3 0 0 1.0 C 1 0 0 B DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0.7 B 10.7 PASS Watauga DNC DNC DNC DNC DNC 0 1 0 0.5 B 6.7 PASS Wayne DNC DNC DNC DNC DNC 0 0 0 0.0 A INC INC Yancey 1 0 0.3 C Design Value Rockingham Wake 0 Annual Wgt. Avg. Grade 0 0.3 B DNC DNC DNC DNC DNC DNC DNC D E O G R A B EM 129 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Total Population Under 18 Billings Burke Cass Pediatric Asthma 562 401 McKenzie Lung Cancer 37 159 98 92,991 21,222 13,612 1,381 6,465 3,702 171,512 38,045 18,870 Dunn Adult Asthma COPD Cardiovascular Disease Diabetes Poverty 936 173 163 11 69 42 1 62 72 66 2,308 Burleigh 65 & Over 2,475 11,893 6,161 4,646 1,076 636 1 149 169 192 54 5,307 6,195 8,048 99 7,969 9,723 17,733 70 323 184 3 264 311 452 12,826 3,854 942 251 802 400 7 505 638 1,061 Mercer 8,853 2,011 1,502 131 624 383 5 588 672 630 Oliver 1,846 435 356 1 134 150 187 Williams Totals 130 35,294 9,399 3,013 331,212 76,777 39,495 28 129 84 612 2,311 1,163 4,995 22,774 12,215 21 1,474 1,843 2,713 192 16,451 19,775 D E O G R A B EM LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 31,082 S TAT E TA B L E S NORTH DAKOTA American Lung Association in North Dakota www.lung.org/northdakota HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Design Value Pass/ Fail Billings 0 0 0 0.0 A 3 1 0 1.5 C 4.9 PASS Burke 0 5 5.5 PASS Burleigh 0 0 0 0.0 A 6 1 0 2.5 D 5.3 PASS Cass 0 0 0 0.0 A 4 0 0 1.3 C 6.4 PASS Dunn 1 10 5.1 PASS McKenzie 0 0 0 0.0 A 4 2 0 2.3 D 3.4 PASS Mercer 0 0 0 0.0 A 5 2 0 2.7 D 5.5 PASS Oliver 1 0 0 0.3 B 6 1 0 2.5 D 4.9 PASS Williams 0 7 6.9 PASS 0 0 0 0 0 0 0.0 0.3 0.0 A B A 4 1 2 0 0 0 3.7 3.8 3.3 F F F D E O G R A B EM 131 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Allen 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty 104,425 24,346 17,055 1,753 8,035 6,376 72 7,507 8,857 15,229 Ashtabula 98,632 22,120 17,501 1,592 7,671 6,382 68 7,634 9,028 17,636 Athens 65,886 9,882 7,559 45 3,860 4,586 17,573 Belmont 69,154 13,189 13,339 711 5,658 3,636 949 5,601 4,681 Butler 376,353 90,328 51,037 6,503 28,834 21,736 Clark 135,959 2,224 Clermont 201,973 48,113 29,391 Clinton Cuyahoga Delaware Fayette Franklin 30,897 24,918 10,513 8,720 93 3,464 15,505 12,247 41,917 9,921 6,529 1,255,921 268,170 210,832 10,504 12,315 29 2,983 3,551 5,513 861 3,795 14,185 10,754 93,526 110,646 224,256 133 12,061 14,687 8,353 D E O G R A B EM Geauga 20,019 139 14,130 16,999 19,052 714 3,217 2,554 19,306 99,147 79,368 193,013 52,718 23,146 48 5,645 6,629 9,524 259 24,687 29,593 52,356 28,679 6,849 4,866 493 2,189 1,783 20 2,121 2,502 4,575 1,251,722 295,725 138,531 21,290 96,685 67,131 861 72,955 88,119 208,972 94,102 22,331 17,501 1,608 7,188 6,237 65 7,563 8,957 6,298 Greene 164,427 34,044 26,323 2,451 13,098 10,146 113 11,809 13,961 19,772 Hamilton 807,598 187,937 116,074 13,530 62,391 47,619 554 54,606 65,154 130,935 Jefferson Knox Lake Lawrence Licking 67,347 13,199 13,329 950 5,414 4,584 46 61,061 14,158 10,223 1,019 4,704 3,770 229,245 47,536 42,296 3,422 61,109 13,547 10,753 170,570 40,213 26,543 18,209 15,263 158 975 4,767 3,907 2,895 13,109 10,454 5,566 6,523 11,547 42 4,461 5,257 8,510 18,324 21,649 18,884 42 4,660 5,495 12,680 117 12,208 14,558 20,933 Lorain 305,147 68,903 51,233 4,960 23,715 19,284 210 22,810 27,050 39,833 Lucas 433,689 100,612 65,018 7,243 33,505 25,953 298 30,017 35,721 82,814 Madison 44,094 9,215 6,244 663 3,518 2,685 31 3,055 3,676 3,614 Mahoning 231,900 47,425 45,088 3,414 18,446 15,530 159 18,829 22,053 37,640 Medina 176,395 40,862 28,428 2,942 13,627 11,121 122 13,076 15,628 12,287 Miami 104,224 24,089 18,432 1,734 8,029 6,632 Montgomery 532,258 119,127 90,442 Noble Portage 8,576 41,422 33,149 14,326 2,646 3,478 162,275 31,122 24,393 72 7,939 9,354 10,992 365 39,253 46,195 91,879 190 1,162 1,086 2,241 13,204 9,990 10 1,372 1,597 1,741 112 11,433 13,617 20,927 Preble 41,329 9,520 7,350 685 3,187 2,653 28 3,180 3,754 5,160 Scioto 76,825 16,922 13,094 1,218 6,006 4,801 53 5,683 6,687 16,881 Stark 375,165 Summit 541,968 116,666 89,731 8,399 42,718 34,297 372 40,333 47,877 76,554 Trumbull 203,751 42,580 40,561 3,065 16,103 13,752 140 16,777 19,626 35,069 Warren 224,469 57,543 30,240 4,143 16,843 13,101 155 14,960 18,078 11,375 Washington Wood 81,870 67,972 5,894 61,112 12,223 12,007 129,730 26,801 18,693 Totals 9,137,750 2,053,349 1,420,150 132 LUNG.org 29,375 24,258 258 880 4,888 4,128 1,929 10,356 7,572 147,824 712,220 557,341 29,084 34,211 48,889 42 5,010 5,868 8,906 89 6,285 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 8,603 10,167 14,385 648,226 770,225 1,351,563 S TAT E TA B L E S OHIO American Lung Association in Ohio www.lung.org/ohio HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Allen Ashtabula Wgt. Avg. Grade Orange Red Purple 4 0 0 1.3 C 7 0 0 2.3 D Athens DNC DNC DNC DNC DNC Belmont DNC DNC DNC DNC DNC Butler 11 0 0 3.7 Clark 11 3.7 F 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A INC INC INC INC INC 0 0 0 0.0 A 0 0 0 0.0 A Design Value Pass/ Fail INC INC DNC DNC 7.8 PASS INC INC 10.9 PASS 0 0 Clermont 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Clinton 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC Cuyahoga 9 1 0 F Delaware 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC Fayette 7 0 0 2.3 D DNC DNC DNC DNC DNC DNC 16 0 0 5.3 F 0 0 0 0.0 A 0 0 3.0 D Franklin 3.5 F Annual Wgt. Avg. Grade 9 Greene 6 0 0 2.0 C Jefferson Knox Lake 0 0 1.0 C 12.4 D E O G R A B EM Geauga Hamilton 3 9.7 PASS DNC DNC DNC DNC DNC FAIL DNC 10.1 PASS DNC DNC 0 0 0 0.0 A 9.3 PASS 16 1 0 5.8 F 1 0 0 0.3 B 11.2 PASS 3 0 0 1.0 C 4 0 0 1.3 C 10.8 PASS 6 16 0 0 2.0 C 0 0 F 5.3 DNC DNC DNC DNC DNC 0 0 0 0.0 A 8.5 PASS Lawrence 4 0 0 1.3 C Licking 3 Lorain 0 0 0 0.0 A 0 0 0 0.0 A 8.7 PASS Lucas 5 0 0 1.7 C 1 0 0 0.3 B 10.1 PASS Madison 4 Mahoning 1 0 0 0.3 B Medina 1 0 0 0.3 B Miami 5 Montgomery 5 0 0 1.7 C Noble 3 Portage 0 0 0 0.0 A 0 0 0 0.0 A INC INC Preble 2 0 0 0.7 B 0 0 0 0.0 A 9.1 PASS 0 0 0 0.0 A 8.6 PASS 1 0 0 0.3 B 11.6 PASS Scioto Stark 0 0 0 0 0 1.0 0 1.3 0 1.7 0 1.0 C C C C DNC DNC DNC DNC DNC 11 0 0 3.7 F 0 0 0 0.0 A 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 DNC DNC DNC DNC 1 0 0 0.3 B DNC DNC DNC DNC DNC 8.0 PASS DNC DNC DNC DNC 10.6 PASS 9.3 PASS DNC DNC INC INC DNC DNC Summit 0 0 0 0.0 A 1 0 0 0.3 B 11.2 PASS Trumbull 5 0 0 1.7 C 0 0 0 0.0 A INC INC Warren 11 0 0 3.7 F DNC DNC DNC DNC DNC DNC DNC Washington 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Wood 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 133 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Lung Cancer Cardiovascular Disease Diabetes Poverty Adair 22,004 5,835 3,271 594 1,556 1,443 15 1,787 1,962 6,197 Bryan 44,884 10,515 7,768 1,070 3,274 3,053 31 3,842 4,138 7,924 Caddo 29,343 7,495 4,653 21 2,446 2,664 5,828 Canadian Cherokee 133,378 35,367 16,305 48,447 11,088 7,479 762 2,096 1,958 3,598 9,419 8,213 94 9,750 10,969 12,844 1,128 34 3,896 3,559 3,184 Cleveland 274,458 60,824 33,816 6,188 20,371 17,047 Comanche 124,648 30,129 14,223 3,065 9,013 7,439 4,265 10,023 193 19,823 22,387 30,190 88 8,556 9,727 17,201 Cotton 5,996 1,418 1,115 144 441 435 4 561 602 995 Creek 70,892 17,030 12,230 1,732 5,181 4,988 50 6,332 6,850 10,927 Dewey 4,995 1,336 952 136 350 349 3 455 482 640 Jefferson 6,276 4 D E O G R A B EM 1,506 1,247 153 458 461 603 640 1,216 Johnston 10,980 2,552 2,029 260 807 784 8 1,004 1,076 2,276 Kay 45,366 11,477 8,310 1,168 3,238 3,140 32 4,034 4,306 8,261 35,042 8,681 6,031 25 3,151 3,409 5,097 Lincoln Love 883 2,542 2,473 9,870 2,477 1,834 252 706 688 7 887 945 1,213 Mayes 40,887 9,954 7,040 1,013 2,976 2,867 29 3,641 3,938 7,471 McClain 38,066 9,807 5,679 27 3,133 3,445 4,040 Oklahoma Ottawa Pittsburg 998 2,723 2,530 776,864 199,953 98,327 20,341 55,262 47,978 544 57,019 63,883 123,515 31,981 7,992 5,750 813 2,289 2,193 22 2,800 2,996 7,103 44,610 10,011 8,213 1,018 3,313 3,195 31 4,082 4,381 7,163 Pottawatomie 71,875 17,434 11,470 1,774 5,213 4,824 50 6,002 6,541 11,672 Sequoyah 41,153 9,726 7,162 Tulsa Totals 134 989 3,021 2,905 639,242 163,049 84,306 16,587 45,693 40,342 2,551,257 635,656 LUNG.org 349,210 64,665 183,501 162,489 29 3,689 3,987 9,934 447 48,432 54,032 99,650 1,789 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 195,925 217,626 391,380 S TAT E TA B L E S OKLAHOMA American Lung Association in Oklahoma www.lung.org/oklahoma HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Adair 3 Bryan 0 Wgt. Avg. Grade Orange Red Purple 0 1.0 C INC INC INC INC INC Annual Wgt. Avg. Grade Design Value Pass/ Fail DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC Caddo 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Canadian 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Cherokee 1 0 0 B DNC DNC 0.3 DNC DNC DNC DNC DNC Cleveland 4 0 0 1.3 C INC INC INC INC INC INC INC Comanche 7 0 0 2.3 D INC INC INC INC INC INC INC Cotton Creek Dewey Jefferson INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC 4 0 0 1.3 C Kay INC INC INC INC INC INC INC INC INC 5 0 0 1.7 C Lincoln INC INC INC INC INC Love INC INC INC INC INC Mayes McClain Oklahoma Ottawa Pittsburg Pottawatomie Sequoyah Tulsa 135 INC INC INC INC INC INC INC DNC DNC D E O G R A B EM Johnston INC 3 3 0 DNC DNC DNC DNC DNC DNC DNC DNC DNC 3 0 0 1.0 C DNC DNC DNC DNC DNC 1 1 0 0.8 B INC INC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 1.0 C 0 5.0 F 0 0 0 0.0 A 1 0 0 0.3 B DNC DNC DNC DNC DNC 5 0 0 1.7 C 2 0 0 0.7 B INC INC INC INC INC DNC DNC DNC DNC DNC 1 0 0 0.3 B LUNG.org INC INC DNC DNC C 0 0 DNC DNC 0 1.0 15 12 DNC 0 4.0 F 8.6 PASS DNC DNC 8.8 PASS DNC DNC 0 0 0 0.0 A 8.9 PASS 0 8.8 PASS 0 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 0.0 A 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 401,515 88,343 65 & Over 67,006 Pediatric Asthma 8,291 Adult Asthma COPD 35,479 Lung Cancer 18,252 226 Cardiovascular Disease Diabetes 25,041 34,780 Poverty 37,507 Columbia 49,600 10,906 8,810 1,023 4,368 2,336 28 3,237 4,469 6,595 Crook 21,630 12 Deschutes Harney Jackson 4,183 5,347 175,268 36,927 33,117 393 1,935 1,143 3,465 15,586 8,234 44,332 44,244 4,160 18,855 2,217 3,423 99 11,673 15,765 23,298 7,200 1,476 1,642 139 638 366 212,567 1,719 10,252 4 541 708 1,147 119 14,926 19,715 40,427 Josephine 84,745 16,554 21,343 1,554 7,553 4,474 48 6,783 8,687 18,268 Klamath 66,016 14,286 13,086 1,341 5,811 3,122 37 4,495 5,994 12,966 Lake Lane 7,829 1,456 1,844 137 709 412 4 609 798 1,374 362,895 68,799 64,973 6,456 33,296 16,555 204 23,240 31,518 69,999 Marion 330,700 83,148 48,905 7,803 28,173 13,540 186 18,453 25,643 53,817 Multnomah 790,294 154,609 96,666 14,509 73,114 31,912 444 41,027 59,635 121,528 Umatilla D E O G R A B EM Washington Totals 136 76,531 19,800 11,009 1,858 6,461 3,107 574,326 137,564 70,107 12,910 50,119 22,712 3,161,116 682,383 LUNG.org 488,099 64,038 282,096 136,418 43 4,207 5,881 13,860 323 29,388 42,614 59,471 1,778 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 185,339 258,424 463,680 S TAT E TA B L E S OREGON American Lung Association in Oregon www.lung.org/oregon HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Wgt. Avg. Grade Clackamas 1.0 DNC 3 Columbia Crook 0 DNC Deschutes Harney 0 0 DNC 1 0 0 0.0 DNC 0 DNC 0 0.3 C DNC A DNC DNC DNC DNC DNC DNC B DNC DNC DNC DNC DNC Jackson 1 1 0 0.8 B 8 DNC 3 DNC 0 4.2 DNC F DNC DNC DNC DNC DNC 7 1 0 2.8 Design Value Pass/ Fail DNC DNC DNC DNC 9.9 PASS DNC DNC D 9.1 PASS 11 3 1 5.8 F 11.8 PASS Josephine DNC DNC DNC DNC DNC 2 1 0 1.2 C 9.2 PASS Klamath DNC DNC DNC DNC DNC 10 3 0 4.8 F 10.3 PASS Lake DNC DNC DNC DNC DNC 13 9 0 8.8 F 10.6 PASS Lane 1.3 14 1 0 5.2 F 4 0 0 Marion 2 0 0 0.7 Multnomah 1 0 0 0.3 B 3 1 0 1.5 C 7.4 PASS Umatilla 3 5 INC 9.6 PASS D E O G R A B EM Washington 137 C 0 0 1.0 B C 1 0 0 0.3 B LUNG.org DNC DNC DNC DNC DNC 2 0 2.7 D 6 1 0 2.5 D AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 DNC DNC INC 8.0 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 Allegheny Armstrong 65 & Over Adult Asthma COPD Lung Cancer 102,295 21,070 19,261 2,355 8,250 5,971 1,230,459 233,675 217,210 26,121 102,088 69,398 168,871 33,153 33,941 Berks 415,271 Blair 125,593 25,939 24,852 94,450 3,706 13,729 10,208 67,198 10,558 32,891 136,411 26,377 28,534 2,949 11,114 8,324 Centre 160,580 24,411 20,365 2,729 14,328 7,762 Chester 515,939 120,162 77,227 13,432 40,664 27,246 Clearfield 132,377 107,816 14,798 50,440 93,646 102,520 145,454 44 5,751 6,223 8,334 29,968 32,895 35,909 40 5,048 5,465 7,881 412 48,892 53,504 14,976 15,660 1,674 6,708 39,001 90 11,550 12,488 19,450 107 9,715 10,961 22,716 D E O G R A B EM 80,994 50,814 82 10,174 11,031 18,616 61,281 13,427 12,190 1,501 4,832 3,639 627,367 67 8,193 8,914 8,365 273 2,900 10,102 7,381 Cambria Poverty 111 14,116 15,302 21,668 22,274 Bucks Cardiovascular Disease Diabetes 807 67,052 13,037 13,867 1,457 5,448 4,137 Beaver Bradford Pediatric Asthma 339 36,441 40,187 30,147 4,835 54 6,630 7,213 12,487 Cumberland 246,338 50,023 42,941 5,592 20,103 13,677 162 18,463 20,208 17,149 Dauphin 272,983 61,299 42,684 6,852 21,743 14,543 179 19,477 21,436 36,332 Delaware 563,894 125,524 86,401 14,032 45,114 29,719 369 39,628 43,687 56,493 Elk Erie Franklin Greene Indiana 30,872 6,030 6,463 674 2,499 1,936 2,702 2,921 2,821 278,045 60,598 44,847 6,774 22,329 14,928 183 20,015 21,996 45,339 153,638 3,906 101 34,945 28,517 37,519 7,221 6,584 12,067 8,644 807 3,100 2,129 86,966 15,860 15,277 1,773 7,302 4,848 Lackawanna 211,917 Lancaster 536,624 128,793 89,727 14,397 41,751 28,456 Lawrence 20 42,598 40,519 4,762 17,222 12,291 11,848 12,880 14,258 25 2,878 3,151 5,200 57 6,505 7,130 14,789 139 16,831 18,302 31,144 353 38,439 42,053 55,725 88,082 17,798 17,902 1,990 7,102 5,314 58 7,365 7,973 15,015 Lebanon 137,067 31,439 25,574 3,514 10,736 7,699 90 10,559 11,473 15,464 Lehigh 360,685 82,249 58,165 9,194 28,575 19,173 237 25,744 28,267 42,456 Luzerne 318,449 62,459 61,036 6,982 26,033 18,616 209 25,496 27,732 46,457 Lycoming 116,048 23,833 20,789 2,664 9,415 6,552 76 8,898 9,717 16,377 Mercer 114,234 22,901 23,137 2,560 9,243 6,836 75 Monroe 166,397 34,257 25,870 3,829 13,551 9,240 Montgomery 819,264 178,455 137,266 19,949 65,556 45,144 538 61,016 66,866 52,939 Northampton 300,813 61,413 53,683 198 23,194 25,338 25,559 Perry Philadelphia 109 12,406 13,675 20,559 6,865 24,435 17,070 45,685 9,948 7,509 1,112 3,651 2,553 1,567,442 346,932 198,475 9,451 10,236 15,242 38,782 127,499 74,034 30 3,457 3,792 4,322 1,024 94,862 106,183 385,781 Somerset 75,522 13,718 15,829 1,533 6,244 4,675 50 6,482 7,015 10,165 Tioga 41,877 8,324 8,398 28 3,428 3,716 5,233 930 3,401 2,486 Washington 208,261 41,143 40,169 4,599 16,954 12,373 137 17,016 18,497 20,501 Westmoreland 357,956 67,000 75,735 7,490 29,318 22,397 235 31,186 33,713 39,587 York 442,867 Totals 138 99,147 71,845 11,083 35,199 24,097 291 32,488 11,271,558 2,386,961 1,883,463 266,826 910,734 616,511 7,400 829,957 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 35,662 45,255 910,319 1,425,095 S TAT E TA B L E S PENNSYLVANIA American Lung Association in Pennsylvania www.lung.org/pennsylvania HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Adams Wgt. Avg. Grade Orange Red Purple 3 0 0 1.0 C Annual Wgt. Avg. Grade 3 0 0 1.0 C Design Value Pass/ Fail 9.6 PASS Allegheny 20 1 0 7.2 F 15 2 0 6.0 F 12.6 Armstrong 11 1 0 4.2 F 0 0 0 0.0 A 11.1 PASS Beaver 14 1 0 5.2 F 1 0 0 0.3 B 10.8 PASS Berks 8 0 0 2.7 D 17 0 0 5.7 F 10.2 PASS Blair 4 0 0 1.3 C Bradford 0 Bucks 24 Cambria 0 0 0.0 A 2 0 F 9.0 3 0 0 1.0 C 3 0 0 1.0 C DNC DNC DNC DNC DNC 13 0 0 4.3 F 2 0 0 0.7 B FAIL 11.4 PASS DNC DNC 10.2 PASS 11.7 PASS Centre 2 0 0 0.7 B 2 0 0 0.7 B 8.6 PASS Chester 6 1 0 2.5 D 2 0 0 0.7 B 10.0 PASS Clearfield 0 0 0 0.0 DNC DNC DNC DNC 6 0 0 2.0 15 0 0 3 0 0 D E O G R A B EM Cumberland Dauphin Delaware Elk A DNC DNC DNC DNC DNC DNC 12 0 0 4.0 F 10.1 PASS C 15 0 0 5.0 F 11.0 PASS 5.0 F 3 0 0 1.0 C 11.6 PASS 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC Erie 3 0 0 1.0 C Franklin 3 0 0 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC 10 1 0 3.8 F DNC DNC DNC DNC DNC DNC DNC Lackawanna 4 0 0 1.3 C 0 0 0 0.0 A INC INC Lancaster 5 0 0 1.7 C 26 1 0 9.2 F 11.2 PASS Lawrence 6 0 0 2.0 C 0 0 F Greene Indiana Lebanon 15 1.0 5.0 C 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 16 0 0 5.3 F 10.8 PASS DNC DNC DNC DNC INC INC Lehigh 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC Luzerne 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Lycoming 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Mercer 9 0 0 3.0 D 0 1 0 0.5 B 2 0 0 0.7 B Monroe 9.7 PASS 0 0 0 0.0 A 8.7 PASS Montgomery 14 0 0 4.7 F 4 0 0 1.3 C 9.0 PASS Northampton 4 0 0 1.3 C 11 0 0 3.7 F 10.0 PASS Perry Philadelphia INC INC INC INC INC 21 3 0 0 0 0.3 Somerset 1 Tioga 1 0 Washington 11 0 8.5 F B 0 0.3 B 0 3.7 F DNC DNC DNC DNC DNC 9 0 0 3.0 D DNC DNC 11.8 PASS DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC 1 0 0 0.3 B 11.7 PASS Westmoreland 7 0 0 2.3 D 0 0 0 0.0 A 9.8 PASS York 9 6 10.1 PASS 139 0 LUNG.org 0 3.0 D 0 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 2.0 C 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Kent 164,801 31,665 29,398 3,101 14,638 8,784 117 10,569 12,804 14,250 Providence 633,473 132,542 91,356 12,982 55,645 29,827 449 35,158 42,350 104,385 Washington 126,517 22,283 23,507 Totals 924,791 186,490 144,261 2,183 11,447 6,849 18,266 81,730 45,460 90 655 8,290 9,985 11,912 54,017 65,138 D E O G R A B EM 140 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 130,547 S TAT E TA B L E S RHODE ISLAND American Lung Association in Rhode Island www.lung.org/rhodeisland HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Kent Wgt. Avg. Grade Orange Red Purple 8 1 0 3.2 D Annual Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0.0 A 4.9 PASS Providence 10 1 0 3.8 F 1 1 0 0.8 B 8.1 PASS Washington 16 1 0 5.8 F 0 0 0 0.0 A 5.1 PASS D E O G R A B EM 141 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 Total Population Under 18 Abbeville 65 & Over Pediatric Asthma 24,932 5,332 4,973 36,383 Lung Cancer 452 1,621 1,530 10,685 Anderson 194,692 45,054 33,829 3,820 12,344 11,213 128 15,093 18,504 32,807 Berkeley 202,786 4,167 134 Charleston 389,262 78,207 57,844 12,568 9,783 Poverty 16 2,100 2,554 4,617 165,829 25,819 3,085 Cardiovascular Disease Diabetes Aiken 49,143 29,985 Adult Asthma COPD 109 10,415 6,631 25,386 21,392 13,223 13,345 16,185 16,679 29,497 25,852 255 27,842 34,524 56,459 Cherokee 56,194 13,378 8,734 1,134 3,526 3,110 37 4,114 5,081 11,195 Chesterfield 46,017 10,586 7,528 898 2,937 2,656 30 3,540 4,366 10,653 Colleton 37,731 8,550 7,241 725 2,418 2,277 25 3,114 3,796 8,601 Darlington 67,548 15,405 11,535 1,306 4,310 3,911 44 5,246 6,446 14,194 26,514 5,036 4,394 427 1,777 1,585 18 2,099 2,595 4,459 138,900 33,464 21,513 2,837 8,670 7,614 90 10,074 12,433 27,558 Edgefield Florence D E O G R A B EM Greenville 491,863 115,082 71,724 9,758 30,913 26,554 323 34,724 43,049 66,299 Lexington 281,833 66,209 41,223 5,614 17,775 15,468 185 20,257 25,138 36,805 Oconee Pickens 75,713 15,209 16,645 1,290 5,009 4,846 121,691 23,855 18,905 2,023 7,956 6,702 50 6,745 8,156 13,493 80 8,773 10,836 20,751 Richland 407,051 88,453 47,511 7,500 25,787 20,235 267 25,368 31,886 59,495 Spartanburg 297,302 69,835 45,633 5,921 18,703 16,355 195 21,578 26,665 43,326 York 251,195 61,836 33,653 5,243 15,602 13,338 165 17,268 21,538 30,789 3,277,053 741,017 488,689 62,830 207,986 178,985 2,150 234,503 290,433 496,850 Totals 142 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S SOUTH CAROLINA American Lung Association in South Carolina www.lung.org/southcarolina HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Design Value Pass/ Fail Abbeville 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Aiken 0 0 0 A DNC DNC Anderson 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Berkeley 0 0 0 A DNC DNC Charleston 0 0 0 0.0 A Cherokee 2 0 0 0.7 B DNC DNC DNC DNC DNC Chesterfield 0 0 0 0.0 A 0 0 0 0.0 A Colleton 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Darlington 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 1 0 0 0.3 DNC DNC DNC DNC Edgefield Florence 0.0 0.0 DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0.3 B Lexington DNC 7.9 PASS DNC DNC 7.9 PASS B 0 0 0 0.0 A 8.4 PASS DNC 0 0 0 0.0 A 8.7 PASS D E O G R A B EM Greenville DNC 1 0 0 0.3 B DNC DNC DNC DNC DNC 2 0 0 0.7 B 0 0 0 0.0 A 9.2 PASS 9.3 PASS Oconee 0 0 0 0.0 A INC INC INC INC INC INC INC Pickens 0 0 DNC DNC 0 0.0 A Richland 0 0 0 0.0 A Spartanburg 1 0 0 0.3 B York 0 143 0 LUNG.org 0 0.0 A 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 2017 DNC DNC 9.0 PASS 8.8 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 Pediatric Asthma 1,215 781 2,477 1,671 24 2,579 2,772 3,846 Codington 27,939 6,862 4,415 582 1,761 1,199 17 1,850 1,994 2,976 8,446 1,380 2,234 117 581 497 17,555 4,206 2,734 3,321 1,116 452 26,986 6,396 3,833 357 1,113 759 95 185 123 542 1,729 1,105 Minnehaha 185,197 46,279 23,258 Pennington 108,702 25,681 17,633 2,177 6,946 4,719 Union Totals 144 3,924 11,663 7,218 14,909 3,644 2,394 309 936 657 21 1,707 1,964 Poverty 38,785 9,206 6,242 Meade 2,312 Cardiovascular Disease Diabetes Brown Jackson 581 Lung Cancer 33,897 Hughes 3,643 Adult Asthma COPD Brookings Custer 6,856 65 & Over 5 826 837 873 11 1,168 1,265 1,821 2 188 203 111,626 LUNG.org 66,838 9,465 29,703 19,163 1,067 17 1,667 1,829 2,598 113 10,689 11,947 21,865 67 7,295 7,836 12,946 9 1,017 1,097 942 D E O G R A B EM 465,737 4,419 285 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 28,987 31,745 53,353 S TAT E TA B L E S SOUTH DAKOTA American Lung Association in South Dakota www.lung.org/southdakota HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Brookings 0.0 0 0 0 A Annual Wgt. Avg. Grade 2 0 0 0.7 Design Value Pass/ Fail B INC INC Brown DNC DNC DNC DNC DNC 0 0 0 0.0 A 6.6 PASS Codington DNC DNC DNC DNC DNC 1 0 0 0.3 B 7.1 PASS Custer Hughes 0 0 0 0.0 A DNC DNC DNC DNC DNC Jackson 0 0 0 Meade 0 0 0 0.0 Minnehaha 0 0 0 0.0 A Pennington Union 0.0 A A DNC DNC DNC DNC DNC 0 0 0 0.0 A 2 0 0 0.7 B INC INC INC INC INC 2 0 0 0.7 B DNC DNC DNC DNC DNC 3.2 PASS INC INC 4.7 PASS DNC DNC 3 0 0 1.0 C 8.3 PASS 2 7.8 PASS 0 0 0.7 B 3 0 0 1.0 C 8.5 PASS D E O G R A B EM 145 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S TENNESSEE American Lung Association in Tennessee www.lung.org/tennessee AT-RISK GROUPS Lung Diseases County Total Population Under 18 Anderson Blount Claiborne Davidson 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer 75,749 15,904 14,578 1,549 5,382 6,163 127,253 26,593 24,050 31,709 6,219 6,001 2,590 9,052 10,324 Cardiovascular Disease Diabetes Poverty 57 7,382 8,189 14,721 97 12,324 13,704 16,388 606 2,285 2,576 678,889 145,277 76,326 14,149 46,887 45,604 24 3,069 3,415 6,575 514 50,248 58,858 111,678 DeKalb 19,182 4,223 3,473 411 1,343 1,518 15 1,803 2,011 3,814 Dyer 37,893 9,170 6,385 893 2,572 2,856 29 3,371 3,776 8,374 Hamilton Jefferson 354,098 74,599 57,953 53,240 Knox 10,896 10,271 451,324 96,191 66,821 7,265 24,920 26,989 1,061 3,801 268 31,502 35,529 52,287 4,330 40 9,368 31,513 33,063 5,184 5,750 8,627 343 38,002 43,287 68,679 Lawrence 42,564 10,676 7,487 1,040 2,858 3,222 32 3,837 4,270 7,931 Loudon 51,130 10,141 12,833 988 3,693 4,513 39 5,653 6,075 6,804 Madison 97,610 22,374 15,115 2,179 6,713 7,242 74 8,408 9,521 16,874 Maury 87,757 20,627 13,377 2,009 6,004 6,508 67 7,544 8,558 11,432 McMinn 52,639 11,338 10,008 1,104 3,714 4,249 40 5,085 5,644 11,864 Meigs 11,830 2,461 2,407 D E O G R A B EM Montgomery 193,479 52,142 16,996 240 846 988 5,078 12,300 11,310 9 1,194 1,317 2,351 148 12,142 14,451 25,378 Putnam 74,553 15,787 12,232 1,538 5,194 5,498 57 6,430 7,225 14,166 Roane 52,753 10,283 11,475 1,001 3,845 4,582 40 5,579 6,125 9,180 Sevier 95,946 20,280 17,553 73 1,975 6,800 7,694 9,139 10,197 13,806 Shelby 938,069 237,852 113,176 23,165 62,228 63,837 709 71,647 83,069 186,186 Sullivan 156,791 30,977 32,448 3,017 11,325 13,169 119 15,927 17,548 25,241 Sumner 175,989 42,434 26,488 4,133 11,963 13,003 134 15,057 17,099 17,557 Williamson 211,672 59,107 25,560 5,757 13,764 14,807 161 16,702 19,368 10,548 Wilson 128,911 30,931 19,198 3,012 8,798 9,604 98 11,097 12,629 10,676 Totals 146 4,201,030 966,482 LUNG.org 602,211 94,128 287,800 303,651 3,187 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 348,325 397,614 661,137 S TAT E TA B L E S TENNESSEE American Lung Association in Tennessee www.lung.org/tennessee HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Anderson 0 0 Wgt. Avg. Grade Orange Red Purple 0 0.0 A Annual Wgt. Avg. Grade DNC DNC DNC DNC DNC Design Value Pass/ Fail DNC DNC Blount 2 0 0 0.7 B INC INC INC INC INC INC INC Claiborne 0 0 0.0 DNC DNC DNC DNC DNC DNC DNC Davidson 4 0 0 1.3 C INC INC INC INC INC INC INC DeKalb 0 0 0.0 DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC Dyer 0 0 A A DNC DNC DNC DNC DNC Hamilton 5 0 0 1.7 C Jefferson 3 Knox 1 0 Lawrence 0 0 1.0 C 0 0.3 B DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC INC INC INC INC INC 9.0 PASS DNC DNC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC INC D E O G R A B EM Loudon 2 0 0 0.7 B 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 McMinn 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 INC INC Roane 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 Sevier Shelby 0 0 8 0 0 0.0 A 0 2.7 D 0 0 0 0.0 A 8.6 PASS Sullivan 0 0 0 0.0 A INC INC INC INC INC INC INC Sumner 2 0 0 0.7 B INC INC INC INC INC INC INC Williamson 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Wilson 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 147 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 65 & Over Pediatric Asthma 334,941 93,147 33,942 Bexar Brazoria Brewster Cameron Collin Lung Cancer 7,371 18,436 11,419 1,897,753 494,269 218,139 Bowie Adult Asthma COPD 39,112 106,843 70,076 1,023 108,644 154,343 288,976 7,337 19,276 12,985 9,145 1,752 1,878 139 561 448 422,156 132,069 54,064 10,451 22,076 15,253 914,127 246,271 92,102 19,488 50,752 33,687 Dallas 2,553,385 682,485 252,270 Poverty 181 17,333 24,804 51,728 93,389 22,169 14,727 1,754 5,411 3,976 346,312 92,721 38,491 Cardiovascular Disease Diabetes 54,006 142,402 90,900 51 6,461 8,867 16,170 188 20,194 29,003 35,519 5 752 1,004 1,349 227 24,295 33,605 133,508 493 51,814 75,532 59,993 1,377 138,406 200,959 451,795 Denton 780,612 201,646 70,965 15,957 44,046 27,885 421 42,057 62,008 61,186 El Paso 835,593 233,304 97,233 18,462 45,852 30,316 450 47,241 66,708 165,987 Ellis 163,632 44,077 19,927 3,488 9,080 6,354 88 10,033 14,265 17,580 322,225 79,179 42,148 6,266 18,452 13,130 174 20,870 29,546 44,355 D E O G R A B EM Galveston Gregg Harris Harrison Hidalgo 124,108 32,020 17,698 2,534 6,999 4,996 4,538,028 1,224,413 428,697 96,889 252,264 158,961 67 8,024 11,115 20,438 2,452 240,522 350,940 744,712 66,746 16,910 10,327 1,338 3,783 2,825 842,304 281,203 90,076 22,252 42,759 27,637 36 4,602 6,340 12,036 453 42,854 60,247 259,506 Hood 55,423 11,607 13,395 918 3,319 2,893 30 5,004 6,519 5,364 Hunt 89,844 21,419 13,951 1,695 5,194 3,868 48 6,290 8,692 14,418 Jefferson 254,308 60,384 34,403 4,778 14,740 10,306 138 22,964 40,306 Johnson 159,990 41,857 21,591 Kaufman 114,690 31,704 13,801 2,509 6,304 4,385 McLennan 245,671 60,939 33,372 4,822 14,060 9,608 132 15,226 21,150 46,949 Montgomery 537,559 143,545 66,131 11,359 29,920 21,043 290 33,281 47,307 53,837 Navarro Nueces Orange Parker Polk Randall Rockwall Smith 3,312 8,971 6,439 16,368 48,323 12,673 7,978 1,003 2,706 2,070 359,715 90,534 47,578 7,164 20,468 14,191 84,260 20,854 12,913 1,650 4,813 3,582 45 5,824 8,049 13,443 2,442 7,217 5,459 68 8,882 12,369 11,680 46,972 9,604 9,187 760 2,833 2,277 26 3,813 5,142 7,304 130,269 31,609 17,919 90,861 24,947 11,026 222,936 55,137 35,076 2,501 7,503 5,223 70 8,308 11,583 10,887 1,974 49 5,590 5,004 3,533 4,363 12,754 9,316 1,176,558 267,942 102,528 21,203 69,258 41,330 148 194 22,497 31,521 70,336 19,085 1,982,498 533,475 208,355 Totals 26 3,411 4,643 9,312 30,860 Travis Webb 62 6,917 9,825 14,824 126,042 Tarrant Victoria 87 10,300 14,450 17,955 42,215 110,194 72,657 20,332,478 5,441,980 2,188,584 LUNG.org 7,234 13,588 8,425 430,631 1,133,050 741,209 5,403 120 15,144 20,694 34,786 1,068 111,992 161,771 255,993 92,382 23,834 13,673 1,886 5,210 3,756 269,721 91,421 23,938 7,958 638 61,060 90,267 152,195 50 6,064 8,350 12,329 145 12,741 18,399 81,276 10,973 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 1,142,813 1,640,941 3,223,435 S TAT E TA B L E S TEXAS American Lung Association in Texas www.lung.org/texas HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Wgt. Avg. Grade Bell DNC Bexar Bowie Brazoria Brewster Cameron DNC 0 3.7 F DNC 31 5 0 12.8 F 0 0 0 0.0 A 8.5 PASS 0 0 0 0.0 A 9.8 PASS 0 8 0 0 0 0.0 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 28 0 0 9.3 F DNC DNC DNC DNC DNC DNC Dallas 32 1 0 11.2 F 1 0 0 0.3 B Denton 59 7 0 23.2 F DNC DNC DNC DNC DNC El Paso 18 0 0 6.0 F 8 2 0 3.7 F 9.9 PASS 11 0 0 3.7 F 0 0 0 0.0 A 9.3 PASS 20 3 0 8.2 F 0 0 0 0.0 A INC Ellis Galveston Gregg Harris 0 0 10.3 DNC DNC 0 19 DNC Pass/ Fail 11 DNC DNC DNC DNC DNC DNC Design Value 10.2 PASS DNC D E O G R A B EM 8 47 0 14 0 2.7 D 1 23.3 F DNC DNC DNC DNC DNC 3 0 0 1.0 C DNC DNC INC DNC DNC 11.6 PASS Harrison 4 0 0 1.3 C 0 0 0 0.0 A 9.0 PASS Hidalgo 0 0 0 0.0 A 0 0 0 0.0 A INC INC Hood Hunt Jefferson Johnson 13 4 0 F DNC 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC 18 1 0 6.5 F DNC DNC DNC DNC DNC DNC DNC 20 1 0 7.2 F DNC DNC DNC DNC DNC DNC DNC 3 6.3 DNC DNC DNC DNC DNC DNC Kaufman 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC McLennan 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC 0 0 F DNC DNC 0 0 2.0 C DNC DNC DNC DNC DNC Montgomery 15 5.0 Navarro 6 Nueces 3 0 0 1.0 C Orange 4 Parker Polk Randall Rockwall Smith DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC 10.1 PASS 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC 34 0 0 11.3 F DNC DNC DNC DNC DNC DNC DNC 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC 2 17 5 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC 0 0 F DNC DNC 0 0 1.7 C DNC DNC DNC DNC DNC F 5.7 Tarrant 59 7 0 23.2 Travis 14 4.7 DNC DNC DNC 1 0 0 0.3 B 0 0 0 0.0 A DNC DNC DNC 10.0 PASS 0 0 Victoria 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC Webb 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC 149 LUNG.org F DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 9.2 PASS S TAT E TA B L E S UTAH American Lung Association in Utah www.lung.org/utah AT-RISK GROUPS Lung Diseases County Total Population Under 18 Box Elder Cache Carbon Daggett Pediatric Asthma Garfield Salt Lake Lung Cancer Cardiovascular Disease Diabetes Poverty 14 2,220 2,804 4,345 120,783 37,123 10,685 2,636 7,531 2,768 32 4,057 5,140 18,657 20,479 5,456 3,241 254 235 336,043 111,031 31,398 Duchesne Adult Asthma COPD 52,097 16,873 6,463 1,198 3,204 1,406 1,109 Davis 65 & Over 20,862 7,230 2,283 387 1,370 637 18 78 40 7,885 20,377 8,120 513 1,236 517 5 1,040 1,297 3,247 0 69 84 84 89 12,138 15,590 23,138 6 802 1,014 2,247 5,009 1,233 1,025 88 346 178 1 304 374 543 1,107,314 311,386 109,258 22,113 72,084 28,671 293 42,720 54,993 117,311 San Juan 15,772 5,071 1,853 360 974 425 Tooele 62,952 21,418 5,557 1,521 3,763 1,497 17 2,220 2,871 4,493 Uintah 37,928 12,923 3,410 10 1,322 1,697 3,733 Utah 4 662 844 4,397 D E O G R A B EM 918 2,262 889 575,205 198,953 42,066 14,129 33,832 12,002 152 17,123 21,908 70,537 Washington 155,602 43,096 31,425 3,061 10,259 5,108 41 Weber 243,645 70,325 27,606 4,994 15,725 6,546 64 10,045 12,791 29,768 Totals 150 2,754,800 842,372 LUNG.org 276,505 59,822 173,040 68,805 729 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 8,826 10,649 20,252 103,548 132,056 302,752 S TAT E TA B L E S UTAH American Lung Association in Utah www.lung.org/utah HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Box Elder 8 0 0 2.7 D Cache 3 0 0 Carbon 4 0 0 1.3 Daggett 1.0 C C Annual Wgt. Avg. Grade 7 1 0 2.8 D 38 15 0 20.2 F Design Value Pass/ Fail 7.5 PASS 9.1 PASS DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC DNC DNC DNC DNC DNC Davis 14 0 0 4.7 F 16 0 0 5.3 F Duchesne DNC 7.8 PASS 21 22 5 21.3 F INC INC INC INC INC INC INC Garfield 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC Salt Lake 38 0 0 12.7 F 47 12 0 21.7 F 0 0 0.3 San Juan Tooele Uintah Utah 151 9 0 B 0 3.0 D DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC 30 24 18 34.0 F INC INC INC INC INC INC 27 0 0 9.0 F 24 15 0 15.5 F D E O G R A B EM Washington Weber 1 9.0 PASS 6 0 0 2.0 C 18 1 LUNG.org 0 6.5 F INC 9.0 PASS 0 0 0 0.0 A INC INC 24 INC 6 0 11.0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 F INC S TAT E TA B L E S VERMONT American Lung Association in Vermont www.lung.org/vermont AT-RISK GROUPS Lung Diseases County Total Population Under 18 Bennington Chittenden Totals Pediatric Asthma 36,317 6,999 7,896 161,382 Rutland 65 & Over 29,797 22,049 Adult Asthma COPD Lung Cancer 725 3,205 1,980 3,086 14,815 7,330 59,736 10,817 12,005 1,120 5,377 3,204 257,435 47,613 41,950 4,930 23,397 12,514 Cardiovascular Disease Diabetes 96 8,926 9,526 LUNG.org 15,695 36 4,247 4,301 6,560 153 15,846 16,493 D E O G R A B EM 152 Poverty 22 2,673 2,666 4,102 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 26,357 S TAT E TA B L E S VERMONT American Lung Association in Vermont www.lung.org/vermont HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Bennington Chittenden Rutland Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Design Value 1 0 0 0.3 B 0 0 0 0.0 A 6.2 PASS 0 0 0 0 0.0 A 6.3 PASS 6 0 0 2.0 C 8.7 PASS 0 0 0.0 A DNC DNC DNC DNC DNC D E O G R A B EM 153 Pass/ Fail LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 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 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty Albemarle 105,703 21,846 18,063 1,852 6,674 5,025 63 6,684 9,069 9,462 Alexandria City 153,511 27,554 15,874 2,336 10,006 6,410 91 Arlington 229,164 40,006 21,698 3,392 15,031 9,204 7,896 10,885 13,832 137 11,139 15,335 16,031 Bristol City 17,141 3,408 3,413 289 1,094 868 10 1,179 1,593 3,260 Caroline 29,984 7,130 4,670 605 1,817 1,373 18 1,818 2,480 3,531 Charles City Chesterfield 7,040 1,100 1,557 93 473 402 4 554 754 814 335,687 81,561 44,925 6,915 20,191 14,765 199 19,183 26,357 22,942 1,142,234 271,539 136,327 23,023 69,150 48,796 680 62,353 85,991 69,985 Fauquier 68,782 16,340 10,588 1,385 4,167 3,231 41 4,286 5,880 4,646 Frederick 83,199 19,427 13,087 1,647 5,070 3,865 50 5,124 7,000 6,342 Fairfax Giles D E O G R A B EM 16,708 3,416 3,426 290 1,058 865 2,497 8,509 6,064 10 1,185 1,603 1,751 Hampton City 136,454 29,445 19,217 81 Hanover 103,227 23,125 16,704 1,961 6,367 4,957 Henrico 325,155 75,430 46,015 6,396 19,852 14,479 192 18,876 25,832 30,037 Loudoun 375,629 109,247 31,044 9,263 21,135 13,961 224 17,211 23,976 13,953 Lynchburg City 79,812 15,534 11,277 1,317 5,119 3,390 Madison 13,134 2,726 2,759 Norfolk City Page Prince Edward 246,393 49,439 25,062 231 829 690 4,192 15,658 9,727 61 6,601 9,037 6,268 47 4,330 5,846 15,975 8 148 23,726 4,791 4,822 406 1,507 1,232 22,952 3,702 3,609 314 1,533 1,054 7,858 10,733 20,072 950 1,286 1,351 11,908 16,313 45,756 14 1,684 2,282 3,532 14 1,364 1,843 4,172 Prince William 451,721 125,637 39,298 10,653 25,879 17,061 269 21,074 29,283 29,925 Richmond City 220,289 40,012 25,506 130 11,694 16,040 50,763 3,393 14,329 9,365 Roanoke 94,409 19,582 19,014 1,660 5,958 4,834 56 6,603 8,935 6,744 Roanoke City 99,897 22,184 15,144 1,881 6,180 4,558 59 5,985 8,166 20,913 Rockbridge 22,354 3,881 5,538 329 1,472 1,274 13 1,784 2,400 2,834 Rockingham 78,593 17,492 14,401 1,483 4,863 3,831 47 5,173 7,016 8,422 Salem City 25,432 4,918 4,476 Stafford Suffolk City 142,003 37,700 13,452 88,161 21,858 11,713 Virginia Beach City 452,745 102,144 57,630 Wythe Totals 154 LUNG.org 646,173 3,197 8,277 5,610 1,853 5,268 3,833 8,661 27,869 19,333 29,119 5,837 5,864 5,220,358 1,208,011 417 1,633 1,240 318,821 222,804 85 7,005 9,733 7,448 52 4,976 6,831 11,370 269 24,736 33,881 36,451 495 1,853 1,507 102,425 15 1,653 2,244 2,391 17 2,056 2,786 4,163 3,102 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 284,920 391,408 475,136 S TAT E TA B L E S VIRGINIA American Lung Association in Virginia www.lung.org/virginia HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Albemarle Alexandria City Arlington 0 0 0 0.0 A INC INC INC INC INC 11 Bristol City Caroline Wgt. Avg. Grade Orange Red Purple 1 0 4.2 F DNC DNC DNC DNC DNC 0 0 0 0.0 A Annual Wgt. Avg. Grade 0 0 0 0.0 A DNC DNC DNC DNC DNC Design Value Pass/ Fail 7.4 PASS DNC DNC 0 0 0 0.0 A 8.9 PASS 0 0 0 0.0 A 8.2 PASS DNC DNC DNC DNC DNC DNC DNC Charles City 4 0 0 1.3 C 0 0 0 0.0 A 7.7 PASS Chesterfield 0 0 0 0.0 A 0 0 0 0.0 A INC Fairfax 6 0 0 2.0 C 0 0 0 0.0 A 8.2 PASS Fauquier 0 0 0 0.0 A DNC DNC DNC DNC DNC Frederick 0 0 0 0.0 A 1 0 0 0.3 B 0 0 0 0.0 Giles DNC INC DNC 9.0 PASS D E O G R A B EM A DNC DNC DNC DNC DNC Hampton City 2 0 0 0.7 B Hanover 1 Henrico 3 0 0 1.0 C 0 0 0 0.0 A 8.0 PASS Loudoun 7 0 0 2.3 D 0 0 0 0.0 A 8.7 PASS 0 7.4 PASS Lynchburg City Madison Norfolk City 0 0 0.3 B DNC DNC DNC DNC DNC 0 DNC 0 DNC 0 0.0 DNC DNC A DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC 7.7 PASS Page 0 0 0 0.0 A Prince Edward 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 INC INC INC INC INC INC INC Prince William Richmond City Roanoke DNC DNC DNC DNC DNC 0 0 0 0.0 DNC DNC DNC DNC Rockbridge 0 0 0 Rockingham 0 0 0 Roanoke City Salem City Stafford Suffolk City Virginia Beach City Wythe 155 0 0 1 0 0 0.3 B INC INC DNC INC INC INC INC INC INC INC 0.0 A DNC DNC DNC DNC DNC DNC DNC 0.0 A 0 0 0 0.0 A 8.5 PASS 0 0 0 0.0 A 8.5 PASS 0.7 1 0 0 0.3 DNC DNC DNC DNC 0 0 LUNG.org INC INC A DNC DNC DNC DNC DNC 2 0 0 0 0.0 A 7.3 PASS 0 0.0 B DNC DNC DNC DNC DNC DNC DNC B DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A A DNC DNC DNC DNC DNC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 7.9 PASS DNC DNC 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 Benton 65 & Over Pediatric Asthma 190,309 50,899 26,210 Adult Asthma COPD Lung Cancer 3,325 13,172 8,583 Cardiovascular Disease Diabetes Poverty 106 10,631 11,734 26,824 Chelan 75,644 18,190 13,547 1,188 5,459 3,797 42 4,953 5,333 9,458 Clallam 73,486 12,880 20,298 41 6,419 6,630 11,195 Clark 459,495 King 114,536 65,323 2,117,125 438,574 263,386 Kitsap 260,131 53,941 42,954 Kittitas 43,269 7,689 6,540 841 5,803 4,522 7,481 32,661 21,440 28,646 157,724 97,651 3,523 19,521 13,074 502 3,314 2,060 255 26,573 29,368 48,401 1,176 116,316 130,619 205,336 145 16,577 18,085 24,950 24 2,556 2,781 8,190 Pierce 843,954 201,220 110,163 13,143 60,558 38,426 Skagit 121,846 Snohomish 772,501 177,236 96,213 11,577 56,362 35,894 429 42,913 48,418 71,017 Spokane 490,945 273 27,143 23,517 74,486 269,536 58,760 42,752 Whatcom 212,284 42,086 33,919 Yakima 248,830 156 9,000 6,344 68 8,382 8,962 D E O G R A B EM 109,896 Thurston Totals 1,773 469 46,643 51,946 102,917 7,178 35,959 23,541 3,838 19,931 13,225 29,445 32,284 17,965 74,144 150 16,672 18,229 32,458 2,749 15,982 10,360 118 13,054 14,194 29,802 74,063 32,662 4,838 16,416 10,504 138 13,029 14,296 46,794 6,179,355 1,387,113 851,970 90,602 451,863 289,421 3,432 354,163 392,878 709,451 LUNG.org AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S WASHINGTON American Lung Association in Washington www.lung.org/washington HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Benton INC INC INC INC INC Chelan DNC DNC DNC DNC DNC Clallam 0 0 0 0.0 A Clark 1 0 0 B King 8 0 0 2.7 D 0.3 Kitsap DNC DNC DNC DNC DNC Kittitas DNC DNC DNC DNC Pierce 0 0 0 Skagit 0 0 DNC 1 Snohomish Spokane Whatcom 157 DNC DNC DNC DNC DNC 2 2 0 1.7 C DNC DNC DNC DNC DNC 4 2 0 2.3 D 7 0 0 2.3 D 0 0 0 0.0 A Design Value INC INC DNC DNC INC INC 6.7 PASS INC INC DNC INC INC INC INC INC 0.0 A 13 1 0 4.8 F 7.5 PASS 0 0.0 A 0 0 0 0.0 A INC DNC DNC DNC DNC 15 2 0 6.0 F 8.1 PASS 0 0 0.3 B 5 0 0 1.7 C INC 0 0 0 0.0 A 0 0 0 0.0 A DNC Pass/ Fail DNC DNC INC D E O G R A B EM Thurston Yakima Annual Wgt. Avg. Grade DNC DNC LUNG.org DNC DNC INC INC INC INC INC INC INC INC INC INC 0 0 0 0.0 A 7.0 PASS 17 9.1 PASS 1 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 6.2 F 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 Berkeley 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Cardiovascular Disease Diabetes Poverty 111,901 26,911 15,243 2,534 9,221 10,805 91 10,968 11,588 13,823 Brooke 23,350 4,124 5,158 388 2,096 2,682 19 2,901 2,960 3,338 Cabell 96,844 19,614 16,756 Gilmer 1,847 8,326 9,800 8,518 1,193 1,310 112 786 877 78 10,149 10,561 18,776 7 877 929 1,650 Greenbrier 35,516 6,979 7,789 657 3,114 4,013 29 4,354 4,437 6,629 Hancock 29,815 544 24 Harrison Kanawha Marion Marshall Raleigh Tucker Wood Totals 158 6,177 2,628 3,371 68,714 14,900 12,499 1,403 5,855 7,237 188,332 38,490 35,175 3,624 16,307 20,209 3,629 3,718 4,032 56 7,643 7,901 10,861 152 21,378 22,079 30,529 56,925 11,532 10,481 1,086 4,917 5,964 46 6,266 6,482 8,899 31,978 6,368 6,457 600 2,796 3,555 26 3,813 3,913 3,965 104,236 16,820 11,513 1,584 9,288 9,493 85 8,956 9,755 19,051 D E O G R A B EM Monongalia Ohio 5,781 43,066 8,330 8,520 784 3,775 4,692 35 4,991 5,135 5,711 77,510 16,482 14,532 1,552 6,623 8,139 63 8,606 8,878 14,676 6,966 1,219 1,620 86,452 18,498 16,258 970,123 197,241 LUNG.org 169,488 115 628 821 1,742 7,401 9,235 18,570 83,761 100,893 6 70 785 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 897 911 1,165 9,804 10,108 14,793 105,231 109,355 157,898 S TAT E TA B L E S WEST VIRGINIA American Lung Association in West Virginia www.lung.org/westvirginia HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Berkeley Brooke 0 0 0 0.0 DNC DNC DNC DNC Annual Wgt. Avg. Grade Design Value Pass/ Fail A 1 0 0 0.3 B 10.3 PASS DNC 0 0 0 0.0 A 11.2 PASS Cabell 2 0 0 0.7 B Gilmer 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC Greenbrier 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC 6 0 0 C Hancock Harrison Kanawha 2.0 DNC DNC DNC DNC DNC 3 0 0 1.0 C 0 0 0 0.0 A 9.2 PASS 0 0 0 0.0 A INC 0 0 0 0.0 A 8.8 PASS INC 0 0 0 0.0 A 9.6 PASS Marion DNC DNC DNC DNC DNC 0 0 0 0.0 A 9.4 PASS Marshall DNC DNC DNC DNC DNC 0 0 0 0.0 A 10.7 PASS D E O G R A B EM Monongalia 3 0 0 1.0 C 0 0 0 0.0 A 8.6 PASS Ohio 4 0 0 1.3 C 1 0 0 0.3 B 10.3 PASS Raleigh Tucker Wood 159 DNC DNC DNC DNC DNC 1 0 0 0.3 B 6 0 0 2.0 C LUNG.org 0 DNC 0 DNC 0 DNC 0.0 DNC A DNC 0 0 0 0.0 A AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 INC INC DNC DNC 9.4 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 Total Population Under 18 Ashland Brown Columbia Dane 65 & Over Pediatric Asthma 15,843 3,542 2,833 258,718 62,681 34,930 56,743 12,579 9,524 523,643 109,975 64,580 Adult Asthma COPD Lung Cancer 260 1,157 621 4,606 18,884 8,819 Cardiovascular Disease Diabetes 10 Poverty 996 1,100 2,616 155 13,713 15,620 27,979 924 4,170 2,190 8,081 40,551 16,979 34 3,470 3,876 4,908 314 26,290 30,144 57,411 Dodge 88,502 18,187 14,761 1,336 6,664 3,427 53 5,421 6,066 7,157 Door 27,554 4,529 7,601 16 2,313 2,427 2,317 333 2,084 1,370 Eau Claire 102,105 20,961 14,721 1,540 7,907 3,459 61 5,497 6,148 13,260 Fond du Lac 101,973 22,331 17,318 1,641 7,537 3,913 61 6,233 6,928 9,248 9,057 1,823 2,016 134 670 394 5 651 698 1,284 Forest Grant 52,250 10,640 8,626 Jefferson 84,559 782 4,010 1,884 Kewaunee La Crosse Manitowoc 13,050 168,437 40,321 21,512 20,366 4,483 3,922 1,367 6,291 3,118 51 2,963 12,345 5,738 101 5,520 7,534 8,805 10,154 20,812 329 1,482 833 12 1,346 1,474 1,652 71 6,615 7,372 16,248 79,806 16,743 15,197 1,230 5,887 3,292 48 5,289 5,825 8,466 135,868 31,458 22,337 2,312 9,891 5,104 Milwaukee 957,735 Outagamie 4,903 118,212 23,826 17,986 1,751 9,144 4,151 Marathon Ozaukee 31 3,043 3,347 6,622 D E O G R A B EM Kenosha 18,608 233,159 118,711 183,245 43,882 24,843 87,850 19,169 15,833 17,132 70,675 30,571 3,224 13,390 6,343 1,409 6,435 81 8,108 9,037 12,675 572 110 3,525 53 47,491 54,244 189,827 9,829 11,229 16,225 5,625 6,236 4,488 Racine 195,080 46,202 29,573 3,395 14,155 7,136 Rock 161,448 38,325 24,969 2,816 11,732 5,853 97 9,248 10,366 21,946 Sauk 63,642 14,520 11,094 1,067 4,639 2,441 38 3,914 4,323 7,340 Sheboygan 117 11,184 12,626 23,505 115,569 26,084 19,254 1,917 8,460 4,412 69 7,000 7,810 10,167 Taylor 20,455 4,832 3,821 355 1,456 822 12 1,323 1,454 2,491 Vilas 21,387 3,623 6,283 266 1,590 1,100 13 1,872 1,949 2,829 Walworth 102,804 22,330 16,304 1,641 7,679 3,802 Waukesha 396,488 87,705 67,598 6,444 29,037 15,576 237 24,644 27,546 18,401 4,149,339 942,518 609,197 69,255 307,919 146,872 2,484 230,839 260,254 509,782 Totals 160 LUNG.org 62 6,018 6,736 12,374 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 S TAT E TA B L E S WISCONSIN American Lung Association in Wisconsin www.lung.org/wisconsin HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Pass/ Fail Ashland 0 0 0 0.0 A Brown 3 0 0 1.0 C Columbia 3 Dane 1 0 0 0.3 B 1 0 0 0.3 B 9.0 PASS Dodge 7 0 0 2.3 D 0 0 0 0.0 A 8.0 PASS Door 9 Eau Claire 0 0 0 0.0 A Fond du Lac 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC Forest 0 0 0 0.0 A 0 0 0 0.0 A INC INC Grant Jefferson Kenosha 0 0 0 1.0 C 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A 0 2.3 D DNC DNC DNC DNC DNC 24 0 0 8.0 F 0 1 0 0.5 B 0 0 1.7 5 0 0 0 0.0 A Manitowoc Marathon Outagamie Racine 12 1 10 0 0 0 0 4.0 C 0 0 0 0 0.0 A F DNC 0 0.3 B DNC DNC DNC DNC DNC 0 F 3.3 3 0 0 1.0 C 15 DNC DNC DNC DNC DNC 0 5.0 F INC INC INC INC INC 0 DNC 0 DNC DNC 0 0.0 DNC 8.2 PASS DNC DNC DNC DNC 7.5 PASS 8.3 PASS A 0 0.0 A 2.0 C DNC DNC DNC DNC DNC 0 1.0 C 0 0 0 0.0 A 25 1 0 8.8 F DNC DNC DNC DNC DNC 6 0 0 2.0 C Waukesha 3 0 0 C LUNG.org 1.0 DNC DNC DNC 9.7 PASS DNC 0 1 0 0 0.3 B DNC DNC DNC 0 Walworth 8.0 PASS DNC DNC DNC DNC DNC 0 Vilas DNC DNC 7.6 PASS 0 3 0 0 0 0.0 A 8.5 PASS 0 6 Taylor DNC 8.0 PASS Sauk Sheboygan DNC 1 0 0 0.3 B Rock 161 5.1 PASS D E O G R A B EM 0 La Crosse Ozaukee 1 0 0 0.3 B DNC DNC DNC DNC DNC 7 Kewaunee Milwaukee 0 0 0 0.0 A Design Value 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 0.0 A DNC 7.2 PASS DNC DNC 6.5 PASS 5.0 PASS DNC DNC 9.8 PASS 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 Lung Cancer Albany 37,956 6,264 3,881 Big Horn 12,022 3,083 2,363 265 715 740 Campbell 49,220 13,816 3,674 1,187 2,812 2,173 Carbon 15,559 3,677 2,241 Converse 14,236 3,652 2,020 314 844 781 Fremont 40,315 10,278 6,773 538 2,526 1,852 316 947 865 883 2,399 2,335 Poverty 15 1,790 1,902 7,181 5 837 876 1,437 19 2,132 2,473 3,668 6 927 1,010 1,682 6 840 920 1,205 16 2,747 5,071 13,383 2,695 2,823 Laramie 97,121 22,812 14,266 1,960 5,929 5,384 38 5,765 6,216 10,084 Natrona 82,178 19,800 10,804 1,701 4,972 4,371 32 4,607 5,031 8,827 Park 29,228 11 507 1,867 1,924 990 1,031 1,852 2,170 2,282 D E O G R A B EM Sheridan Sublette 6,063 5 2,573 Goshen 5,898 232 856 878 Cardiovascular Disease Diabetes 30,009 6,456 5,731 9,899 2,383 1,348 555 1,883 1,893 205 599 547 2,739 12 2,113 2,242 2,777 4 584 647 605 Sweetwater 44,626 11,984 4,474 1,030 2,597 2,140 Teton 23,125 4,349 3,001 374 1,496 1,280 9 1,331 1,464 1,516 Uinta 20,822 6,141 2,432 528 1,169 1,029 8 1,082 1,201 2,030 Weston Totals 162 7,234 1,570 1,331 135 453 451 526,933 124,858 LUNG.org 73,225 10,727 32,063 28,641 18 2,180 2,451 3,744 3 501 536 675 208 AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 30,421 33,029 55,093 S TAT E TA B L E S WYOMING American Lung Association in Wyoming www.lung.org/wyoming HIGH OZONE DAYS 2013–2015 HIGH PARTICLE POLLUTION DAYS 2013–2015 24-Hour County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Annual Wgt. Avg. Grade Pass/ Fail Albany 2 0 0 0.7 B Big Horn 0 0 Campbell 0 0 0 0.0 A 1 0 0 0.3 B 4.2 PASS Carbon 1 0 0 0.3 B 0 0 0 0.0 A INC INC Converse 2 0 0 0.7 B 3 0 0 1.0 C INC INC Fremont 0 Goshen 0 0 0.0 A 0 0.0 A INC INC INC INC INC 0 0 0 0.0 A Design Value INC INC INC INC INC 1 0 0 0.3 B INC INC INC INC INC 4.3 PASS INC INC 6.9 PASS INC INC Laramie 3 0 0 1.0 C 0 1 0 0.5 B 4.1 PASS Natrona 2 0 0 0.7 B 0 0 0 0.0 A 4.6 PASS 0 0 0 0.0 A 4.1 PASS 2 0 0 0.7 B 6.9 PASS 0 0 0 0.0 A 5.0 PASS Park Sublette DNC DNC DNC DNC DNC D E O G R A B EM Sheridan DNC DNC DNC DNC DNC 1 0 0 0.3 B Sweetwater 4 0 0 1.3 C 0 0 0 0.0 A 4.8 PASS Teton 0 0 0 0.0 A 0 0 0 0.0 A 4.7 PASS Uinta 2 Weston 163 0 0 0 LUNG.org 0 0.7 B 0 0.0 A DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC AMERICAN LUNG ASSOCIATION STATE OF THE AIR 2017 2017 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.