American Lung Associatiom State of the Air In Memoriam This report is dedicated to Janice E. Nolen, the leading force behind the history of this report and a tireless champion of lung health and healthy air. Acknowledgments The American Lung Association “State of the Air® 2020” is the result of the hard work of many people: To produce the national report: Deb Brown, who leads the Mission Team; 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; Kevin M. Stewart, who assisted in the data analysis, writing and coordination of the report content and metro area assessments; Laura Kate Bender, Diana Van Vleet, Ronni Flannery and Liz Mueller, who integrated the Healthy Air Campaign with this report; Will Barrett, who compiled material for metro area assessments; Zach Jump, M.A., who converted the raw data into meaningful tables and comparisons and calculated all the population data; Susan Rappaport, M.P.H., who supervised the data analysis; John Balmes, 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 Shanna Johnson, who managed content production online; Laura Lavelle, Carrie Emge and Elexis Rodgers, who developed the social sharing and digital engagement strategy; Julia Fitzgerald, Kim Lacina, Allison MacMunn, Stephanie Goldina, 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. For state-level outreach: Michael Seilback and Lance Boucher coordinated work with the state staff across the nation. Staff contacted state and local air directors to ensure that they were informed and had a chance to review the draft data. Outside the American Lung Association: Allen S. Lefohn of A.S.L. and Associates, who compiled the data; Beaconfire RED 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 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® 2020.” American Lung Association National Headquarters 55 W. Wacker Drive, Suite 1150 Chicago, IL 60601 Advocacy Office 1331 Pennsylvania Avenue, NW, Suite 1425 North Washington, DC 20004 Phone: 1 (800) 586-4872 Fax: (202) 452-1805 www.stateoftheair.org www.Lung.org Copyright ©2020 by the American Lung Association American Lung Association and State of the Air are registered trademarks of the American Lung Association. Designed by Our Designs, Inc., Nashville, TN 3 Lung.org American Lung Association State of the Air 2020 Contents The State of the Air 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Rankings People at Risk in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Most-Polluted Cities in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Most-Polluted Counties in the U.S. . . . . . . . . . . . . . . . . . . . . . . . 23 Cleanest Cities in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Cleanest Counties in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Health Effects of Ozone and Particle Pollution . . . . . . . . . . . . . . . . . . 36 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 State Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 The State of the Air 2020 The “State of the Air” 2020 found that, in 2016-2018, more cities had high days of ozone and short-term particle pollution compared to 2015-2017 and many cities measured increased levels of year-round particle pollution. 2020 marks the 50th anniversary of the Clean Air Act, the landmark law that has driven dramatic improvements in air quality over its history. This is critical because far too many communities reported air pollution that still threatens health, and climate change impacts continue to threaten to progress. Further, harmful revisions and setbacks to key protections currently in place or required under the Act threaten to make air quality even worse in parts of the country. “State of the Air” 2020 shows that we must not take the Clean Air Act for granted. The “State of the Air” 2020 report shows that too many cities across the nation increased the number of days when particle pollution, often called “soot,” soared to often record-breaking levels. More cities suffered from higher numbers of days when ground-level ozone, also known as “smog,” reached unhealthy levels. Many cities saw their year-round levels of particle pollution increase as well. Too many cities across the nation experienced more ozone and more particle pollution in 2016-2018. Many reached or tied their highest levels ever. The “State of the Air” 2020 report adds to the evidence that a changing climate is making it harder to protect human health. The three years covered in this report ranked among the five hottest years on record globally. High ozone days and spikes in particle pollution followed, putting millions more people at risk and adding challenges to the work cities are doing across the nation to clean up. The 2020 report—the 21st annual release—uses the most recent quality-assured air pollution data, collected by the federal, state and local governments and tribes in 2016, 2017 and 2018. The “State of the Air” 2020 report looks at levels of ozone and particle pollution found at official monitoring sites across the United States in those years. For comparison, the “State of the Air” 2019 report covered data from 2015, 2016 and 2017. The report examines fine particle pollution (particulate matter smaller than 2.5 microns in diameter, also known as PM2.5) in two separate ways: averaged year-round (annual average) and 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). (The full “State of the Air” 2020 methodology is included in a later chapter.) Overall Trends The “State of the Air” 2020 found that, in 2016-2018, millions more Americans were living in communities impacted by unhealthy levels of pollution in the form of more unhealthy ozone days, more particle pollution days and higher annual particle levels than was found in previous reports. Nearly five in ten people—150 million Americans or approximately 45.8 percent of the population—live in counties with unhealthy ozone or particle pollution (with at least one F). That represents an increase from the past three reports: it’s higher than the 141.1 million in the 2019 report (covering 2015-2017), 133.9 million in the 2018 report (covering 2014-2016) and 125 million in the 2017 report (covering 2013-2015). More than 20.8 million people, or 6.4 percent of the population, live in the 14 counties that failed all three measures. Nearly five in 10 people live where the air is unhealthy. 5 Lung.org Los Angeles remains the city with the worst ozone pollution in the nation, as it has been for 20 years of the 21-year history of the report. Bakersfield, CA, returned to the most-polluted slot for year-round particle pollution, while Fresno-Madera-Hanford, CA, returned to its rank as the city with the worst short-term particle pollution. This shows growing evidence that a changing climate is making it harder to protect human health. All three years ranked among the five hottest years in history, increasing American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 high ozone days and widespread wildfires, putting millions more people at risk and adding challenges to the work cities are doing across the nation to clean up. Rollbacks of EPA cleanup rules and reduced Clean Air Act enforcement are further adding to these air quality challenges. This marks the fourth report in a row that worsening air quality threatened the health of more people, despite other protective measures being in place. Climate change clearly drives the conditions that increase these pollutants. The nation must do more to address climate change and to protect communities from these growing risks to public health. The Clean Air Act must remain intact and enforced to enable the nation to continue working to protect all Americans from the dangers of air pollution. As the nation celebrates the 50th anniversary of the Clean Air Act this year and the dramatic improvements in air quality over its history, everyone must ensure that the Clean Air Act’s tools remain in place, funded and followed in order to protect the public. The Lung Association will continue to champion the Clean Air Act and push for clean air for all, defending Americans against proposals to reverse and reduce protections in place and supporting new efforts to curb harmful pollution. Comparison of Growth Areas and Declining Emissions, 1970–2018 300% Gross Domesধc Product Vehicle Miles Traveled Percent of Change 200% Populaধon 100% Energy Consumpধon CO2 Emissions 0% Aggregate Emissions (Six Common Pollutants) –100% 1970 2000 2010 2018 Figure 1: Air pollution emissions have dropped steadily since 1970 thanks to the Clean Air Act. Source: U.S. EPA, Air Trends: Air Quality National Summary, 2019. Ozone Pollution Far more people suffered unhealthy ozone pollution in 2016-2018 than in the last three reports. In 2016-2018, more than 137 million people lived in the 205 counties that earned an F for ozone. That is significantly higher than in the 2019, 2018 and 2017 reports and is the highest since the 2016 report. This trend shows strong evidence of the impacts on air quality from the warmer years also reported in this period. Of the ten most polluted cities, six did worse than in the 2019 report, including some of the nation’s largest metropolitan areas. Why? Increased heat. The three years in this report were three of the five warmest on record in the United States: the year 2016 remains the warmest year on record, while 2017 is now the fourth warmest, and 2018 ranked fifth warmest. Warmer temperatures make ozone more likely to form and harder to clean up. 6 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 Changes in where ozone is worst in the U.S. continue a trend seen in the past four reports, where increased oil and gas extraction 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. Ozone rankings are all based on unhealthy air days as recorded using the Air Quality Index adopted with the 2015 national air quality standard for ozone. In 2018, EPA officially designated all or parts of the 25 most polluted cities as “nonattainment” areas for that ozone air quality standard. That action requires these areas to take steps to clean up the sources of pollution going forward. Los Angeles remains at the top of the list of most polluted cities for ozone, as it has been for all but one of the 21 reports, despite the metro area’s continued fight against ozone. Los Angeles-Long Beach also recorded more unhealthy ozone days in this report, measured by weighted average. In addition to Los Angeles, 13 others among the 25 cities with the worst ozone pollution each had a higher weighted average of unhealthy days in 2016-2018, including some of the nation’s largest metropolitan areas: Phoenix, Las Vegas, Denver, Salt Lake City, Chicago and Milwaukee. Many smaller cities on that list also suffered from more ozone: Visalia, CA; Bakersfield, CA; El Centro, CA; El Paso-Las Cruces, TX-NM; Chico, CA; Fort Collins, CO; and Sheboygan, WI. Eleven of the 25 cities with the worst ozone pollution had fewer unhealthy ozone days on average in 2016-2018. Those included San Jose-San Francisco-Oakland and Dallas-Fort Worth, each of which reached its fewest unhealthy ozone days ever. Other cities that had fewer high-ozone days included Fresno; Sacramento; San Diego; New York-Newark; Redding-Red Bluff, CA; Houston; Washington-Baltimore; Philadelphia; and Hartford, CT. Regional Differences. Only seven cities among the worst for ozone are east of the Mississippi River, including the New York City metro area, where Fairfield County, CT, suffers from the highest levels in the eastern U.S. Others in the Northeast and MidAtlantic in the 25 most-polluted list are Washington-Baltimore; Philadelphia; and Hartford, CT. The Midwest has three: Chicago; Sheboygan, WI and Milwaukee. For the first time, with Atlanta’s improvement, no city in the Southeast has any city on the mostozone-polluted list. Cities in the West and the Southwest continue to dominate the most-ozone-polluted list. California retains its historic distinction, as it is home to 10 of the 25 most polluted cities. The Southwest continues to fill most of the remaining slots, with eight of the 25 cities, including three in Texas—Houston, El Paso, and Dallas-Fort Worth. Colorado has two— Denver and Fort Collins. Arizona, Nevada and Utah each have one. The findings show the continued impact of transported pollution that moves ozone and ozone precursors across state lines. For example, emissions generated in Chicago cross Lake Michigan to reach Sheboygan, WI. Fairfield County, CT, remains the county with the highest ozone in the eastern half of the nation because of the transported ozone and ozone precursors from upwind states. Short-Term Particle Pollution More cities experienced more days of spikes in particle pollution, compared to the 2019 report. Twenty-two of the 25 most polluted cities had more such days on average in the 2020 report. Many cities reached their highest number of such days ever reported. More people experienced unhealthy spikes in particle pollution than in the last three reports. More than 53.3 million people suffered those episodes of unhealthy spikes in 86 counties where they live. In the 2019 report, the total was approximately 49.6 million people who experienced too many unhealthy days; in the 2018 report, approximately 35.1 million people; and in the 2017 report, approximately 43 million people. 7 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 Why? Wildfires in 2017 and 2018, especially in California, were a main reason for many of these spikes. In the western U.S., climate change has made more likely the conditions of heat and drought that promote wildfire hazards. In some communities, wood smoke from home heating, especially when worsened by stagnant air masses known as inversions, has also contributed to high levels of particle pollution. Nine of the ten most polluted cities had more days when particle pollution reached unhealthy levels; four of those reached their worst exposure ever recorded. Of the 25 most polluted cities, 22 had more days on average in this year’s report, with nine cities reaching their highest number of days on average ever recorded. Fresno-Madera-Hanford, CA, returns to rank as the #1 most polluted city for shortterm particle levels. This marks the third time Fresno-Madera-Hanford has ranked at the top in this category; the last period was from 2011-2013, covered in the 2015 report. Bakersfield, which had been ranked in that spot for eight of the last ten reports, shifted to the 2nd most polluted city. Nine cities had their highest-ever weighted average number of days with spikes in particle levels: Fairbanks, AK; Yakima, WA; Redding-Red Bluff, CA; Phoenix, AZ; Spokane-Spokane Valley-Coeur d’Alene, WA-ID; Chico, CA; Salinas, CA; Santa MariaSanta Barbara, CA; and Las Vegas, NV. Just as people move around, so too does harmful pollution. Wildfire smoke is just one example of pollution threatening health far from the source. Showing the impact of wildfires, this year’s report marks the second year that Santa Maria-Santa Barbara, CA, showed up on the list of the most polluted for short-term particle pollution. Prior to the 2019 report, this city had been on the list of cleanest cities in the nation for the previous six years for the same pollutant. Twelve other cities on the most-polluted list also suffered from more days with unhealthy levels of particle pollution. These include Bakersfield; San Jose-San Francisco; Los Angeles; Salt Lake City, UT; Sacramento; Visalia, CA; Logan, UT; Medford-Grants Pass, OR; El Centro, CA; Eugene, OR; Reno, NV; and Portland, OR. Only three of the 25 most polluted cities improved and had fewer unhealthy air days on average than in the 2019 report. Though it improved from its worst performance in last year’s report, Missoula, MT, remained among the nation’s 10 most polluted cities. Two other cities on the list had fewer unhealthy days on average: Seattle and Pittsburgh. In California, Montana, Oregon and Washington, extended wildfires increased the days when PM levels spiked during 2016-2018. The Los Angeles metro area had two days when levels spiked to “hazardous,” the highest, “maroon” level in the Air Quality Index. The Chico, CA, metro area also recorded two hazardous days in Butte County, reaching its highest ever short-term weighted average. Eugene, OR, and rural counties Mendocino County, CA, Okanagan County, WA and Gallatin County, MT, each reached one hazardous day. Wildfires are not the only source of high particle pollution days. Other contributing sources include wood stove use (especially in Fairbanks, AK), older diesel vehicles and equipment, and industrial sources (as in Pittsburgh, PA). Changes in weather patterns can create atmospheric inversions that trap particles in place, leading to days with spikes. Pittsburgh is the only city in the 25 most polluted that is east of the Mississippi River. Year-Round Particle Pollution This year saw mixed results in terms of annual particle levels among the 26 most polluted cities in the United States: 13 of these cities saw increased particle levels; 11 cities improved; one was not included in last year’s report; and one maintained the same levels as last year’s report. Nine cities among the most polluted achieved their lowest ever annual particle levels. (The list of most polluted cities for annual particle pollution contains 26 cities instead of 25 due to a tie for 25th place.) 8 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 More people live in areas with unhealthy year-round particle pollution than in last year’s report. More than 21.2 million people live in 19 counties where the annual average concentration of particle pollution was too high. This is higher than the 20.5 million Americans living in 18 counties in the 2019 report. Bakersfield, CA returned to the rank of most polluted city for year-round particle pollution in 2016-2018. As with the short-term particle category, Bakersfield and Fresno also swapped rankings for annual particle pollution levels. Bakersfield returns to #1 most polluted in the nation while Fresno ranks #2, having tied its lowest annual average. Thirteen of the 26 cities most polluted year-round by particle pollution saw increases over levels in the 2019 report: Bakersfield, CA; Visalia, CA; San Jose-San FranciscoOakland, CA; Phoenix, AZ; El Centro, CA; Detroit-Warren-Ann Arbor, MI; McAllenEdinburgh, TX; Philadelphia-New Castle-Weirton, PA-OH-WV; Sacramento-Roseville, CA; Shreveport-Bossier City-Minden, LA; Medford-Grants Pass, OR; Chico, CA and St. Louis-St. Charles-Farmington, MO-IL. Eleven of the 26 most polluted cities had lower year-round particle levels, of which nine matched (Pittsburgh and Fresno) or newly achieved (Atlanta, Birmingham, Chicago, Cincinnati, Cleveland, Houston, and Indianapolis) their lowest respective averages ever. Of the remaining two cities among the most polluted in the nation by annual particles, Los Angeles, CA, had the same level as last year, while Brownsville, TX, did not have annual particle pollution data available last year for comparison. More cities among the most polluted by annual particle levels saw increases than improved in the 2020 report. Nine cities among the most polluted for annual particle pollution fail to meet the current national air quality standards. However, evidence shows that no threshold exists for harmful effects from particle pollution—that is, that even levels lower than the official standard are not safe to breathe. Overall, cities in the western U.S. dominate the list, with 15 cities among the 26 most polluted by annual particles. California continues to claim more places on the list than any other state, with six of the ten most polluted, including each of the worst five—and six of the nine cities that fail to achieve the national standard. Fairbanks, Phoenix, Pittsburgh and Detroit are also among the ten most polluted, with only Detroit achieving the national standard. Beyond cities in western states, the remainder of the most particle-polluted cities all meet the standard and are distributed throughout the Midwest, Southeast and Mid-Atlantic regions. Cities with high power plant emissions as well as local, industrial sources continue to show up on the list, including Pittsburgh; Detroit; Cleveland; Philadelphia; Cincinnati; Birmingham, AL; Indianapolis; Shreveport, LA; and Atlanta. Fortunately, year-round particle pollution continues to decline across most of the nation, unlike the days with high ozone and high short-term particle pollution. Because of their high numbers and long duration, western wildfires contributed to some of the elevated annual averages in Western cities. That is especially true in California and Pacific Northwest communities that experienced major wildfire smoke impacts in 2018. Cleanest Cities Four cities rank on all three cleanest cities lists for ozone, year-round particle pollution and short-term particle pollution. They had zero high ozone or high particle pollution days and are among the 25 cities with the lowest year-round particle levels. All four repeat their ranking on this list. Listed alphabetically, these cities are: Bangor, ME Burlington-South Burlington, VT Urban Honolulu, HI Wilmington, NC Nine other cities rank among the cleanest cities for both year-round and short-term levels of particle pollution. That means they had no days in the unhealthy level for short9 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 term particle pollution and are on the list of the cleanest cities for year-round particle pollution. Listed alphabetically below, they are: Appleton-Oshkosh-Neenah, WI Elmira-Corning, NY Gainesville-Lake City, FL Grand Island, NE Palm Bay-Melbourne-Titusville, FL Sioux Falls, SD Springfield, MA St. George, UT Syracuse-Auburn, NY Seventeen other cities rank among the cleanest for ozone and short-term particle pollution. That means they had no days in the unhealthy level for ozone or for short-term particle pollution. Listed alphabetically below, they are: Bowling Green-Glasgow, KY Clarksville, TN-KY Corpus Christi-Kingsville-Alice, TX Fayetteville-Sanford-Lumberton, NC Fayetteville-Springdale-Rogers, AR Florence, SC Fort Smith, AR-OK Gadsden, AL Houma-Thibodaux, LA La Crosse-Onalaska, WI-MN Lincoln-Beatrice, NE Monroe-Ruston, LA Morgantown-Fairmont, WV Roanoke, VA Springfield, MO Tallahassee, FL Topeka, KS Five cities rank on both lists for ozone and year-round particle pollution levels. These cities had no days in the unhealthy level for ozone pollution and are on the list of the cleanest cities for year-round particle pollution. Listed alphabetically below, they are: Anchorage, AK Bismarck, ND Casper, WY People at Risk The “State of the Air” 2020 shows that too many people in the United States live where the air is unhealthy for them to breathe. ■ ■ ■ 10 Duluth, MN-WI Salinas, CA Lung.org Nearly five in 10 people (45.8 percent) in the United States live in counties with unhealthful levels of either ozone or particle pollution. Approximately 150 million Americans live in these 257 counties with unhealthful levels of either ozone or shortterm or year-round particles. ● The number has increased—again. This year’s report found 8.76 million more Americans living in counties with unhealthy air compared to last year’s report, and 15.9 million more Americans compared to the 2018 report. Fortunately, the total is still far below the 166 million in the years covered in the 2016 report (2012-2014). ● Why? One big reason is climate change. Warmer weather, different rain patterns and major wildfires all contribute to continued challenges to long-term progress in reducing harmful air pollution under the Clean Air Act. More than four in 10 (41.9 percent) of the people in the United States live in areas with unhealthy levels of ozone pollution. More than 137 million people live in the 205 counties that earned an F for ozone in this year’s report, approximately 3 million more people than in last year’s report. Nearly one in six people (16.3 percent) in the United States—more than 53.3 million—live in an area with too many days with unhealthful levels of particle pollution. More people experienced those unhealthy spikes than in the last three reports. In the 2019 report, approximately 49.6 million people experienced too many unhealthy days; in the 2018 report, approximately 35.1 million people; and in the 2017 report, approximately 43 million people. American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 More than 21.2 million people (6.5 percent) suffered from unhealthy year-round levels of particle pollution in 2016-2018. These people live in 19 counties where the annual average concentration of particle pollution was too high. This population estimate is higher than the 20.5 million Americans living in 18 counties with unhealthy levels of year-round particle pollution reported in the 2019 report that covered 20152017. ■ 20.8 million people (6.4 percent) live in 14 counties with unhealthful levels of all three: ozone and short-term and year-round particle pollution in 2016-2018. This is over 600,000 more people living in the 12 U.S. counties with unhealthy levels for all three measures than in the 2019 report that covered 2015-2017. Many people are at greater risk because of their age; because they have asthma or other chronic lung disease or cardiovascular disease; because they have ever smoked; because they belong to communities of color or because they have low socioeconomic status. With the risks from airborne pollution being so great, the Lung Association seeks to inform people who may be in danger. The following list identifies the numbers of people in each at-risk group. ■ ■ ■ ■ ■ ■ ■ ■ ■ 11 Lung.org Older and Younger—Nearly 22 million adults age 65 and over and 34.2 million children under age 18 live in counties that received an F for at least one pollutant. More than 2.8 million seniors and 5 million children live in counties failing all three tests. Asthma—2.5 million children and 10.6 million adults with asthma live in counties that received an F for at least one pollutant. More than 316,000 children and nearly 1.4 million adults with asthma live in counties failing all three tests. Chronic Obstructive Pulmonary Disease (COPD)—Nearly 7 million people with COPD live in counties that received an F for at least one pollutant. More than 750,000 people with COPD live in counties failing all three tests. Lung Cancer—More than 77,000 people were diagnosed with lung cancer and live in counties that received an F for at least one pollutant. Nearly 8,400 people were diagnosed with lung cancer and live in counties failing all three tests. Cardiovascular Disease—More than 9.3 million people with cardiovascular diseases live in counties that received an F for at least one pollutant. Over 1 million people live in counties failing all three tests. Poverty—Evidence shows that people who have low incomes may face higher risk from air pollution. More than 18.7 million people with incomes meeting the federal poverty definition live in counties that received an F for at least one pollutant. More than 3 million people in poverty live in counties failing all three tests. Communities of Color—Studies have found that Hispanics, Asians, American Indians/Alaska Natives and especially African Americans experienced higher risks of harm, including premature death, from exposure to air pollution. Approximately 74 million people of color live in counties that received at least one failing grade for ozone and/or particle pollution. Over 14 million people of color live in counties that received failing grades on all three measures. People Who Have Ever Smoked—There is some recent evidence suggesting that people who have a history of smoking are at greater risk of premature death and of lung cancer when subjected to long-term exposure to fine particle pollution. Over 14.3 million Americans who have ever smoked live in counties that received at least one F for particle pollution. Of those, some 5.5 million people live in counties that received failing grades for all three pollutants. American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 Threats and opportunities for the nation’s air quality After 50 years under the Clean Air Act, the nation has made significant strides in cleaning up harmful air pollution. However, this year’s report shows that many communities are still waiting for healthy air, and that climate change poses current and growing threats to the nation’s progress. Fully implementing and enforcing the Clean Air Act and addressing climate change requires a strong, coordinated effort on the part of our federal, state, tribal and local leaders, and the need is more urgent than ever. Unfortunately, in almost every case, the current Administration has continued to attempt to roll back, weaken, or undermine core healthy air protections under the Clean Air Act. Not only has this Administration targeted specific Clean Air Act safeguards for rollbacks, it has also sought to weaken EPA’s ability to set future protections. Many of the rollbacks are not yet final and face challenges in court. However, the impacts of some of this Administration’s actions could be felt for years to come. At the same time as the Administration is halting progress or even moving backward on addressing climate change, many members of the U.S. Congress have worked to advance policies to reduce greenhouse gas emissions. This critical work presents real opportunities for cleaning up air pollution and improving lung health. However, some climate proposals actually include provisions that would weaken the Clean Air Act, a tradeoff that could lead to more health harm from air pollution. Below are key threats and opportunities for the nation’s progress toward cleaner, healthier air, plus ways that you can help. Opportunity: Congressional action on climate change To protect public health from climate change, the nation needs urgent action in every arena—from the Administration to the U.S. Congress to state, local and tribal governments to the private sector. The Clean Air Act requires EPA to limit greenhouse gases because of the danger they pose to human health. Congressional action is critical too, and climate conversations and ideas have been proliferating on Capitol Hill. There are many ways Congressional legislation could reduce emissions, like investing further in clean, renewable energy and incentivizing low- and zero-emission cars, buses and trucks. The Lung Association led a Declaration on Climate Change and Health with more than a dozen other leading national health organizations laying out five requirements for climate action. The nation needs climate policies that: Adopt science-based targets to prevent climate change above 1.5° C. Maximize benefits to health, reducing carbon and methane pollution while at the same time reducing other dangerous emissions from polluting sources. ■ Ensure pollution is cleaned up in all communities, including those near polluting sources that have historically borne a disproportionate burden from air pollution. ■ Leave the Clean Air Act fully in place. Any policy to address climate change must not weaken or delay the Clean Air Act or the authority that it gives EPA to reduce carbon emissions. ■ Ensure communities have the tools and resources to identify, prepare for and adapt to the unique health impacts of climate change in their communities. ● The nation’s public and environmental health systems must have adequate resources to protect communities by identifying, preparing for and responding to the health impacts of climate change. ● Community leaders must be able to adequately protect those whose health is most at risk, and provide access to uninterrupted, quality health care during and after disasters. What you can do: ■ Urge your members of Congress to support climate action to protect health, including the Climate Change Health Protection and Promotion Act. Take action now. ■ ■ 12 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 Threat 1: Weakening the Clean Air Act Congress must make certain that the Clean Air Act remains strong, fully implemented and fully enforced. The Clean Air Act remains a strong public health law put in place by an overwhelming bipartisan majority in Congress 50 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 EPA and each state to take steps to clean up the air to protect public health. For years, the “State of the Air” report chronicled the slow but steady improvement in the nation’s air quality thanks to the Clean Air Act. Now, that positive trend is threatened. Climate change is making pollution cleanup more difficult, and unfortunately, some in Congress seek changes to the Clean Air Act that would dismantle key provisions of the law and threaten the progress made over five decades. Undermining the Clean Air Act itself is one of the fundamental goals of polluters and their allies. They have repeatedly challenged Clean Air Act provisions in court, and have repeatedly lost, so now they seek to weaken the law. Proposed efforts include exempting certain polluting facilities from some emissions controls, delaying sciencebased updates to air pollution standards and undermining public health as the core premise of the Act’s key pollution limits. Another emerging threat is the idea that legislation to address climate change must come at the price of weakening the Clean Air Act. Several bills have been introduced that would put a fee or price on carbon, but would also postpone or permanently restrict EPA’s ability to reduce greenhouse gas emissions. We don’t accept this tradeoff. The Clean Air Act can and should work hand-in-hand with new laws in Congress to address climate change. Now is not the time to remove tools from the nation’s toolbox to address this urgent challenge. To protect the lives and health of millions of Americans, the Lung Association calls on Congress to reject attempts to weaken the Clean Air Act and make certain the law remains strong, fully implemented and fully enforced. What you can do: ■ Spread the word that some climate change legislation would actually weaken the Clean Air Act. Threat 2: Considering outdated particle and ozone pollution limits A fundamental reason for the success of the Clean Air Act is the requirement that EPA base decisions and actions on up-to-date science to protect public health. EPA has to periodically review its national limits on ozone and particle pollution (as well as four other pollutants) based on the current science and update them if necessary to reflect how much of each pollutant is safe to breathe. This requires ensuring that independent expert scientists regularly analyze current, peer-reviewed research and then provide their conclusions and perspectives to the EPA staff scientists and the Administrator. This process is critical. Over the years, research has shown that these pollutants are more dangerous than was known previously. In this way, the Clean Air Act requires EPA to make sure the national ozone and particle pollution standards protect Americans’ health. However, in 2018, the agency put forward a very aggressive timeline for completing a full review of both the ozone and particulate matter standards before the end of 2020.1 Such a shortened review has severely limited what has historically been a thorough assessment of the science. The current EPA also removed independent science advisors from key advisory committees, including the Clean Air Scientific Advisory Committee (CASAC), and replaced them with people with far less experience in the research or who were paid by polluting industries.2 EPA also dismissed a panel of experts who had been providing advice based on their deep understanding of the complex research on particle pollution. Many former participants and independent 13 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 health and medical groups, including the Lung Association, urged EPA to reinstitute the panel.3 Former chairs and members of CASAC have raised concerns about the lack of scientific expertise in the new members of the committee, as well as the dramatically reduced capacity for scientific reviews.4 With these changes to the process, in 2020, EPA proposed keeping the current limits on particle pollution in place, and is expected to do the same for ozone pollution—despite the fact that science has shown for years that these limits are too weak. What you can do: ■ Tell EPA today that they need to set strong limits on particle and ozone pollution that protect the public. Take action now. Threat 3: Dramatically weakening cleaner cars standards In 2020, EPA and the Department of Transportation finalized rules to weaken limits on greenhouse gas emissions from cars, SUVs and personal trucks for model year 2021-2026 vehicles. Weakening these cleaner cars standards will not only greatly slow progress in cleaning up climate pollution from the transportation sector, but will also cause additional premature deaths from air pollution. Even more drastically, in 2019, the Administration decided to attack the rights states have to set stronger standards to protect their residents. Under the Clean Air Act, California has the right to establish its own, stronger emissions standards for cars and trucks, and other states have the option of adopting California’s standards. The Administration formally revoked California’s permission to set its own limits on greenhouse gas emissions for cars, SUVs and light trucks, setting off a heated legal battle. California’s Clean Air Act authority to set more protective emissions standards has helped drive lifesaving reductions in harmful pollution from vehicles nationwide; maintaining this authority is critical. The Lung Association strongly opposed these rollbacks and recruited nearly 100 national, state and local health organizations to join comments to EPA in opposition.5 What you can do: ■ Drive less. Combine trips, walk, bike, carpool or vanpool, and use buses, subways or other alternatives to driving. ■ Support community plans that provide ways to get around that don’t require a car, such as more sidewalks, bike trails and transit systems. Threat 4: Putting limits on mercury and air toxics at risk In April 2020, EPA finalized a proposal that could undermine the Mercury and Air Toxics Standards, lifesaving protections that are fully implemented, widely supported, and successful in reducing a long list of dangerous emissions. In its proposal, EPA deliberately undercounted the benefits of these protections. EPA adopted the Mercury and Air Toxics Standards in 2011 to limit emissions of mercury and other hazardous air pollutants, including carcinogens, like arsenic, acid gases and other dangerous toxins. Reducing these emissions from power plants results in the reduction of other harmful emissions at the same time. Since then, the standards have not only slashed mercury and air toxics emissions but have also reduced particulate matter, preventing thousands of premature deaths and asthma attacks every year. EPA has proposed not to count the benefits stemming from reductions of particulate matter and other pollutants not explicitly covered by the rule, which artificially tips the balance to make the rule appear less cost effective than it is. This approach to calculating benefits, by design, obscures the enormous positive health impacts resulting from the Mercury and Air Toxics Standards. What you can do: ■ Call on your members of Congress to oppose EPA’s decision that threatens to undermine the Mercury and Air Toxics Standards. The standards have bipartisan 14 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 support, and your representative and senators need to hear from you so they speak up about this critical issue. Threat 5: Censoring the science available for EPA’s decisions In March 2020, EPA issued a proposal that resurrected a dangerous effort at the agency to suppress sound science, misleadingly labeled “Strengthening Transparency in Regulatory Science.” The proposed rule, which the Lung Association has deemed the “Censoring Science” proposal, would permit EPA to restrict the scientific studies the agency considers when it makes policy. EPA’s effort is under the guise of transparency because the proposal would undervalue or block studies based on data that, for privacy reasons, can’t be made public. However, this effort is disingenuous. The proposed rule would exclude sound research from informing regulations or important scientific information. The rule would ignore or discount key health studies that show that particle pollution, for example, can cause premature death—because those health studies are based on personal medical data that cannot and should not be released. Many databases that scientists use today do allow unrestricted access to their information, but others do not because of the need for patient confidentiality for subjects included in the research. The studies are available and transparent, but the private health data they are based on must be protected. Blocking the use of these key studies that have been through multiple independent reviews and show widespread harm from outdoor air pollutants introduces dangerous bias that could limit the evidence, risking weaker air pollution safeguards. Even in the midst of the COVID-19 crisis, EPA is pushing ahead with the Censoring Science proposal. The Lung Association is leading health, medical, scientific and academic organizations in pushing back. What you can do: ■ Raise your voice. There’s still time to sign our petition opposing EPA’s efforts to censor science. Join us at www.Lung.org/savescience Threat 6: Replacing the Clean Power Plan with dangerously weak standards Climate change is a public health emergency. To address it, the nation must dramatically cut greenhouse gases, including carbon pollution. Power plants comprise the largest stationary source of carbon pollution in the United States. The electric sector produced 28 percent of all U.S. greenhouse gas emissions in 2017.6 Unfortunately, the current EPA repealed a sweeping plan to limit carbon pollution from power plants, the Clean Power Plan, and has now finalized a new rule that will not only fail to meaningfully cut carbon, but could actually increase harmful emissions. The now-repealed Clean Power Plan was the only nationwide plan to clean up carbon pollution from power plants. Adopted in 2015, it would have delivered a flexible, practical toolkit for states to reduce carbon from power plants approximately 32 percent (below 2005 levels) by 2030. States could have chosen a variety of ways to cut carbon, including requiring cleaner fuels for existing utilities, improving energy efficiency, producing more clean energy or partnering with other states to jointly reduce carbon pollution. This would have not only tackled climate change, but also reduced ozone, particle pollution, and other air pollutants and immediately benefited people’s health. EPA’s replacement for the Clean Power Plan could be worse than doing nothing at all. Even though EPA repealed the Clean Power Plan, the Clean Air Act still requires that the agency reduce carbon pollution from power plants. In 2019, EPA finalized into law a dangerous replacement, called the “Affordable Clean Energy” (ACE) Rule. The ACE rule rejects the strong menu of options to reduce emissions that states had under the Clean Power Plan. Instead, it sets only minimal, totally inadequate limits on carbon emissions at power plants themselves. Worse, independent scientists found that this rule could result 15 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 in dirtier power plants running more often, which would actually increase air pollution emissions and the risk of premature deaths.7 In short, EPA’s replacement for the Clean Power Plan could be worse than doing nothing at all. The Lung Association led national health and medical organizations in speaking out in opposition to the ACE rule8 and is suing the Administration to stop it.9 The Clean Air Act requires that EPA address carbon pollution in a way that protects public health. The nation urgently needs a system-wide reduction in carbon dioxide emissions from power plants and other sources to combat climate change. What you can do: ■ Raise your voice. The Lung Association is taking EPA to court to get them to clean up climate pollution from power plants, but they’re not the only ones who can act. Call on your states and local governments to switch to clean, renewable electricity to address climate change and protect public health. ■ Reduce your electricity use. Turn off the lights and unplug appliances when you’re not using them. Switch to more energy-efficient electric appliances. If you have the option in your community, buy power from clean, renewable sources. Threat 7: Removing limits on methane emissions from the oil and gas industry Natural gas is far from clean. Oil and gas production wells, processing plants, transmission pipelines and storage units emit harmful gases, including volatile organic compounds and methane, a potent greenhouse gas. For the last few years, “State of the Air” has reported elevated levels of unhealthy ozone in places where oil and gas production has expanded, even in largely rural counties in the West. Despite this, EPA has taken multiple steps to weaken pollution limits for the industry that were set in 2016.10 Most recently, the agency proposed in 2019 to entirely roll back methane standards for new oil and gas sources, which would also result in other dangerous pollution that could have been prevented. EPA’s proposal would also prevent any limits on existing oil and gas industry sources, despite the fact that they are currently a major source of air pollution, including methane. We led hundreds of health professionals in raising their voices in opposition to EPA’s efforts.11 What you can do: ■ Raise your voice. Producing and burning natural gas for electricity creates air pollution and causes climate change. Call on your state and local governments to switch to clean, renewable electricity to address climate change and protect public health. ■ Reduce your electricity use. Turn off the lights and unplug appliances when you’re not using them. Switch to more energy-efficient electric appliances. If you have the option in your community, buy power from clean, renewable sources. Threat 8: Cutting funding needed to clean up the air The Trump Administration’s proposed budget would greatly reduce the ability of EPA to protect public health. The Clean Air Act set up smart, open processes for protecting Americans from air pollution, which have enabled the U.S. to reduce some of the most common pollutants by more than 70 percent. Still, these processes only work if EPA and state, local and tribal air agencies have the funding and staffing they need to implement and enforce the law. The Trump Administration has consistently proposed budgets that would greatly reduce the ability of EPA to protect public health, including slashing overall funding for the agency and reducing grants to support the work of state and local agencies and tribes to implement the requirements of the Clean Air Act and other critical laws. The Lung Association calls on Congress to ensure that EPA has sufficient funding to protect public health with the full range of programs, including state, local and tribal grants. In many cases, key EPA and other public health programs need funding increases to keep pace with their role in protecting the public. Investment in clean air and public health protections is critical. 16 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 Threat 9: Chipping away at air pollution enforcement EPA has issued several directives to roll back or undermine steps to implement the Clean Air Act’s requirements for reducing major air pollutants, weakening both current pollution cleanup and likely future air pollution standards, including for ozone and particulate matter. EPA proposed weakening “New Source Review” requirements, which would allow new polluting sources to add to the burden of unhealthy air in communities in several ways. The proposal would allow emissions to be calculated at an hourly rate as opposed to an annual one. The result would be that emissions could increase dramatically, but facilities would not have to install and operate modern pollution controls as long as their hourly rate of emissions did not increase. A similar bill, HR 172, has also been introduced in Congress. In 2019, EPA finalized guidance that redefined “ambient air” to allow industries to pollute more at their own facilities. This decision reversed a decades-old policy that narrowed the area that an industry could use, which helped limit public exposure to its emissions.12 The change will allow the industry to produce more emissions. EPA also announced an end to its decades-old “Once-In, Always-In” policy, allowing facilities to increase toxic air emissions.13 Under the old policy, if a facility emitted toxic air pollution above a certain threshold, it had to install and keep running strong pollution controls in the future. EPA’s reversal weakened the requirements that these facilities keep running their controls, potentially resulting in some of them increasing their pollution to just under the legal threshold. Finally, amidst the COVID-19 crisis, polluting industries have sought, and EPA has granted, compliance waivers. We strongly oppose a widespread relaxation of Clean Air Act compliance and enforcement. The COVID-19 pandemic and its disproportionate impacts on people with lung disease and other chronic conditions make the continued reduction of air pollution more important, not less. What You Can Do We at the Lung Association are long-time champions for healthy air! You can help reduce air pollution outdoors by taking these steps: Speak Up Today: Tell EPA to set stronger limits on particle and ozone pollution. The science is clear: The nation needs stronger limits on ozone and particle pollution to safeguard health. The current National Ambient Air Quality Standards for particulate matter and ozone are not sufficient to protect public health. Every family has the right to breathe healthy air—and the right to know when air pollution levels are unhealthy. Tell the Environmental Protection Agency to follow the science and set stronger limits on particle and ozone pollution. Other Ways You Can Help: Share your story. Do you or any member of your family have a personal reason to fight for healthier, cleaner air? Let us know why clean air matters to you. Your story helps us remind decision makers what is at stake when it comes to clean air. Speak up to Congress. Urge your members of Congress to oppose EPA’s proposal that could undermine the Mercury and Air Toxics Standards, to oppose legislation that would weaken the Clean Air Act, and to support climate action to protect health, including the Climate Change Health Protection and Promotion Act. Take action on climate and health now. Support strong science. Sign our petition opposing EPA’s efforts to censor science. Join us at www.Lung.org/savescience Get involved locally. Participate in state and local efforts to clean up air pollution and 17 Lung.org American Lung Association State of the Air 2020 S ta te of t h e A i r 2 0 2 0 address climate change, including by supporting clean, renewable electricity and cleaner vehicles. To find your local air pollution control agency, go to www.4cleanair.org. Step up to Curb Pollution in Your Community: Drive less. Once stay-at-home orders are lifted, 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, protected bike lanes and transit systems. If you must drive, switch to electric vehicles. Use less electricity. Turn out the lights and use energy-efficient electric appliances. Generating electricity is one of the biggest sources of pollution, particularly in the eastern U.S. If you have the option in your community, buy power from clean, renewable sources. 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 wood stove 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 wood stoves. Make sure your local school system requires cleaner school buses, which includes replacing them with electric buses or retrofitting old school buses with filters and other equipment to reduce emissions. Make sure your local schools don’t idle their buses; this step can immediately reduce emissions. Parents shouldn’t idle in their cars outside of schools either. Thank you for being a champion for healthy air. Endnotes 1. Memo from Scott Pruitt, EPA Administrator, Re: Back-to-Basics Process for Reviewing National Ambient Air Quality Standards, May 9, 2018. 2. Memo from EPA Administrator Scott Pruitt. Subject: Strengthening and Improving Membership on EPA Federal Advisory Committees. October 31, 2017. 3. The testimony took place at the December 12, 2018 meeting of the Chartered Clean Air Scientific Advisory Committee (CASAC) Public Meeting on Particulate Matter. All testimony is posted on that site. 4. Letter to Tony Cox, Chair Clean Air Scientific Advisory Committee from H. Christopher Frey, Jonathan M. Samet, et al. RE: CASAC Advice on the EPA’s Integrated Review Plan for the Ozone National Ambient Air Quality Standards (External Review Draft). November 26, 2018. 5. Letter from health and medical organizations opposing EPA’s proposed SAFE rule. https://www.lung.org/getmedia/7bcf3cd41d8b-4dfa-9acb-77d470e8654c/letter-from-health-orgs-cars.pdf.pdf 6. U.S. Environmental Protection Agency. Inventory of Greenhouse Gas Emissions and Sinks: 1990-2016. Washington, DC: U.S. EPA, 2017. Accessed at https://www.epa.gov/ghgemissions/sources-greenhouse-gas-emissions#electricity . 7. Driscoll C, Buonocore J, Levy J, Lambert K, et al. 2015 US power plant carbon standards and clean air and health co-benefits. Nature Climate Change 5: 525-540. Schwartz J, Buonocore J, Levy J, Driscoll C, Fallon Lambert K, and Reid S. Health Co-Benefits of Carbon Standard for existing Power Plants: Part 2 of the Co-Benefits of Carbon Standards Study. September 30, 2014. Harvard School of Public Health, Syracuse University, Boston University. Available at https://science-policy-exchange.org/sites/ default/files/documents/Co-benefits%20of%20Carbon%20Standards%20Part%202%20Sept%202014.pdf. 8. These comments are available at http://www.Lung.org/get-involved/become-an-advocate/advocacy-archive.html. 9. U.S. Court of Appeals for the District of Columbia. Case # 19-1140. American Lung Association, et al. v. EPA. 10. U.S. EPA. Proposed Improvements 2016 New Source Performance Standards, September 11, 2018. 11. Letter from More than 660 Health Professionals in Support of Existing Methane Standard. https://www.Lung.org/ getmedia/3cdda4b9-4e2f-4697-bd02-b4e2ab302d9a/letter-from-more-than-660.pdf.pdf 12. U.S. EPA. Draft Guidance: Revised Policy on Exclusions from “Ambient Air.” November 2018. 13. U.S. EPA. News Release: Reducing Regulatory Burdens: EPA withdraws “once in always in” policy for major sources under Clean Air Act. January 25, 2018. 18 Lung.org American Lung Association State of the Air 2020 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 Ever People of Total of the Grades were: Asthma Asthma COPD Cancer Disease Under 18 Over Smoked Poverty Color Population Counties Grade A (0.0) 6,771,123 1,540,293 5,031,440 54,370 6,467,143 19,623,845 14,558,915 28,761,321 11,548,118 35,476,477 89,725,896 297 Grade B (0.3-0.9) 3,395,014 825,353 2,534,578 28,260 3,264,583 10,789,019 7,142,293 14,992,254 6,255,351 22,545,548 48,238,919 146 Grade C (1.0-2.0) 1,667,126 453,027 1,170,274 12,828 1,576,668 5,899,670 3,304,468 7,263,158 3,592,833 13,274,054 Grade D (2.1-3.2) 297,273 78,677 227,604 2,422 293,574 1,006,718 647,467 1,353,195 3,650,451 805,614 2,072,796 22,256 2,943,875 12,296,306 7,698,577 14,323,380 Grade F (3.3+) 24,844,467 45 1,220,236 4,261,043 20 6,472,755 29,407,484 53,316,714 86 533,123 National Population in Counties with PM2.5 Monitors 16,365,270 3,835,792 11,435,112 124,583 15,088,287 51,343,463 34,641,698 69,123,521 29,256,648 104,469,732 228,178,923 645 People at Risk from Year-Round Particle Pollution (Annual PM2.5) Chronic Diseases Age Groups Number In Counties Where Adult Pediatric Lung CV 65 and Ever People of Total of the Grades Were: Asthma Asthma COPD Cancer Disease Under 18 Over Smoked Poverty Color Population Counties Pass 13,797,857 3,247,886 9,842,855 106,862 12,901,183 42,746,567 29,184,251 58,662,062 24,290,620 84,732,794 191,137,371 519 Fail 1,399,442 323,798 767,735 8,595 1,098,607 5,048,346 2,913,516 5,499,833 3,112,327 14,329,923 21,224,804 19 National Population in Counties with PM2.5 Monitors 16,365,270 3,835,792 11,435,112 124,583 15,088,287 51,343,463 34,641,698 69,123,521 29,256,648 104,469,732 228,178,923 645 People at Risk from Ozone1 Chronic Diseases Age Groups Number In Counties Where Adult Pediatric 65 and People of Total of the Grades Were: Asthma Asthma COPD CV Disease Under 18 Over Poverty Color Population Counties Grade A (0.0) 1,485,752 361,796 1,149,162 1,520,167 4,612,771 3,484,440 2,872,939 7,809,825 20,784,760 170 Grade B (0.3-0.9) 1,949,843 446,903 1,580,840 2,067,129 5,690,920 4,802,293 3,020,587 8,174,133 26,703,636 156 Grade C (1.0-2.0) 2,646,783 609,876 2,023,691 2,615,173 7,893,302 5,762,978 4,256,792 12,510,496 35,749,159 162 Grade D (2.1-3.2) 1,548,364 344,073 1,093,194 1,439,274 4,628,217 3,330,503 2,336,936 9,669,752 21,124,073 71 Grade F (3.3+) 9,684,568 2,320,597 6,462,926 8,607,973 31,417,262 19,906,283 17,458,838 68,018,031 137,058,693 205 National Population in Counties with Ozone Monitors 17,448,325 4,115,709 12,413,590 16,386,810 54,651,603 37,598,655 30,170,408 106,556,189 243,244,612 803 Note: 1. “State of the Air” 2020 covers the period 2016-2018. The Appendix provides a full discussion of the methodology. 19 Lung.org American Lung Association State of the Air 2020 Rankings People at Risk In 25 U.S. Cities Most Polluted by Short-Term Particle Pollution (24-hour PM2.5) 2020 Rank1 Metropolitan Statistical Areas Total Population2 65 and Pediatric Adult Lung CV Ever Under 183 Over3 Asthma4,6 Asthma5,6 COPD7 Cancer8 Disease9 Smoked10 People of Color11 Poverty12 1 Fresno-Madera-Hanford, CA 1,303,438 366,122 159,680 22,603 79,423 41,465 505 59,329 307,787 913,514 264,309 2 Bakersfield, CA 896,764 259,180 98,347 16,001 53,894 27,503 348 39,003 208,055 596,328 177,021 3 San Jose-San FranciscoOakland, CA 9,666,055 2,083,848 1,441,150 128,651 647,292 353,447 3,744 513,313 2,532,824 5,940,594 910,851 4 Fairbanks, AK 98,971 23,861 10,204 1,708 6,791 4,061 55 4,617 31,974 30,429 8,104 5 Yakima, WA 251,446 74,480 34,524 5,444 16,911 8,764 135 13,490 66,527 144,155 40,961 6 Los Angeles-Long Beach, CA 18,764,814 4,270,638 2,583,214 263,657 1,234,623 662,425 7 Missoula, MT 118,791 22,315 18,506 1,189 9,790 5,034 62 7,707 41,975 12,853 14,719 7 Redding-Red Bluff, CA 243,956 53,947 49,942 3,331 16,467 9,990 94 15,013 65,808 57,523 37,668 7 Salt Lake City-Provo-Orem, UT 2,606,548 775,252 263,814 42,545 170,894 75,292 664 104,041 457,968 603,254 217,929 10 Phoenix-Mesa, AZ 4,911,851 1,164,393 775,920 93,868 379,311 261,519 2,194 337,858 1,505,840 2,203,881 600,386 11 Sacramento-Roseville, CA 2,619,754 599,091 414,668 36,986 173,009 96,594 1,013 141,372 679,845 1,234,160 338,884 12 Visalia, CA 465,861 142,848 53,292 8,819 27,348 14,170 181 20,216 105,845 335,036 102,451 13 Logan, UT-ID 140,794 42,891 13,952 2,427 8,983 3,916 39 5,308 25,208 22,401 17,024 14 Spokane-Spokane ValleyCoeur d'Alene, WA-ID 721,396 160,636 124,491 11,686 52,584 30,239 379 46,302 215,142 102,458 87,827 14 Seattle-Tacoma, WA 4,853,364 1,036,349 704,616 75,755 365,436 187,900 2,611 286,299 1,434,277 1,687,561 424,549 16 Pittsburgh-New CastleWeirton, PA-OH-WV 2,612,492 493,652 526,956 47,773 214,077 160,936 1,678 219,828 363,815 291,201 7,264 956,017 4,815,313 13,006,958 2,440,945 920,378 17 Chico, CA 231,256 46,213 42,992 2,853 15,844 9,018 90 13,309 62,372 65,598 42,016 18 Medford-Grants Pass, OR 306,957 62,363 70,945 4,521 28,323 18,493 155 26,297 108,610 54,567 46,792 19 Salinas, CA 435,594 113,834 59,201 7,028 27,378 14,688 169 21,215 106,690 306,813 55,614 20 El Centro, CA 181,827 51,765 23,580 3,196 11,043 5,862 71 8,440 42,925 162,999 37,014 21 Santa Maria-Santa Barbara, CA 446,527 98,787 68,465 6,099 29,547 15,916 173 23,056 115,063 249,761 54,029 22 Eugene-Springfield, OR 379,611 69,868 73,392 5,065 36,150 21,366 192 29,676 133,980 70,215 67,217 23 Reno-Carson City-Fernley, NV 629,453 132,368 114,311 9,214 39,394 37,442 319 47,976 208,837 216,972 63,145 24 Portland-VancouverSalem, OR-WA 3,239,335 704,918 498,715 51,192 288,636 159,742 1,659 222,293 1,060,542 25 Las Vegas-Henderson, NV 2,276,993 525,247 342,326 36,562 139,723 124,078 1,152 156,491 722,232 870,251 340,971 1,300,943 314,702 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 2018 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 2018 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 2016. 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. Ever smoked estimates are for adults 18 and over who have ever smoked 100 or more cigarettes in their life, based on state rates (BRFSS) applied to population estimates (U.S. Census). 11. People of color are anyone of Hispanic ethnicity or a race other than white. 12. Poverty estimates come from the U.S. Census Bureau and are for all ages. 20 Lung.org American Lung Association State of the Air 2020 Rankings People at Risk In 25 U.S. Cities Most Polluted by Year-Round Particle Pollution (Annual PM2.5) 2020 Rank1 Metropolitan Statistical Areas Total Population2 65 and Pediatric Adult Lung CV Ever Under 183 Over3 Asthma4,6 Asthma5,6 COPD7 Cancer8 Disease9 Smoked10 People of Color11 Poverty12 896,764 259,180 98,347 16,001 53,894 1,303,438 366,122 159,680 22,603 465,861 142,848 53,292 8,819 18,764,814 1 Bakersfield, CA 2 Fresno-Madera-Hanford, CA 3 Visalia, CA 4 Los Angeles-Long Beach, CA 5 San Jose-San FranciscoOakland, CA 6 Fairbanks, AK 7 Phoenix-Mesa, AZ 8 El Centro, CA 8 Pittsburgh-New CastleWeirton, PA-OH-WV 2,612,492 493,652 10 Detroit-Warren-Ann Arbor, MI 5,353,002 1,167,571 11 Cleveland-Akron-Canton, OH 3,599,264 12 McAllen-Edinburg, TX 930,464 12 Philadelphia-ReadingCamden, PA-NJ-DE-MD 7,204,035 1,563,815 14 Birmingham-HooverTalladega, AL 1,315,071 299,130 14 Cincinnati-Wilmington Maysville, OH-KY-IN 27,503 348 39,003 208,055 596,328 177,021 79,423 41,465 505 59,329 307,787 913,514 264,309 27,348 14,170 181 20,216 105,845 335,036 102,451 4,270,638 2,583,214 263,657 1,234,623 662,425 7,264 956,017 4,815,313 13,006,958 2,440,945 9,666,055 2,083,848 1,441,150 128,651 647,292 353,447 3,744 513,313 2,532,824 98,971 23,861 10,204 1,708 6,791 4,061 4,911,851 1,164,393 775,920 93,868 379,311 261,519 181,827 51,765 23,580 3,196 11,043 5,862 526,956 55 5,940,594 910,851 31,974 30,429 8,104 2,194 337,858 1,505,840 2,203,881 600,386 162,999 37,014 71 4,617 8,440 42,925 47,773 214,077 160,936 1,678 219,828 920,378 363,815 291,201 878,042 100,227 467,545 361,975 3,258 405,383 1,903,919 1,711,850 766,528 762,709 665,627 59,285 266,809 248,192 2,369 303,179 103,338 23,991 46,626 37,355 460 1,172,273 137,782 546,942 367,327 107,332 104,605 216,148 39,477 303,425 1,308,507 862,428 482,828 221,989 875,994 278,136 4,448 505,159 2,313,363 2,755,807 863,095 458,703 188,402 54,456 863 131,219 445,278 2,272,152 531,476 347,135 39,399 171,496 158,664 1,608 181,756 812,130 462,928 262,757 16 Indianapolis-Carmel-Muncie, IN 2,431,361 587,696 347,061 51,145 182,624 164,004 1,743 195,671 830,603 618,582 297,292 16 Missoula, MT 16 Sacramento-Roseville, CA 16 Shreveport-Bossier CityMinden, LA 20 Chicago-Naperville, IL-IN-WI 20 Medford-Grants Pass, OR 306,957 62,363 22 Houston-The Woodlands, TX 7,183,143 1,897,159 23 Atlanta-Athens-Clarke CountySandy Springs, GA-AL 6,775,511 1,642,659 855,689 124,911 23 Chico, CA 231,256 46,213 42,992 2,853 25 Brownsville-HarlingenRaymondville, TX 445,423 133,641 60,430 10,575 25 St. Louis-St. Charles Farmington, MO-IL 118,791 22,315 18,506 1,189 9,790 5,034 62 7,707 41,975 12,853 14,719 2,619,754 599,091 414,668 36,986 173,009 96,594 1,013 141,372 679,845 1,234,160 338,884 39,553 144,433 203,797 85,607 436,341 104,477 72,410 9,142 29,706 33,398 282 9,866,910 2,241,630 1,451,741 140,534 673,886 510,490 6,298 70,945 4,521 28,323 18,493 809,495 150,125 395,360 317,983 3,559 462,780 1,889,107 4,591,549 1,018,964 461,612 374,851 4,240 461,776 1,931,461 3,450,999 803,621 15,844 9,018 90 13,309 62,372 65,598 42,016 23,290 19,934 220 29,290 112,466 406,442 123,562 155 633,418 2,960,335 26,297 4,578,321 1,110,613 108,610 54,567 46,792 2,909,777 643,945 483,131 50,287 208,874 193,154 1,965 220,425 969,825 748,141 337,275 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 2018 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 2018 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 2016. 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. Ever smoked estimates are for adults 18 and over who have ever smoked 100 or more cigarettes in their life, based on state rates (BRFSS) applied to population estimates (U.S. Census). 10. People of color are anyone of Hispanic ethnicity or a race other than white. 11. Poverty estimates come from the U.S. Census Bureau and are for all ages. 21 Lung.org American Lung Association State of the Air 2020 Rankings People at Risk In 25 Most Ozone-Polluted Cities 2020 Rank1 Metropolitan Statistical Areas 1 Los Angeles-Long Beach, CA Total Population2 18,764,814 65 and Pediatric Adult CV Under 183 Over3 Asthma4,6 Asthma5,6 COPD7 Disease8 4,270,638 2,583,214 263,657 1,234,623 662,425 People of Color9 Poverty10 956,017 13,006,958 4,815,313 2 Visalia, CA 465,861 142,848 53,292 8,819 27,348 14,170 20,216 335,036 105,845 3 Bakersfield, CA 896,764 259,180 98,347 16,001 53,894 27,503 39,003 596,328 208,055 4 Fresno-Madera-Hanford, CA 1,303,438 366,122 159,680 22,603 79,423 41,465 59,329 913,514 307,787 5 Sacramento-Roseville, CA 2,619,754 599,091 414,668 36,986 173,009 96,594 141,372 1,234,160 679,845 6 3,343,364 San Diego-Chula Vista-Carlsbad, CA 7 Phoenix-Mesa, AZ 722,408 469,454 44,599 222,727 118,450 170,564 1,832,022 866,445 4,911,851 1,164,393 775,920 93,868 379,311 261,519 337,858 2,203,881 1,505,840 8 San Jose-San Francisco-Oakland, CA 9,666,055 2,083,848 1,441,150 128,651 647,292 353,447 513,313 5,940,594 2,532,824 9 Las Vegas-Henderson, NV 2,276,993 525,247 342,326 36,562 139,723 124,078 156,491 1,300,943 722,232 10 Denver-Aurora, CO 11 Salt Lake City-Provo-Orem, UT 12 New York-Newark, NY-NJ-CT-PA 13 Redding-Red Bluff, CA 14 Houston-The Woodlands, TX 15 El Centro, CA 3,572,798 803,973 464,674 57,540 250,127 117,348 156,017 1,239,843 1,115,483 2,606,548 775,252 263,814 42,545 170,894 75,292 22,679,948 4,852,039 3,601,621 332,013 1,727,257 999,220 603,254 457,968 1,399,513 11,714,237 104,041 6,555,824 243,956 53,947 49,942 3,331 16,467 9,990 15,013 57,523 65,808 7,183,143 1,897,159 809,495 150,125 395,360 317,983 462,780 4,591,549 1,889,107 181,827 51,765 23,580 3,196 11,043 5,862 8,440 162,999 42,925 16 Chicago-Naperville, IL-IN-WI 9,866,910 2,241,630 1,451,741 140,534 673,886 510,490 633,418 4,578,321 2,960,335 17 1,063,075 El Paso-Las Cruces, TX-NM 282,247 138,167 22,128 61,919 47,098 67,360 905,812 285,690 18 Chico, CA 231,256 46,213 42,992 2,853 15,844 9,018 13,309 65,598 62,372 19 Fort Collins, CO 350,518 68,703 54,938 4,917 25,460 12,323 16,693 61,373 114,131 20 Washington-Baltimore-Arlington, DC-MD-VA-WV-PA 9,796,147 2,213,754 1,378,591 170,198 715,068 458,462 617,799 4,798,740 2,794,310 21 7,948,477 162,557 442,787 361,074 526,069 Dallas-Fort Worth, TX-OK 22 Sheboygan, WI 2,051,630 931,511 4,201,204 2,120,744 115,456 25,431 20,789 2,146 8,211 4,980 7,138 18,681 38,889 23 Philadelphia-Reading-Camden, PA-NJ-DE-MD 7,204,035 1,563,815 1,172,273 137,782 546,942 367,327 505,159 2,755,807 2,313,363 24 Milwaukee-Racine-Waukesha, WI 2,049,391 464,985 326,928 39,235 145,433 83,225 116,927 619,356 676,594 25 Hartford-East Hartford, CT 1,473,084 293,974 258,397 28,550 121,927 63,740 89,946 467,678 468,975 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 ozone 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 2018 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 2018 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. People of color are anyone of Hispanic ethnicity or a race other than white. 10. Poverty estimates come from the U.S. Census Bureau and are for all ages. 22 Lung.org American Lung Association State of the Air 2020 Rankings People at Risk in 25 Counties Most Polluted by Short-Term Particle Pollution (24-hour PM2.5) High PM2.5 Days in Unhealthy Ranges, At-Risk Groups 2016–2018 2020 Rank1 County State Total 65 and Pediatric Adult Lung CV Ever Population2 Under 183 Over3 Asthma4,6 Asthma5,6 COPD7 Cancer8 Disease9 Smoked10 People Weighted of Color11 Poverty12 Avg.13 Grade14 1 Fresno CA 994,400 281,819 122,113 17,399 60,395 31,587 385 45,226 234,129 705,643 208,627 37.8 F 2 Kings CA 151,366 40,964 15,516 2,529 9,283 4,580 59 6,416 35,590 103,277 25,481 36.2 F 3 Kern CA 896,764 259,180 98,347 16,001 53,894 27,503 348 39,003 208,055 596,328 177,021 35.8 F 4 Stanislaus CA 549,815 148,801 72,319 9,187 34,134 18,290 213 26,395 133,042 323,635 26.7 F 5 Fairbanks North Star Borough AK 6 CA San Joaquin 7 Ravalli 98,971 752,660 23,861 10,204 204,316 95,916 1,708 12,614 6,791 46,649 4,061 24,840 55 4,617 292 35,760 31,974 30,429 181,645 519,021 84,744 8,104 26.5 105,351 21.5 F F MT 43,172 8,246 11,138 439 3,398 2,415 23 3,745 15,880 3,154 6,628 19.8 F 8 Merced CA 274,765 80,588 30,845 4,975 16,418 8,420 107 11,965 63,423 200,196 56,863 19.7 F 9 Yakima 9 Lewis and Clark WA 251,446 74,480 34,524 5,444 16,911 8,764 135 13,490 66,527 144,155 40,961 17.8 F MT 68,700 14,770 12,903 787 5,395 3,278 36 4,971 24,014 6,059 7,061 17.8 F 11 Madera CA 157,672 43,339 22,051 2,676 9,745 5,298 61 7,688 38,068 104,594 30,201 17.2 F 11 Siskiyou CA 43,724 8,802 11,160 543 3,062 1,998 17 3,066 12,428 10,636 7,396 17.2 F 13 Plumas CA 18,804 3,173 5,345 196 1,378 927 7 1,435 5,635 3,123 2,317 16.2 F 14 Okanogan WA 42,132 9,769 9,094 714 3,150 1,916 23 3,087 12,841 14,878 7,049 14.8 F 15 Lincoln MT 19,794 3,609 5,670 192 1,557 1,182 10 1,840 7,431 1,491 3,964 14.3 F 16 Los Angeles CA 10,105,518 17 Shoshone ID 12,796 18 Missoula MT 18 Utah UT 18 Tehama 21 Colusa 22 Pinal 2,188,893 1,375,957 135,136 673,459 358,245 188 866 662 3,911 515,500 2,622,021 7,466,160 1,409,155 2,630 2,923 6 988 118,791 22,315 18,506 1,189 9,790 5,034 62 7,707 622,213 207,710 48,050 11,399 38,230 15,362 159 20,064 CA 63,916 15,363 12,389 948 4,205 2,533 25 3,797 CA 21,627 5,907 3,163 365 1,344 745 8 1,087 AZ 447,138 100,778 91,129 8,124 34,832 26,058 201 34,552 13.8 F 1,140 2,371 13.3 F 41,975 12,853 14,719 12.3 F 100,766 111,686 57,136 12.3 F 16,786 20,718 10,749 12.3 F 5,273 14,202 2,350 12.0 F 142,549 194,203 54,399 11.5 F 4,079 22 Salt Lake UT 1,152,633 312,889 125,157 17,171 78,549 35,187 294 49,059 211,172 338,240 102,660 11.5 F 24 CA Sacramento 1,540,975 363,909 217,601 22,467 100,345 54,282 596 78,584 391,898 859,537 217,138 11.3 F 24 Mendocino CA 87,606 18,713 19,366 1,155 5,988 3,712 34 5,617 24,035 30,951 15,140 11.3 F Notes: 1. Counties are ranked by weighted average. See note 13 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 2018 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 2018 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 2016. 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. Ever smoked estimates are for adults 18 and over who have ever smoked 100 or more cigarettes in their life, based on state rates (BRFSS) applied to population estimates (U.S. Census). 11. People of color are anyone of Hispanic ethnicity or a race other than white. 12. Poverty estimates come from the U.S. Census Bureau and are for all ages. 13. The weighted average was derived by counting the number of days in each unhealthful range (orange, red, purple, maroon) in each year (2016-2018), 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. 14. 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+. 23 Lung.org American Lung Association State of the Air 2020 Rankings People at Risk in 25 Counties Most Polluted by Year-Round Particle Pollution (Annual PM2.5) PM2.5 Annual, At-Risk Groups 2016–2018 2020 Rank1 County State Total 65 and Pediatric Adult Lung CV Ever Population2 Under 183 Over3 Asthma4,6 Asthma5,6 COPD7 Cancer8 Disease9 Smoked10 People Design Pass/ of Color11 Poverty12 Value13 Fail14 1 Kern CA 896,764 259,180 98,347 16,001 53,894 27,503 348 39,003 208,055 596,328 177,021 17.8 Fail 2 Kings CA 151,366 40,964 15,516 2,529 9,283 4,580 59 6,416 35,590 103,277 25,481 16.8 Fail 3 CA 465,861 4 Fresno Tulare CA 994,400 281,819 122,113 17,399 60,395 31,587 385 45,226 234,129 705,643 208,627 15.0 Fail 142,848 53,292 8,819 27,348 14,170 181 20,216 105,845 335,036 102,451 16.1 Fail 5 Plumas CA 18,804 3,173 5,345 196 1,378 927 7 1,435 5,635 3,123 2,317 14.7 Fail 5 San Bernardino CA 2,171,603 572,278 251,361 35,331 135,544 70,099 841 99,838 524,916 1,564,843 317,514 14.7 Fail 7 Stanislaus CA 549,815 148,801 72,319 9,187 34,134 18,290 213 26,395 133,042 323,635 84,744 14.2 Fail 8 Riverside CA 2,450,758 616,126 353,122 38,038 156,550 85,478 949 124,180 612,354 1,600,121 307,511 13.9 Fail 9 CA San Joaquin 752,660 204,316 95,916 12,614 46,649 24,840 292 35,760 181,645 519,021 105,351 13.8 Fail 10 Merced CA 274,765 80,588 30,845 4,975 16,418 8,420 107 11,965 63,423 200,196 56,863 13.4 Fail 11 Fairbanks North Star Borough AK 98,971 23,861 10,204 1,708 6,791 4,061 55 4,617 31,974 30,429 8,104 13.1 Fail 12 Pinal AZ 447,138 100,778 91,129 8,124 34,832 26,058 201 34,552 142,549 194,203 54,399 13.0 Fail 13 Lincoln MT 19,794 3,609 5,670 192 1,557 1,182 10 1,840 7,431 1,491 3,964 12.9 Fail 14 Madera CA 157,672 43,339 22,051 2,676 9,745 5,298 61 7,688 38,068 104,594 30,201 12.8 Fail 15 Los Angeles CA 10,105,518 2,188,893 1,375,957 135,136 673,459 358,245 3,911 515,500 2,622,021 7,466,160 1,409,155 12.7 Fail 16 Allegheny PA 12.6 1,218,452 227,749 230,377 22,168 99,742 70,310 778 96,971 424,109 263,512 138,397 Fail 16 Imperial CA 181,827 51,765 23,580 3,196 11,043 5,862 71 8,440 42,925 162,999 37,014 12.6 Fail 18 Klamath OR 19 Hawaii HI 200,983 43,553 42,032 4,444 14,524 6,922 92 13,054 62,784 140,018 30,903 12.3 Fail 20 Alameda CA 1,666,753 342,510 230,510 21,146 112,623 59,859 645 86,118 438,363 1,148,783 147,394 12.0 Pass 21 ID Lemhi 22 Wayne 67,653 14,706 14,340 1,066 6,153 3,903 34 5,512 23,338 15,294 12,310 12.4 Fail 7,961 1,488 2,409 106 544 458 4 726 2,679 533 1,154 11.4 Pass MI 1,753,893 414,221 270,554 35,558 150,021 113,859 1,066 126,753 607,144 886,177 376,649 11.3 Pass 23 Shoshone ID 12,796 2,630 2,923 188 866 662 6 988 4,079 1,140 2,371 11.2 Pass 24 Ventura CA 850,967 194,553 132,387 12,011 56,290 31,535 329 46,171 221,522 468,345 76,206 11.0 Pass 24 Cuyahoga OH 1,243,857 257,882 225,983 20,045 92,829 84,905 817 103,312 453,134 512,719 217,166 11.0 Pass Notes: 1. Counties are ranked by design value. See note 13 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 2018 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 2018 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 2016. 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. Ever smoked estimates are for adults 18 and over who have ever smoked 100 or more cigarettes in their life, based on state rates (BRFSS) applied to population estimates (U.S. Census). 11. People of color are anyone of Hispanic ethnicity or a race other than white. 12. Poverty estimates come from the U.S. Census Bureau and are for all ages. 13. 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). 14. Grades are based on EPA's determination of meeting or failure to meet the NAAQS for annual PM2.5 levels during 2015-2017. Counties meeting the NAAQS received grades of Pass; counties not meeting the NAAQS received grades of Fail. 24 Lung.org American Lung Association State of the Air 2020 Rankings People at Risk in 25 Most Ozone-Polluted Counties At-Risk Groups High Ozone Days in Unhealthy Ranges, 2016–2018 2020 Rank1 County State Total 65 and Pediatric Adult CV Population2 Under 183 Over3 Asthma4,6 Asthma5,6 COPD7 Disease8 1 2,171,603 San Bernardino CA 572,278 251,361 35,331 135,544 70,099 99,838 People Weighted of Color9 Poverty10 Avg.11 Grade12 1,564,843 317,514 174.3 F 2 Riverside CA 2,450,758 616,126 353,122 38,038 156,550 85,478 124,180 1,600,121 307,511 138.8 F 3 Los Angeles CA 10,105,518 2,188,893 1,375,957 135,136 673,459 358,245 515,500 7,466,160 1,409,155 111.0 F 4 Tulare CA 465,861 142,848 53,292 8,819 27,348 14,170 20,216 335,036 102,451 105.2 F 5 Kern CA 103.2 6 Fresno CA 994,400 281,819 122,113 17,399 60,395 31,587 45,226 705,643 208,627 7 Nevada CA 99,696 17,071 27,380 1,054 7,266 4,821 7,432 15,030 10,171 51.2 F 8 San Diego CA 3,343,364 722,408 469,454 44,599 222,727 118,450 170,564 1,832,022 372,148 43.3 F 9 Placer CA 393,149 87,441 76,906 5,398 26,478 15,911 23,831 109,849 27,596 40.7 F 10 El Dorado CA 190,678 37,821 40,389 2,335 13,335 8,279 12,506 42,700 15,401 40.2 F 11 Maricopa AZ 4,410,824 1,052,788 669,285 84,871 340,115 231,647 298,086 1,989,191 535,183 39.8 F 12 Kings CA 151,366 40,964 15,516 2,529 9,283 4,580 6,416 103,277 25,481 39.5 F 13 CA 31.8 Stanislaus 896,764 549,815 259,180 98,347 148,801 72,319 16,001 9,187 53,894 34,134 27,503 18,290 39,003 26,395 596,328 323,635 177,021 84,744 F 85.8 F F 14 Tuolumne CA 54,539 9,158 14,279 565 3,969 2,562 3,923 11,026 6,417 31.7 F 15 Madera CA 157,672 43,339 22,051 2,676 9,745 5,298 7,688 104,594 30,201 16 NV Clark 2,231,647 517,629 328,692 36,032 136,812 120,615 151,858 1,289,911 307,977 31.0 F 30.2 F 17 Jefferson CO 580,233 114,515 95,477 8,196 41,776 21,576 29,476 127,678 39,799 29.2 F 18 Salt Lake UT 1,152,633 312,889 125,157 17,171 78,549 35,187 49,059 338,240 102,660 25.7 F 19 CA 25.0 Sacramento 1,540,975 363,909 217,601 22,467 100,345 54,282 78,584 859,537 217,138 F 20 Fairfield CT 943,823 212,038 149,918 20,593 76,126 39,383 54,861 363,243 92,971 23.0 F 21 CA 22.5 Tehama 21 Mariposa 23 Harris 63,916 15,363 12,389 948 4,205 2,533 3,797 20,718 10,749 F CA 17,471 2,828 4,882 175 1,289 859 1,325 3,551 2,569 22.5 F TX 4,698,619 1,251,684 494,264 99,047 257,086 201,143 291,795 3,331,840 767,367 22.3 F 24 Merced CA 274,765 80,588 30,845 4,975 16,418 8,420 11,965 200,196 56,863 22.0 F 25 Imperial CA 181,827 51,765 23,580 3,196 11,043 5,862 8,440 162,999 37,014 19.7 F 25 CO 19.7 Douglas 342,776 88,978 40,935 6,368 22,775 11,168 14,826 61,999 8,975 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 ozone 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 2018 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 2018 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. People of color are anyone of Hispanic ethnicity or a race other than white. 10. Poverty estimates come from the U.S. Census Bureau and are for all ages. 11. The weighted average was derived by counting the number of days in each unhealthful range (orange, red, purple) in each year (2016-2018), 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. 12. Grade is assigned by weighted average as follows: A=0.0, B=0.3-0.9, C=1.0-2.0, D=2.1-3.2, F=3.3+. 25 Lung.org American Lung Association State of the Air 2020 Rankings Cleanest U.S. Cities for Short-Term Particle Pollution (24-hour PM2.5)1 Metropolitan Statistical Area Population Metropolitan Statistical Area Albany-Schenectady, NY 1,171,593 Grand Island, NE Albuquerque-Santa Fe-Las Vegas, NM 1,156,187 Grand Rapids-Kentwood-Muskegon, MI Population 75,808 1,406,918 Metropolitan Statistical Area Peoria, IL Portland-Lewiston-South Portland, ME Alexandria, LA 153,044 Green Bay-Shawano, WI 367,045 Richmond, VA Appleton-Oshkosh-Neenah, WI 408,544 Greenville-Kinston-Washington, NC 282,969 Roanoke, VA Bangor, ME 151,096 Harrisonburg-Staunton, VA 258,284 Rochester-Batavia-Seneca Falls, NY Birmingham-Hoover-Talladega, AL 1,315,071 Hartford-East Hartford, CT 433,334 Saginaw-Midland-Bay City, MI 377,932 Houma-Thibodaux, LA 209,136 Salisbury-Cambridge, MD-DE 441,977 Huntsville-Decatur, AL 614,739 Scranton—Wilkes-Barre, PA 555,485 Jackson-Brownsville, TN 195,589 Sierra Vista-Douglas, AZ 126,770 Johnstown-Somerset, PA 205,682 Sioux Falls, SD 265,653 Kalamazoo-Battle Creek-Portage, MI 504,022 Springfield, MA 702,724 Kokomo-Peru, IN 117,933 Springfield, MO 466,978 La Crosse-Onalaska, WI-MN 136,808 Springfield-Jacksonville-Lincoln, IL 308,124 Lafayette-Opelousas-Morgan City, LA 621,902 St. George, UT 171,700 Lafayette-West Lafayette-Frankfort, IN 262,341 Syracuse-Auburn, NY 727,647 Lansing-East Lansing, MI 550,085 Tallahassee, FL Lawton, OK 126,198 Tampa-St. Petersburg-Clearwater, FL Bloomington-Pontiac, IL 208,589 Boston-Worcester-Providence, MA-RI-NH-CT 8,285,407 1,206,992 Burlington-Fort Madison-Keokuk, IA-IL-MO 104,588 Burlington-South Burlington-Barre, VT 279,223 Champaign-Urbana, IL 226,379 Charlotte-Concord, NC-SC Charlottesville, VA 2,753,810 218,233 Cincinnati-Wilmington-Maysville, OH-KY-IN 2,272,152 Clarksville, TN-KY Cleveland-Akron-Canton, OH Corpus Christi-Kingsville-Alice, TX Davenport-Moline, IA-IL Dayton-Springfield-Kettering, OH Decatur, IL Eau Claire-Menomonie, WI 305,825 3,599,264 536,555 470,898 1,079,837 104,712 213,800 Edwards-Glenwood Springs, CO 132,713 Elmira-Corning, NY 180,050 Erie-Meadville, PA 357,124 Fayetteville-Sanford-Lumberton, NC 848,083 Fayetteville-Springdale-Rogers, AR 526,050 Florence, SC 204,961 Florence-Muscle Shoals, AL 147,149 Fort Smith, AR-OK 250,148 Fort Wayne-Huntington-Auburn, IN 606,645 Gadsden, AL 102,501 Gainesville-Lake City, FL 399,485 Lung.org 385,145 3,142,663 Lexington-Fayette-Richmond-Frankfort, KY 743,778 Terre Haute, IN 186,652 Lima-Van Wert-Celina, OH 217,707 Topeka, KS 232,594 Lincoln-Beatrice, NE 356,083 Tuscaloosa, AL 251,808 Little Rock-North Little Rock, AR 909,346 Urban Honolulu, HI Louisville/Jefferson CountyElizabethtown-Bardstown, KY-IN Lynchburg, VA Memphis-Forrest City, TN-MS-AR Virginia Beach-Norfolk, VA-NC 1,488,015 263,353 1,367,788 Mobile-Daphne-Fairhope, AL 648,157 Monroe-Ruston, LA 249,399 Montgomery-Selma-Alexander City, AL 462,747 Morgantown-Fairmont, WV 196,356 Waterloo-Cedar Falls, IA 1,044,060 Orlando-Lakeland-Deltona, FL 4,096,575 Owensboro, KY 119,114 Palm Bay-Melbourne-Titusville, FL 596,849 Parkersburg-Marietta-Vienna, WV-OH 150,188 Pensacola-Ferry Pass, FL-AL 531,631 American Lung Association State of the Air 2020 169,659 140,045 Wichita-Winfield, KS 672,796 Wilmington, NC 294,436 New Orleans-Metairie-Hammond, LA-MS 1,506,145 North Port-Sarasota, FL 980,080 1,854,604 Wheeling, WV-OH 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. 26 314,172 1,162,893 Rockford-Freeport-Rochelle, IL Hot Springs-Malvern, AR Buffalo-Cheektowaga-Olean, NY 643,099 1,282,442 132,855 213,430 231,638 403,217 1,473,084 Bloomington-Bedford, IN Bowling Green-Glasgow, KY Population Rankings Top 25 Cleanest U.S. Cities for Year-Round Particle Pollution (Annual PM2.5)1 2020 Design Rank2 Value3 Metropolitan Statistical Area 1 3.6 Urban Honolulu, HI 980,080 2 4.1 Kahului-Wailuku-Lahaina, HI 167,207 3 4.4 Cheyenne, WY 4 4.7 Elmira-Corning, NY 180,050 5 4.9 Wilmington, NC 294,436 6 5.0 Casper, WY 7 5.1 Syracuse-Auburn, NY 7 5.1 Bellingham, WA 225,685 9 5.2 Springfield, MA 702,724 9 5.2 St. George, UT 171,700 9 5.2 Duluth, MN-WI 289,457 12 5.3 Bismarck, ND 128,320 13 5.5 Pueblo-Cañon City, CO 215,550 14 5.7 Palm Bay-Melbourne-Titusville, FL 596,849 14 5.7 Burlington-South Burlington-Barre, VT 279,223 16 5.8 Bangor, ME 151,096 16 5.8 Anchorage, AK 399,148 18 5.9 Grand Junction, CO 153,207 18 5.9 Sioux Falls, SD 265,653 18 5.9 Pittsfield, MA 126,348 18 5.9 Grand Island, NE 22 6.0 Colorado Springs, CO 738,939 23 6.3 Appleton-Oshkosh-Neenah, WI 408,544 23 6.3 Gainesville-Lake City, FL 399,485 23 6.3 Salinas, CA 435,594 Population 98,976 79,115 727,647 75,808 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). 27 Lung.org American Lung Association State of the Air 2020 Rankings Cleanest U.S. Cities for Ozone Air Pollution1 Metropolitan Statistical Area Population Metropolitan Statistical Area Population Anchorage, AK 399,148 Missoula, MT 118,791 Bangor, ME 151,096 Monroe-Ruston, LA 249,399 Bismarck, ND 128,320 Morgantown-Fairmont, WV 196,356 Bowling Green-Glasgow, KY 231,638 Myrtle Beach-Conway, SC-NC 543,140 Brownsville-Harlingen-Raymondville, TX 445,423 New Bern-Morehead City, NC 194,743 Brunswick, GA 118,456 Panama City, FL 185,287 Burlington-South Burlington-Barre, VT 279,223 Rapid City-Spearfish, SD 165,764 Roanoke, VA 314,172 Casper, WY 79,115 Clarksville, TN-KY 305,825 Rochester-Austin, MN 259,813 Corpus Christi-Kingsville-Alice, TX 536,555 Rocky Mount-Wilson-Roanoke Rapids, NC 297,726 Crestview-Fort Walton Beach-Destin, FL 278,644 Salinas, CA 435,594 Dothan-Ozark, AL 197,201 Savannah-Hinesville-Statesboro, GA 577,093 Duluth, MN-WI 289,457 Scottsboro-Fort Payne, AL 123,121 Fairbanks, AK Shreveport-Bossier City-Minden, LA 436,341 Fargo-Wahpeton, ND-MN 267,964 98,971 Springfield, MO 466,978 Fayetteville-Sanford-Lumberton, NC 848,083 Tallahassee, FL 385,145 Fayetteville-Springdale-Rogers, AR 526,050 Topeka, KS 232,594 Florence, SC 204,961 Tupelo-Corinth, MS 202,792 Fort Smith, AR-OK 250,148 Urban Honolulu, HI 980,080 Gadsden, AL 102,501 Wausau-Stevens Point-Wisconsin Rapids, WI 307,114 Hickory-Lenoir-Morganton, NC 368,416 Wilmington, NC 294,436 Houma-Thibodaux, LA 209,136 Jackson-Vicksburg-Brookhaven, MS 678,169 Joplin-Miami, MO-OK 210,077 La Crosse-Onalaska, WI-MN 136,808 Laredo, TX 275,910 Lincoln-Beatrice, NE 356,083 Longview, TX 286,143 McAllen-Edinburg, TX 930,464 Notes: 1. This list represents cities with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on 2015 NAAQS. 28 Lung.org American Lung Association State of the Air 2020 Rankings Cleanest Counties for Short-Term Particle Pollution (24-hour PM2.5)1 County State MSAs and Respective CSA2 Baldwin AL Mobile-Daphne-Fairhope, AL County State MSAs and Respective CSA2 Kauai HI Clay AL Black Hawk IA Waterloo-Cedar Falls, IA Colbert AL Florence-Muscle Shoals, AL Clinton IA Davenport-Moline, IA-IL Etowah AL Gadsden, AL Johnson IA Cedar Rapids-Iowa City, IA Jefferson AL Birmingham-Hoover-Talladega, AL Lee IA Burlington-Fort Madison-Keokuk, IA-IL-MO Madison AL Huntsville-Decatur, AL Montgomery IA Mobile AL Mobile-Daphne-Fairhope, AL Muscatine IA Montgomery AL Montgomery-Selma-Alexander City, AL Palo Alto IA Morgan AL Huntsville-Decatur, AL Scott IA Russell AL Columbus-Auburn-Opelika, GA-AL Van Buren IA Tuscaloosa AL Tuscaloosa, AL Woodbury IA Sioux City, IA-NE-SD Arkansas AR Champaign IL Champaign-Urbana, IL Crittenden AR Memphis-Forrest City, TN-MS-AR DuPage IL Chicago-Naperville, IL-IN-WI Garland AR Hot Springs-Malvern, AR Hamilton IL Davenport-Moline, IA-IL Davenport-Moline, IA-IL Jackson AR Jersey IL St. Louis-St. Charles-Farmington, MO-IL Polk AR Kane IL Chicago-Naperville, IL-IN-WI Pulaski AR Little Rock-North Little Rock, AR Macon IL Decatur, IL Washington AR Fayetteville-Springdale-Rogers, AR McHenry IL Chicago-Naperville, IL-IN-WI Apache AZ McLean IL Bloomington-Pontiac, IL Cochise AZ Sierra Vista-Douglas, AZ Peoria IL Peoria, IL La Paz AZ Randolph IL Del Norte CA Rock Island IL Davenport-Moline, IA-IL Garfield CO Edwards-Glenwood Springs, CO Sangamon IL Springfield-Jacksonville-Lincoln, IL Rio Blanco CO St. Clair IL St. Louis-St. Charles-Farmington, MO-IL Fairfield CT New York-Newark, NY-NJ-CT-PA Will IL Chicago-Naperville, IL-IN-WI Hartford CT Hartford-East Hartford, CT Winnebago IL Rockford-Freeport-Rochelle, IL New Haven CT New York-Newark, NY-NJ-CT-PA Allen IN Fort Wayne-Huntington-Auburn, IN New London CT Hartford-East Hartford, CT Clark IN Kent DE Philadelphia-Reading-Camden, PA-NJ-DE-MD Louisville/Jefferson County--Elizabethtown-Bardstown, KY-IN Sussex DE Salisbury-Cambridge, MD-DE Alachua FL Gainesville-Lake City, FL Brevard FL Palm Bay-Melbourne-Titusville, FL Broward FL Miami-Port St. Lucie-Fort Lauderdale, FL Escambia FL Pensacola-Ferry Pass, FL-AL Hillsborough FL Tampa-St. Petersburg-Clearwater, FL Leon FL Tallahassee, FL Orange FL Orlando-Lakeland-Deltona, FL Palm Beach FL Miami-Port St. Lucie-Fort Lauderdale, FL Pinellas FL Tampa-St. Petersburg-Clearwater, FL Polk FL Orlando-Lakeland-Deltona, FL Sarasota FL North Port-Sarasota, FL Seminole FL Orlando-Lakeland-Deltona, FL Volusia FL Orlando-Lakeland-Deltona, FL Honolulu HI Urban Honolulu, HI Dubois IN Floyd IN Louisville/Jefferson County--Elizabethtown-Bardstown, KY-IN Greene IN Howard IN Kokomo-Peru, IN LaPorte IN Chicago-Naperville, IL-IN-WI Monroe IN Bloomington-Bedford, IN Spencer IN St. Joseph IN South Bend-Elkhart-Mishawaka, IN-MI Tippecanoe IN Lafayette-West Lafayette-Frankfort, IN Vanderburgh IN Evansville, IN-KY Vigo IN Terre Haute, IN Whitley IN Fort Wayne-Huntington-Auburn, IN Johnson KS Kansas City-Overland Park-Kansas City, MO-KS Neosho KS Sedgwick KS Wichita-Winfield, KS 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 2006 NAAQS. 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. CSA stands for Combined Statistical Area, which may include multiples and individual counties. 29 Lung.org American Lung Association State of the Air 2020 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 Shawnee KS Topeka, KS Kennebec ME Sumner KS Wichita-Winfield, KS Oxford ME Trego KS Penobscot ME Bangor, ME Boyd KY Charleston-Huntington-Ashland, WV-OH-KY Allegan MI Grand Rapids-Kentwood-Muskegon, MI Campbell KY Cincinnati-Wilmington-Maysville, OH-KY-IN Bay MI Saginaw-Midland-Bay City, MI Christian KY Clarksville, TN-KY Chippewa MI Daviess KY Owensboro, KY Genesee MI Detroit-Warren-Ann Arbor, MI Fayette KY Lexington-Fayette--Richmond--Frankfort, KY Ingham MI Lansing-East Lansing, MI Hardin KY Louisville/Jefferson County--Elizabethtown-Bardstown, KY-IN Kalamazoo MI Kalamazoo-Battle Creek-Portage, MI Kent MI Grand Rapids-Kentwood-Muskegon, MI Jefferson KY Louisville/Jefferson County--Elizabethtown-Bardstown, KY-IN Lenawee MI Detroit-Warren-Ann Arbor, MI Macomb MI Detroit-Warren-Ann Arbor, MI Pulaski KY Warren KY Bowling Green-Glasgow, KY Jefferson Parish LA New Orleans-Metairie-Hammond, LA-MS Lafayette Parish LA Lafayette-Opelousas-Morgan City, LA Orleans Parish LA New Orleans-Metairie-Hammond, LA-MS Ouachita Parish LA Monroe-Ruston, 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 Essex Missaukee MI Oakland MI Detroit-Warren-Ann Arbor, MI St. Clair MI Detroit-Warren-Ann Arbor, MI Washtenaw MI Detroit-Warren-Ann Arbor, MI Becker MN LA Houma-Thibodaux, LA West Baton Rouge Parish LA Baton Rouge, LA Bristol Manistee MI MA Boston-Worcester-Providence, MA-RI-NH-CT MA Boston-Worcester-Providence, MA-RI-NH-CT Franklin MA Springfield, MA Hampden MA Springfield, MA Cook MN Lake MN Duluth, MN-WI Scott MN Minneapolis-St. Paul, MN-WI Stearns MN Minneapolis-St. Paul, MN-WI Washington MN Minneapolis-St. Paul, MN-WI Cass MO Kansas City-Overland Park-Kansas City, MO-KS Cedar MO Hampshire MA Springfield, 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 Baltimore MD Washington-Baltimore-Arlington, DC-MD-VA-WVPA Greene MO Springfield, MO St. Louis MO St. Louis-St. Charles-Farmington, MO-IL DeSoto MS Memphis-Forrest City, TN-MS-AR Grenada MS Harrison MS Gulfport-Biloxi, MS Jackson MS Gulfport-Biloxi, MS Cumberland NC Fayetteville-Sanford-Lumberton, NC Cecil MD Philadelphia-Reading-Camden, PA-NJ-DE-MD Davidson NC Greensboro--Winston-Salem--High Point, NC Dorchester MD Salisbury-Cambridge, MD-DE Forsyth NC Greensboro--Winston-Salem--High Point, NC Garrett MD Mecklenburg NC Charlotte-Concord, NC-SC Howard Montgomery NC MD Washington-Baltimore-Arlington, DC-MD-VA-WVPA Kent MD Montgomery Prince George's MD Washington-Baltimore-Arlington, DC-MD-VA-WVPA MD Washington-Baltimore-Arlington, DC-MD-VA-WVPA New Hanover NC Wilmington, NC Pitt NC Greenville-Kinston-Washington, NC Hall NE Grand Island, NE Lancaster NE Lincoln-Beatrice, NE Washington NE Omaha-Council Bluffs-Fremont, NE-IA NH Boston-Worcester-Providence, MA-RI-NH-CT Androscoggin ME Portland-Lewiston-South Portland, ME Belknap Cumberland ME Portland-Lewiston-South Portland, ME Cheshire NH Hancock ME Grafton NH 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 2006 NAAQS. 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. CSA stands for Combined Statistical Area, which may include multiples and individual counties. 30 Lung.org American Lung Association State of the Air 2020 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 Hillsborough NH Boston-Worcester-Providence, MA-RI-NH-CT Comanche OK Lawton, OK Rockingham NH Boston-Worcester-Providence, MA-RI-NH-CT Oklahoma OK Oklahoma City-Shawnee, OK Atlantic NJ Philadelphia-Reading-Camden, PA-NJ-DE-MD Pittsburg OK Cumberland NJ Philadelphia-Reading-Camden, PA-NJ-DE-MD Sequoyah OK Fort Smith, AR-OK Essex NJ New York-Newark, NY-NJ-CT-PA Armstrong PA Pittsburgh-New Castle-Weirton, PA-OH-WV Gloucester NJ Philadelphia-Reading-Camden, PA-NJ-DE-MD Bradford PA Hudson NJ New York-Newark, NY-NJ-CT-PA Cambria PA Johnstown-Somerset, PA Hunterdon NJ New York-Newark, NY-NJ-CT-PA Chester PA Philadelphia-Reading-Camden, PA-NJ-DE-MD Mercer NJ New York-Newark, NY-NJ-CT-PA Erie PA Erie-Meadville, PA Middlesex NJ New York-Newark, NY-NJ-CT-PA Greene PA Morris NJ New York-Newark, NY-NJ-CT-PA Lackawanna PA Scranton--Wilkes-Barre, PA Ocean NJ New York-Newark, NY-NJ-CT-PA Mercer PA Youngstown-Warren, OH-PA Passaic NJ New York-Newark, NY-NJ-CT-PA Monroe PA New York-Newark, NY-NJ-CT-PA Warren NJ Allentown-Bethlehem-Easton, PA-NJ Philadelphia PA Philadelphia-Reading-Camden, PA-NJ-DE-MD Bernalillo NM Albuquerque-Santa Fe-Las Vegas, NM Tioga PA Albany NY Albany-Schenectady, NY Washington PA Pittsburgh-New Castle-Weirton, PA-OH-WV Bronx NY New York-Newark, NY-NJ-CT-PA Westmoreland PA Pittsburgh-New Castle-Weirton, PA-OH-WV Chautauqua NY York PA Harrisburg-York-Lebanon, PA Erie Kent RI Boston-Worcester-Providence, MA-RI-NH-CT Essex NY Providence RI Boston-Worcester-Providence, MA-RI-NH-CT Kings NY New York-Newark, NY-NJ-CT-PA Washington RI Boston-Worcester-Providence, MA-RI-NH-CT Monroe NY Rochester-Batavia-Seneca Falls, NY Chesterfield SC Onondaga NY Syracuse-Auburn, NY Florence SC Florence, SC Orange NY New York-Newark, NY-NJ-CT-PA Oconee SC Greenville-Spartanburg-Anderson, SC Queens NY New York-Newark, NY-NJ-CT-PA Spartanburg SC Greenville-Spartanburg-Anderson, SC Richmond NY New York-Newark, NY-NJ-CT-PA Brookings SD Steuben NY Elmira-Corning, NY Minnehaha Suffolk NY New York-Newark, NY-NJ-CT-PA Dyer TN Allen OH Lima-Van Wert-Celina, OH NY Buffalo-Cheektowaga-Olean, NY SD Sioux Falls, SD Lawrence TN Nashville-Davidson--Murfreesboro, TN Athens OH Madison TN Jackson-Brownsville, TN Belmont OH Wheeling, WV-OH Maury TN Nashville-Davidson--Murfreesboro, TN Butler OH Cincinnati-Wilmington-Maysville, OH-KY-IN Montgomery TN Clarksville, TN-KY Clark OH Dayton-Springfield-Kettering, OH Putnam TN Cuyahoga OH Cleveland-Akron-Canton, OH Shelby TN Memphis-Forrest City, TN-MS-AR Greene OH Dayton-Springfield-Kettering, OH Sumner TN Nashville-Davidson--Murfreesboro, TN Hamilton OH Cincinnati-Wilmington-Maysville, OH-KY-IN Nueces TX Corpus Christi-Kingsville-Alice, TX Lake OH Cleveland-Akron-Canton, OH Tarrant TX Dallas-Fort Worth, TX-OK Lorain OH Cleveland-Akron-Canton, OH Uintah UT Mahoning OH Youngstown-Warren, OH-PA Washington UT St. George, UT Medina OH Cleveland-Akron-Canton, OH Albemarle VA Charlottesville, VA Montgomery OH Dayton-Springfield-Kettering, OH Charles City VA Richmond, VA Portage OH Cleveland-Akron-Canton, OH Chesterfield VA Richmond, VA Stark OH Cleveland-Akron-Canton, OH Frederick Summit OH Cleveland-Akron-Canton, OH VA Washington-Baltimore-Arlington, DC-MD-VA-WVPA 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 2006 NAAQS. 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. CSA stands for Combined Statistical Area, which may include multiples and individual counties. 31 Lung.org American Lung Association State of the Air 2020 Rankings Cleanest Counties for Short-Term Particle Pollution (24-hour PM2.5)1 (cont.) County State MSAs and Respective CSA2 Hampton City VA Virginia Beach-Norfolk, VA-NC Henrico VA Richmond, VA Loudoun VA Washington-Baltimore-Arlington, DC-MD-VA-WVPA Lynchburg City VA Lynchburg, VA Norfolk City VA Virginia Beach-Norfolk, VA-NC Richmond City VA Richmond, VA Roanoke VA Roanoke, VA Rockingham VA Harrisonburg-Staunton, VA Salem City VA Roanoke, VA Virginia Beach City VA Virginia Beach-Norfolk, VA-NC Bennington VT Chittenden VT Burlington-South Burlington-Barre, VT Rutland VT Ashland WI Brown WI Green Bay-Shawano, WI Eau Claire WI Eau Claire-Menomonie, WI Forest WI Grant WI Kenosha WI Chicago-Naperville, IL-IN-WI La Crosse WI La Crosse-Onalaska, WI-MN Milwaukee WI Milwaukee-Racine-Waukesha, WI Outagamie WI Appleton-Oshkosh-Neenah, WI Ozaukee WI Milwaukee-Racine-Waukesha, WI Sauk WI Madison-Janesville-Beloit, WI Taylor WI Vilas WI Waukesha WI Milwaukee-Racine-Waukesha, WI Berkeley WV Washington-Baltimore-Arlington, DC-MD-VA-WVPA Brooke WV Pittsburgh-New Castle-Weirton, PA-OH-WV Cabell WV Charleston-Huntington-Ashland, WV-OH-KY Hancock WV Pittsburgh-New Castle-Weirton, PA-OH-WV Harrison WV Kanawha WV Charleston-Huntington-Ashland, WV-OH-KY Marion WV Morgantown-Fairmont, WV Marshall WV Wheeling, WV-OH Monongalia WV Morgantown-Fairmont, WV Ohio WV Wheeling, WV-OH Wood WV Parkersburg-Marietta-Vienna, WV-OH Sweetwater 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 2006 NAAQS. 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. CSA stands for Combined Statistical Area, which may include multiples and individual counties. 32 Lung.org American Lung Association State of the Air 2020 Rankings Top 25 Cleanest Counties for Year-Round Particle Pollution (Annual PM2.5)1 2020 Rank2 County 1 Burke ND 2.9 1 Kauai HI 2.9 3 Hillsborough NH 3.4 3 Lake MN 3.4 5 Essex NY 3.6 5 Custer SD 3.6 5 Honolulu HI 3.6 8 Hancock ME 3.7 8 Jackson SD 3.7 10 Mercer ND 3.8 10 Billings ND 3.8 12 Gallatin MT 4.0 12 Hughes SD 4.0 14 Maui HI 4.1 15 Litchfield CT 4.2 15 McKenzie ND 4.2 15 Ashland WI 4.2 15 Forest WI 4.2 19 La Paz AZ 4.3 19 Park WY 4.3 21 Laramie WY 4.4 21 Cook MN 4.4 23 Campbell WY 4.5 23 Williams ND 4.5 23 Belknap NH 4.5 23 Vilas WI 4.5 State Design Value3 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). 33 Lung.org American Lung Association State of the Air 2020 Rankings Cleanest Counties for Ozone Air Pollution1 County State Metropolitan Statistical Area Denali Borough AK Fairbanks North Star Borough AK Matanuska-Susitna Borough AK Anchorage, AK DeKalb AL Scottsboro-Fort Payne, AL Elmore AL Montgomery-Selma-Alexander City, AL Etowah AL Gadsden, AL Houston AL Dothan-Ozark, AL Morgan AL Huntsville-Decatur, AL Russell AL Columbus-Auburn-Opelika, GA-AL Fairbanks, AK Clark AR Newton AR Polk AR AR Fayetteville-Springdale-Rogers, AR Colusa CA San Jose-San Francisco-Oakland, CA Mendocino CA CA Salinas, CA San Francisco CA San Jose-San Francisco-Oakland, CA Baker FL Jacksonville-St. Marys-Palatka, FL-GA Bay FL Panama City, FL Collier FL Cape Coral-Fort Myers-Naples, FL Columbia FL Gainesville-Lake City, FL Flagler FL Orlando-Lakeland-Deltona, FL Holmes FL FL Tallahassee, FL Liberty FL Okaloosa FL Crestview-Fort Walton Beach-Destin, FL Santa Rosa FL Pensacola-Ferry Pass, FL-AL Volusia FL Orlando-Lakeland-Deltona, FL Wakulla FL Tallahassee, FL Chatham GA Savannah-Hinesville-Statesboro, GA Chattooga GA Chattanooga-Cleveland-Dalton, TN-GA Glynn GA Brunswick, GA Honolulu HI IA Johnson KS Leavenworth KS Clarksville, TN-KY Edmonson KY Bowling Green-Glasgow, KY Fayette KY Lexington-Fayette--Richmond--Frankfort, KY Perry KY Pike KY Trigg KY Clarksville, TN-KY Warren KY Bowling Green-Glasgow, KY Bossier Parish LA Shreveport-Bossier City-Minden, LA Caddo Parish LA Shreveport-Bossier City-Minden, LA Lafourche Parish LA Houma-Thibodaux, LA Ouachita Parish LA Monroe-Ruston, LA St. James Parish LA New Orleans-Metairie-Hammond, LA-MS Garrett MD ME Portland-Lewiston-South Portland, ME Kennebec ME Oxford ME ME Bangor, ME Becker MN Carlton MN Duluth, MN-WI Crow Wing MN Hennepin MN Minneapolis-St. Paul, MN-WI Lake MN Duluth, MN-WI Lyon MN Mille Lacs MN Minneapolis-St. Paul, MN-WI Olmsted MN Rochester-Austin, MN St. Louis MN Duluth, MN-WI Washington MN Minneapolis-St. Paul, MN-WI Cedar MO Greene MO Springfield, MO Jasper MO Joplin-Miami, MO-OK Hancock MS Gulfport-Biloxi, MS Hinds MS Jackson-Vicksburg-Brookhaven, MS Lauderdale MS Lee Urban Honolulu, HI MS Tupelo-Corinth, MS Yalobusha MS Montgomery IA Van Buren Charleston-Huntington-Ashland, WV-OH-KY KY Penobscot Monterey Leon KY Christian Aroostook ME Lake CA CA Carter Androscoggin Glenn CA Marin State Metropolitan Statistical Area Pulaski KY Sumter AL Washington County Bell KY Flathead MT Kansas City-Overland Park-Kansas City, MO-KS Kansas City-Overland Park-Kansas City, MO-KS Lewis and Clark MT Missoula MT Missoula, MT Phillips MT Richland MT Neosho KS Rosebud MT Shawnee KS Topeka, KS Alexander NC Hickory-Lenoir-Morganton, NC Sumner KS Wichita-Winfield, KS Caldwell NC Hickory-Lenoir-Morganton, NC Carteret NC New Bern-Morehead City, NC Trego KS Notes: 1. This list represents counties with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on 2008 NAAQS. 34 Lung.org American Lung Association State of the Air 2020 Rankings Cleanest Counties for Ozone Air Pollution1 (cont.) County State Metropolitan Statistical Area County State Metropolitan Statistical Area Caswell NC Harrison TX Longview, TX Cumberland NC Fayetteville-Sanford-Lumberton, NC Hidalgo TX McAllen-Edinburg, TX Durham NC Raleigh-Durham-Cary, NC Nueces TX Corpus Christi-Kingsville-Alice, TX Edgecombe NC Rocky Mount-Wilson-Roanoke Rapids, NC Polk TX Granville NC Raleigh-Durham-Cary, NC Webb TX Johnston NC Raleigh-Durham-Cary, NC San Juan UT Lee NC Fayetteville-Sanford-Lumberton, NC Fauquier VA Washington-Baltimore-Arlington, DC-MD-VAWV-PA Frederick VA Washington-Baltimore-Arlington, DC-MD-VAWV-PA Roanoke VA Roanoke, VA Martin NC Montgomery NC New Hanover NC Wilmington, NC Pitt NC Greenville-Kinston-Washington, NC Rowan NC Charlotte-Concord, NC-SC Swain NC ND Bismarck, ND Cass ND Fargo-Wahpeton, ND-MN Skagit Bismarck, ND NE Lincoln-Beatrice, NE Belknap NH Boston-Worcester-Providence, MA-RI-NH-CT Grafton NH Merrimack NH Boston-Worcester-Providence, MA-RI-NH-CT Mahoning OH Youngstown-Warren, OH-PA Portage OH Cleveland-Akron-Canton, OH Adair OK OK Fort Smith, AR-OK WI La Crosse-Onalaska, WI-MN Marathon WI Wausau-Stevens Point-Wisconsin Rapids, WI Vilas WI Lancaster Sequoyah La Crosse Taylor WI Williams ND OK Joplin-Miami, MO-OK Greenbrier WV Monongalia WV Morgantown-Fairmont, WV Big Horn WY Carbon WY Converse WY Fremont WY Natrona WY Casper, WY Teton WY Teton, WY Weston WY Bradford PA Cambria PA Johnstown-Somerset, PA Franklin PA Washington-Baltimore-Arlington, DC-MD-VAWV-PA Aiken SC Augusta-Richmond County, GA-SC Anderson SC Greenville-Spartanburg-Anderson, SC Berkeley SC Charleston-North Charleston, SC Notes: 1. This list represents counties with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on 2008 NAAQS. Colleton SC Darlington SC Florence, SC Horry SC Myrtle Beach-Conway, SC-NC Custer SD Jackson SD Meade SD Rapid City-Spearfish, SD Anderson TN Knoxville-Morristown-Sevierville, TN DeKalb TN Brewster TX Cameron TX Brownsville-Harlingen-Raymondville, TX Gregg TX Longview, TX 35 Lung.org WA Seattle-Tacoma, WA Forest WI Mercer ND Ottawa Burlington-South Burlington-Barre, VT Ashland WI McKenzie ND ND VT Clallam WA Dunn ND Oliver Wythe VA Rutland VT Burke ND Burleigh Rockbridge VA Chittenden Billings ND Laredo, TX American Lung Association State of the Air 2020 H e a l t h Ef fe c t s 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, nearly 150 million people live in counties where monitors show unhealthy levels of one or both— meaning the air a family breathes could shorten life, cause lung cancer or have other harmful effects. So what are particle pollution and ozone? Particle Pollution Ever look at dirty tailpipe 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. What Is Particle Pollution? Particle pollution refers to a mix of tiny solid and liquid particles that are in the air we breathe. Many of the particles are so small as to be invisible, but when levels are high, the air becomes opaque. Nothing about particle pollution is simple. In fact, it is so dangerous that 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 cannot 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 Researchers categorize particles according to size, grouping them as coarse, fine and ultrafine. Coarse particles (shown as blue dots in the illustration) fall between 2.5 microns and 10 microns in diameter and are called PM10-2.5. Fine particles (shown as pink dots in the illustration) are 2.5 microns in diameter or smaller and are called PM2.5. Ultrafine particles (not shown) are smaller than 0.1 micron in diameter2 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. The differences in size make a big difference in where particles affect us. Our natural defenses help us to cough or sneeze some coarse particles out of our bodies. However, those defenses do not keep out smaller fine or ultrafine particles. These particles get 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. 36 Lung.org American Lung Association State of the Air 2020 H e a l t h Ef fe c t s “A mixture of mixtures.” Because particles form in so many ways, they can be composed of many different compounds. Although we often think of particles as solids, not all are. Some are liquid; some are solids suspended in liquids. As EPA put it, particles are really “a mixture of mixtures.”3 The mixtures differ between different regions in the United States and in different times of the year. Much of that comes from the sources that produce the particles. For example, nitrate particles from motor vehicle exhaust form a larger proportion of the unhealthful mix in the winter in western states, especially California and portions of the Midwest. By contrast, eastern 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.4 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;5 ■ People with lung disease, especially asthma, but also people with chronic obstructive pulmonary disease (COPD);6 ■ People with cardiovascular disease7; ■ People of color8; ■ Current or former smokers9; ■ People with low incomes;10 and ■ People who are obese.11 People with lung cancer also appear to be at higher risk from particle pollution, according to a 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 poorer survival.12 ■ EPA had concluded in the past that people with diabetes are also at higher risk of harm from particle pollution. In their most recent review of people at risk, they revised that decision. The evidence of increased risk remains strong, especially given the increased risk of cardiovascular disease from diabetes. Research has found evidence that longterm 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.13 What Can Particles Do to Your Health? Particle pollution can be very dangerous to breathe depending on the level. 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. ■ ■ 37 Lung.org 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.14 Another long-term study of people in six U.S. cities tracked from 1974 to 2009 added more evidence of the benefits. The findings suggest that cleaning up particle pollution had almost immediate health benefits. The researchers 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/m3.15 American Lung Association State of the Air 2020 H e a l t h Ef fe c t s These studies add to the growing research that cleaning up air pollution improves life and health. Short-Term Exposure Can Be Deadly First, short-term exposure to particle pollution can kill.16 Peaks or spikes in particle pollution can last from hours to days. Premature deaths from breathing these particles 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 deaths would not have occurred so early if the air were cleaner. Even low levels of particles can be deadly. A 2016 study found that people aged 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.17 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.18 Looking nationwide in a 2017 study, researchers found more evidence that older adults faced a higher risk of premature death even when levels of short-term particle pollution remained well below the current national standards. This was consistent whether the older adults lived in cities, suburbs or rural areas.19 Some of the strongest research has documented that short-term exposure to particle pollution causes premature death from respiratory and cardiovascular causes.20 Particle pollution also has many other harmful effects, ranging from decreased lung function to heart attacks. Extensive research has linked short-term increases in particle pollution to: increased mortality in infants;21 ■ increased hospital admissions for cardiovascular disease, including heart attacks and ischemic heart disease;22 ■ increased hospital admissions and emergency department visits for COPD;23 ■ increased hospitalization for asthma among children;24 and ■ increased severity of asthma attacks in children.25 A 2008 study of lifeguards in Galveston, TX, provided evidence of the impact of shortterm exposure to particle pollution on healthy, active adults. Testing the breathing capacity of these outdoor workers several times a day, researchers found that many lifeguards had reduced lung volume when fine particle 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.26 ■ 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 showed27 and as later studies verified.28 Recent research has confirmed that long-term exposure to particle pollution still kills, even with the declining levels in the U.S. since 200029 and even in areas, such as New England, that currently meet the official limit, or standard, for year-round particle pollution.30 In 2013, the International Agency for Research on Cancer (known as IARC), part of the World Health Organization, concluded that particle pollution causes lung cancer. The IARC based its decision on the review of multiple studies from the U.S., Europe, and Asia and the presence of carcinogens on the particles.31 Research has also linked year-round exposure to particle pollution to: ■ ■ ■ 38 Lung.org development of asthma in children;32 worsening of COPD in adults;33 slowed lung function growth in children and teenagers;34 American Lung Association State of the Air 2020 H e a l t h Ef fe c t s increased risk of death from cardiovascular disease;35 and ■ increased risk of heart attacks and strokes.36 Studies examining the impact on the nervous system of long-term exposure to particle pollution have found links to cognitive affects in adults including reduced brain volume, cognitive decrements and dementia.37 Scientists have found evidence that particle pollution may impact pregnancy and birth outcomes, such as preterm birth, low birth weight and fetal and infant mortality.38 ■ The EPA is conducting their new review of the current research on particle pollution. Their findings from the last review, completed in December 2019,39 are highlighted in the box below. EPA Concludes Fine Particle Pollution Poses Serious Health Threats (2019) ■ 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) ■ Likely to cause cancer ■ Likely to cause harm to the nervous system (e.g. reduced brain volume, cognitive effects) ■ May cause reproductive and developmental harm —U.S. Environmental Protection Agency, Integrated Science Assessment for Particulate Matter, December 2019. EPA 600/R-19/188 Where Does Particle Pollution Come From? Particle pollution forms 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. Dust storms, construction and demolition, mining operations, and agriculture are among the activities that produce particles. Tire, brake pad and road wear can also create particles. Combustion of carbon-based fuels generates most of the fine particles in our atmosphere. Burning wood in residential fireplaces and wood stoves as well as wildfires, agricultural fires and prescribed fires are some of the largest sources. Wildfires are growing, particularly in the Mountain West because of climate change. These processes create about 36 percent of fine particles.40 Burning fossil fuels in factories, power plants, diesel- and gasoline-powered motor vehicles (cars and trucks) and equipment emits a large part of the raw materials for fine particles. Chemical processes in the atmosphere create most of the tiniest fine and ultrafine particles in the air. Burning fuels, other human activity and natural sources emit gases that form particles in the air. These gases can oxidize and then condense to become a particle of a simple chemical compound. Or they can react with other gases or particles in the atmosphere to form a particle of a different or of multiple chemical compounds. Particles formed by this latter process come from the reaction of elemental carbon (soot), heavy metals, sulfur dioxide (SO2), nitrogen oxides (NOx), ammonia (NH3) and volatile organic compounds with water and other compounds in the atmosphere.41 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. 39 Lung.org American Lung Association State of the Air 2020 H e a l t h Ef fe c t s 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.42 Some studies have found that different kinds of particles may have greater risk for different health outcomes.43,44,45 Other studies have identified the challenges of exploring all the kinds of particles and their health effects with the limited monitoring across the nation.46,47 Some particles serve as carriers for other chemicals that are also toxic, and the combination may worsen the impact.48,49 The best evidence shows that having less of all types of particles in the air leads to better health and longer lives. Ozone It may be hard to imagine that pollution could be invisible, but ozone begins that way. As ozone concentrates and mixes with other pollutants, we often call it by its older, more common name—smog. It is currently one of the least well-controlled pollutants in the United States.50 And it is also one of the most dangerous. Scientists have studied the effects of ozone on health for decades. Hundreds of studies have confirmed that ozone harms people at levels currently found in the United States. In the last decade, we have 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. When ozone is present, there are other harmful pollutants created by the same processes that make ozone. oxygen oxygen oxygen The ozone layer found high in the upper atmosphere (the stratosphere) shields us from much of the sun’s ultraviolet radiation. However, ozone air pollution at ground level where we can breathe it (in the troposphere) causes serious health problems. Where Does Ozone Come From? 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 are nitrogen oxides (NOx) and volatile organic compounds (VOCs). They are produced primarily when fossil fuels like gasoline, oil or coal are burned or when some chemicals, like solvents, evaporate. NOx is emitted from power plants, motor vehicles and other sources of high-heat combustion. VOCs are emitted from motor vehicles, chemical plants, refineries, factories, gas stations, paint and other sources.51 40 Lung.org American Lung Association State of the Air 2020 H e a l t h Ef fe c t s If the ingredients are present under the right conditions, they react to form ozone. Sunlight is key. 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 formed, even internationally across borders and across the oceans. 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 contain nitrogen oxides (NOx) and volatile organic compounds (VOCs) that are key to the formation of ozone in the presence of heat and sunlight. Who Is at Risk from Breathing Ozone? Anyone who spends time outdoors where ozone pollution levels are high may be at risk. Four groups of people are especially vulnerable to the effects of breathing ozone: children and teens52; ■ anyone 65 and older53; ■ people with existing lung diseases, such as asthma and chronic obstructive pulmonary disease (also known as COPD, which includes emphysema and chronic bronchitis54; and ■ people who work or exercise outdoors.55 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.56 More research is needed to confirm these findings. ■ The impact on your health can depend on many factors, however. For example, the risks are greater if ozone levels are higher, if you are breathing faster because you’re working or exercising outdoors or if you spend more time outdoors. Again, the impact of even short-term exposure to ozone pollution on healthy adults was demonstrated in the Galveston lifeguard study. In addition to the harmful effects of particle pollution, lifeguards had greater obstruction of their airways at the end of the day when ozone levels were high.57 How Ozone Pollution Harms Your Health Premature death. Breathing ozone can shorten your life. Strong evidence exists of the deadly impact of ozone from 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.58 Newer research has confirmed that ozone increased the risk of premature death even when other pollutants also are present.59 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: ■ ■ ■ 41 Lung.org shortness of breath, wheezing and coughing; asthma attacks; increased risk of respiratory infections; American Lung Association State of the Air 2020 H e a l t h Ef fe c t s 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.60,61,62 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 early death. ■ ■ Examining the records from a long-term national database, researchers found a higher risk of death from respiratory diseases associated with increases in ozone.63 ■ 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.64 ■ 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.65 ■ Studies link lower birth weight and decreased lung function in newborns to ozone levels in their community.66 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 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.67 ■ Research shows lower levels of ozone cause harm. EPA released their latest complete review of the current research on ozone pollution in February 2013.68 EPA had engaged a panel of expert scientists, the Clean Air Scientific Advisory Committee, to help them assess the evidence that was brought together by EPA; 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 below. Based on that review, EPA strengthened the official limit on ozone, called the National Ambient Air Quality Standard, in 2015. However, new research provides evidence that ozone can cause serious harm even at much lower levels. In a 2017 scientific paper, researchers provided further evidence in a nationwide study that older adults faced a higher risk of premature death even when levels of ozone pollution remained well below the current national standard.69 EPA Concludes Ozone Pollution Poses Serious Health Threats (2013) 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. 42 Lung.org American Lung Association State of the Air 2020 H e a l t h Ef fe c t s Focusing on Children’s Health Children face special risks from air pollution because their lungs are growing and because they are so active and breathe in a great deal of air. 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.70 In addition, the body’s defenses that help adults fight off infections are still developing in young bodies.71 Children have more respiratory infections than adults, which also seems to increase their susceptibility to air pollution.72 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.73 Air Pollution Affects Children Before They Are 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.74 Pregnant women exposed to even low levels of particle pollution had higher risk for preterm birth in a Boston study.75 Preterm births occurred more frequently when particle pollution spiked, as an Australian study found, even when they controlled for other risk factors.76 Air Pollution Limits Lung Growth in Children The Southern California Children’s Health study looked at the long-term effects of air pollution on children and 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 reduced lung growth, which may never recover to their full capacity. The average drop in lung function was similar to the impact of growing up in a home with parents who smoked.77 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.78 Another earlier report from the Children’s Health 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.79 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 the Southern California Children’s Health study showed that reducing pollution could improve children’s health. They compared the children who had been part of their earlier studies to a new 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. Children growing up in the cleaner air had much greater lung function growth, 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.”80 Further evidence that cleaner air provides real benefits to children’s health came in a 2016 report from the same study exploring changes to 4,602 children’s respiratory symptoms such as coughing, congestion and phlegm. The study looked at the changes in these symptoms in three groups of children living in Southern California over different periods of time when air quality also differed (1993-2001, 1996-2004, and 2003-2012). As air quality improved, the children in the study suffered fewer bronchial symptoms 43 Lung.org American Lung Association State of the Air 2020 H e a l t h Ef fe c t s whether they had asthma or not. In communities where the air quality improved the most, the children experienced even fewer symptoms.81 So, does cleaning up the air really improve children’s health? In 2017, the researchers reviewed these long-term studies of children in Southern California and the impact of improvements in air quality on their health. They concluded that the 20 years of collected data provided strong evidence of the potential to improve children’s health by reducing some of the most common outdoor air pollutants.82 The U.S. is not alone in this finding. 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.83 Disparities in the Impact of Air 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 of pollution,84 including a workshop the American Lung Association held in 2001 that focused on urban air pollution and health inequities.85 The most recent EPA review of the research on the health effects of particle pollution concluded that nonwhite populations, especially blacks, faced higher risk from particle pollution.86 Many studies have looked at differences in the impact of air pollution on premature death. Recent studies have looked at the mortality in the Medicaid population and found that those who live in predominately black or African American communities suffered greater risk of premature death from particle pollution than those who live in communities that are predominately white.87 Another large study found that Hispanics and Asians, but especially blacks, had a higher risk of premature death from particle pollution than whites did. This study found that income did not drive the differences. Higher-income blacks who had higher income than many whites still faced greater risk than those whites, suggesting that the impact of other factors such as chronic stress as a result of discrimination may be playing a role.88 Other researchers have found greater risk for African Americans from hazardous air pollutants, including those pollutants that also come from traffic sources.89 Due to decades of residential segregation, African Americans tend to live where there is greater exposure to air pollution.90 Socioeconomic position also appears tied to 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-related mortality nationwide.91 In a 2008 study that found greater risk for premature death for communities with higher African American populations, researchers also found greater risk for people living in areas with higher unemployment or higher use of public transportation.92 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.93 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.94 Studies of Atlanta, GA, found that particle pollution increased the risk of asthma attacks for zip codes where poverty was high and among people eligible for Medicaid.95 44 Lung.org American Lung Association State of the Air 2020 H e a l t h Ef fe c t s 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 tend to 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; and 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, people of color 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. People 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. Non-Hispanic 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.96 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.97 Highways May Be Especially Dangerous for Breathing Being in heavy traffic or living near a road with heavy traffic may be risky compared with being in other places in a community. Growing evidence shows that many different pollutants along busy 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 comprehensive review of the evidence. In January 2010, the Health Effects Institute published a major review of the evidence put together by a panel of expert scientists. The panel looked at over 700 studies from around the world, examining the health effects of traffic pollution. 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 the band within 0.2 to 0.3 miles (300 to 500 meters) of the highway.98 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.99 Studies have found increased risk of premature death from living near a major highway or an urban road.100 Another study found an increase in risk of heart attacks from being in traffic, whether driving or taking public transportation.101 Urban women in a Boston study experienced decreased lung function associated with traffic-related pollution.102 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, although not for Parkinson’s disease or multiple sclerosis. Researchers found the strongest association among those who lived closest to the 45 Lung.org American Lung Association State of the Air 2020 H e a l t h Ef fe c t s roads (less than 50 meters), who had never moved and who lived in major cities.103 A study of older men in 2011 also found that long-term exposure to traffic pollution increased their risk of having poor cognition.104 How to Protect Yourself from Ozone and Particle Pollution 46 To minimize your exposure to ozone and particle pollution: Lung.org 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; ■ Reduce the use of fireplaces and wood-burning stoves; and ■ Consider getting a portable air cleaner with a HEPA filter if you live in an area prone to wildfire smoke (do not get an air cleaner that generates ozone). Bottom line: Help yourself and everyone else breathe easier. Support national, state and local efforts to clean up sources of pollution. Your life and the life of someone you love may depend on it. ■ American Lung Association State of the Air 2020 H e a l t h Ef fe c t s Endnotes 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 these other pollutants. 2 U.S. EPA. Integrated Science Assessment for Particulate Matter (Final Report). U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-08/139F, 2009. Available at http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=216546. 3 U.S. EPA, Air Quality Criteria for Particulate Matter. October 2004. 4 U.S. EPA, Integrated Science Assessment for Particulate Matter. December 2019. EPA/600/R-19/188. 5 U.S. EPA, 2019, Section 12.5.1.1. 6 U.S. EPA, 2019, Section 12.3.5. 7 U.S. EPA, 2019, Section 12.3.1. 8 U.S. EPA, 2019, Section 12.5.4. 9 U.S. EPA, 2019, Section 12.6.1. 10 U.S. EPA, 2019, Section 12.5.3. 11 U.S. EPA, 2019, Section 12.3.3. 12 Eckel SP, Cockburn M, Shu YH, Deng H, Lurmann FW, Liu L, Gilliland FD. Air pollution affects lung cancer survival. Thorax, 2016;71:891898.. 13 Rao X, Patel P, Puett R, Rajogpalan S. Air pollution as a risk factor for type 2 diabetes. Toxicol Sci. 2015;143(2):231-241; Eze IC, Hemkens LG, Bucher HC, Hoffman B, et al. Association between ambient air pollution and diabetes mellitus in Europe and North America: Systematic review and meta-analysis. Environ Health Perspect. 2015;123(5):381-389. 14 Correia AW, Pope CA III, Dockery DW, Wang Y, Ezzati M, Domenici F. Effect of air pollution control on life expectancy in the United States: An analysis of 545 U.S. Counties for the period from 2000 to 2007. Epidemiology. 2013;24(1):23-31. 15 Lepeule J, Laden F, Dockery D, Schwartz J. Chronic exposure to fine particles and mortality: An extended follow-up of the Harvard Six Cities Study from 1974 to 2009. Environ Health Perspect. 2012;120:965-970. 16 U.S. EPA, 2019, Section 6.1.9. 17 Shi L, Zanobetti A, Kloog I, et. al. Low-concentration PM2.5 and mortality: estimating acute and chronic effects in a population-based study. Environ Health Perspect. 2016;124:46-52. http://dx.doi.org/10.1289/ehp.1409111. 18 Schwartz J, Bind MA, Koutrakis P. Estimating causal effects of local air pollution on daily deaths: Effect of low levels. Environ Health Perspect. 2017; 125:23-29. http://dx.doi.org/10.1289/EHP232. 19 Di Q, Dai L, Wang Y, Zanobetti A, Choirat C, Schwartz JD, Dominici F. Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults. JAMA. 2017;318:2446-2456. 20 U.S. EPA, 2019, Section 11.1. 21 U.S. EPA, 2019, Section 9.1.2.6. 22 U.S. EPA, 2019, Section 6.1.2. 23 U.S. EPA, 2019, Section 5.1.2.1.1. 24 U.S. EPA, 2019, Section 5.1.2.1. 25 U.S. EPA, 2019, Section 5.1.2.2.1. 26 Thaller EI, Petronell SA, Hochman D, Howard S, Chhikara RS, Brooks EG. Moderate increases in ambient PM2.5 and ozone are associated with lung function decreases in beach lifeguards. J Occp Environ Med. 2008;50:202-211. 27 Dockery DW et al. An association between air pollution and mortality in six U.S. cities. N Engl J Med. 1993;329:1753-1759. Pope CA et al. Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am J Respir Crit Care Med. 1995;151:669674. 28 U.S. EPA, 2019, Section 11.2.2.1. 29 Thurston GD, Ahn J, Cromar KR, et al. Ambient particulate matter air pollution exposure and mortality in the NIH-AARP Diet and Health Cohort. Environ Health Perspect. 2015;124:484-490; Lepeule J, Laden F, Douglas Dockery D, and Schwartz J. Chronic exposure to fine particles and mortality: An extended follow-up of the Harvard Six Cities Study from 1974 to 2009. Environ Health Perspect. 2012;120:965-970. 30 Shi L, Zanobetti A, et al. Low-concentration PM2.5 and mortality: estimating acute and chronic effects in a population-based study. Environ Health Perspect. 2015;124:46-52. 31 Hamra GB, Guha N, Cohen A, et. al. Outdoor particulate matter exposure and lung cancer: A systematic review and meta-analysis. Environ Health Perspect. 2014;122:906-911. 32 U.S. EPA, 2019, Section 5.2.3.1. 33 U.S. EPA, 2019, Section 5.2.5. 34 U.S. EPA, 2019, Section 5.2.2.2.1. 35 U.S. EPA, 2019, Section 6.2.10. 36 U.S. EPA, 2019, Section 6.2.2 and Section 6.2.3. 37 U.S. EPA, 2019, Section 8.2.9. 38 U.S. EPA, 2019, Section 9.1.2, especially Section 9.1.2.3.1. and Section 9.1.2.6. 39 U.S. EPA, 2019. 40 U.S. EPA, 2019, Section 2.3.1.1. 41 U.S. EPA, 2019, Section 2.3.2. 42 Morakinyo OM, Mokgobu MI, Mukhola MS, Hunter RP. Review: Health outcomes of exposure to biological and chemical components of inhalable and respirable particulate matter. Int J Environ Res Public Health. 2016: 592. 43 Thurston GD, et al. Ischemic heart disease mortality and long-term exposure to source-related components of U.S. fine particle air pollution. Environ Health Perspect. 2016;124:785-794. http://dx.doi.org/10.1289/ehp.1509777. 44 Bell ML, et al. Associations of PM2.5 constituents and sources with hospital admissions: analysis of four counties in Connecticut 47 Lung.org American Lung Association State of the Air 2020 H e a l t h Ef fe c t s and Massachusetts (USA) for persons ≥ 65 years of age. Environ Health Perspect. 2014;122:138-144; http://dx.doi.org/10.1289/ ehp.1306656. 45 Ebisu K, Bell ML. Airborne PM2.5 chemical components and low birth weight in the Northeastern and Mid-Atlantic regions of the United States. Environ Health Perspect. 2012;120:1746-1752; http://dx.doi.org/10.1289/ehp.1104763. 46 Levy JI, Diez D, Dou Y, Barr CD, Dominici F. A meta-analysis and multisite time-series analysis of the differential toxicity of major fine particulate matter constituents. Am J Epidemiol. 2012;175(11):1091-1099. https://academic.oup.com/aje/article/175/11/1091/140117. 47 Dai L, Zanobetti A, Koutrakis P, Schwartz JD. Associations of fine particulate matter species with mortality in the United States: A multicity time-series analysis. Environ Health Perspect. 2014;122(8):837-842. https://ehp.niehs.nih.gov/doi/10.1289/ehp.1307568. 48 Morakinyo et al., 2016 49 Cassee FR, Héroux M-E, Gerlofs-Nijland ME, Kelly FJ. Particulate matter beyond mass: recent health evidence on the role of fractions, chemical constituents and sources of emission. Inhalation Toxicol. 2013;25(14):802-812. https://www.tandfonline.com/doi/full/10.3 109/08958378.2013.850127. 50 U.S. EPA. Nonattainment Areas for Criteria Pollutants (Green Book). 2017. Accessed at https://www.epa.gov/green-book. Data updated as of January 31, 2018. 51 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. 52 U.S. EPA, 2013, Section 8.3.1.1. 53 U.S. EPA, 2013, Section 8.3.1.2; Medina-Ramón M, Schwartz J. Who is more vulnerable to die from ozone air pollution? Epidemiology. 2008;19:672-679. 54 U.S. EPA, 2013, Sections 8.2.2 and 8.2.3. 55 U.S. EPA, 2013, Section 8.4.4. 56 U.S. EPA. 2013, Sections 8.3.2, 8.3.3 and 8.4.2. 57 Thaller, et al., 2008. 58 U.S. EPA, 2013, Section 6.2. 59 Di Q, Wang Y, Zanobetti A, et al. Air Pollution and Mortality in the Medicare Population. N Engl J Med. 2017;376:2513-2522. 60 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; Strickland MJ, Darrow LA, et al. Short-term associations between ambient air pollutants and pediatric asthma emergency department visits. Am J Respir Critical Care Med, 2010;182:307-316.  61 Desqueyroux H, Pujet JC, Prosper M, Squinazi F, Momas I. Short-Term Effects of Low-Level Air Pollution on Respiratory Health of Adults Suffering from Moderate to Severe Asthma. Environ Res. 2002;89:29-37. 62 Lin S, Liu X, Le LH, Hwang SA. Chronic exposure to ambient ozone and asthma hospital admissions among children. Environ Health Perspect. 2008;116:1725-1730; Medina-Ramón, et al., 2006 63 Jerrett M, Burnett RT, et al. Long-term ozone exposure and mortality. N Engl J Med. 2009;360:1085-1095. 64 Lin S, Liu X, Le LH, and Hwang S-A. Chronic exposure to ambient ozone and asthma hospital admissions among children. Environ Health Perspect. 2008;116:1725-1730. 65 Islam T, McConnell R, Gauderman WJ, Avol E, Peters JM, Gilliland F. Ozone, oxidant defense genes, and risk of asthma during adolescence. Am J Respir Crit Care Med. 2009; 177(4):388-395. 66 Salam MT, Millstein J, Li YF, Lurmann FW, Margolis HG, Gilliland FD. Birth outcomes and prenatal exposure to ozone, carbon monoxide, and particulate matter: Results from the Children’s Health Study. Environ Health Perspect. 2005;113:1638-1644; Morello-Frosch R, Jesdale BM, Sadd JL, Pastor M. Ambient air pollution exposure and full-term birth weight in California. Environ Health. 2010;9:44. 67 Parker JD, Akinbami LJ, Woodruff TJ. Air Pollution and Childhood Respiratory Allergies in the United States. Environ Health Perspect. 2009;117:140-147. 68 U.S. EPA, 2013. 69 Di Q, Dai L, Wang Y, et al. Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults. JAMA. 2017;318:24462456. 70 American Academy of Pediatrics Committee on Environmental Health, Ambient Air Pollution: Health hazards to children. Pediatrics. 2004;114:1699-1707. Statement was reaffirmed in 2010. Dietert RR, Etzel RA, Chen D, et al. Workshop to identify critical windows of exposure for children’s health: Immune and respiratory systems workgroup summary. Environ Health Perspect. 2000;108(supp 3):483-490. 71 World Health Organization. The effects of air pollution on children’s health and development: A review of the evidence. E86575. 2005. Available at http://www.euro.who.int/document/E86575.pdf. 72 WHO, 2005. 73 American Academy of Pediatrics, 2004. 74 Laurent O, Hu J, LI L, et al. A statewide nested case-control study of preterm birth and air pollution by source and composition: California, 2001-2008. Environ Health Perspect. 2016;124:1479-1486. Doi: 10.1289/ehp.1510133. 75 Nach RM, Mao G, Zhang X, et al. Intrauterine inflammation and maternal exposure to ambient PM2.5 during preconception and specific periods of pregnancy: the Boston Birth Cohort. Environ Health Perspect. 2016;124:1608-1615. http://dx.doi.org/10.1289/EHP243. 76 Li S, Guo Y, Williams G. Acute impact of hourly ambient air pollution on preterm birth. Environ Health Perspect. 2016. 124:1623– 1629; http://dx.doi.org/10.1289/EHP200 77 Gauderman et al., 2004. 78 Galizia A, Kinney PL. Year-round residence in areas of high ozone: Association with respiratory health in a nationwide sample of nonsmoking young adults. Environ Health Perspect. 1999;107:675-679. 79 Peters JM, Avol E, Gauderman WJ, et al. A study of twelve southern California communities with differing levels and types of air pollution. II: Effects on pulmonary function. Am J Respir Crit Care Med. 1999;159:768-775. 80 Gauderman WJ, Urman R, Avol E, et al. Association of improved air quality with lung development in children. N Eng J Med. 2015;372:905-913. 81 Berhane K, Chang C-C, McConnell R, et al. Association of Changes in Air Quality with Bronchitic Symptoms in Children in California, 1993-2012. JAMA. 2016;315:1491-1501. 48 Lung.org American Lung Association State of the Air 2020 H e a l t h Ef fe c t s 82 Gilliland F, Avol E, McConnell R, et al. 2017. The Effects of Policy-Driven Air Quality Improvements on Children’s Respiratory Health. Research Report 190. Boston, MA: Health Effects Institute. 83 Bayer-Oglesby L, Grize L, et al. Decline of ambient air pollution levels and improved respiratory health in Swiss children. Environ Health Perspect. 2005;113:1632-1637. 84 Institute of Medicine. Toward Environmental Justice: Research, Education, and Health Policy Needs. Washington, DC: National Academy Press, 1999; O’Neill MS, Jerrett M, Kawachi I, et al. Health, wealth, and air pollution: Advancing theory and methods. Environ Health Perspect. 2003;111:1861-1870; Finkelstein MM, Jerrett M, DeLuca P, et al. Relation between income, air pollution and mortality: A cohort study. CMAJ. 2003;169:397-402; Zeka A, Zanobetti A, Schwartz J. Short term effects of particulate matter on cause specific mortality: effects of lags and modification by city characteristics. Occup Environ Med. 2006;62:718725. 85 American Lung Association. Urban air pollution and health inequities: A workshop report. Environ Health Perspect. 2001; 109 (suppl 3): 357-374. 86 U.S. EPA, 2019, Section 12.5.4. 87 Kioumourtzoglou MA, Schwartz J, James P, Dominici F, Zanobetti A. PM2.5 and mortality in 207 us cities: Modification by temperature and city characteristics. Epidemiology, 2016;27:221-227.  88 Di Q, et al, N Engl J Med, 2017. 89 Apelberg BJ, Buckley TJ, White RH. Socioeconomic and racial disparities in cancer risk from air toxics in Maryland. Environ Health Perspect. 2005;113:693-699. 90 Nardone A, Casey JA, Morello-Frosch R, Mujahid M, Balmes JR, Thakur N. Associations between historical residential redlining and current age-adjusted rates of emergency department visits due to asthma across eight cities in California: an ecological study. Lancet Planet Health. 2020;4(1):e24-e31. 91 Zeger SL, Dominici F, McDermott A, Samet J. Mortality in the Medicare population and chronic exposure to fine particulate air pollution in urban centers (2000-2005). Environ Health Perspect. 2008;116:1614-1619. 92 Bell ML, Dominici F. Effect modification by community characteristics on the short-term effects of ozone exposure and mortality in 98 US communities. Am J Epidemiol. 2008;167:986-997 93 Babin S, Burkom H, Holtry R, et al. Medicaid patient asthma-related acute care visits and their associations with ozone and particulates in Washington, DC, from 1994-2005. Int J Environ Health Res. 2008;18(3):209-221. 94 Wang Y, Kloog I, Coul BA, Kosheleva A, Zanobetti A, Schwartz JD. Estimating causal effects of long-term PM2.5 exposure on mortality in New Jersey. Environ Health Perspect. 2016;124:1182-1188. 95 O’Lenick, CR, Winquist A, Mulholland JA, et al. Assessment of neighbourhood-level socioeconomic status as a modifier of air pollution-asthma associations among children in Atlanta. J Epi Comm Health. 2017;71(2):129-136; Strickland MJ, Klein M, Flanders WD, et al. Modification of the effect of ambient air pollution on pediatric asthma emergency visits: susceptible subpopulations, Epidemiology. 2014;25:843-850. 96 Miranda ML, Edwards SE, Keating MH, Paul CJ. Making the environmental justice grade: The relative burden of air pollution exposure in the United States. Int J Environ Res Public Health. 2011;8:1755-1771. 97 Bell ML, Ebisu K. Environmental inequality in exposures to airborne particulate matter component in the United States. Environ Health Perspect. 2012;120:1699–1704. 98 Health Effects Institute Panel on the Health Effects of Traffic-Related Air Pollution. Traffic-Related Air Pollution: A Critical Review of the Literature on Emissions, Exposure, and Health Effects. Health Effects Institute: Boston, 2010. Available at www.healtheffects.org. 99 Andersen ZJ, Hvidberg M, Jensen SS, et al. Chronic obstructive pulmonary disease and long-term exposure to traffic-related air pollution: A cohort study. Am J Respir Crit Care Med. 2011;183:455-461. 100 Finklestein MM, Jerrett M, Sears MR. Traffic air pollution and mortality rate advancement periods. Am J Epidemiol. 2004;160:173-177; Hoek G, Brunkreef B, Goldbohn S, Fischer P, van den Brandt P. Associations between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study. Lancet. 2002;360:1203-1209. 101 Peters A, von Klot S, Heier M, Trentinaglia I, Cyrys J, Hormann A, Hauptmann M, Wichmann HE, Lowel H. Exposure to traffic and the onset of myocardial infarction. N Engl J Med. 2004;351:1721-1730. 102 Suglia SF, Gryparis A, Schwartz J, Wright RJ. Association between traffic-related black carbon exposure and lung function among urban women. Environ Health Perspect. 2008;116(10):1333-1337. 103 Chen H, Kwong JC, Copes R, et al. Living near major roads and the incidence of dementia, Parkinson’s disease and multiple sclerosis: a population-based cohort study. Lancet. 2017. Published online: https://doi.org/10.1016/S0140-6736(16)32399-6. 104 Power MC, Weisskopf MG, Alexeeff SE, et al. 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. 49 Lung.org American Lung Association State of the Air 2020 M et h o d o l o g y Statistical Methodology: The Air Quality Data Data Sources Ozone and short-term particle pollution. 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 the Aerometric Information Retrieval System (AIRS) database. The American Lung Association contracted with Dr. Allen S. Lefohn, A.S.L. & Associates, Helena, MT, to characterize the hourly averaged ozone concentration information and the 24-hour averaged PM2.5 concentration information for the three-year period for 2016-2018 for each monitoring site. Year-round particle pollution. Design values for the annual PM2.5 concentrations by county for the period 2016-2018 were retrieved from data posted on December 3, 2019, at the U.S. Environmental Protection Agency’s website at https://www.epa.gov/ sites/production/files/2019-12/pm25_designvalues_20162018_final_12_03_19.xlsx. One exception is the design value for Whatcom County, WA, where that the value is based on the combined design value determined by the state and EPA using data from two monitors. That design value was provided by the State of Washington in email communication. Ozone Data Analysis The 2016, 2017 and 2018 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 June 26, 2019, 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 that inaccurately reflect the normal conditions. The highest 8-hour daily maximum concentration in each county for 2016, 2017 and 2018, based on the EPA-defined ozone season, was identified. The current national ambient air quality standard for ozone is 70 parts per billion (ppb) measured over eight hours. 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 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) >200 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. 50 Lung.org American Lung Association State of the Air 2020 M et h o d o l o g y 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 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., six to eight 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-hour period was 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). Short-Term Particle Pollution Data Analysis A.S.L. & Associates identified the maximum daily 24-hour AQS PM2.5 concentration for each county in 2016, 2017 and 2018 with monitoring information. The 24-hour PM2.5 data were downloaded on August 7, 2019, following the close of the authorized period for quality review and assurance certification of data. In addition, on August 7, 2019, hourly averaged PM2.5 concentration data were characterized into 24-hour average PM2.5 values by 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 EPA based on the EPA Air Quality Index, as adopted by EPA on December 14, 2012: 24-hour PM2.5 Concentration Air Quality Index Levels 0.0 µg/m to 12.0 µg/m n Good (Green) 3 3 12.1 µg/m to 35.4 µg/m 3 3 n Moderate (Yellow) 35.5 µg/m to 55.4 µg/m n Unhealthy for Sensitive Groups (Orange) 55.5 µg/m3 to 150.4 µg/m3 n Unhealthy (Red) 150.5 µg/m3 to 250.4 µg/m3 n Very Unhealthy (Purple) equal to or greater than 250.5 µg/m3 n Hazardous (Maroon) 3 3 All previous data collected for 24-hour average PM2.5 were characterized using the AQI thresholds listed above. 51 Lung.org American Lung Association State of the Air 2020 M et h o d o l o g y 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 and hourly averaged PM data averaged over 24 hours were used. Included in the analysis are data collected using only FRM and FEM methods, which reported hourly and 24-hour averaged data. As instructed by the Lung Association, A.S.L. & Associates included the exceptional and natural events that were identified in the database and identified for the Lung Association the dates and monitoring sites that experienced such events. Some data have been flagged by the state or local air pollution control agency to indicate that they had raised issues with EPA about those data. For each day across all sites within a specific county, the highest daily maximum 24-hour 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 above. 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. 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 3 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. ■ ■ ■ 52 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 two percent of the days during the three years to exceed 35 µg/m3 (called a “98th percentile” form) before violating the standard. That would be roughly 21 unhealthy days in three years. The grading used in this report would allow only about one percent of the days to be over 35 µg/m3 (called a “99th percentile” form) of the PM2.5. The American Lung Association supports using the tighter limits in a 99th percentile form as a more appropriate standard that is intended to protect the public from short-term episodes or spikes in pollution. American Lung Association State of the Air 2020 M et h o d o l o g y 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 an F. That second county would have a weighted average of 3.7. Note that this system differs significantly from the methodology EPA uses to determine violations of both the ozone and the 24-hour PM2.5 standards. 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. The Lung Association calculates the county population at risk from these pollutants based on the population from the entire county where the monitor is located. The Lung Association then calculates the metropolitan population at risk based upon 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 2019 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.” 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. 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 2019 as defined by the OMB. 53 Lung.org American Lung Association State of the Air 2020 M et h o d o l o g y 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. 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. To assess the magnitude of chronic conditions at the state and county levels, we have employed a synthetic estimation technique originally developed by the U.S. Census Bureau. This method uses age-specific national and state estimates of self-reported conditions to project disease prevalence to the county level. The exception to this is poverty, for which estimates are available at the county level. Population Estimates The 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. 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. For that reason, the Lung Association calculates the county population at risk from these pollutants based on the population from the entire county where the monitor is located. The Lung Association then calculates the metropolitan population at risk based upon the largest metropolitan area that contains that county. The counties assigned to a metropolitan area follow the groupings determined by the White House Office of Management and Budget (OMB) and used by the U.S. Census Bureau. The Lung Association uses the largest definition of a metropolitan area for these groupings where at least one urban core of 50,000 people or more is present. The Metropolitan Statistical Areas and Combined Statistical Areas are used as the basis for considering populations at risk in these urban areas because they reflect the “high degree of social and economic interaction as measured by commuting ties,” as OMB describes them.1 The definitions of these areas reflect review and analysis of such patterns by these agencies. The U.S. Census Bureau estimated data on the total population of each county in the United States for 2018. The Census Bureau also estimated the age- and race/ethnicityspecific breakdown of the population and the number of individuals living in poverty by county. These estimates are the best information on population demographics available between decennial censuses. People of color are defined as anyone Hispanic or non-Hispanic black, Asian, American Indian/Alaska Native, Native Hawaiian and Other Pacific Islander, or two or more races. 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. 1 Executive Office of the President, Office of Management and Budget Bulletin No. 18-04. September 14, 2018. 54 Lung.org American Lung Association State of the Air 2020 M et h o d o l o g y 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 Ever Smoked. In 2018, the Behavioral Risk Factor Surveillance System (BRFSS) survey found that approximately 23.1 million (9.3 percent) of adults residing in the United States and 7.2 percent of children from 30 states and Washington, DC, reported currently having asthma. Among adults in the United States in 2018, 17.2 million (6.9 percent) had ever been diagnosed with chronic obstructive pulmonary disease (COPD), 22.5 million (9.1 percent) had ever been diagnosed with cardiovascular disease, and 37.5 million (40.0 percent) had ever smoked at least 100 cigarettes. The prevalence estimate for pediatric asthma is calculated for those younger than 18 years. Local area prevalence of pediatric asthma is estimated by applying 2018 state prevalence rates, or, if not available, the national rate from the BRFSS to pediatric countylevel resident populations obtained from the U.S. Census Bureau website. Pediatric asthma data from the 2018 BRFSS were available for 30 states and Washington, DC, from the 2016 BRFSS for three states, from the 2015 BRFSS for three states, from the 2014 BRFSS for five states, from the 2012 BRFSS for two states, from the 2011 BRFSS for one state, and national data were used for the eight states2 that had no data available. Data from earlier years were not used due to changes in the 2011 survey methodology. The prevalence estimates for COPD, cardiovascular disease, adult asthma and ever smoked are calculated for those aged 18-44 years, 45-64 years and 65 years and older. Local area prevalence is estimated by applying age-specific state prevalence rates from the 2018 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 Lung Cancer. State- and gender-specific lung cancer incidence rates for 2016 were obtained from StateCancerProfiles.gov, a system that provides access to statistics from both the NCI’s Surveillance, Epidemiology and End Results (SEER) program and the CDC’s National Program of Cancer Registries. Local area incidence of lung cancer is estimated by applying 2016 age-adjusted and sex-specific incidence rates to 2018 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. 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. 2 2016: Arizona, Oklahoma, and Washington. 2015: Louisiana and Texas. 2014: Alabama, North Carolina, Tennessee, and West Virginia. 2012: North Dakota and Wyoming. 2011: Iowa. National: Alaska, Arkansas, Colorado, Delaware, Idaho, South Carolina, South Dakota, and Virginia. 55 Lung.org American Lung Association State of the Air 2020 M et h o d o l o g y Local estimates of chronic diseases and smoking 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. 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, 2018. StateCancerProfile.gov, 2019. Cancer Incidence by State and Gender, 2016. 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, 2018. 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 18-04 September 14, 2018. U.S. Census Bureau. Small Area Income and Poverty Estimates. State and County Data, 2018. 56 Lung.org American Lung Association State of the Air 2020 State Tables 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 2018 U.S. Census and represents the at-risk 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 2018 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 2018 based on state rates (BRFSS) applied to county population estimates (U.S. Census). 5. COPD estimates are for adults 18 and over who had ever been diagnosed with chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema, based on state rates (BRFSS) applied to county population estimates (U.S. Census). 6. Lung cancer estimates are for all ages and represent the estimated number of people diagnosed with lung cancer in 2016 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. Ever smoked estimates are for adults 18 and over who have ever smoked 100 or more cigarettes 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, 2018. 2. INC (Incomplete) indicates that monitoring is underway for that pollutant in that county, but that the data are incomplete for all three years. 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 (2016-2018), 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=0.30.9, C=1.0-2.0, D=2.1-3.2, F=3.3+. 5. The design value is the calculated concentration of a pollutant based on the form of the National Ambient Air Quality Standard. EPA uses the design values 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 2016-2018 were retrieved from data posted on December 3, 2019, at the U.S. Environmental Protection Agency’s website at https://www.epa.gov/sites/production/files/2019-12/ pm25_designvalues_20162018_final_12_03_19.xlsx. One exception is the design value for Whatcom County, WA, where that value is based on the combined design value determined by the state and EPA using data from two monitors. That design value was provided by the State of Washington in email communication. 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. People of color are defined as anyone Hispanic or non-Hispanic black, Asian, American Indian/Alaska Native, Native Hawaiian and Other Pacific Islander, or two or more races and are based on 2018 county population estimates (U.S Census). 11. Adding across rows does not produce valid estimates. Adding the atrisk categories (asthma, COPD, poverty, etc.) will double-count people who fall into more than one category. 57 Lung.org American Lung Association State of the Air 2020 State Tables ALABAMA American Lung Association in Alabama www.Lung.org/alabama AT-RISK GROUPS Lung Diseases County Baldwin Total Population Under 18 65 & Over Pediatric Asthma 218,022 47,110 44,571 Adult Asthma COPD Lung Cancer 6,217 18,036 18,817 Heart Disease Ever Smoked Poverty People of Color 143 24,290 75,937 21,069 36,821 Clay 13,275 2,688 2,751 Colbert 54,762 11,370 10,914 1,501 4,577 4,692 355 1,118 1,173 36 6,030 19,204 7,459 11,830 DeKalb 71,385 17,188 12,322 2,268 5,726 5,719 47 7,237 23,873 14,975 14,186 Elmore 81,887 18,211 12,400 2,403 6,739 6,460 54 7,997 27,836 8,559 22,116 Etowah 102,501 21,997 19,487 2,903 8,499 8,637 67 11,032 35,577 17,509 22,872 Houston 104,722 24,120 18,639 Jefferson 659,300 150,071 104,547 3,183 8,507 8,480 9 1,512 4,711 2,285 2,585 69 10,767 35,475 17,032 35,272 19,805 53,749 51,356 431 64,175 222,224 103,604 331,629 Madison 366,519 79,966 55,125 10,553 30,350 29,165 241 36,026 125,369 42,667 129,763 Mobile 413,757 96,711 67,041 12,763 33,472 32,375 271 40,606 138,707 84,539 179,067 Montgomery 225,763 52,774 34,173 6,965 18,255 17,182 147 21,366 75,260 43,567 150,610 Morgan 119,089 27,168 20,803 3,585 9,722 9,770 79 12,344 40,560 15,419 29,373 Russell 57,781 13,968 8,280 1,843 4,633 4,369 38 Shelby 215,707 50,645 33,087 6,684 17,480 17,010 Sumter Talladega Tuscaloosa Totals 58 12,691 2,407 2,286 79,828 16,918 14,370 2,233 6,651 6,682 5,775 17,384 15,192 3,005,900 677,073 488,539 Lung.org 142 21,125 72,395 16,916 48,467 318 1,081 1,030 208,911 43,761 27,743 89,354 245,979 238,108 5,392 19,085 12,384 31,211 8 1,306 4,478 4,076 9,575 52 8,456 27,752 14,825 29,938 137 18,537 70,772 33,330 81,015 1,972 American Lung Association State of the Air 2020 298,197 1,019,215 460,215 1,166,330 State Tables ALABAMA American Lung Association in Alabama www.Lung.org/alabama HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Baldwin Clay Wgt. Avg. Grade Orange Red Purple Maroon 1 0 0 0.3 B Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0 0.0 A 7.3 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.4 PASS Colbert 1 0 0 0.3 B DeKalb 0 0 0 0.0 A Elmore 0 Etowah 0 0 0 0.0 A 0 0 0.0 A 0 0 0 0 0.0 A 7.5 PASS 1 0 0 0 0.3 B 7.6 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.3 PASS Houston 0 0 0 0.0 A 1 0 0 0 0.3 B 7.8 PASS Jefferson 12 2 0 5.0 F 0 0 0 0 0.0 A 10.5 PASS Madison 2 0 0 0.7 B 0 0 0 0 0.0 A 7.5 PASS Mobile 5 0 0 1.7 C 0 0 0 0 0.0 A 8.1 PASS Montgomery 1 0 0 0.3 B 0 0 0 0 0.0 A 8.6 PASS Morgan 0 0 0 0.0 A 0 0 0 0 0.0 A 7.5 PASS Russell 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC Shelby 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC Sumter 0 0 0 0.0 DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC Talladega Tuscaloosa 59 A DNC DNC DNC DNC DNC 1 0 0 0.3 B Lung.org 0 0 0 0 0.0 A 7.8 PASS American Lung Association State of the Air 2020 State Tables ALASKA American Lung Association in Alaska www.Lung.org/alaska AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Anchorage Municipality 291,538 71,339 32,333 Denali Borough 5,106 20,168 12,616 2,059 384 245 Fairbanks North Star Borough 98,971 23,861 10,204 Juneau City and Borough 32,113 6,830 4,298 Adult Asthma COPD 1,708 6,791 4,061 489 2,338 1,552 107,610 28,860 12,814 2,065 7,272 4,753 Totals 532,291 131,274 59,894 9,395 36,727 23,086 Lung.org Heart Disease Ever Smoked Poverty People of Color 161 14,639 95,199 27,075 124,439 27 158 104 Matanuska-Susitna Borough 60 Lung Cancer 1 122 742 135 412 55 4,617 31,974 8,104 30,429 18 1,850 60 295 American Lung Association State of the Air 2020 11,130 2,299 11,476 5,625 34,516 10,937 22,649 26,854 173,561 48,550 189,405 State Tables ALASKA American Lung Association in Alaska www.Lung.org/alaska HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Anchorage Municipality DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 5.8 PASS Denali Borough Fairbanks North Star Borough Juneau City and Borough Matanuska-Susitna Borough 61 0 0 DNC 0 0 DNC 0 0.0 0 0.0 DNC DNC A A DNC 0 0 0 0.0 A Lung.org DNC DNC DNC DNC DNC DNC DNC DNC 51 19 0 0 26.5 F 13.1 FAIL 1 0 0 6.2 0 0.3 B PASS 6 1 0 0 2.5 D 5.3 PASS American Lung Association State of the Air 2020 State Tables ARIZONA American Lung Association in Arizona www.Lung.org/arizona AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Apache 71,818 19,518 10,986 Cochise Coconino Gila La Paz Maricopa Pediatric Asthma Adult Asthma COPD Lung Cancer Heart Disease Ever Smoked Poverty People of Color 1,573 5,322 3,728 32 126,770 27,312 28,326 2,202 10,015 7,771 57 10,389 41,425 18,273 57,227 142,854 29,454 17,855 2,374 11,338 6,940 64 8,729 43,956 20,964 65,726 53,889 10,827 15,506 873 4,363 3,814 24 5,220 18,698 10,804 20,487 21,098 3,540 8,287 4,410,824 1,052,788 669,285 285 1,733 1,698 84,871 340,115 231,647 4,820 21,136 26,435 58,801 9 2,405 7,893 4,921 9,141 1,970 298,086 1,344,593 535,183 1,989,191 Mohave 209,550 35,739 63,526 2,881 17,610 15,506 94 21,258 75,665 34,411 48,373 Navajo 110,445 29,472 20,010 2,376 8,223 6,101 49 8,024 33,302 30,876 64,394 Pima 1,039,073 216,736 205,255 17,472 82,678 60,474 464 79,742 336,049 164,927 504,663 Pinal 447,138 100,778 91,129 8,124 34,832 26,058 201 34,552 142,549 54,399 194,203 Santa Cruz 46,511 12,435 8,421 1,002 3,455 2,555 Yavapai 231,993 37,687 73,278 3,038 19,703 17,642 103 24,260 85,109 30,060 45,569 Yuma 212,128 53,494 39,828 4,312 15,802 11,389 95 15,050 64,422 39,648 147,604 Totals 62 7,124,091 1,629,780 1,251,692 Lung.org 131,385 555,189 395,322 21 3,183 American Lung Association State of the Air 2020 3,361 13,995 11,287 39,600 515,896 2,228,791 982,188 3,244,979 State Tables ARIZONA American Lung Association in Arizona www.Lung.org/arizona HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Apache Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC Cochise 2 0 0 0.7 B Coconino 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC 30 1 0 10.5 F DNC DNC DNC DNC DNC DNC DNC DNC Gila La Paz 6 0 0 2.0 C Maricopa 112 5 Mohave DNC DNC DNC DNC DNC Navajo 3 0 0 39.8 F 0 1.0 C Pima 14 0 0 4.7 F Pinal 44 Santa Cruz Yavapai Yuma 63 1 0 15.2 F 0 0 0 0 0.0 A INC INC 0 0 0 0 0.0 A 4.3 PASS 13 2 2 0 6.7 F 9.9 PASS INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 6.5 PASS 30 3 0 0 11.5 F 13.0 FAIL DNC DNC DNC DNC DNC 3 4 0 0 3.0 D 9.1 PASS 6 0 0 2.0 C 18 0 0 6.0 F Lung.org DNC DNC DNC DNC DNC DNC DNC DNC 5 0 0 0 1.7 C 8.5 PASS American Lung Association State of the Air 2020 State Tables ARKANSAS American Lung Association in Arkansas www.Lung.org/arkansas AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Heart Disease Ever Smoked Poverty People of Color Arkansas 17,769 4,074 3,484 292 1,344 1,446 Ashley 20,046 4,582 4,081 328 1,514 1,653 16 2,230 7,378 3,876 6,354 Clark 22,061 4,184 3,687 299 1,765 1,641 17 2,206 8,328 3,838 6,963 Craighead 108,558 27,090 15,030 Crittenden 48,342 13,076 6,838 936 3,503 3,436 Garland 99,154 19,941 23,632 1,427 7,693 8,653 Jackson 16,811 3,381 3,051 242 1,324 1,349 Newton 7,805 1,502 2,069 107 609 719 Polk Pulaski Union Washington Totals 64 20,049 4,567 4,611 392,680 91,009 61,075 39,126 9,419 7,017 236,961 57,728 27,809 1,029,362 240,553 162,384 Lung.org 1,939 8,093 7,489 327 1,504 1,705 6,513 29,892 29,262 674 2,926 3,083 4,132 17,895 15,419 17,216 78,062 75,854 14 1,943 6,521 3,120 5,427 85 9,854 37,974 18,768 26,491 38 4,484 16,586 9,056 28,292 77 11,919 37,920 19,844 18,046 13 1,798 6,344 3,732 3,934 6 999 3,040 1,340 506 16 2,342 7,422 3,962 2,477 305 31 38,546 141,761 64,312 188,759 4,101 14,109 7,000 15,358 186 20,080 82,763 34,741 69,366 802 100,501 370,147 173,589 371,973 American Lung Association State of the Air 2020 State Tables ARKANSAS American Lung Association in Arkansas www.Lung.org/arkansas HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Arkansas DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.1 PASS Ashley DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 8.2 PASS Clark Craighead Crittenden 0 0 0 0.0 A DNC DNC DNC DNC DNC 6 1 0 2.5 D DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC 0 0 0 0 0.0 A 8.4 PASS Garland DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.4 PASS Jackson DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.1 PASS Newton 0 Polk 0 0 0 0.0 A 0 0 0 0 0.0 A 8.3 PASS Pulaski 3 0 0 1.0 C 0 0 0 0 0.0 A 9.7 PASS Union Washington 65 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 8.9 PASS 0 0 0 0.0 A Lung.org 0 0 0 0 0.0 A 8.1 PASS American Lung Association State of the Air 2020 State Tables CALIFORNIA American Lung Association in California www.Lung.org/california AT-RISK GROUPS Lung Diseases County Alameda Amador Butte Calaveras Colusa Contra Costa Del Norte Total Population Under 18 65 & Over 1,666,753 342,510 230,510 Adult Asthma COPD 39,383 5,914 10,633 45,602 7,721 12,553 477 3,340 2,233 21,627 5,907 3,163 1,150,215 259,791 181,443 Fresno 994,400 281,819 122,113 People of Color 86,118 438,363 147,394 1,148,783 15 2,945 11,929 4,130 8,898 18 365 1,344 745 3,448 13,649 5,454 8,802 8 1,087 5,273 2,350 14,202 445 361 1,890 1,092 2,335 13,335 8,279 63,410 301,667 88,980 652,755 11 1,616 7,478 5,065 10,472 74 12,506 53,670 15,401 42,700 17,399 60,395 31,587 28,047 7,453 4,453 Ever Smoked Poverty 90 13,309 62,372 42,016 65,598 16,039 76,494 43,209 27,828 5,854 5,018 Heart Disease 645 365 2,936 1,919 2,853 15,844 9,018 190,678 37,821 40,389 Lung Cancer 21,146 112,623 59,859 231,256 46,213 42,992 El Dorado Glenn Pediatric Asthma 385 460 1,767 1,003 45,226 234,129 208,627 705,643 11 1,476 6,967 4,271 13,812 Humboldt 136,373 26,184 24,380 1,617 9,423 5,297 53 7,783 37,018 27,002 35,274 Imperial 181,827 51,765 23,580 3,196 11,043 5,862 71 8,440 42,925 37,014 162,999 Inyo 17,987 3,681 4,210 Kern 896,764 259,180 98,347 Kings 151,366 40,964 15,516 Lake Los Angeles 16,001 53,894 27,503 Madera 157,672 43,339 22,051 2,676 9,745 5,298 Marin 259,666 51,925 57,943 3,206 18,183 11,518 Mariposa Mendocino Merced Mono 17,471 2,828 4,882 87,606 18,713 19,366 1,155 5,988 3,712 4,975 16,418 8,420 14,250 2,608 2,253 6,416 35,590 25,481 103,277 25 3,911 4,261 17,916 11,689 19,519 515,500 2,622,021 1,409,155 7,466,160 61 7,688 38,068 30,201 104,594 100 17,499 73,506 16,742 74,122 175 1,289 859 274,765 80,588 30,845 39,003 208,055 177,021 596,328 59 833 4,442 2,804 135,136 673,459 358,245 7 1,206 5,040 2,172 6,877 348 2,529 9,283 4,580 64,382 13,490 14,635 10,105,518 2,188,893 1,375,957 227 1,249 792 7 1,325 5,259 2,569 3,551 34 5,617 24,035 15,140 30,951 107 11,965 63,423 56,863 200,196 161 999 558 6 435,594 113,834 59,201 7,028 27,378 14,688 Napa 139,417 28,800 26,665 1,778 9,552 5,640 54 8,403 37,970 11,829 66,865 99,696 17,071 27,380 1,054 7,266 4,821 39 7,432 29,614 10,171 15,030 Nevada Orange Placer Plumas 3,185,968 698,788 470,387 43,141 212,780 117,068 393,149 87,441 76,906 5,398 26,478 15,911 18,804 3,173 5,345 169 815 3,932 1,312 4,944 Monterey 21,215 106,690 55,614 306,813 1,233 170,329 834,500 330,559 1,907,489 152 196 1,378 927 23,831 105,669 27,596 109,849 7 1,435 5,635 2,317 3,123 Riverside 2,450,758 616,126 353,122 38,038 156,550 85,478 949 124,180 612,354 307,511 1,600,121 Sacramento 1,540,975 363,909 217,601 22,467 100,345 54,282 596 San Benito 61,537 15,827 7,937 977 3,896 2,089 San Bernardino 2,171,603 572,278 251,361 35,331 135,544 70,099 San Diego 24 841 78,584 391,898 217,138 859,537 3,013 15,205 5,294 40,928 99,838 524,916 317,514 1,564,843 3,343,364 722,408 469,454 44,599 222,727 118,450 San Francisco 883,305 118,692 138,249 7,328 64,765 34,033 1,296 170,564 866,445 372,148 1,832,022 343 48,859 251,054 87,596 527,131 San Joaquin 752,660 204,316 95,916 12,614 46,649 24,840 292 35,760 181,645 105,351 519,021 San Luis Obispo 284,010 50,000 57,040 3,087 20,105 11,680 110 17,346 79,503 34,200 89,147 San Mateo 769,545 158,383 123,921 9,778 52,381 29,308 298 6,099 29,547 15,916 173 23,056 115,063 54,029 249,761 Santa Barbara Santa Clara 66 446,527 98,787 68,465 1,937,570 424,427 261,131 Lung.org 26,203 128,742 68,463 752 American Lung Association State of the Air 2020 42,903 206,033 51,830 470,051 98,491 501,284 139,074 1,335,966 State Tables 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 Heart Disease Ever Smoked Poverty People of Color Santa Cruz 274,255 52,852 45,127 3,263 18,926 10,493 106 15,327 74,236 32,027 118,323 Shasta 180,040 38,584 37,553 2,382 12,262 7,457 70 11,216 49,022 26,919 36,805 Siskiyou 43,724 8,802 11,160 543 3,062 1,998 Solano 446,610 98,740 70,430 Sonoma Stanislaus 17 3,066 12,428 7,396 10,636 6,096 29,805 16,651 173 24,365 117,186 34,281 278,552 499,942 98,196 98,714 6,062 34,723 20,633 193 30,806 138,211 48,846 184,266 549,815 148,801 72,319 9,187 34,134 18,290 213 26,395 133,042 84,744 323,635 Sutter 96,807 25,059 14,902 1,547 6,142 3,434 37 5,029 24,137 13,011 52,946 Tehama 63,916 15,363 12,389 948 4,205 2,533 25 3,797 16,786 10,749 20,718 Tulare Tuolumne Ventura Yolo Totals 67 465,861 142,848 53,292 54,539 9,158 14,279 850,967 194,553 132,387 220,408 46,233 27,535 39,422,802 8,958,610 5,647,400 Lung.org 8,819 27,348 14,170 181 565 3,969 2,562 12,011 56,290 31,535 329 2,854 14,649 7,339 553,079 2,596,984 1,405,179 21 20,216 105,845 102,451 335,036 3,923 16,064 6,417 11,026 46,171 221,522 76,206 468,345 85 10,357 56,245 42,311 118,464 15,267 American Lung Association State of the Air 2020 2,034,564 10,142,484 4,951,178 24,936,906 State Tables CALIFORNIA American Lung Association in California www.Lung.org/california HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Alameda 20 3 1 8.8 F 10 Amador 15 0 0 5.0 F Butte 48 3 0 17.5 F 13 Calaveras 13 2 Wgt. Avg. Grade 0 11.2 F DNC DNC DNC DNC DNC DNC INC INC 3 0 15.2 F 15 5 0 0 7.5 F 0 0 0.0 A 12 16 0 0 12.0 F Contra Costa 8 0 0 D 11 12 0 2 11.0 F 8.5 PASS 10.5 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC El Dorado 87 21 1 40.2 F Fresno 191 43 1 85.8 F Humboldt DNC DNC 10.1 PASS 0 Glenn 12.0 PASS 2 9.3 F 41 Del Norte Pass/ Fail 4 2 Colusa 2.7 Design Value 0 0 0 0.0 A 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC 73 27 0 0 37.8 F DNC DNC DNC DNC DNC DNC DNC DNC 15.0 FAIL DNC DNC 4 0 0 0 1.3 C 7.4 PASS Imperial 56 2 0 19.7 F 19 2 0 0 7.3 F 12.6 FAIL Inyo 32 0 0 10.7 F 10 9 3 0 9.8 F 7.2 PASS Kern 257 35 0 103.2 F 64 29 0 0 35.8 F 17.8 FAIL Kings 111 0 39.5 F 68 27 0 0 36.2 F 16.8 FAIL Lake Los Angeles Madera Marin Mariposa Mendocino Merced Mono Monterey Napa 5 0 0 0 0.0 A 207 111.0 F 2 2 1 0 2.3 D 6.1 PASS 68 12 84 6 0 31.0 F 41 7 0 0 17.2 F 12.8 FAIL 0 0 0 0.0 A 8 12 1 0 9.3 F 9.1 PASS 60 5 0 22.5 F 0 0 0 0.0 A 19 7 1 1 11.3 F 9.1 PASS 63 2 0 22.0 F 41 12 0 0 19.7 F 13.4 FAIL DNC DNC DNC DNC DNC 0 0 0 0.0 A 2 0 0 0.7 B Nevada 110 29 0 51.2 F Orange 45 Placer 95 14 3 40.7 F 4 0 17.0 F 31 7 0 0 13.8 F DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC 12.7 FAIL DNC DNC INC INC 9 10 0 0 8.0 F 6.3 PASS 10 13 2 0 11.2 F INC INC 8 5 0 0 5.2 F 6.5 PASS 14 1 0 0 5.2 F 8.0 PASS 9 4 1 0 5.7 F 8.7 PASS Plumas DNC DNC DNC DNC DNC 32 11 0 0 16.2 F 14.7 FAIL Riverside 244 99 12 138.8 F 21 4 0 0 9.0 F 13.9 FAIL Sacramento 60 0 25.0 F 18 4 5 0 11.3 F 10.4 PASS San Benito 10 7 0 0 2.3 D 11 0 0 0 3.7 F 5.5 PASS San Bernardino 220 146 42 174.3 F 22 5 0 0 9.8 F 14.7 FAIL San Diego 118 8 0 43.3 F San Francisco 6 0 0 0 2.0 C 9.3 PASS 0 0 0 0.0 A 9 11 1 0 9.2 San Joaquin 32 1 0 11.2 F 45 9 3 0 San Luis Obispo 19 1 0 6.8 F 2 0 0 0 San Mateo 1 1 0 0.8 B 7 12 0 0 Santa Barbara 5 0 0 1.7 C 6 8 1 0 6.7 F 8.1 PASS Santa Clara 4 14 68 3 0 Lung.org 2.8 D 11 0 American Lung Association State of the Air 2020 0 F 9.6 21.5 F 13.8 FAIL 0.7 B 8.9 PASS 8.3 F 9.3 PASS 10.2 F 10.7 PASS PASS State Tables CALIFORNIA (cont.) American Lung Association in California www.Lung.org/california HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Santa Cruz Shasta Wgt. Avg. Grade Orange Red Purple Maroon 1 0 0 0.3 B 42 2 0 15.0 F Wgt. Avg. Grade Design Value Pass/ Fail 8 5 0 0 5.2 F 6.9 PASS 1 5 0 0 2.8 D 9.6 PASS Siskiyou 4 0 0 1.3 C 17 23 0 0 17.2 F 10.1 PASS Solano 5 1 0 2.2 D 7 14 1 0 10.0 F 10.8 PASS Sonoma 1 0 0 0.3 B 4 11 2 0 8.2 F 7.0 PASS Stanislaus 82 9 0 31.8 F 54 16 1 0 26.7 F 14.2 FAIL Sutter 50 0 0 16.7 F 11 0 3.7 F 9.2 PASS Tehama 57 7 0 22.5 F 13 16 0 0 12.3 F INC INC Tulare 242 49 0 105.2 F 19 9 0 0 10.8 F Tuolumne 83 0 31.7 F Ventura 39 3 0 14.5 F 4 4 3 2 7.0 F 11.0 PASS 8 0 0 2.7 D 1 2 1 0 2.0 C 9.3 PASS Yolo 69 8 Lung.org 0 0 DNC DNC DNC DNC DNC DNC American Lung Association State of the Air 2020 16.1 FAIL DNC DNC State Tables COLORADO 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 Heart Disease Ever Smoked Poverty People of Color Adams 511,868 135,776 53,587 9,717 34,100 15,049 208 19,585 150,229 46,711 257,963 Arapahoe 651,215 153,397 85,065 10,979 44,914 21,361 264 28,479 200,921 52,474 261,137 Archuleta Boulder Chaffee Clear Creek Delta 13,765 2,485 3,585 326,078 61,951 46,486 178 995 642 4,434 23,860 11,305 6 929 4,781 1,525 3,193 132 15,118 106,582 30,699 73,061 20,027 3,009 5,084 215 1,510 924 8 1,327 7,151 2,023 2,962 9,605 1,448 1,953 104 723 420 4 30,953 6,197 8,024 444 2,188 1,401 586 3,391 686 1,130 13 2,034 10,484 4,429 5,839 Denver 716,492 139,926 84,216 Douglas 342,776 88,978 40,935 6,368 22,775 11,168 139 14,826 102,766 8,975 61,999 El Paso 713,856 172,064 91,063 12,315 49,015 22,736 290 30,212 217,978 68,538 222,362 Garfield 59,770 15,072 7,858 10,014 52,557 22,264 291 1,079 4,023 1,962 28,952 229,276 82,104 326,156 24 2,628 18,101 4,946 19,175 Grand 15,525 2,609 2,732 187 1,152 623 6 856 5,310 1,219 2,000 Gunnison 17,246 2,931 2,236 210 1,299 578 7 760 5,727 1,678 2,220 Jefferson La Plata 580,233 114,515 95,477 8,196 41,776 21,576 56,310 10,684 9,668 765 4,090 2,139 Larimer 350,518 68,703 54,938 4,917 25,460 12,323 Mesa 153,207 33,045 29,238 2,365 10,759 5,864 235 29,476 190,255 39,799 127,678 23 2,935 18,677 5,005 12,182 142 16,693 114,131 36,054 61,373 62 8,192 49,537 21,463 28,885 Moffat 13,188 3,418 2,020 245 875 457 Montezuma 26,158 5,756 5,785 412 1,811 1,087 11 1,550 8,541 4,235 7,318 Montrose 42,214 9,120 9,836 653 2,935 1,796 17 2,578 13,903 4,854 10,177 Park Pueblo 18,556 2,810 3,793 167,529 37,623 30,988 5 201 1,389 835 625 3,997 1,614 2,590 8 1,167 6,578 1,487 2,052 2,693 11,628 6,320 68 8,807 53,520 28,127 80,496 Rio Blanco 6,336 1,506 985 108 433 224 3 306 1,974 653 977 San Miguel 8,191 1,438 1,201 3 Weld Totals 70 314,305 82,497 38,224 5,165,921 1,156,958 714,977 Lung.org 103 605 305 5,904 20,952 9,752 82,803 361,827 173,114 410 2,746 702 1,152 127 12,935 93,286 32,314 108,618 2,095 American Lung Association State of the Air 2020 231,967 1,619,841 482,314 1,682,695 State Tables COLORADO American Lung Association in Colorado www.Lung.org/colorado HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Adams Wgt. Avg. Grade Orange Red Purple Maroon 3 0 0 1.0 C Arapahoe 27 1 0 9.5 F Archuleta INC INC INC INC INC Wgt. Avg. Grade Design Value Pass/ Fail 2 0 0 0 0.7 B INC INC 1 0 0 0 0.3 B 6.0 PASS DNC DNC DNC DNC DNC DNC DNC DNC Boulder 38 1 0 13.2 F Chaffee INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC Clear Creek 21 DNC DNC DNC DNC DNC DNC DNC DNC Delta INC INC INC INC INC INC INC INC INC INC INC INC INC Denver 10 0 0 3.3 F 5 0 0 0 1.7 C 9.2 PASS Douglas 53 4 0 19.7 F 3 1 0 0 1.5 C 6.2 PASS El Paso 11 0 0 3.7 F 2 0 0 0 0.7 B 6.0 PASS Garfield Grand 2 0 8.0 F 2 1 0 1.2 C INC INC INC INC INC 3 0 0 0 1.0 C 7.0 PASS 0 0 0 0 0.0 A INC INC DNC DNC DNC DNC DNC DNC DNC DNC Gunnison 2 1 0 1.2 C DNC DNC DNC DNC DNC DNC DNC DNC Jefferson 80 5 0 29.2 F DNC DNC DNC DNC DNC DNC DNC DNC La Plata 16 0 0 5.3 F 5 9 1 0 6.8 F 8.4 PASS Larimer 42 4 0 16.0 F 1 1 0 0 0.8 B 7.3 PASS Mesa 4 0 0 1.3 C 1 0 0 0 0.3 B 5.9 PASS Moffat 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Montezuma 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC Montrose 1 0 0 0.3 DNC DNC DNC DNC DNC DNC DNC DNC Park 4 0 0 1.3 C Pueblo Rio Blanco B DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 5.5 PASS 2 0 0 0.7 B San Miguel INC INC INC INC INC Weld 14 0 0 4.7 F 71 2 0 0 0 0.7 B INC INC Lung.org 0 0 0 0 0.0 A 7.9 PASS DNC DNC DNC DNC DNC DNC DNC DNC 6 1 0 0 2.5 D 9.1 PASS American Lung Association State of the Air 2020 State Tables 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 Heart Disease Ever Smoked Poverty People of Color Fairfield 943,823 212,038 149,918 20,593 76,126 39,383 560 54,861 291,103 92,971 363,243 Hartford 892,697 187,304 152,874 18,191 72,903 37,913 530 53,407 280,026 96,957 351,528 Litchfield 181,111 32,933 38,502 3,198 15,522 8,888 108 12,862 61,124 12,441 21,609 Middlesex 162,682 28,777 33,067 2,795 13,956 7,758 97 11,147 54,545 10,556 26,484 New Haven 857,620 173,046 148,886 New London 266,784 51,733 48,611 5,024 22,251 11,781 Tolland 150,921 26,160 23,845 2,541 12,817 6,287 90 8,681 48,503 10,835 23,699 Windham 117,027 23,202 19,418 2,253 9,739 5,032 70 7,025 37,262 13,135 20,797 Totals 72 3,572,665 735,193 615,121 Lung.org 16,806 70,700 36,755 71,401 294,014 153,797 509 51,816 271,621 96,563 322,987 159 16,711 85,901 25,063 65,967 2,120 American Lung Association State of the Air 2020 216,509 1,130,084 358,521 1,196,314 State Tables CONNECTICUT American Lung Association in Connecticut www.Lung.org/connecticut HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Fairfield 42 18 0 23.0 F 0 0 0 0 0.0 A 8.1 PASS Hartford 10 1 0 3.8 F 0 0 0 0 0.0 A 7.5 PASS Litchfield 12 1 0 4.5 F 1 0 0 0 0.3 B 4.2 PASS Middlesex 26 New Haven 31 9 0 14.8 F 0 0 0 0 0.0 A 6.8 PASS New London 21 3 0 8.5 F 0 0 0 0 0.0 A INC INC Tolland 12 0 0 4.0 F DNC DNC DNC DNC DNC DNC DNC DNC Windham 13 1 0 4.8 F DNC DNC DNC DNC DNC DNC DNC DNC 73 3 0 10.2 F Lung.org DNC DNC DNC DNC DNC DNC American Lung Association State of the Air 2020 DNC DNC State Tables 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 Heart Disease Ever Smoked Poverty People of Color Kent 178,550 40,805 30,483 2,920 14,080 9,420 121 11,922 57,685 23,966 69,754 New Castle 559,335 120,227 87,028 8,605 45,228 29,593 380 Sussex 229,286 42,584 63,575 3,048 18,083 15,036 156 20,944 82,503 27,750 56,660 Totals 967,171 203,616 181,086 74 Lung.org 14,573 77,392 54,049 656 American Lung Association State of the Air 2020 36,633 183,147 62,976 241,696 69,499 323,336 114,692 368,110 State Tables DELAWARE American Lung Association in Delaware www.Lung.org/delaware HIGH OZONE DAYS 2016–2018 24-Hour Annual County Orange Red Purple Kent New Castle Sussex 75 HIGH PARTICLE POLLUTION DAYS 2016–2018 Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail 5 0 0 1.7 C 0 0 0 0 0.0 A INC INC 22 1 0 7.8 F 3 0 0 0 1.0 C INC INC 8 0 0 2.7 D 0 0 0 0 0.0 A 6.7 PASS Lung.org American Lung Association State of the Air 2020 State Tables 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 Pediatric Asthma 85,303 13,885 District of Columbia 702,455 Totals 702,455 127,494 85,303 76 127,494 65 & Over Lung.org Adult Asthma COPD 67,121 30,357 13,885 67,121 30,357 Lung Cancer Heart Disease Ever Smoked Poverty People of Color 275 36,404 199,495 442,187 275 36,404 199,495 107,806 442,187 American Lung Association State of the Air 2020 107,806 State Tables DISTRICT OF COLUMBIA American Lung Association in the District of Columbia www.Lung.org/districtofcolumbia HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple District of Columbia 77 14 1 0 Lung.org Wgt. Avg. Grade Orange Red Purple Maroon 5.2 F 2 0 0 American Lung Association State of the Air 2020 0 Wgt. Avg. Grade 0.7 B Design Value Pass/ Fail 9.0 PASS State Tables FLORIDA American Lung Association in Florida www.Lung.org/florida AT-RISK GROUPS Lung Diseases County Alachua Baker Total Population Under 18 65 & Over Pediatric Asthma 269,956 48,541 37,836 Adult Asthma COPD Lung Cancer 3,616 19,164 15,388 28,355 6,715 4,015 Heart Disease Ever Smoked Poverty People of Color 151 18,802 86,310 50,922 105,796 500 1,908 1,641 16 2,082 8,806 3,944 5,448 Bay 185,287 39,761 31,678 2,962 12,837 11,548 104 15,034 60,251 24,276 44,216 Brevard 596,849 108,913 141,345 8,114 43,092 42,603 334 Broward 1,951,260 412,789 324,313 30,754 135,830 121,311 1,090 157,257 635,762 244,310 1,256,553 Citrus 147,929 22,036 53,705 1,642 11,016 12,524 Collier 378,488 64,794 121,935 4,827 27,352 29,654 Columbia 70,503 15,312 13,314 58,240 209,867 64,854 154,762 83 18,233 56,902 22,082 18,173 212 1,141 4,853 4,472 40 42,379 138,432 39,689 141,797 5,904 22,990 11,340 19,550 Duval 950,181 214,676 133,483 15,994 64,667 54,910 530 69,179 297,059 134,476 450,723 Escambia 315,534 65,784 53,148 4,901 21,910 19,334 177 24,935 102,101 43,832 113,022 Flagler 112,067 18,884 34,428 1,407 8,183 8,789 Highlands Hillsborough Holmes Indian River 105,424 17,970 37,222 62 12,492 41,244 11,450 28,218 1,339 7,586 8,495 1,436,888 323,986 205,315 59 12,315 38,936 21,577 35,445 24,138 97,850 83,443 19,477 3,938 3,871 803 105,402 450,198 207,358 743,667 293 1,369 1,279 11 1,701 6,519 4,232 2,638 157,413 25,219 52,019 1,879 11,568 12,687 Lake 356,495 68,268 95,109 5,086 25,249 25,793 199 35,876 124,638 40,582 109,098 Lee 754,610 132,623 215,894 9,881 54,399 56,536 422 79,279 270,457 90,400 250,391 Leon 292,502 54,472 39,155 4,058 20,635 16,477 163 20,048 92,747 57,656 127,693 Liberty 8,457 1,512 1,229 88 18,204 58,831 16,775 39,052 113 611 515 5 646 2,798 1,523 2,436 Manatee 394,855 72,121 108,173 5,373 28,333 29,240 220 40,840 140,444 40,662 114,856 Marion 359,977 66,922 104,178 4,986 25,605 26,824 201 37,756 127,728 52,818 107,688 Martin 160,912 26,388 49,690 1,966 11,817 12,698 Miami-Dade Okaloosa Orange Osceola Palm Beach 2,761,581 558,250 448,112 41,591 194,215 171,072 207,269 46,083 33,189 90 18,050 59,572 16,824 35,430 1,542 220,114 904,339 436,103 2,401,789 3,433 14,141 12,360 1,380,645 305,917 164,820 22,791 94,243 76,289 367,990 89,835 48,605 772 6,693 24,413 20,439 1,485,941 283,456 355,266 116 15,854 65,662 25,612 55,655 21,118 105,463 103,565 93,319 425,534 211,307 831,907 206 25,540 111,571 48,711 254,727 830 141,344 512,309 179,359 682,305 Pasco 539,630 109,651 122,105 8,169 37,833 36,867 301 50,087 183,202 67,164 141,208 Pinellas 975,280 157,672 241,641 11,747 72,125 71,655 544 98,212 351,963 112,593 255,246 Polk 708,009 156,487 143,142 11,659 48,289 45,154 396 60,146 230,084 109,018 297,726 St. Lucie 321,128 63,294 77,503 4,716 22,646 22,443 179 30,756 110,409 38,398 139,092 Santa Rosa 179,349 39,352 28,645 2,932 12,372 10,983 101 14,184 57,775 16,404 31,748 Sarasota 426,718 60,616 156,509 4,516 31,975 36,276 238 Seminole 467,832 98,309 72,533 7,324 32,569 28,403 261 36,334 151,087 46,050 189,106 Volusia 547,538 96,836 133,733 7,214 39,636 39,194 306 Wakulla Totals 78 32,461 6,945 5,086 19,454,790 3,884,327 3,891,944 Lung.org 517 2,260 2,002 289,390 1,368,014 1,272,860 52,791 165,020 43,389 72,475 53,638 193,067 70,499 157,810 18 2,581 10,546 3,543 6,473 10,867 1,689,555 6,505,159 2,609,732 9,423,919 American Lung Association State of the Air 2020 State Tables FLORIDA American Lung Association in Florida www.Lung.org/florida HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Alachua 1 0 0 0.3 B Baker 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Bay 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Brevard 1 0 0 0.3 B 0 0 0 0 0.0 A 5.7 PASS Broward 5 0 0 1.7 C 0 0 0 0 0.0 A 6.6 PASS Citrus DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.3 PASS INC INC INC INC INC INC INC INC Collier 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Columbia 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Duval 1 0 0 0.3 B 1 0 0 0 0.3 B INC INC Escambia 3 0 0 1.0 C 0 0 0 0 0.0 A 7.4 PASS Flagler 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Highlands 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Hillsborough 9 1 0 3.5 F Holmes 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Indian River 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC Lake 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC Lee 1 0 0 0.3 B Leon 0 0 0 0.0 A Liberty 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Manatee 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC Marion 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC Martin 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC Miami-Dade 7 0 0 2.3 D Okaloosa 0 Orange 3 1 0 1.5 C Osceola 4 Palm Beach 2 0 0 0.7 B Pasco 5 Pinellas 1 0 0 0.3 B Polk 6 0 0 2.0 C St. Lucie 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Santa Rosa 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Sarasota 2 0 0 0.7 B 0 0 0 0 0.0 A 6.7 PASS Seminole 4 0 0 1.3 C 0 0 0 0 0.0 A 6.2 PASS Volusia 0 0 0 0.0 A 0 0 0 0 0.0 A 6.6 PASS Wakulla 0 79 0 0 0 0 0 0.0 A 0 1.3 C 0 1.7 C 0 0.0 Lung.org A 0 0 0 0 0.0 A 7.9 PASS 1 0 0 0 0.3 B 6.6 PASS 0 0 0 0 0.0 A 7.3 PASS 1 0 0 0 0.3 B 8.0 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.2 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.4 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.3 PASS 0 0 0 0 0.0 A 6.9 PASS DNC DNC DNC DNC DNC DNC American Lung Association State of the Air 2020 DNC DNC State Tables 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 Heart Disease Ever Smoked Poverty People of Color Bibb 153,095 37,623 23,876 2,852 10,333 8,813 95 11,232 43,798 36,326 95,172 Chatham 289,195 61,279 44,478 4,645 20,274 16,743 181 21,065 85,672 39,488 149,834 Chattooga Clarke 24,790 5,555 4,354 127,330 21,989 13,959 Clayton 289,615 80,559 26,997 Cobb 756,865 178,546 92,777 Coffee 421 1,731 1,540 1,667 9,179 6,433 6,107 18,739 14,223 43,093 10,534 5,930 799 2,914 2,395 154,291 39,147 20,833 2,967 10,335 8,547 Coweta 145,864 35,765 20,242 2,711 9,959 8,433 Dawson DeKalb Dougherty Douglas Floyd Fulton Glynn 25,083 5,186 5,045 756,558 174,942 94,120 7,441 38,080 31,645 57,196 180 16,817 77,506 50,072 261,809 13,534 52,002 41,860 Columbia 16 1,998 7,379 4,575 4,353 79 474 51,282 217,167 67,585 367,250 27 2,987 12,256 9,505 18,230 97 10,665 43,446 10,858 49,193 91 10,593 41,875 14,844 42,590 393 1,797 1,672 13,261 52,017 41,366 16 2,214 7,720 2,168 2,016 471 50,572 217,418 106,598 535,786 91,243 21,222 14,027 1,609 6,229 5,187 56 6,556 26,366 25,104 68,944 145,331 37,605 16,774 2,851 9,725 7,854 91 9,601 40,542 18,113 88,809 97,927 22,702 16,390 1,721 6,739 5,857 1,050,114 229,407 122,730 61 17,390 73,347 57,077 85,219 18,521 17,247 7,536 28,659 19,427 28,490 657 1,404 5,993 5,553 68,864 305,399 137,929 633,490 53 927,781 249,129 93,264 Hall 202,148 51,265 30,106 3,886 13,547 11,528 127 14,625 57,279 26,249 80,340 Henry 230,220 58,952 26,816 4,469 15,487 12,578 144 15,405 64,571 17,086 134,022 Houston 155,469 39,714 19,762 3,010 10,388 8,453 97 10,447 43,529 18,519 69,011 Lowndes 116,321 27,869 14,366 2,113 7,807 5,993 73 Murray 18,885 61,212 47,918 7,372 25,802 13,913 31,187 Gwinnett 39,921 9,891 5,931 582 750 2,710 2,329 57,458 253,730 84,763 590,670 7,267 32,673 28,539 54,131 25 2,956 11,447 5,987 7,194 Muscogee 194,160 48,112 26,004 3,647 13,016 10,521 122 13,041 54,699 37,759 116,402 Paulding 164,044 42,844 17,394 3,248 10,946 8,682 103 10,487 45,455 12,654 49,499 Pike Richmond 18,634 4,359 2,969 330 1,291 1,131 201,554 46,063 28,342 3,492 13,849 11,249 Rockdale 90,594 22,370 13,059 1,696 6,175 5,294 Sumter 29,733 6,728 4,979 Walker 69,410 15,094 12,876 Washington 20,386 4,398 3,540 333 1,440 1,273 9,036 2,053 1,751 156 632 588 Wilkinson Totals 80 6,705,024 1,609,423 840,938 Lung.org 56 510 2,051 1,760 1,144 4,893 4,428 121,999 456,759 367,277 12 1,450 5,469 1,947 2,410 126 13,995 58,280 41,554 132,321 6,695 26,023 11,803 63,255 18 2,258 8,724 7,208 18,073 44 5,794 20,924 10,542 6,459 13 1,646 6,126 4,787 11,732 6 4,192 American Lung Association State of the Air 2020 778 2,712 2,062 3,908 451,097 1,910,727 899,609 3,773,776 State Tables GEORGIA American Lung Association in Georgia www.Lung.org/georgia HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Bibb 3 0 0 1.0 C Chatham 0 0 0 0.0 A Chattooga 0 Clarke Clayton Cobb Coffee Columbia Coweta Dawson DeKalb Dougherty Douglas Floyd 0 0 0.0 A 3 0 0 1.0 C Wgt. Avg. Grade Design Value Pass/ Fail 3 0 0 0 1.0 C 9.3 PASS 1 0 0 0 0.3 B 7.8 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 1 0 0 0.5 B 8.1 PASS DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 9.1 PASS 2 1 0 1.2 C DNC DNC DNC DNC DNC 1 0 0 0.3 B INC INC INC INC INC 6 0 0 2.0 C 8 0 0 2.7 D 1 0 0 0 0.3 B 8.7 PASS INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 1 1 0 0 0.8 B 8.6 PASS DNC DNC DNC DNC DNC 1 1 0 0 0.8 B 8.8 PASS 6 2 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC Fulton 21 1 0 7.5 F Glynn 0 0 0 0.0 A 2 0 0 0 0.7 B 7.2 PASS Gwinnett 6 0 0 2.0 C 1 0 0 0 0.3 B 9.0 PASS Hall Henry 1 0 0 0 0.3 B 10.1 PASS DNC DNC DNC DNC DNC 1 1 0 0 0.8 B 7.9 PASS 13 1 0 4.8 F DNC DNC DNC DNC DNC DNC DNC DNC Houston DNC DNC DNC DNC DNC 3 0 0 0 1.0 C 8.3 PASS Lowndes DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 7.4 PASS Murray Muscogee Paulding 1 0 0 0.3 B 1 0 0 0.3 B INC INC INC INC INC Pike 6 Richmond 1 0 0 0.3 B Rockdale Sumter 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 9.2 PASS INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC 4 1 0 0 1.8 C 9.5 PASS 12 0 0 4.0 F DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Walker DNC DNC DNC DNC DNC 0 1 0 0 0.5 B 8.8 PASS Washington DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 7.9 PASS Wilkinson DNC DNC DNC DNC DNC 81 Lung.org INC INC INC INC INC INC American Lung Association State of the Air 2020 INC INC State Tables HAWAII American Lung Association in Hawaii www.Lung.org/hawaii AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Hawaii 200,983 43,553 42,032 Honolulu 980,080 207,765 173,793 Kauai Maui Totals 82 Pediatric Asthma Adult Asthma COPD 4,444 14,524 6,922 21,200 71,769 30,825 Lung Cancer Heart Disease Ever Smoked Poverty People of Color 92 13,054 62,784 30,903 140,018 449 56,918 302,694 73,345 803,626 72,133 15,749 14,539 1,607 5,211 2,448 33 167,207 36,347 30,566 3,709 12,147 5,506 76 10,237 51,886 14,130 116,808 1,420,403 303,414 260,930 Lung.org 30,960 103,651 45,701 650 American Lung Association State of the Air 2020 4,599 22,446 6,021 50,931 84,808 439,810 124,399 1,111,383 State Tables HAWAII American Lung Association in Hawaii www.Lung.org/hawaii HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Hawaii Honolulu Wgt. Avg. Grade Orange Red Purple Maroon DNC DNC DNC DNC DNC 0 0 0 0.0 A 16 2 0 0 Wgt. Avg. Grade 6.3 F Design Value Pass/ Fail 12.3 FAIL 0 0 0 0 0.0 A 3.6 PASS Kauai DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 2.9 PASS Maui DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 4.1 PASS 83 Lung.org American Lung Association State of the Air 2020 State Tables IDAHO American Lung Association in Idaho www.Lung.org/idaho AT-RISK GROUPS Lung Diseases County Ada Bannock Total Population Under 18 65 & Over Pediatric Asthma 469,966 111,737 67,792 7,997 30,846 19,607 87,138 22,849 12,400 1,635 5,520 3,423 Benewah 9,226 2,084 2,073 Butte 2,611 626 612 Canyon Adult Asthma COPD 223,499 63,627 30,762 Lung Cancer Ever Smoked Poverty People of Color 227 27,145 135,509 44,434 73,002 42 149 609 472 4 45 168 131 4,554 13,744 8,652 Heart Disease 4,789 24,104 11,768 14,350 703 2,881 1,342 1,414 1 200 801 392 226 108 12,057 60,254 25,416 66,818 Franklin 13,726 4,380 1,943 313 802 523 Idaho 16,513 3,259 4,606 233 1,118 917 8 1,429 5,439 2,587 1,538 Jerome 24,015 7,394 3,117 529 1,431 904 12 1,250 6,274 2,974 9,335 7,961 1,488 2,409 106 544 458 4 12,796 2,630 2,923 188 866 662 6 Lemhi Shoshone Totals 84 867,451 220,074 128,637 Lung.org 15,751 55,647 35,748 7 419 American Lung Association State of the Air 2020 738 3,560 1,194 1,228 726 2,679 1,154 533 988 4,079 2,371 1,140 50,025 245,580 93,632 169,584 State Tables IDAHO American Lung Association in Idaho www.Lung.org/idaho HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Ada Wgt. Avg. Grade Orange Red Purple Maroon 20 0 0 6.7 F Wgt. Avg. Grade Design Value Pass/ Fail 6 1 0 0 2.5 D 7.7 PASS Bannock DNC DNC DNC DNC DNC 2 3 0 0 2.2 D INC INC Benewah DNC DNC DNC DNC DNC Butte 3 0 0 1.0 C 22 5 2 0 11.2 F DNC DNC DNC DNC DNC DNC INC INC DNC DNC Canyon DNC DNC DNC DNC DNC 7 1 0 0 2.8 D 9.4 PASS Franklin DNC DNC DNC DNC DNC 7 2 0 0 3.3 F INC Idaho INC INC INC INC INC Jerome DNC DNC DNC DNC DNC 10 1 0 0 Lemhi DNC DNC DNC DNC DNC 11 4 0 Shoshone DNC DNC DNC DNC DNC 29 6 1 85 Lung.org DNC DNC DNC DNC DNC DNC American Lung Association State of the Air 2020 INC DNC DNC 3.8 F INC INC 0 5.7 F 11.4 PASS 0 13.3 F 11.2 PASS State Tables ILLINOIS American Lung Association in Illinois www.Lung.org/illinois AT-RISK GROUPS Lung Diseases County Adams Champaign Clark Cook DuPage Effingham Hamilton Jersey Jo Daviess Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD 65,691 14,779 13,290 887 4,405 3,716 209,983 39,434 26,930 2,368 14,952 9,930 15,596 3,540 3,097 5,180,493 1,129,672 758,167 Ever Smoked Poverty People of Color 4,807 20,067 7,803 5,551 133 11,800 62,828 37,121 69,623 10 1,144 4,766 1,702 562 3,271 12,643 62,583 48,073 321,077 1,538,653 701,869 3,000,419 587 34,208 8,104 6,043 487 2,267 1,829 8,163 1,794 1,783 108 550 481 21,847 4,455 4,260 268 1,508 1,256 21,366 4,017 6,004 Heart Disease 42 213 1,044 883 67,835 353,721 259,528 928,589 210,552 143,938 Lung Cancer 241 1,485 1,438 60,485 276,877 60,169 312,483 22 2,336 10,181 3,277 1,520 5 628 2,537 990 321 14 1,620 6,851 1,864 957 14 1,929 7,107 1,656 1,181 Kane 534,216 136,009 73,009 8,167 34,780 25,892 338 32,243 152,367 45,180 231,005 Lake 700,832 168,886 99,810 10,141 46,434 35,011 444 43,799 204,350 54,353 273,375 McHenry 308,570 72,396 45,024 4,347 20,605 15,817 195 19,921 91,332 18,136 59,799 McLean 172,828 37,136 22,860 2,230 11,878 8,277 109 10,040 50,773 23,366 35,797 Macon 104,712 23,150 20,960 1,390 7,061 5,902 Macoupin 45,313 9,644 9,006 66 579 3,089 2,600 7,612 32,055 17,557 24,937 29 3,363 14,083 5,740 1,834 Madison 264,461 57,756 45,485 3,468 17,974 14,239 167 18,086 80,268 35,925 40,298 Peoria 180,621 42,619 30,816 2,559 11,997 9,427 114 11,931 53,343 29,227 54,743 Randolph 32,106 6,203 5,972 372 2,250 1,806 21 2,302 10,083 3,834 4,881 Rock Island 143,477 31,963 27,672 1,919 9,665 7,949 91 10,203 43,632 19,754 41,412 St. Clair 261,059 61,073 41,261 3,667 17,419 13,467 165 16,975 77,184 38,065 100,558 Sangamon 195,348 43,347 34,887 2,603 13,202 10,622 123 13,556 59,249 25,172 38,619 Will 692,310 172,143 90,406 Winnebago Totals 86 284,081 66,490 49,819 10,405,870 2,345,162 1,560,499 Lung.org 10,337 45,481 33,460 3,993 18,901 15,178 140,823 703,250 526,778 438 41,517 198,663 44,038 256,365 179 19,358 84,760 45,006 89,449 6,576 American Lung Association State of the Air 2020 656,731 3,082,010 1,221,804 4,645,689 State Tables ILLINOIS American Lung Association in Illinois www.Lung.org/illinois HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple 0 Wgt. Avg. Grade Orange Red Purple Maroon Adams 1 Champaign 5 0 0 1.7 C Clark 3 0 0 0.3 B 0 1.0 C Cook 44 9 0 19.2 F DuPage 15 0 0 5.0 F Effingham Hamilton Jersey Jo Daviess Kane 4 0 0 1.3 C Wgt. Avg. Grade DNC DNC DNC DNC DNC DNC Design Value Pass/ Fail DNC DNC 0 0 0 0 0.0 A 7.6 PASS DNC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 10.3 PASS 0 0 0 0 0.0 A 8.8 PASS DNC DNC DNC DNC DNC DNC DNC DNC 3 0 0 1.0 C 0 0 0 0 0.0 A 8.4 PASS 11 0 0 3.7 F 0 0 0 0 0.0 A INC INC 3 0 0 1.0 C 14 0 0 4.7 F 21 McHenry 17 0 0 5.7 F 0 0 0 0 0.0 A 7.6 PASS McLean 2 0 0 0.7 B 0 0 0 0 0.0 A 8.7 PASS Macon 6 0 0 2.0 C Macoupin 3 0 0 8.0 F DNC DNC 0 0 0 0 0.0 A 8.4 PASS Lake Madison 2 DNC DNC DNC DNC DNC DNC 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 9.0 PASS DNC DNC DNC DNC DNC DNC DNC DNC 25 2 0 9.3 F 1 0 0 0 0.3 B 9.9 PASS Peoria 8 0 0 2.7 D 0 0 0 0 0.0 A 8.5 PASS Randolph 3 0 0 1.0 C 0 0 0 0 0.0 A 8.4 PASS Rock Island 2 0 0 0.7 B 0 0 0 0 0.0 A INC INC St. Clair 9 1 0 3.5 F 0 0 0 0 0.0 A 9.7 PASS Sangamon 4 0 0 1.3 C 0 0 0 0 0.0 A 8.6 PASS Will 5 0 0 1.7 C 0 0 0 0 0.0 A INC INC Winnebago 5 1 0 2.2 D 0 0 0 0 0.0 A INC INC 87 Lung.org American Lung Association State of the Air 2020 State Tables INDIANA American Lung Association in Indiana www.Lung.org/indiana AT-RISK GROUPS Lung Diseases County Allen Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Heart Disease Ever Smoked Poverty People of Color 375,351 96,407 54,718 8,390 27,609 24,979 Bartholomew 82,753 19,689 13,487 1,713 6,239 5,773 Boone 66,999 17,718 8,954 1,542 4,909 4,486 48 5,290 22,323 3,585 6,615 Brown 15,234 2,732 3,668 238 1,252 1,352 11 1,691 5,810 1,519 687 387 1,562 1,568 14 1,932 7,188 1,756 1,201 Carroll 20,127 4,451 3,949 Clark 117,360 26,376 18,524 2,295 9,035 8,391 Delaware 114,772 21,074 19,672 1,834 9,194 8,142 Dubois Elkhart 42,565 10,277 7,430 205,560 56,565 30,282 269 29,997 125,725 49,641 99,590 60 7,019 28,495 8,238 15,386 84 10,083 41,223 12,975 20,078 82 894 3,218 3,145 4,923 14,750 13,493 9,986 41,911 23,799 15,212 31 3,825 14,755 3,155 4,214 148 16,276 67,254 23,202 52,263 Floyd 77,781 17,609 12,549 1,532 5,989 5,657 56 6,800 27,357 7,231 9,564 Greene 32,006 7,019 6,248 611 2,493 2,512 23 3,087 11,473 4,423 1,103 Hamilton 330,086 89,053 40,862 7,750 23,994 21,480 236 25,130 108,861 13,797 54,838 Hendricks 167,009 41,780 23,141 3,636 12,442 11,279 120 13,373 56,582 9,657 27,120 Henry 48,271 9,877 9,134 Howard 82,366 18,680 16,056 Huntington 36,240 7,812 6,230 680 2,827 2,697 26 3,268 12,934 3,532 1,985 Jackson 44,111 10,835 7,218 943 3,306 3,134 32 Johnson 156,225 38,713 22,769 3,369 11,643 10,548 Knox 860 3,818 3,734 1,626 6,321 6,250 36,895 7,921 6,582 35 4,576 17,525 6,434 3,149 59 7,740 29,080 9,942 12,346 3,796 15,120 5,183 5,343 112 12,630 53,005 11,784 17,578 689 2,864 2,691 27 3,302 13,112 5,447 2,785 Lake 484,411 113,194 80,104 9,851 36,859 34,784 LaPorte 110,007 23,561 19,692 2,050 8,582 8,225 79 10,039 39,317 16,212 23,147 Madison 129,641 28,038 23,714 2,440 10,079 9,700 93 11,892 46,215 20,908 19,694 Marion 954,670 235,211 120,358 Monroe 146,917 22,966 19,249 1,999 12,037 9,253 Morgan 70,116 15,846 11,874 1,379 5,429 5,316 Perry 19,102 4,013 3,590 Porter Posey St. Joseph 346 20,470 70,986 60,620 169,594 37,424 27,803 682 71,598 321,447 160,661 431,505 106 11,071 54,238 28,177 24,381 50 349 1,497 1,450 3,257 13,131 12,330 25,540 5,627 4,799 42,135 168,517 74,864 222,969 6,391 24,863 7,339 2,850 14 1,782 6,869 2,167 1,160 122 14,874 59,981 14,826 29,129 490 1,987 1,980 18 2,420 9,130 2,311 1,073 270,771 64,005 42,783 5,570 20,430 18,618 Shelby 44,593 10,170 7,644 885 3,433 3,332 32 Spencer 20,327 4,440 3,932 386 1,587 1,600 15 1,961 7,300 1,839 1,066 Sullivan 20,690 3,979 3,718 194 22,570 93,183 35,068 75,154 346 1,656 1,561 4,029 15,724 5,065 3,495 15 1,905 7,576 2,513 1,724 Tippecanoe 193,048 39,983 22,471 3,480 14,884 11,360 139 13,470 66,978 32,114 47,441 Vanderburgh 180,974 39,047 30,573 3,398 14,042 13,032 129 15,856 64,158 26,349 29,780 Vigo 107,386 21,965 17,517 1,912 8,404 7,483 Wabash 31,280 6,512 6,526 Warrick 62,567 14,921 10,947 Whitley 34,074 7,899 6,124 Totals 88 5,127,419 1,203,389 774,891 Lung.org 77 567 2,455 2,451 1,299 4,744 4,620 45 687 2,607 2,554 104,727 388,291 351,578 9,114 38,291 18,824 15,570 22 3,060 11,316 3,631 1,767 5,624 21,754 4,373 4,900 24 3,116 11,961 2,377 1,604 3,677 American Lung Association State of the Air 2020 422,705 1,768,553 664,918 1,289,466 State Tables INDIANA American Lung Association in Indiana www.Lung.org/indiana HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Allen Wgt. Avg. Grade Orange Red Purple Maroon 10 0 0 3.3 F Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0 0.0 A 8.6 PASS Bartholomew 8 0 0 2.7 D Boone 9 0 0 3.0 D Brown 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Carroll 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC Clark Delaware Dubois 1 0 0 0 0.3 B 7.6 PASS DNC DNC DNC DNC DNC DNC DNC DNC 12 0 0 4.0 F 0 0 0 0 0.0 A 9.0 PASS 5 0 0 1.7 C 1 0 0 0 0.3 B 7.9 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.6 PASS Elkhart 10 0 0 3.3 F 2 0 0 0 0.7 B 8.3 PASS Floyd 16 0 0 5.3 F 0 0 0 0 0.0 A INC INC Greene 7 0 0 2.3 D 0 0 0 0 0.0 A 7.9 PASS Hamilton 10 0 0 3.3 F Hendricks 2 0 0 0.7 B 1 0 0 0 0.3 B 8.1 PASS DNC DNC DNC DNC DNC DNC DNC DNC Henry DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 7.5 PASS Howard INC INC INC INC INC 0 0 0 0 0.0 A 8.3 PASS Huntington 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Jackson 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC Johnson Knox INC INC INC INC INC 8 0 0 2.7 D Lake 12 1 0 4.5 F 2 1 1 0 1.8 C 9.4 PASS LaPorte 16 1 0 5.8 F 0 0 0 0 0.0 A INC INC Madison 7 0 0 2.3 D 1 0 0 0 0.3 B 8.3 PASS 18 7 Marion Monroe 0 0 6.0 F 1 0 0 2.8 D 10.4 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.8 PASS Morgan 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Perry 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC Porter Posey St. Joseph Shelby 19 0 0 6.3 F 3 0 0 1.0 C 19 0 0 6.3 F 7 0 0 2.3 D 0 1 0 0 0.5 B 7.7 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.9 PASS DNC DNC DNC DNC DNC DNC DNC DNC Spencer DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.4 PASS Sullivan DNC DNC DNC DNC DNC Tippecanoe DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.1 PASS INC INC INC INC INC INC INC INC Vanderburgh 9 0 0 3.0 D 0 0 0 0 0.0 A 9.1 PASS Vigo 6 0 0 2.0 C 0 0 0 0 0.0 A 9.0 PASS Wabash 11 0 0 3.7 F DNC DNC DNC DNC DNC DNC DNC DNC Warrick 10 1 0 3.8 F DNC DNC DNC DNC DNC DNC DNC DNC Whitley 89 DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.7 PASS Lung.org American Lung Association State of the Air 2020 State Tables IOWA American Lung Association in Iowa www.Lung.org/iowa AT-RISK GROUPS Lung Diseases County Black Hawk Total Population Under 18 65 & Over Pediatric Asthma 132,408 28,810 21,719 Adult Asthma COPD Lung Cancer 1,658 8,216 5,752 Heart Disease 79 Ever Smoked Poverty People of Color 7,803 42,284 20,811 25,446 Bremer 24,947 5,567 4,886 320 1,529 1,182 15 1,660 8,023 1,547 1,251 Clinton 46,518 10,602 9,160 610 2,839 2,303 28 3,224 14,995 5,727 4,059 Delaware 17,069 4,031 3,292 232 1,032 848 10 1,182 5,457 1,521 629 Harrison Johnson Lee Linn 14,134 3,278 2,785 151,260 30,183 17,736 34,055 7,297 6,917 225,909 52,510 35,702 189 858 706 1,737 9,670 5,659 420 2,113 1,720 3,022 13,782 9,969 10,003 2,274 2,144 131 609 514 Muscatine 42,929 10,691 7,145 615 2,558 1,931 Polk Pottawattamie 8,929 2,037 1,958 487,204 121,315 63,631 Scott 173,283 41,080 28,142 2,365 10,501 7,756 Story 98,105 16,245 11,812 935 6,530 3,622 Warren Woodbury Totals 90 56 59 92 426 366 729 3,052 2,249 Lung.org 1,539 6,025 4,326 22,963 105,155 73,411 732 3,247 1,360 668 2,634 13,314 4,973 10,116 645 2,884 834 638 25,704 148,762 47,499 111,152 5,959 29,594 10,760 11,737 103 10,506 54,424 21,030 35,262 7,020 1,601 1,576 102,539 26,742 15,471 5 289 51,056 12,657 8,025 1,720,901 398,950 258,436 6 26 6,983 29,203 19,715 1,268 5,669 4,343 Van Buren 20 2,415 11,175 4,758 3,178 117 542 449 93,533 22,030 16,335 988 4,543 1,347 569 7,160 48,280 22,536 33,328 134 13,425 71,163 20,652 32,676 Montgomery Palo Alto 8 90 4 4,575 32,414 16,410 16,343 526 2,282 917 287 30 3,034 15,805 3,502 3,087 61 1,023 American Lung Association State of the Air 2020 5,818 31,072 13,835 28,376 97,992 539,718 200,019 318,802 State Tables IOWA American Lung Association in Iowa www.Lung.org/iowa HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Black Hawk Wgt. Avg. Grade Orange Red Purple Maroon Design Value Pass/ Fail DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.8 PASS Bremer 2 Clinton 1 0 0 0.3 B Delaware DNC DNC DNC DNC DNC Harrison Wgt. Avg. Grade 2 0 0 0 0.7 0 0.7 B B DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.3 PASS INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC Johnson DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.6 PASS Lee DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.5 PASS Linn Montgomery Muscatine 4 0 0 1.3 C 1 0 0 0 0.3 B 8.0 PASS 0 0 0 0.0 A 0 0 0 0 0.0 A 6.5 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.3 PASS Palo Alto 2 0 0 0.7 B 0 0 0 0 0.0 A 6.7 PASS Polk 2 0 0 0.7 B 2 0 0 0 0.7 B 7.4 PASS Pottawattamie Scott Story Van Buren DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 7.9 PASS 6 0 0 2.0 C INC INC INC INC INC 0 0 0 0.0 A 0 0 0 0 0.0 A 8.4 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.9 PASS Warren INC INC INC INC INC Woodbury DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.7 PASS 91 Lung.org DNC DNC DNC DNC DNC DNC American Lung Association State of the Air 2020 DNC DNC State Tables KANSAS American Lung Association in Kansas www.Lung.org/kansas AT-RISK GROUPS Lung Diseases County Johnson Total Population Under 18 65 & Over Pediatric Asthma 597,555 145,643 86,723 Leavenworth 81,352 19,284 11,779 Neosho 15,951 3,929 3,164 Sedgwick 513,607 131,919 74,487 Shawnee 177,499 41,950 32,296 Sumner Trego Wyandotte Totals 92 Lung.org 337 1,472 6,125 4,159 46 300 1,167 904 10,072 37,686 25,503 3,203 13,238 9,780 290 30,155 116,530 79,896 Ever Smoked Poverty People of Color 39,886 189,480 32,334 121,136 5,441 25,996 7,925 17,116 33,529 159,665 67,722 165,169 100 13,250 57,584 24,062 46,674 13 1,752 7,411 3,016 2,436 38 219 190 3,516 11,844 7,635 Heart Disease 9 1,243 5,151 2,271 1,604 433 1,685 1,287 2,793 500 740 1,577,077 394,943 233,773 Lung Cancer 11,120 44,566 30,438 22,996 5,667 4,303 165,324 46,051 20,281 Adult Asthma COPD 2 270 1,005 316 151 93 9,834 49,497 30,035 98,310 889 105,206 495,790 167,681 452,596 American Lung Association State of the Air 2020 State Tables KANSAS American Lung Association in Kansas www.Lung.org/kansas HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Johnson 0 0 0 0.0 A Leavenworth 0 Neosho 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC Sedgwick 0 1 0 0.5 B 0 0 0 0 0.0 A 7.8 PASS Shawnee 0 0 0 0.0 A 0 0 0 0 0.0 A 8.5 PASS Sumner 0 0 0 0.0 A 0 0 0 0 0.0 A 7.2 PASS Trego 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC Wyandotte 4 1 0 1.8 C 1 0 0 0 0.3 B 9.1 PASS 93 0 0 0.0 Lung.org A 0 0 0 0 0.0 A 7.4 PASS DNC DNC DNC DNC DNC DNC American Lung Association State of the Air 2020 DNC DNC State Tables KENTUCKY American Lung Association in Kentucky www.Lung.org/kentucky AT-RISK GROUPS Lung Diseases County Bell Boone Total Population Under 18 65 & Over Pediatric Asthma 26,569 5,646 5,105 131,533 34,210 17,804 Adult Asthma COPD Lung Cancer 333 2,390 2,703 2,017 11,121 11,720 Boyd 47,240 10,048 9,221 Bullitt 81,069 17,795 12,652 1,049 7,241 7,836 Campbell 93,152 19,395 14,549 1,143 8,391 8,846 Carter 27,004 6,077 5,065 Heart Disease Ever Smoked Poverty People of Color 24 2,861 10,625 7,998 1,588 117 11,883 49,163 8,371 16,417 592 4,248 4,830 358 2,389 2,693 42 5,124 18,895 8,229 3,249 72 8,043 32,032 7,596 4,649 82 9,076 37,236 11,741 7,249 24 2,847 10,624 8,154 920 Christian 71,671 19,263 8,791 1,136 5,839 5,419 64 5,452 26,155 11,906 24,824 Daviess 101,104 24,735 17,128 1,458 8,700 9,528 89 9,963 38,671 15,026 12,362 Edmonson Fayette Greenup Hancock Hardin Henderson Jefferson 12,274 2,253 2,546 323,780 67,639 43,214 35,268 7,535 7,388 8,758 2,238 1,486 110,356 27,155 15,397 45,591 10,568 8,012 770,517 170,791 124,503 133 1,143 1,301 3,987 28,861 28,195 11 1,387 5,090 2,110 643 287 28,335 128,453 45,485 94,095 444 3,167 3,674 31 3,942 14,111 5,747 1,375 132 746 836 1,601 9,475 9,877 8 874 3,309 1,038 414 98 10,038 41,975 14,254 26,889 623 4,002 4,456 10,068 68,156 72,482 40 4,668 17,765 7,235 6,219 680 74,957 302,915 115,810 254,471 Jessamine 53,920 12,999 8,087 766 4,662 4,946 48 5,074 20,673 6,562 6,149 Livingston 9,242 1,883 2,006 111 845 1,007 8 1,082 3,756 1,268 443 McCracken 65,346 14,650 12,940 Madison 92,368 19,144 12,737 1,129 8,258 8,154 82 8,229 36,752 14,065 9,613 Morgan 13,345 2,438 2,235 144 1,243 1,331 12 1,373 5,514 3,102 994 Oldham 66,470 16,937 8,777 998 5,688 6,064 59 6,115 25,060 3,463 7,813 Perry 26,092 5,984 4,429 353 2,302 2,557 23 2,662 10,200 7,355 1,217 Pike 58,402 12,021 10,962 709 5,310 6,004 52 6,318 23,560 13,499 1,833 Pulaski 64,623 14,373 12,130 847 5,745 6,500 57 6,865 25,522 12,392 3,811 Simpson 18,529 4,466 3,056 263 1,605 1,757 16 1,827 7,123 2,271 2,775 Trigg 14,643 3,206 3,259 189 1,312 1,576 Warren Washington Totals 94 131,264 30,099 16,896 12,084 2,878 2,176 2,512,214 566,426 392,551 Lung.org 864 5,778 6,573 58 1,774 11,387 11,049 13 1,707 5,840 1,901 1,766 116 11,090 50,704 20,486 29,111 170 1,055 1,197 33,391 221,060 233,114 7,011 25,748 9,423 10,949 11 1,259 4,678 1,644 1,533 2,224 240,062 982,147 368,131 533,371 American Lung Association State of the Air 2020 State Tables KENTUCKY American Lung Association in Kentucky www.Lung.org/kentucky HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Bell 0 0 0 0.0 A Boone 1 Boyd 3 0 0 1.0 C Bullitt 3 Campbell 6 0 0 2.0 C 0 0 0 0 0.0 A 8.0 PASS Carter 0 0 0 0.0 A 1 0 0 0 0.3 B 6.4 PASS Christian 0 0 0 0.0 A 0 0 0 0 0.0 A 8.2 PASS Daviess 2 1 0 1.2 C 0 0 0 0 0.0 A 8.4 PASS Edmonson 0 Fayette 0 0 0 0.0 A Greenup 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Hancock 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC Hardin 1 0 0 0.3 B Henderson Jefferson 1 0 0 0 0.8 B 0 1.0 C 0 0.0 A 1 1 0 0 0.8 B 8.5 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.6 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC 0 0 0 0 0.0 A 8.2 PASS 6 0 0 2.0 C 1 0 0 0 0.3 B 8.8 PASS 24 3 0 9.5 F 0 0 0 0 0.0 A 9.4 PASS Jessamine 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Livingston 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC McCracken Madison 1 0 0 0.3 B DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 8.3 PASS INC INC INC INC INC INC INC INC Morgan 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC Oldham 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC Perry 0 0 0 0.0 A 0 1 0 0 0.5 B 7.6 PASS Pike 0 0 0 0.0 A 2 0 0 0 0.7 B 7.2 PASS Pulaski 0 0 0 0.0 A 0 0 0 0 0.0 A 7.7 PASS Simpson 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Trigg 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Warren 0 0 0 0.0 A Washington 1 95 0 0 0.3 Lung.org B 0 0 0 0 0.0 A 8.1 PASS DNC DNC DNC DNC DNC DNC American Lung Association State of the Air 2020 DNC DNC State Tables LOUISIANA American Lung Association in Louisiana www.Lung.org/louisiana AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Ever Smoked Poverty People of Color Ascension Parish 124,672 33,371 14,734 2,920 8,326 8,809 Bossier Parish 127,185 31,589 18,240 2,764 8,613 9,258 83 10,615 41,148 17,888 42,942 Caddo Parish 242,922 57,537 41,606 5,035 16,568 18,803 157 22,419 80,865 52,996 134,679 Calcasieu Parish 203,112 50,566 30,057 4,425 13,742 15,049 132 17,430 66,031 29,744 66,679 8,744 285 East Baton Rouge Parish 440,956 Iberville Parish 99,927 62,528 32,721 6,743 5,181 30,745 81 Heart Disease 32,399 590 2,342 2,595 9,828 39,309 13,341 39,717 36,720 145,964 71,761 245,155 21 3,021 11,289 6,880 17,178 Jefferson Parish 434,051 95,458 74,330 8,353 30,340 34,465 281 40,959 147,899 67,200 206,828 Lafayette Parish 242,782 57,350 32,067 5,018 16,809 17,753 157 19,972 79,598 36,301 84,123 Lafourche Parish 98,115 22,793 15,168 1,994 6,789 7,561 64 Livingston Parish 139,567 35,715 18,422 3,125 9,418 10,114 91 11,477 44,810 15,562 17,575 Orleans Parish 391,006 78,086 57,760 6,833 28,256 30,204 252 34,414 134,593 90,329 270,766 Ouachita Parish 154,475 38,427 22,847 3,363 10,450 11,410 100 13,203 50,179 31,790 64,840 Pointe Coupee Parish 21,940 Rapides Parish 4,793 4,516 130,562 32,250 21,375 St. Bernard Parish 46,721 St. James Parish 12,440 419 1,519 1,839 14 8,825 32,780 15,989 22,780 2,282 7,606 4,428 8,717 2,822 8,811 9,954 85 11,796 42,873 24,641 50,765 5,340 1,089 3,126 3,251 30 3,589 14,683 9,306 17,722 21,037 4,748 3,610 415 1,461 1,677 14 2,002 7,142 3,492 10,886 St. John the Baptist Parish 43,184 10,617 6,144 929 2,950 3,256 28 3,756 14,163 7,766 28,513 St. Martin Parish 12,978 8,057 1,136 3,669 4,088 35 4,761 17,702 10,179 18,995 53,621 St. Tammany Parish 258,111 61,917 43,694 5,418 17,603 20,343 167 24,330 86,210 30,253 55,792 Tangipahoa Parish 133,777 32,761 19,230 2,867 9,110 9,843 87 11,300 43,567 23,304 49,317 Terrebonne Parish 111,021 28,090 15,984 2,458 7,492 8,238 West Baton Rouge Parish Totals 96 26,427 6,461 3,607 3,477,965 814,617 524,497 Lung.org 565 1,809 1,955 71,282 239,947 262,863 72 9,522 35,984 18,950 36,999 17 2,229 2,254 American Lung Association State of the Air 2020 8,629 3,299 11,811 304,449 1,153,025 585,399 1,502,779 State Tables LOUISIANA American Lung Association in Louisiana www.Lung.org/louisiana HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Ascension Parish 9 0 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC Bossier Parish 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Caddo Parish 0 0 0 0.0 A Calcasieu Parish East Baton Rouge Parish 6 0 0 2.0 C 18 0 0 6.0 F 2 0 0 0 0.7 B 10.4 PASS 1 0 0 0 0.3 B 7.8 PASS 4 0 0 0 1.3 C 9.1 PASS Iberville Parish 9 0 0 3.0 D Jefferson Parish 4 0 0 1.3 C 0 0 0 0 0.0 A 7.4 PASS Lafayette Parish 1 0 0 0.3 B 0 0 0 0 0.0 A 7.9 PASS Lafourche Parish 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Livingston Parish 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC Orleans Parish DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.0 PASS Ouachita Parish 0 0 0 0.0 A Pointe Coupee Parish 2 Rapides Parish 0 1 0 0 0.5 B 8.5 PASS 0 0 0.7 B 0 0 0 0 0.0 A 8.0 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC St. Bernard Parish 5 0 0 1.7 St. James Parish 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC St. John the Baptist Parish 2 0 0 B DNC DNC St. Martin Parish 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC St. Tammany Parish 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC 0.7 C 0 0 DNC 0 DNC 0 DNC 0.0 DNC A DNC 8.3 PASS DNC Tangipahoa Parish DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.4 PASS Terrebonne Parish West Baton Rouge Parish 97 DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.2 PASS 8 0 0 Lung.org 2.7 D 0 0 0 American Lung Association State of the Air 2020 0 0.0 A 9.2 PASS State Tables MAINE American Lung Association in Maine www.Lung.org/maine AT-RISK GROUPS Lung Diseases County Androscoggin Aroostook Cumberland Franklin Hancock Kennebec Total Population Under 18 65 & Over Pediatric Asthma 107,679 23,332 19,091 Adult Asthma COPD 1,722 10,438 6,605 67,111 12,226 16,196 902 6,601 4,679 293,557 54,796 54,161 4,044 29,601 18,586 29,897 5,235 6,705 54,811 9,364 13,489 122,083 23,566 24,350 Lung Cancer Heart Disease Ever Smoked Poverty People of Color 80 8,501 41,811 12,838 10,352 50 6,319 27,614 9,988 4,061 218 23,919 118,220 23,332 28,318 386 2,998 2,038 22 2,711 12,339 4,141 1,285 691 5,465 3,878 41 5,242 22,867 6,233 2,934 1,739 12,071 7,955 91 10,403 49,097 13,290 6,643 Knox 39,771 7,081 10,057 523 3,924 2,803 30 3,815 16,461 4,209 1,939 Oxford 57,618 10,624 12,483 784 5,693 3,925 43 151,096 27,394 28,204 2,022 15,332 9,637 Penobscot Washington York Totals 98 31,490 5,938 7,687 206,229 38,565 42,233 1,161,342 218,121 234,656 Lung.org 438 3,069 2,187 2,846 20,501 13,624 16,098 115,693 75,918 5,202 23,565 9,490 2,785 113 12,413 61,257 21,154 9,578 23 2,964 12,864 5,613 3,324 154 17,877 83,647 18,133 12,164 865 American Lung Association State of the Air 2020 99,366 469,742 128,421 83,383 State Tables MAINE American Lung Association in Maine www.Lung.org/maine HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Androscoggin 0 0 0 0.0 A Aroostook 0 0 0 0.0 A 0 2 0 0 1.0 C 7.0 PASS Cumberland 2 0 0 0.7 B 0 0 0 0 0.0 A 6.6 PASS Franklin DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.1 PASS INC INC INC INC INC INC INC INC Hancock 8 1 0 3.2 D 0 0 0 0 0.0 A 3.7 PASS Kennebec 0 0 0 0.0 A 0 0 0 0 0.0 A 5.5 PASS Knox 5 Oxford 0 0 0 0.0 A Penobscot 0 0 0 0.0 A Washington 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC York 4 1 0 1.8 C DNC DNC DNC DNC DNC DNC DNC DNC 99 0 0 1.7 C Lung.org DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.4 PASS 0 0 0 0 0.0 A 5.8 PASS American Lung Association State of the Air 2020 State Tables 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 Heart Disease Ever Smoked Poverty People of Color Anne Arundel 576,031 128,107 84,550 9,687 42,383 25,408 315 37,074 161,525 39,231 186,967 Baltimore 828,431 178,931 142,310 13,531 60,923 38,537 451 57,147 237,801 79,482 359,919 Calvert 92,003 21,300 13,687 1,611 6,678 4,196 50 Carroll 168,429 36,532 28,378 2,763 12,380 8,057 92 11,918 48,947 9,828 19,008 Cecil 102,826 23,268 16,186 1,760 7,494 4,747 56 6,981 29,266 8,406 15,540 Charles 161,503 38,703 20,198 2,927 11,697 6,879 88 9,899 44,200 10,487 99,163 Dorchester Frederick Garrett 31,998 6,752 6,911 255,648 59,180 36,972 29,163 5,426 6,524 511 2,330 1,656 4,475 18,590 11,311 6,139 25,984 4,912 20,253 17 2,516 9,602 4,851 11,974 140 16,499 71,306 15,552 69,902 410 2,190 1,567 16 2,381 9,054 3,483 1,068 Harford 253,956 56,335 41,128 4,260 18,591 11,781 139 17,369 72,620 17,528 62,121 Howard 323,196 78,743 44,629 5,954 23,168 13,918 176 20,239 88,372 16,874 158,169 Kent Montgomery 19,383 3,066 5,177 232 1,487 1,109 11 1,715 6,274 2,329 4,267 1,052,567 244,355 163,516 18,478 76,171 47,126 573 69,273 294,362 72,247 595,735 Prince George’s 909,308 202,301 120,600 15,298 67,250 38,802 495 56,021 252,079 73,777 795,954 Washington 150,926 32,969 26,006 Baltimore City Totals 100 602,495 123,177 84,387 5,557,863 1,239,145 841,159 Lung.org 2,493 11,058 7,099 9,315 45,538 25,702 93,703 407,927 247,896 83 10,533 43,453 15,871 32,881 327 37,219 169,118 109,306 435,247 3,028 American Lung Association State of the Air 2020 362,924 1,563,960 484,164 2,868,168 State Tables MARYLAND American Lung Association in Maryland www.Lung.org/maryland HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Anne Arundel 23 0 Baltimore 33 5 1 14.2 F Calvert Carroll 0 7.7 F Wgt. Avg. Grade INC INC INC INC INC INC Design Value Pass/ Fail INC INC 0 0 0 0 0.0 A 8.0 PASS 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC Cecil 23 2 0 8.7 F Charles 7 Dorchester 4 1 0 1.8 C Frederick 5 0 0 0 2.3 D 0 1.7 C 0 0 0 0 0.0 A 7.8 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.1 PASS DNC DNC DNC DNC DNC DNC DNC DNC Garrett 0 0 0 0.0 A 0 0 0 0 0.0 A 5.7 PASS Harford 27 3 0 10.5 F 1 0 0 0 0.3 B 7.6 PASS Howard Kent Montgomery Prince George’s Washington Baltimore City 101 DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 9.1 PASS 10 0 0 3.3 F 0 0 0 0 0.0 A 7.0 PASS 3 0 0 1.0 C 0 0 0 0 0.0 A 7.0 PASS 22 1 0 7.8 F 0 0 0 0 0.0 A 7.0 PASS 4 0 0 1.3 C 1 0 0 0 0.3 B 7.7 PASS 14 1 0 5.2 F 2 0 0 0 0.7 B 8.4 PASS Lung.org American Lung Association State of the Air 2020 State Tables 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 Barnstable 213,413 32,172 65,299 2,065 18,134 11,789 Berkshire 126,348 21,362 29,398 1,371 10,616 6,057 Bristol 564,022 116,099 95,464 7,452 45,673 23,133 Dukes Essex Franklin 17,352 3,042 4,219 790,638 168,488 134,796 70,963 12,407 15,624 10,814 63,406 32,338 796 5,921 3,326 470,406 101,140 79,049 6,491 37,770 18,884 Hampshire 161,355 23,689 27,808 1,520 14,215 6,687 Heart Disease Ever Smoked Poverty People of Color 122 18,089 77,552 16,661 21,843 73 9,020 42,865 13,673 15,393 324 33,362 175,717 59,147 99,268 195 1,442 849 Hampden Middlesex Lung Cancer 10 1,273 5,911 1,316 2,209 454 41 270 92 46,729 244,625 82,387 241,022 4,929 23,798 7,395 6,799 27,193 144,014 76,016 180,153 9,510 52,429 15,397 26,743 1,614,714 318,831 246,388 20,463 133,149 63,092 927 89,492 496,382 113,717 459,018 Norfolk 705,388 147,749 118,882 9,483 56,882 28,764 405 41,474 218,600 44,959 180,270 Plymouth 518,132 110,660 93,864 7,102 41,323 21,924 297 31,965 162,570 31,285 94,913 Suffolk 807,252 134,089 96,651 8,606 70,404 28,432 463 38,572 243,931 133,144 444,449 Worcester 830,839 174,732 129,978 11,215 66,986 33,064 477 47,301 255,325 72,636 198,685 Totals 102 6,890,822 1,364,460 1,137,420 Lung.org 87,574 565,921 278,339 3,955 American Lung Association State of the Air 2020 398,909 2,143,717 667,733 1,970,765 State Tables MASSACHUSETTS American Lung Association in Massachusetts www.Lung.org/massachusetts HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple 0 Wgt. Avg. Grade Orange Red Purple Maroon Berkshire INC INC INC INC INC 1 0 0 0 0.3 B 5.9 PASS Bristol 19 1 0 6.8 F DNC DNC 0 0 0 0 0.0 A 6.1 PASS Dukes 7 Essex 10 0 0 3.3 F 0 0 0 0 0.0 A 5.1 PASS 3 0 0 1.0 C 0 0 0 0 0.0 A 5.2 PASS Hampden 11 1 0 4.2 F 0 0 0 0 0.0 A 5.2 PASS Hampshire 8 1 0 3.2 D 0 0 0 0 0.0 A 5.1 PASS Middlesex 1 0 0 0.3 B INC INC INC INC INC INC INC INC Norfolk 8 0 0 2.7 D INC INC INC INC INC INC INC INC Plymouth 8 0 0 2.7 D Suffolk 4 0 0 1.3 C 0 0 0 0 0.0 A 7.7 PASS 11 0 0 3.7 F 0 0 0 0 0.0 A 5.8 PASS Franklin Worcester 103 Lung.org F DNC DNC DNC DNC DNC DNC Pass/ Fail 10 0 3.3 F Design Value Barnstable 2 0 3.3 Wgt. Avg. Grade DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 5.4 PASS American Lung Association State of the Air 2020 State Tables 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 Heart Disease Ever Smoked Poverty People of Color Allegan 117,327 28,372 19,414 2,436 9,909 7,890 72 8,878 40,692 12,429 13,834 Bay 103,923 21,084 21,195 1,810 9,126 7,591 63 8,849 38,136 16,044 10,502 Benzie Berrien 17,753 3,239 4,639 278 1,568 1,445 11 1,761 6,806 1,812 1,152 154,141 33,571 30,402 2,882 13,298 10,971 Cass 51,653 10,646 10,862 914 4,504 3,870 32 4,523 19,009 5,727 7,086 Chippewa 37,517 6,877 6,742 590 3,414 2,594 23 2,955 13,863 5,608 11,418 Clinton Genesee Huron 79,332 17,756 13,442 94 12,758 55,419 23,151 38,978 1,524 6,860 5,432 406,892 91,550 71,136 48 7,859 35,057 27,953 31,166 6,005 7,813 6,120 28,132 5,896 8,213 247 515 2,725 2,493 31,730 144,190 75,251 111,832 19 3,015 11,787 3,876 1,506 Ingham 292,735 58,406 39,459 5,014 26,538 17,510 178 19,121 103,394 49,916 90,032 Kalamazoo 264,870 57,311 39,630 4,920 23,343 16,323 161 18,205 92,494 36,927 60,273 Kent 653,786 157,809 89,296 Lenawee Macomb 13,547 55,930 39,833 98,266 20,713 18,645 398 1,778 8,584 6,959 874,759 184,009 148,636 43,600 222,134 72,623 173,392 60 15,796 77,026 60,680 8,013 35,544 9,668 13,236 532 68,173 315,302 95,731 187,352 Manistee 24,528 4,264 6,318 366 2,194 1,992 15 2,417 9,473 3,026 2,724 Mason 29,100 5,889 6,854 506 2,526 2,235 18 2,683 10,801 3,455 2,548 Missaukee 15,113 3,474 3,099 298 1,278 1,090 9 1,279 5,385 1,920 993 Monroe 150,439 32,193 27,262 2,764 13,122 10,737 92 12,192 54,370 14,891 13,313 Muskegon 173,588 40,082 29,524 3,441 14,864 11,642 106 13,194 60,821 26,321 41,131 Oakland 1,259,201 264,031 211,527 22,665 111,061 87,047 767 97,578 453,846 102,052 356,274 Ottawa 290,494 69,797 43,492 5,992 24,766 17,950 177 20,041 99,051 19,087 47,689 St. Clair 159,337 33,131 30,022 2,844 13,971 11,684 97 13,320 58,288 21,745 14,276 Schoolcraft Tuscola Washtenaw Wayne Wexford Totals 104 8,068 1,370 2,162 52,516 10,732 10,635 118 722 689 921 4,603 3,907 370,963 68,932 51,377 5,917 34,184 22,804 1,753,893 414,221 270,554 35,558 150,021 113,859 33,466 7,761 6,388 7,504,826 1,653,225 1,220,525 Lung.org 226 835 3,168 1,044 1,169 4,526 19,332 6,580 3,541 24,914 133,546 52,258 111,106 1,066 126,753 607,144 376,649 886,177 666 2,838 2,356 141,916 654,031 499,536 5 32 20 2,724 11,838 4,318 1,848 4,569 American Lung Association State of the Air 2020 560,156 2,653,965 1,048,005 2,211,595 State Tables MICHIGAN American Lung Association in Michigan www.Lung.org/michigan HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Allegan Bay Benzie Wgt. Avg. Grade Orange Red Purple Maroon 21 0 0 7.0 F Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0 0.0 A 7.4 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.9 PASS 9 1 0 3.5 F DNC DNC DNC DNC DNC DNC DNC DNC Berrien 22 0 0 7.3 F INC INC INC INC INC INC INC INC Cass 22 0 7.3 DNC DNC DNC DNC DNC DNC DNC DNC Chippewa 0 F 1 0 0 0.3 B Clinton 11 Genesee 12 0 0 4.0 F 0 0 0 3.7 DNC DNC 0 0 0 0 0.0 A 7.2 PASS 8 Ingham 8 0 0 2.7 D 0 0 0 0 0.0 A INC INC Kalamazoo 13 0 0 4.3 F 0 0 0 0 0.0 A 8.2 PASS Kent 12 0 0 4.0 F 0 0 0 0 0.0 A 8.2 PASS Lenawee 7 0 0 2.3 D 0 0 0 0 0.0 A 7.6 PASS Macomb 20 0 0 6.7 F 0 0 0 0 0.0 A 7.6 PASS Manistee 4 0 0 1.3 C 0 0 0 0 0.0 A 5.8 PASS Mason 8 Missaukee 7 0 0 2.3 D Monroe 0 2.7 D DNC DNC DNC DNC DNC DNC Huron 0 0 2.7 F 0 0 0 0 0.0 A INC INC D DNC DNC DNC DNC DNC Muskegon 13 Oakland 16 1 0 5.8 F Ottawa 11 0 St. Clair 12 1 0 4.5 F Schoolcraft 11 0 Tuscola 5 5 0 0 6.8 F 0 3.7 F DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 5.0 PASS INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.1 PASS INC INC INC INC INC INC INC INC 0 0 0 0 0.0 A 8.0 PASS 0 3.7 F INC INC INC INC INC INC INC INC 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC Washtenaw 15 0 0 5.0 F 0 0 0 0 0.0 A 8.1 PASS Wayne 22 0 0 7.3 F 3 0 0 0 1.0 C 11.3 PASS Wexford 7 105 0 0 2.3 Lung.org D DNC DNC DNC DNC DNC DNC American Lung Association State of the Air 2020 DNC DNC State Tables MINNESOTA American Lung Association in Minnesota www.Lung.org/minnesota AT-RISK GROUPS Lung Diseases County Anoka Total Population Under 18 65 & Over Pediatric Asthma 353,813 84,396 49,712 Adult Asthma COPD Lung Cancer 4,456 22,389 11,644 Heart Disease Ever Smoked Poverty People of Color 197 18,783 110,424 19,568 68,706 Becker 34,371 8,391 7,052 443 2,128 1,275 19 2,197 10,905 3,764 4,775 Beltrami 46,847 11,769 7,548 621 2,886 1,515 26 Carlton 35,837 8,042 6,136 425 2,297 1,273 20 2,118 11,515 3,454 4,282 Cass 29,519 6,243 7,659 330 1,891 1,250 16 2,232 9,959 3,771 5,070 Cook 5,393 851 1,540 45 368 247 Crow Wing Dakota Goodhue Hennepin 64,889 14,053 14,549 425,423 103,669 60,282 46,403 10,293 9,124 1,259,428 276,541 176,788 742 4,154 2,548 2,493 14,349 8,220 13,126 3 36 5,474 26,712 13,895 4,434 21,430 8,105 3,342 237 543 2,969 1,737 22,453 131,830 26,434 94,730 26 14,602 81,448 40,605 444 1,949 511 810 2,959 15,103 3,250 3,819 702 64,806 399,090 127,826 394,877 Lake 10,658 2,005 2,775 106 704 459 6 Lyon 25,629 6,615 4,060 349 1,568 834 14 1,373 7,804 3,009 4,282 Mille Lacs 26,139 6,292 4,787 332 1,634 937 15 1,582 8,269 3,163 2,924 Olmsted 156,277 38,258 24,272 2,020 9,747 5,132 Ramsey 550,210 128,232 79,328 6,771 34,888 17,492 307 St. Louis 199,754 38,011 38,748 2,007 13,289 7,434 111 12,510 66,986 28,232 18,071 Scott 147,381 40,458 16,035 2,136 8,936 4,371 Stearns 159,256 36,701 24,079 1,938 10,121 5,166 Washington 259,201 63,678 38,906 3,362 16,216 8,679 Wright 136,349 38,003 17,215 2,007 8,182 4,167 Totals 106 3,972,777 922,501 590,595 Lung.org 48,709 252,527 130,659 87 817 3,694 900 535 8,399 48,374 10,908 31,602 28,089 171,376 78,160 212,529 82 6,820 43,401 7,563 28,313 89 8,365 49,923 18,879 23,102 145 14,188 80,540 10,755 46,084 76 2,216 American Lung Association State of the Air 2020 6,658 40,160 6,639 10,776 211,719 1,247,079 373,111 971,755 State Tables MINNESOTA American Lung Association in Minnesota www.Lung.org/minnesota HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Anoka Becker Beltrami Carlton Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail 1 0 0 0.3 B 1 0 0 0 0.3 B 7.3 PASS 0 0 0 0.0 A 0 0 0 0 0.0 A 4.8 PASS DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 5.6 PASS 0 0 0 0.0 A 1 0 0 0 0.3 B 4.8 PASS Cass DNC DNC DNC DNC DNC Cook DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 4.4 PASS Crow Wing Dakota 0 0 0 0.0 A INC INC INC INC INC INC INC INC 1 0 0 0 0.3 B 5.6 PASS DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 7.1 PASS Goodhue 1 Hennepin 0 0 0 0.0 A 1 0 0 0 0.3 B 7.6 PASS Lake 0 0 0 0.0 A 0 0 0 0 0.0 A 3.4 PASS Lyon 0 0 0 0.0 A Mille Lacs 0 Olmsted Ramsey 0 0 0 0.3 0 0.0 B A 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 5.2 PASS DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 7.1 PASS DNC DNC DNC DNC DNC 2 1 0 0 1.2 C 7.9 PASS St. Louis 0 0 0 0.0 A 2 0 0 0 0.7 B 5.2 PASS Scott 2 0 0 0.7 B 0 0 0 0 0.0 A INC INC Stearns 1 0 0 0.3 B 0 0 0 0 0.0 A 6.0 PASS Washington 0 0 0 0.0 A 0 0 0 0 0.0 A 6.1 PASS Wright 4 0 0 1.3 C 1 0 0 0 0.3 B 6.6 PASS 107 Lung.org American Lung Association State of the Air 2020 State Tables MISSISSIPPI American Lung Association in Mississippi www.Lung.org/mississippi AT-RISK GROUPS Lung Diseases County Bolivar Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD 31,333 7,611 4,951 495 2,288 2,286 DeSoto 182,001 46,709 23,468 3,040 13,002 12,828 Forrest 75,036 17,357 10,188 1,130 5,500 5,183 Grenada 21,055 5,040 3,744 Hancock Harrison 47,334 9,716 9,383 Lung Cancer 328 1,560 1,636 632 3,689 3,994 24 Heart Disease Ever Smoked Poverty People of Color 2,720 10,156 8,715 21,119 140 14,980 57,883 16,255 67,090 57 6,008 24,334 17,341 32,299 16 1,982 6,948 4,621 9,590 36 4,891 16,472 8,181 7,287 206,650 49,416 30,904 3,216 15,154 15,124 159 17,888 67,367 40,288 75,374 Hinds 237,085 57,047 33,341 3,712 17,278 16,873 180 19,775 76,704 44,204 179,704 Jackson 143,277 33,416 22,721 2,175 10,644 10,914 110 13,025 47,427 25,348 46,723 Lauderdale 75,317 17,636 13,072 1,148 5,598 5,771 58 6,953 24,900 18,243 36,106 Lee 85,202 21,542 12,598 1,402 6,148 6,206 65 7,359 27,368 10,977 29,848 Yalobusha 12,392 2,776 2,474 Totals 108 1,116,682 268,266 166,844 Lung.org 181 943 1,017 17,457 81,804 81,834 9 1,249 4,203 2,208 5,206 856 American Lung Association State of the Air 2020 96,829 363,762 196,381 510,346 State Tables MISSISSIPPI American Lung Association in Mississippi www.Lung.org/mississippi HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Bolivar DeSoto 2 0 Wgt. Avg. Grade Orange Red Purple Maroon 0 0.7 B 3 1 0 1.5 C Wgt. Avg. Grade INC INC INC INC INC INC Design Value Pass/ Fail INC INC 0 0 0 0 0.0 A 7.6 PASS Forrest DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 8.6 PASS Grenada DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.4 PASS Hancock 0 0 0 0.0 A 1 0 0 0 0.3 B 7.9 PASS Harrison 4 0 0 1.3 C 0 0 0 0 0.0 A 7.9 PASS Hinds 0 0 0 0.0 A 1 0 0 0 0.3 B 8.7 PASS Jackson 3 0 0 1.0 C 0 0 0 0 0.0 A 7.9 PASS Lauderdale 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Lee 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Yalobusha 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC 109 Lung.org American Lung Association State of the Air 2020 State Tables MISSOURI American Lung Association in Missouri www.Lung.org/missouri AT-RISK GROUPS Lung Diseases County Andrew Boone Total Population Under 18 65 & Over Pediatric Asthma 17,607 4,034 3,253 Adult Asthma COPD 339 1,274 1,282 180,005 36,565 22,058 3,076 13,353 11,528 Buchanan 88,571 19,933 14,275 1,677 6,429 6,143 Callaway 44,889 9,401 7,304 Cass Cedar Clay Clinton 104,954 25,369 17,692 14,165 3,411 3,308 246,365 59,326 34,771 20,470 4,808 3,703 4,991 17,598 16,394 Jasper 120,636 30,127 18,863 2,535 8,455 8,043 Jefferson 224,347 51,958 33,636 4,371 16,322 15,621 57,686 14,658 7,740 1,233 4,077 3,817 Monroe Perry St. Charles Ste. Genevieve St. Louis Taney St. Louis City Totals 110 5,128 21,465 20,199 40 302,838 57,526 41,490 3,912,444 877,264 622,910 Lung.org 7,796 28,873 27,490 991 4,084 4,223 4,840 22,996 20,693 73,803 284,532 271,189 4,108 18,895 6,055 4,056 6 824 3,063 1,158 630 13 1,574 6,531 2,040 945 276 30,098 134,884 22,272 52,255 326 1,318 1,349 18,469 72,771 72,009 8,824 39,706 19,498 19,533 155 17,152 76,093 19,327 12,885 159 630 680 55,852 11,774 12,108 51,219 234,543 89,787 264,030 83 376 1,377 1,378 996,945 219,527 180,210 14 1,699 6,984 1,793 1,316 483 8,664 1,895 2,023 17,888 3,880 3,485 8,292 35,283 8,427 13,054 10 1,312 4,861 2,502 782 201 21,989 100,880 43,423 37,197 13,879 50,227 47,231 19,150 4,470 3,472 399,182 92,666 60,779 6,759 30,171 13,117 15,402 170 17,611 81,840 17,153 47,615 404 1,474 1,482 291,923 60,957 48,085 People of Color 31 3,512 15,620 4,795 4,453 72 287 996 1,079 700,307 164,979 104,655 Ever Smoked Poverty 12 1,471 6,048 1,429 1,031 61 2,134 7,482 7,361 Jackson Heart Disease 124 11,540 61,440 28,584 39,027 791 3,332 3,190 Greene Lincoln Lung Cancer 12 1,569 6,275 1,720 806 686 38 209 2,698 American Lung Association State of the Air 2020 81,620 344,635 102,720 342,878 4,970 19,689 8,367 6,419 21,543 106,327 66,858 168,759 297,687 1,333,768 461,025 1,033,073 State Tables MISSOURI American Lung Association in Missouri www.Lung.org/missouri HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Andrew Boone Buchanan Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 8.5 PASS Callaway 1 Cass 2 0 0 0.7 B 0 0 0 0 0.0 A 6.5 PASS Cedar 0 0 0 0.0 A 0 0 0 0 0.0 A 6.9 PASS Clay Clinton Greene Jackson 0 0 0.3 B 17 0 0 5.7 F 5 0 0 1.7 C 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 6.4 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.4 PASS DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 8.8 PASS Jasper 0 Jefferson 7 0 0 2.3 D Lincoln 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC Monroe 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Perry 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC 22 2 0 8.3 F DNC DNC DNC DNC DNC DNC DNC DNC 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC St. Charles Ste. Genevieve 0 0 0.0 A St. Louis 14 0 0 4.7 F Taney INC INC INC INC INC St. Louis City 12 111 1 0 Lung.org 4.5 F DNC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 7.9 PASS 0 0 0 0 0.0 A 9.1 PASS DNC DNC DNC DNC DNC DNC 0 1 0 American Lung Association State of the Air 2020 0 0.5 B DNC DNC 8.5 PASS State Tables MONTANA American Lung Association in Montana www.Lung.org/montana AT-RISK GROUPS Lung Diseases County Fergus Total Population Under 18 65 & Over Pediatric Asthma 11,113 2,317 2,724 Adult Asthma COPD Lung Cancer 123 858 590 Heart Disease 6 Ever Smoked Poverty People of Color 918 3,977 1,313 672 Flathead 102,106 22,475 19,949 1,198 7,936 4,941 54 Gallatin 111,876 22,425 14,146 1,195 9,178 4,293 59 6,524 38,489 9,721 9,792 36 4,971 Lewis and Clark Lincoln Missoula 68,700 14,770 12,903 787 19,794 3,609 5,670 5,395 3,278 192 1,557 1,182 118,791 22,315 18,506 7,515 35,571 11,288 7,426 24,014 7,061 6,059 10 1,840 7,431 3,964 1,491 1,189 9,790 5,034 62 7,707 41,975 14,719 12,853 Phillips 4,074 968 910 52 305 208 2 320 1,405 608 683 Powder River 1,716 287 466 15 139 100 1 156 651 205 113 Ravalli 43,172 8,246 11,138 439 3,398 2,415 Richland 10,913 2,757 1,632 147 827 467 6 696 3,600 950 1,161 Rosebud 9,063 2,624 1,431 140 648 384 5 577 2,860 1,523 4,084 Silver Bow 34,993 7,087 6,667 378 2,790 1,655 Yellowstone 160,137 37,629 27,117 2,005 12,325 7,093 Totals 696,448 147,509 123,259 7,860 55,147 31,640 112 Lung.org 23 3,745 15,880 6,628 3,154 18 2,533 12,374 5,697 3,609 84 10,765 54,134 17,150 22,191 365 American Lung Association State of the Air 2020 48,266 242,361 80,827 73,288 State Tables MONTANA American Lung Association in Montana www.Lung.org/montana HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Fergus Flathead Gallatin Lewis and Clark Lincoln Wgt. Avg. Grade Orange Red Purple Maroon 1 0 0 0.3 B 0 0 0 0.0 A DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC 5.0 PASS 16 7 3 0 10.8 F 8.8 PASS 10 3 0 1 4.0 PASS 0 5.7 F 31 15 0 17.8 14 18 1 0 14.3 F F 12.9 FAIL 9.5 PASS 17 12 1 0 12.3 F 10.4 PASS Phillips 0 0 0 0.0 A 6 1 0 0 2.5 D 5.4 PASS Powder River 3 0 0 1.0 C 6 5 0 0 4.5 F 7.6 PASS Rosebud A 0 4.8 F Pass/ Fail 0 Richland 0 0.0 3 0 Design Value Missoula Ravalli 0 10 Wgt. Avg. Grade DNC DNC DNC DNC DNC 0 0 0 0.0 A 0 0 0 0.0 A DNC DNC 0 19.8 F 10.0 PASS 6 5 0 0 4.5 F 6.2 PASS DNC Yellowstone DNC DNC DNC DNC DNC 8 1 0 0 3.2 D INC INC Lung.org DNC 17 0 2 1 0 0 1.2 C INC INC Silver Bow 113 DNC 34 21 4 0 American Lung Association State of the Air 2020 0 9.0 F 8.7 PASS State Tables NEBRASKA American Lung Association in Nebraska www.Lung.org/nebraska AT-RISK GROUPS Lung Diseases County Douglas Hall Knox Total Population Under 18 65 & Over Pediatric Asthma 566,880 145,250 73,752 Adult Asthma COPD 7,306 37,671 25,001 61,607 16,920 9,150 851 3,992 2,824 8,419 2,039 2,078 103 567 488 Lancaster 317,272 72,512 44,139 3,647 21,789 14,260 Sarpy 184,459 50,551 21,677 2,543 11,989 7,845 Scotts Bluff Washington Totals 114 Lung Cancer 35,989 9,001 6,849 20,667 5,017 3,673 1,195,293 301,290 161,318 Lung.org 453 2,402 1,836 252 1,402 1,075 15,155 79,813 53,330 Heart Disease 293 Ever Smoked Poverty People of Color 30,123 165,432 64,276 175,045 32 3,506 17,768 7,839 21,157 4 661 2,642 1,098 1,233 164 17,246 95,483 37,583 60,782 96 9,330 52,480 10,399 35,878 19 2,372 10,884 5,021 10,234 11 1,370 6,350 1,423 1,170 619 American Lung Association State of the Air 2020 64,608 351,038 127,639 305,499 State Tables NEBRASKA American Lung Association in Nebraska www.Lung.org/nebraska HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Douglas Hall Knox Lancaster Wgt. Avg. Grade Orange Red Purple Maroon 4 0 0 1.3 C Wgt. Avg. Grade Design Value Pass/ Fail 2 0 0 0 0.7 B 8.6 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 5.9 PASS 1 0 0 0.3 B 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.7 PASS Sarpy DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 8.9 PASS Scotts Bluff DNC DNC DNC DNC DNC 1 0 0 0 0.3 B INC INC Washington DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.9 PASS 115 Lung.org American Lung Association State of the Air 2020 State Tables NEVADA American Lung Association in Nevada www.Lung.org/nevada AT-RISK GROUPS Lung Diseases County Churchill Clark Total Population Under 18 65 & Over Pediatric Asthma 24,440 5,574 4,628 2,231,647 517,629 328,692 Adult Asthma COPD Lung Cancer 388 1,490 1,457 36,032 136,812 120,615 Heart Disease Ever Smoked Poverty People of Color 12 1,878 7,988 2,756 6,666 1,129 151,858 705,307 307,977 1,289,911 Douglas 48,467 7,917 13,808 551 3,151 3,651 25 4,868 18,082 3,457 9,541 Elko 52,460 14,298 5,943 995 3,078 2,550 27 3,168 15,484 4,276 17,530 Lyon Washoe White Pine Carson City Totals 116 55,808 11,946 11,813 465,735 100,776 76,161 9,475 1,884 1,702 55,414 11,243 11,261 2,943,446 671,267 454,008 Lung.org 832 3,451 3,529 28 7,015 29,030 26,449 131 602 563 783 3,486 3,479 46,726 181,100 162,293 4,594 18,821 5,803 14,325 236 33,558 151,502 47,627 174,026 5 28 1,489 American Lung Association State of the Air 2020 719 3,173 1,082 2,702 4,507 18,826 5,952 18,435 205,149 939,183 378,930 1,533,136 State Tables NEVADA American Lung Association in Nevada www.Lung.org/nevada HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Churchill Clark Wgt. Avg. Grade Orange Red Purple Maroon 9 0 0 3.0 D 89 1 0 30.2 F Wgt. Avg. Grade DNC DNC DNC DNC DNC DNC Design Value Pass/ Fail DNC DNC 10 2 0 0 4.3 F 9.5 PASS 10 4 1 0 6.9 PASS Douglas DNC DNC DNC DNC DNC Elko INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC Lyon 12 DNC DNC DNC DNC DNC DNC DNC DNC Washoe 29 0 0 9.7 F 0 F White Pine 4 Carson City 7 0 0 2.3 D 117 0 0 4.0 0 1.3 C Lung.org 6.0 F 8 0 0 0 2.7 D 7.6 PASS DNC DNC DNC DNC DNC DNC DNC DNC 6 4 0 0 4.0 F 5.8 PASS American Lung Association State of the Air 2020 State Tables NEW HAMPSHIRE American Lung Association in New Hampshire www.Lung.org/newhampshire AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Heart Disease Ever Smoked Poverty People of Color Belknap 61,022 11,281 13,505 960 5,763 4,268 38 4,313 22,888 4,149 3,043 Cheshire 76,493 13,685 15,224 1,165 7,438 5,103 48 5,029 28,446 7,307 4,654 Coos 31,589 5,139 7,494 Grafton 89,786 14,522 18,566 1,236 8,920 6,087 Hillsborough 415,247 84,629 65,348 7,205 39,845 25,919 Merrimack 151,132 28,949 27,566 2,465 14,536 9,863 Rockingham Totals 118 309,176 59,995 55,538 1,134,445 218,200 203,241 Lung.org 438 3,051 2,289 5,108 29,511 20,446 18,577 109,064 73,977 20 2,335 12,210 3,828 1,606 57 6,022 34,067 7,427 8,431 261 24,459 147,824 30,147 66,220 95 9,570 55,157 10,149 11,759 195 19,796 112,882 16,270 23,733 714 American Lung Association State of the Air 2020 71,525 413,475 79,277 119,446 State Tables NEW HAMPSHIRE American Lung Association in New Hampshire www.Lung.org/newhampshire HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Belknap 0 0 0 0.0 A Cheshire 1 0 0 0.3 B Coos 4 Grafton 0 0 0 0.0 A 0 0 0 0 0.0 A 5.7 PASS Hillsborough 4 0 0 1.3 C 0 0 0 0 0.0 A 3.4 PASS Merrimack 0 Rockingham 7 0 0 2.3 D 119 0 0 0 1.3 C 0 0.0 Lung.org A 0 0 0 0 0.0 A 4.5 PASS 0 0 0 0 0.0 A 5.4 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 5.2 PASS American Lung Association State of the Air 2020 State Tables NEW JERSEY American Lung Association in New Jersey www.Lung.org/newjersey AT-RISK GROUPS Lung Diseases County Atlantic Total Population Under 18 65 & Over 265,429 56,347 47,611 Pediatric Asthma Adult Asthma COPD 4,083 17,682 11,925 Lung Cancer Heart Disease Ever Smoked Poverty People of Color 144 18,022 77,960 33,167 116,925 Bergen 936,692 198,355 161,086 14,374 62,463 41,592 509 62,335 273,792 63,403 415,338 Camden 507,078 115,090 79,408 8,340 33,052 21,467 275 31,529 143,123 64,417 221,760 Cumberland 150,972 36,107 23,053 2,617 9,656 6,237 Essex 799,767 188,977 108,532 Gloucester 291,408 63,440 46,126 Hudson 676,061 138,221 79,920 Hunterdon 124,714 24,097 23,105 Mercer 369,811 78,695 56,000 Middlesex 829,685 180,190 124,198 13,058 54,722 34,942 451 50,650 235,083 65,823 479,059 Monmouth 621,354 131,723 109,201 9,546 41,656 28,059 337 42,574 183,773 41,380 155,338 Morris 494,228 104,322 84,336 7,560 33,123 22,079 269 33,227 145,375 22,980 144,503 Ocean 601,651 144,247 135,652 10,453 38,246 27,988 327 44,170 174,990 57,366 93,692 Passaic 503,310 119,860 73,213 8,686 32,288 20,596 273 29,818 138,627 67,374 297,927 Union 558,067 130,522 80,252 9,459 36,144 23,038 303 33,451 155,253 43,279 336,018 Warren Totals 120 105,779 20,815 19,230 7,836,006 1,731,008 1,250,923 Lung.org 13,695 51,513 32,283 4,597 19,315 12,597 10,016 44,808 26,516 1,746 8,615 5,887 5,703 24,536 15,698 1,508 7,229 4,892 125,441 515,047 335,797 82 434 9,099 41,681 21,430 81,710 46,181 219,471 116,246 555,679 158 18,633 83,879 21,869 63,727 368 68 35,767 185,636 95,704 481,548 9,062 38,312 5,317 18,604 201 22,796 105,508 38,279 189,371 57 4,257 American Lung Association State of the Air 2020 7,446 31,963 7,006 20,003 494,760 2,234,427 765,040 3,671,202 State Tables NEW JERSEY American Lung Association in New Jersey www.Lung.org/newjersey HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Atlantic 2 0 0 0.7 B 0 0 0 0 0.0 A 6.8 PASS Bergen 25 3 0 9.8 F 1 0 0 0 0.3 B 7.6 PASS Camden 24 0 0 8.0 F 4 0 0 0 1.3 C 10.2 PASS Cumberland 1 0 0 0.3 B 0 0 0 0 0.0 A INC INC Essex 7 1 0 2.8 D 0 0 0 0 0.0 A 8.4 PASS Gloucester 20 0 0 6.7 F 0 0 0 0 0.0 A INC INC Hudson 12 2 0 5.0 F 0 0 0 0 0.0 A 8.2 PASS Hunterdon 13 3 0 5.8 F 0 0 0 0 0.0 A INC INC Mercer 22 2 0 8.3 F 0 0 0 0 0.0 A 8.2 PASS Middlesex 23 1 0 8.2 F 0 0 0 0 0.0 A 8.2 PASS Monmouth 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC Morris 10 1 0 3.8 F 0 0 0 0 0.0 A 5.9 PASS Ocean 17 1 0 6.2 F 0 0 0 0 0.0 A 6.6 PASS 9 0 0 3.0 D 0 0 0 0 0.0 A 7.6 PASS Passaic Union Warren 121 DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 9.2 PASS 5 0 0 1.7 C Lung.org 0 0 0 0 0.0 A 8.1 PASS American Lung Association State of the Air 2020 State Tables NEW MEXICO American Lung Association in New Mexico www.Lung.org/newmexico AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Bernalillo 678,701 147,370 111,216 Doña Ana Pediatric Asthma Adult Asthma COPD 11,089 52,392 32,622 Lung Cancer 251 Heart Disease Ever Smoked Poverty People of Color 42,467 214,828 109,959 417,521 217,522 53,231 34,338 4,005 15,959 9,644 Eddy 57,900 15,344 8,406 1,155 4,180 2,559 80 12,677 65,922 52,914 158,940 21 3,314 17,140 8,981 31,228 Lea 69,611 20,752 7,948 1,561 4,720 2,708 26 3,463 19,403 10,813 45,250 Rio Arriba 39,006 9,121 7,558 686 3,024 2,040 14 2,681 12,328 8,498 34,040 Sandoval 145,179 33,748 25,756 2,539 11,168 7,291 54 9,519 45,587 18,215 82,591 San Juan 125,043 33,054 18,685 2,487 9,072 5,622 46 7,290 37,159 28,486 77,550 Santa Fe 150,056 26,988 36,485 2,031 12,611 8,953 55 11,943 51,444 17,972 85,555 Taos 32,835 5,778 8,688 435 2,797 2,045 12 Valencia 76,456 17,911 13,502 1,348 5,862 3,819 28 Totals 122 1,592,309 363,297 272,582 Lung.org 27,336 121,785 77,304 589 American Lung Association State of the Air 2020 2,747 11,404 6,955 21,199 4,987 23,937 12,908 51,733 101,088 499,152 275,701 1,005,607 State Tables NEW MEXICO American Lung Association in New Mexico www.Lung.org/newmexico HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Bernalillo Wgt. Avg. Grade Orange Red Purple Maroon 19 0 0 6.3 F Doña Ana 52 2 0 18.3 F Eddy 27 3 0 10.5 F Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0 0.0 A 7.8 PASS 4 1 0 0 1.8 C 8.3 PASS DNC DNC DNC DNC DNC DNC DNC DNC Lea 9 0 0 3.0 D Rio Arriba 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC DNC Sandoval 13 0 0 4.3 F DNC DNC DNC DNC DNC DNC DNC DNC San Juan 23 0 0 7.7 F DNC DNC DNC DNC DNC DNC DNC DNC Santa Fe 3 0 0 1.0 C INC INC INC INC INC INC INC INC Taos Valencia 123 DNC DNC DNC DNC DNC 6 0 0 2.0 C Lung.org 1 0 0 0 0.3 B 7.6 PASS INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC American Lung Association State of the Air 2020 State Tables NEW YORK American Lung Association in New York www.Lung.org/newyork AT-RISK GROUPS Lung Diseases County Albany Bronx Total Population Under 18 65 & Over Pediatric Asthma 307,117 56,359 52,073 Adult Asthma COPD Lung Cancer 3,472 25,603 14,152 1,432,132 354,692 183,375 127,939 25,997 25,704 1,601 10,377 6,321 Dutchess 293,718 55,149 51,633 3,397 24,355 14,248 Erie 919,719 186,092 165,052 Ever Smoked Poverty People of Color 177 19,470 90,763 32,888 86,584 21,849 110,324 57,608 Chautauqua Heart Disease 825 76,621 382,917 380,470 1,301,368 74 8,983 38,327 22,426 16,477 170 19,713 88,606 25,387 84,652 11,463 74,829 43,545 531 60,689 271,226 122,204 227,998 Essex 37,300 6,062 8,743 373 3,174 2,035 22 2,943 11,985 4,150 2,877 Franklin 50,293 9,750 8,452 601 4,141 2,352 29 3,235 14,867 7,404 9,188 4,434 573 1,386 35 390 283 Hamilton 3 426 1,556 404 230 Herkimer 61,833 12,755 12,815 786 4,993 3,104 36 4,436 18,608 8,176 3,433 Jefferson 111,755 26,798 15,276 1,651 8,690 4,474 65 6,006 29,927 12,996 20,979 Kings Monroe New York 2,582,830 588,975 359,246 36,281 203,969 106,513 742,474 154,214 128,049 9,500 60,032 34,403 1,628,701 233,360 268,902 14,375 142,578 74,658 1,489 143,029 706,976 483,632 1,642,012 429 47,684 216,203 103,620 220,692 939 101,452 493,938 245,347 863,489 Niagara 210,433 42,064 40,109 2,591 17,160 10,375 122 14,590 63,263 26,833 30,878 Onondaga 461,809 98,024 78,635 6,038 37,131 21,330 267 29,524 133,908 61,143 107,930 Orange 381,951 97,160 53,541 5,985 29,133 16,190 221 21,885 103,817 42,664 139,224 Oswego 117,898 24,769 19,265 1,526 9,514 5,487 Putnam Queens 98,892 19,590 17,169 1,207 8,098 4,856 68 7,534 34,420 18,209 7,229 57 6,713 29,819 5,863 21,898 2,278,906 458,457 357,517 28,241 186,074 103,111 Richmond 476,179 104,038 77,053 6,409 38,014 21,741 Rockland 325,695 91,712 51,107 5,649 23,877 13,737 188 19,050 86,148 44,728 121,045 Saratoga 230,163 46,168 41,728 2,844 18,769 11,165 133 15,570 68,748 14,319 22,730 Steuben Suffolk Tompkins Wayne Westchester Totals 124 95,796 20,504 18,850 1,481,093 313,019 249,756 1,263 7,667 4,705 19,282 119,280 69,976 1,317 140,434 661,427 261,819 1,708,555 275 55 857 29,865 136,971 55,217 189,066 6,675 28,430 12,069 6,125 96,596 434,698 105,578 485,941 102,793 15,006 14,900 924 8,983 4,413 59 5,865 30,343 15,146 23,650 90,064 19,198 17,002 1,183 7,223 4,430 52 6,234 26,813 8,511 9,160 967,612 211,912 165,008 15,619,529 3,272,397 2,482,346 Lung.org 13,054 77,133 45,070 201,579 1,261,513 700,282 559 9,021 American Lung Association State of the Air 2020 62,459 280,384 78,572 453,925 957,682 4,485,090 2,199,775 7,807,335 State Tables NEW YORK American Lung Association in New York www.Lung.org/newyork HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Albany 4 0 0 1.3 C 0 0 0 0 0.0 A 6.9 PASS Bronx 15 0 0 5.0 F 0 0 0 0 0.0 A 8.1 PASS Chautauqua 9 0 0 3.0 D 0 0 0 0 0.0 A 6.2 PASS Dutchess 7 Erie 9 0 0 3.0 D 0 0 0 0 0.0 A 7.2 PASS Essex 4 0 0 1.3 C 0 0 0 0 0.0 A 3.6 PASS Franklin 1 0 2.8 D INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC Hamilton 2 0 0 0.7 Herkimer 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC Jefferson 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC Kings Monroe New York B DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.8 PASS 9 0 0 3.0 D 0 0 0 0 0.0 A 6.8 PASS 15 1 0 5.5 F 1 0 0 0 0.3 B 9.5 PASS Niagara 5 Onondaga 4 0 0 1.3 C Orange 2 0 0 0.7 B Oswego 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC 8 2 0 3.7 F DNC DNC DNC DNC DNC DNC DNC DNC Putnam 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 5.1 PASS 0 0 0 0 0.0 A 6.2 PASS Queens 19 1 0 6.8 F Richmond 22 1 0 7.8 F Rockland 10 0 1 4.0 F DNC DNC DNC DNC DNC DNC DNC DNC Saratoga 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC Steuben Suffolk 0 0 0 0 0.0 A 7.0 PASS 0 0 0 0 0.0 A 7.4 PASS 2 0 0 0.7 B 0 0 0 0 0.0 A 4.7 PASS 25 3 0 9.8 F 0 0 0 0 0.0 A 6.7 PASS Tompkins 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC Wayne 7 0 0 2.3 D DNC DNC DNC DNC DNC DNC DNC DNC Westchester 22 1 0 7.8 F DNC DNC DNC DNC DNC DNC DNC DNC 125 Lung.org American Lung Association State of the Air 2020 State Tables NORTH CAROLINA American Lung Association in North Carolina www.Lung.org/northcarolina AT-RISK GROUPS Lung Diseases County Alexander Avery Buncombe Total Population Under 18 65 & Over Pediatric Asthma 37,353 7,529 7,489 17,505 2,621 3,891 Adult Asthma COPD Lung Cancer 865 2,813 2,646 301 1,399 1,303 Heart Disease Ever Smoked Poverty People of Color 25 3,445 13,146 4,653 5,017 12 1,718 6,543 2,542 2,021 259,103 47,834 51,828 5,497 19,891 18,001 172 23,440 92,213 28,859 42,740 Caldwell 82,029 16,490 16,302 1,895 6,189 5,874 Carteret 69,524 12,208 17,363 1,403 5,376 5,455 46 7,385 25,772 6,717 9,386 Caswell 22,698 4,272 4,881 15 2,210 8,183 3,642 8,822 55 491 1,736 1,681 7,616 28,953 12,830 10,605 Catawba 158,652 35,043 28,337 4,027 11,688 10,675 106 13,629 54,071 20,321 39,209 Cumberland 332,330 82,119 39,617 9,437 23,719 17,892 223 21,369 104,633 53,788 190,679 Davidson 166,614 36,559 30,377 4,201 12,302 11,429 111 14,624 57,137 24,694 33,811 Durham 316,739 65,824 41,470 7,564 23,795 18,507 211 22,259 105,636 41,063 181,752 52,005 11,711 10,253 1,346 3,796 3,561 Edgecombe Forsyth Graham Granville Guilford 379,099 86,957 60,617 9,993 27,649 23,954 8,484 1,694 2,019 60,115 12,272 10,293 61,971 11,308 15,248 43,327 7,195 8,527 354 1,299 4,747 4,738 41 827 3,396 2,912 30,046 126,134 60,361 164,800 6 40 13,663 39,284 33,087 Jackson 4,655 17,746 11,705 33,137 252 195 636 632 1,410 4,537 4,127 533,670 118,897 80,949 Haywood Johnston 34 854 3,035 1,575 1,192 5,188 20,906 7,331 25,247 41,028 177,867 79,267 267,695 6,424 22,679 8,071 4,631 29 3,786 15,566 6,570 8,205 202,675 51,654 26,989 5,936 14,366 12,225 Lee 61,452 14,733 10,118 1,693 4,420 3,920 41 4,954 20,287 9,459 25,942 Lenoir 55,976 12,606 11,088 1,449 4,087 3,860 37 5,046 19,134 12,193 28,441 Lincoln 83,770 17,649 14,802 2,028 6,269 5,835 56 7,384 29,063 8,555 12,538 Macon 35,285 6,590 10,056 Martin Mecklenburg 22,671 4,587 5,246 1,093,901 257,713 122,549 135 14,831 64,910 23,374 66,425 757 2,670 2,800 527 1,699 1,694 29,615 79,580 61,334 15,000 2,740 3,741 315 1,149 1,157 Montgomery 27,271 6,007 5,597 690 2,002 1,903 Person Pitt Rockingham Rowan Swain Union Wake Yancey Totals 126 232,274 42,800 41,211 4,918 17,874 15,270 39,507 8,260 7,725 15 2,272 8,093 4,571 10,867 729 Mitchell New Hanover 24 3,938 13,017 5,700 3,882 71,907 351,251 126,098 586,264 10 1,572 5,501 2,383 1,232 18 2,505 9,398 4,379 10,067 154 19,425 81,539 34,250 52,600 949 2,952 2,804 26 3,629 13,807 5,773 13,402 179,914 38,347 23,789 4,407 13,404 10,273 90,690 18,387 18,552 2,113 6,823 6,562 60 141,262 31,407 24,830 3,609 10,386 9,385 95 11,958 47,925 22,298 40,038 14,245 3,148 2,729 235,908 63,295 29,928 9 1,245 4,857 2,124 5,509 729 376 1,369 1,387 161,486 458,606 384,753 8,560 32,052 16,003 25,083 158 17,063 74,408 16,361 66,941 30,054 79,104 62,737 17,903 3,269 4,607 Lung.org 362 1,046 957 7,274 16,454 14,175 1,092,305 261,531 126,886 6,243,227 1,405,256 919,904 119 12,422 59,411 40,201 82,137 74,034 351,225 89,819 438,820 12 1,900 6,577 3,153 1,405 4,162 American Lung Association State of the Air 2020 474,322 2,072,676 800,683 2,500,542 State Tables NORTH CAROLINA American Lung Association in North Carolina www.Lung.org/northcarolina HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Alexander 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Avery 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC Buncombe 1 0 0 0.3 B Caldwell 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Carteret 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Caswell 0 0 0 0.0 A INC INC INC INC INC INC INC INC Catawba Cumberland Davidson 3 4 0 0 3.0 D 7.1 PASS DNC DNC DNC DNC DNC 1 2 0 0 1.3 C 8.6 PASS 0 0 0 0.0 A 0 0 0 0 0.0 A 8.1 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.7 PASS Durham 0 0 0 0.0 A Edgecombe 0 Forsyth 5 0 0 1.7 C Graham 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Granville 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Guilford 5 0 0 1.7 C Haywood 3 Jackson 4 0 0 1.3 C Johnston 0 0 0 0.0 A Lee 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Lenoir 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Lincoln 1 1 0 0.8 B DNC DNC DNC DNC DNC DNC DNC DNC Macon 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Martin Mecklenburg Mitchell 0 0 0 0.0 A 0 1.0 C 14 0 0 4.7 F 1 0 0 0 0.3 B 8.6 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.5 PASS 1 0 0 0 0.3 B 7.8 PASS DNC DNC DNC DNC DNC DNC DNC DNC 3 2 0 0 2.0 C 7.8 PASS 1 0 0 0 0.3 B 7.8 PASS 0 0 0 0 0.0 A 8.8 PASS DNC DNC DNC DNC DNC 1 3 0 0 1.8 C 7.0 PASS Montgomery 0 0 0 0.0 A New Hanover 0 0 0 0.0 A Person 1 Pitt 0 0 0 0.0 A Rockingham 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Rowan 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0.3 B Swain 0 0 0 0.0 A Union 7 Wake 1 0 0 0.3 B Yancey 3 127 0 0 0 2.3 D 0 1.0 C Lung.org 0 0 0 0 0.0 A 6.3 PASS 0 0 0 0 0.0 A 4.9 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.6 PASS 8 4 0 0 4.7 F 8.3 PASS DNC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 7.7 PASS DNC DNC DNC DNC DNC DNC American Lung Association State of the Air 2020 DNC DNC State Tables NORTH DAKOTA American Lung Association in North Dakota www.Lung.org/northdakota AT-RISK GROUPS Lung Diseases County Billings Burke Burleigh Cass Dunn Total Population Under 18 65 & Over Pediatric Asthma 919 187 206 2,100 526 436 Adult Asthma COPD Lung Cancer 12 60 43 Heart Disease 1 34 129 92 Ever Smoked Poverty People of Color 77 319 82 70 1 164 687 195 139 95,273 22,130 15,315 1,440 5,997 3,806 52 6,317 31,431 6,798 10,826 181,516 40,855 21,794 2,658 11,534 6,440 99 9,837 59,543 18,270 28,532 4,332 1,032 690 67 271 178 2 296 1,425 443 811 13,632 4,292 1,248 279 767 428 7 637 3,957 1,240 3,078 Mercer 8,267 1,904 1,592 124 522 368 5 641 2,773 585 629 Oliver 1,952 491 433 McKenzie 32 120 89 1 162 641 198 133 Ward 67,744 15,964 8,640 1,039 4,245 2,424 37 Williams 35,350 10,135 3,388 659 2,069 1,144 19 Totals 128 411,085 97,516 53,742 Lung.org 6,345 25,713 15,011 224 American Lung Association State of the Air 2020 3,774 21,971 7,057 11,854 1,699 10,668 2,265 7,202 23,604 133,414 37,133 63,274 State Tables NORTH DAKOTA American Lung Association in North Dakota www.Lung.org/northdakota HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Billings 0 0 0 0.0 A 1 1 0 0 0.8 B 3.8 PASS Burke 0 0 0 0.0 A 2 0 0 0 0.7 B 2.9 PASS Burleigh 0 0 0 0.0 A 5 3 0 0 3.2 D INC INC Cass 0 0 0 0.0 A 1 0 0 0 0.3 B 6.6 PASS Dunn 0 0 0 0.0 A 1 1 0 0 0.8 B INC INC McKenzie 0 0 0 0.0 A 1 1 0 0 0.8 B 4.2 PASS Mercer 0 0 0 0.0 A 4 1 0 0 1.8 C 3.8 PASS Oliver 0 0 0 0.0 A 3 1 0 0 1.5 C 5.3 PASS Ward Williams 129 INC INC INC INC INC 0 0 0 0.0 A Lung.org INC INC INC INC INC INC INC INC 2 0 0 0 0.7 B 4.5 PASS American Lung Association State of the Air 2020 State Tables OHIO American Lung Association in Ohio www.Lung.org/ohio AT-RISK GROUPS Lung Diseases County Allen Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Heart Disease Ever Smoked Poverty People of Color 102,663 23,667 18,117 1,840 7,439 6,780 68 8,248 36,270 13,901 19,806 Ashtabula 97,493 21,521 18,589 1,673 7,134 6,834 65 8,424 35,277 16,353 10,409 Athens 65,818 9,568 8,671 744 5,347 3,995 43 4,498 24,854 17,237 7,036 Belmont 67,505 12,769 14,072 993 5,140 4,952 45 Butler 382,378 89,730 56,176 6,975 27,618 23,859 252 28,189 133,201 45,821 74,557 Clark 134,585 30,121 26,122 2,341 9,819 9,299 89 11,488 48,322 19,467 21,492 Clermont 205,466 47,330 33,533 3,679 14,881 13,589 136 16,359 72,814 16,745 13,589 Clinton Cuyahoga Delaware Fayette Franklin 42,057 9,690 7,176 1,243,857 257,882 225,983 20,045 92,829 84,905 204,826 53,818 28,062 1,310,300 304,643 157,391 94,031 21,496 19,159 Greene 167,995 34,671 28,829 Hamilton 816,684 187,547 125,251 28 3,385 14,902 4,802 2,753 817 103,312 453,134 217,166 512,719 4,183 14,228 12,563 28,666 6,693 5,091 Geauga 753 3,046 2,794 6,149 25,412 8,272 4,973 135 14,821 69,173 8,271 31,771 520 2,066 1,928 23,680 95,292 75,398 19 2,353 10,148 4,227 2,215 863 1,671 6,798 6,766 62 2,695 12,573 11,139 85,844 450,179 198,207 490,422 8,451 33,949 5,341 4,265 111 13,406 60,873 18,567 27,513 14,578 59,375 51,474 537 61,127 286,330 122,843 285,966 Harrison 15,174 3,183 3,227 247 1,123 1,125 10 1,410 5,618 2,285 788 Jefferson 65,767 12,596 14,173 979 4,990 4,875 43 6,091 24,750 12,052 6,313 Knox 61,893 14,061 11,231 1,093 4,502 4,151 41 5,072 22,013 8,039 2,897 Lake 230,514 46,209 46,066 3,592 17,306 16,634 59,866 13,009 11,313 1,011 4,404 4,163 Licking 175,769 40,733 28,906 3,166 12,710 11,580 116 13,955 62,123 15,591 17,928 Lorain 309,461 68,166 56,629 5,299 22,685 21,254 204 26,000 111,522 42,562 68,373 Lucas 429,899 98,562 70,047 7,661 31,226 27,868 283 Lawrence Madison 44,413 9,117 6,863 152 20,569 85,597 16,970 28,285 39 709 3,327 2,935 5,117 21,690 11,093 3,181 33,461 151,668 78,398 135,938 30 3,481 16,146 4,215 5,188 Mahoning 229,642 45,992 48,145 3,575 17,249 16,630 151 20,712 85,227 36,520 56,113 Medina 179,146 39,987 31,990 3,108 13,073 12,354 118 15,080 64,507 11,474 11,087 Miami 106,222 24,389 19,773 1,896 7,692 7,259 70 8,921 37,861 8,329 8,482 Montgomery 532,331 117,543 95,583 Noble Portage Preble Scioto Stark 9,137 39,064 35,589 14,354 2,634 3,951 162,927 30,531 26,794 350 205 1,093 1,197 2,373 12,492 10,893 40,997 9,174 7,893 43,324 190,400 87,187 156,334 10 1,558 5,585 2,109 716 107 12,973 60,319 17,564 17,391 713 2,988 2,868 27 3,543 14,778 3,936 1,535 75,502 16,334 13,792 1,270 5,568 5,137 371,574 79,684 72,293 6,194 27,432 26,009 245 32,089 135,104 52,330 50,778 50 6,271 27,241 16,288 5,056 357 45,167 197,440 63,889 126,757 Summit 541,918 113,228 97,232 8,801 40,339 37,151 Trumbull 198,627 40,788 42,931 3,170 14,808 14,571 131 18,270 73,565 34,413 25,510 Warren 232,173 57,270 33,646 4,452 16,471 14,719 154 17,462 80,296 11,709 33,080 Washington Wood Totals 130 60,155 11,844 12,663 921 4,536 4,396 40 5,477 22,452 9,251 3,016 130,696 26,642 19,998 2,071 9,841 8,218 86 9,672 46,960 14,733 15,623 9,233,344 2,032,822 1,547,361 Lung.org 158,010 678,504 607,854 6,082 American Lung Association State of the Air 2020 731,724 3,297,695 1,278,157 2,289,855 State Tables OHIO American Lung Association in Ohio www.Lung.org/ohio HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Allen Ashtabula Wgt. Avg. Grade Orange Red Purple Maroon 9 0 0 3.0 D 11 0 0 3.7 F Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0 0.0 A 7.8 PASS DNC DNC DNC DNC DNC DNC DNC DNC Athens DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.4 PASS Belmont DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.9 PASS Butler 23 0 0 7.7 F 0 0 0 0 0.0 A 10.5 PASS Clark 12 0 0 4.0 F 0 0 0 0 0.0 A 8.7 PASS Clermont 9 0 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC Clinton 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC DNC Cuyahoga Delaware Fayette 20 0 0 6.7 F 0 0 0 0 0.0 A 11.0 PASS 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC Franklin 13 0 0 4.3 F Geauga 23 0 0 7.7 F 1 0 0 0 0.3 B 8.4 PASS DNC DNC DNC DNC DNC DNC DNC DNC Greene 3 0 0 1.0 C 0 0 0 0 0.0 A 7.8 PASS Hamilton 24 1 0 8.5 F 0 0 0 0 0.0 A 9.7 PASS Harrison Jefferson Knox Lake DNC DNC DNC DNC DNC 1 0 0 0.3 B 1 0 0 0.3 B 24 0 0 8.0 F Lawrence 5 0 0 1.7 C Licking 3 Lorain 4 0 0 1.3 C Lucas 16 1 0 5.8 F 0 DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.0 PASS 1 0 0 0 0.3 B 6.6 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.5 PASS 1 0 0 0 0.3 B 8.5 PASS 4 Mahoning 0 0 0 0.0 A 0 0 0 0 0.0 A 7.9 PASS Medina 1 0 0 0.3 B 0 0 0 0 0.0 A 7.6 PASS Montgomery 5 0 0 1.3 C INC INC 2 0 0 0 0.7 B 9.5 PASS Madison Miami 0 0 1.0 C INC INC INC INC INC INC 0 1.7 C 11 0 0 3.7 F B DNC DNC 0 0 0 0 0.0 A 8.5 PASS 2 Portage 0 0 0 0.0 A 0 0 0 0 0.0 A 7.3 PASS Preble 2 0 0 0.7 B 1 0 0 0 0.3 B 7.8 PASS Stark 0 0.7 DNC DNC DNC DNC DNC DNC DNC DNC Noble Scioto 0 DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0 0.3 B INC INC 11 0 0 3.7 F 0 0 0 0 0.0 A 9.3 PASS Summit 2 0 0 0.7 B 0 0 0 0 0.0 A 9.0 PASS Trumbull 10 0 0 3.3 F 1 0 0 0 0.3 B 7.8 PASS Warren 15 0 0 5.0 F DNC DNC DNC DNC DNC DNC Washington 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC Wood 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC 131 Lung.org American Lung Association State of the Air 2020 DNC DNC State Tables OKLAHOMA American Lung Association in Oklahoma www.Lung.org/oklahoma AT-RISK GROUPS Lung Diseases County Adair Total Population Under 18 65 & Over 22,082 5,869 3,512 Bryan 47,192 11,054 8,477 Caddo 28,977 7,285 4,881 Canadian Pediatric Asthma Adult Asthma COPD Lung Cancer 575 1,680 1,432 Heart Disease Ever Smoked Poverty People of Color 14 1,969 7,312 5,372 13,343 1,083 3,720 3,143 30 714 2,241 1,908 4,391 16,217 7,604 13,824 19 2,642 9,768 5,239 12,439 144,447 37,771 18,770 3,701 11,111 8,728 93 11,688 47,213 10,336 35,104 Carter 48,177 12,075 8,103 1,183 3,733 3,193 31 4,416 16,281 8,335 14,715 Cherokee 48,675 10,655 8,130 1,044 3,923 3,169 31 4,376 16,883 9,862 25,635 Choctaw 14,668 3,541 3,036 347 1,142 1,059 Cleveland 281,669 60,612 37,659 5,939 22,971 17,209 Comanche 120,422 28,332 15,192 2,776 9,583 7,151 Cotton Creek 5,776 1,299 1,119 71,604 17,201 12,638 9 1,505 5,113 3,312 5,789 181 23,030 96,631 32,077 80,962 78 127 462 424 9,524 40,239 18,303 53,129 4 1,685 5,625 4,936 46 593 2,056 926 1,389 6,847 24,700 9,874 17,424 Dewey 4,894 1,324 902 130 367 326 3 459 1,622 580 910 Jefferson 6,123 1,478 1,307 4 Johnston 10,949 2,573 2,129 Kay 44,161 11,091 8,539 Le Flore 49,980 11,997 9,038 1,176 3,918 3,422 32 4,772 17,207 10,903 14,386 Lincoln 34,920 8,310 6,400 22 3,437 12,154 5,069 6,277 Love 10,134 2,461 1,935 McClain 39,985 10,265 6,194 1,006 3,085 2,610 26 3,566 13,385 3,592 8,477 Mayes 41,107 9,598 7,576 940 3,251 2,866 26 3,999 14,311 6,271 14,522 Nowata Oklahoma 10,218 2,328 1,962 792,582 203,382 108,318 145 476 443 252 861 762 1,087 3,393 2,996 7 1,074 3,802 2,068 3,354 28 814 2,750 2,469 241 789 695 4,239 14,993 8,751 11,403 7 228 814 735 19,928 61,212 48,023 633 2,135 1,473 1,385 979 3,480 1,466 2,949 7 1,028 3,606 1,650 3,399 508 64,776 260,424 131,185 351,494 Osage 47,014 10,217 9,386 1,001 3,791 3,454 30 4,853 16,853 6,864 17,226 Ottawa 31,175 7,643 5,720 749 2,422 2,105 20 2,949 10,637 6,210 10,970 Pittsburg 43,877 9,745 8,790 955 3,504 3,109 28 4,393 15,498 8,160 13,530 Sequoyah 41,179 9,421 7,802 923 3,274 2,914 26 4,078 14,456 7,636 15,412 Tulsa Washington Totals 132 648,360 164,042 93,318 51,843 12,408 10,099 2,742,190 673,977 410,932 Lung.org 16,073 50,281 40,387 1,216 4,052 3,604 66,039 214,430 173,273 415 33 1,758 American Lung Association State of the Air 2020 54,771 215,266 89,706 248,773 5,085 17,924 6,607 14,239 236,072 920,166 409,431 1,012,459 State Tables OKLAHOMA American Lung Association in Oklahoma www.Lung.org/oklahoma HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Adair 0 0 Wgt. Avg. Grade Orange Red Purple Maroon 0 0.0 A Wgt. Avg. Grade Design Value Pass/ Fail DNC DNC DNC DNC DNC DNC DNC DNC Bryan INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC Caddo INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC Canadian 7 0 0 2.3 D Carter INC INC INC INC INC Cherokee Choctaw Cleveland Comanche Cotton 2 0 0 0 0.7 B INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC 8 0 0 2.7 D 5 0 0 1.7 C INC INC INC INC INC Creek 1 Dewey 7 0 0 2.3 D 0 0 0.3 B 1 0 0 0 0.3 B 8.5 PASS 0 0 0 0 0.0 A 7.0 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0 0.7 B INC INC Jefferson INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC Johnston INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC Kay 2 0 0 0.7 B 2 0 0 0 0.7 B 7.7 PASS Le Flore DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC Lincoln INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC Love INC INC INC INC INC McClain Mayes DNC DNC DNC DNC DNC DNC DNC DNC 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC 1 0 0 0.3 DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC B Nowata INC INC INC INC INC Oklahoma 16 0 0 5.3 F Osage 8 0 0 2.7 Ottawa 0 0 0 0.0 A Pittsburg 1 0 0 0.3 B 0 0 0 0 0.0 A 8.1 PASS Sequoyah 0 0 0 0.0 A 0 0 0 0 0.0 A 8.2 PASS 8 2 0 3.7 F 2 0 0 0 0.7 B 9.6 PASS Tulsa Washington 133 D 0 0 0 0 0.0 A 8.6 PASS INC INC INC INC INC Lung.org DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC 1 0 0 0 0.3 B American Lung Association State of the Air 2020 INC INC State Tables OREGON American Lung Association in Oregon www.Lung.org/oregon AT-RISK GROUPS Lung Diseases County Clackamas Total Population Under 18 65 & Over Pediatric Asthma 416,075 89,515 75,318 Adult Asthma COPD Lung Cancer 6,490 38,275 23,053 Heart Disease Ever Smoked Poverty People of Color 210 32,094 142,169 30,022 76,734 Columbia 52,377 11,067 9,809 802 4,842 2,982 27 4,171 18,098 5,302 6,237 Crook 23,867 4,716 5,944 342 2,212 1,503 12 2,155 8,599 3,049 2,862 7,329 1,502 1,793 109 673 451 Harney Jackson 4 646 2,606 1,089 962 219,564 45,245 48,236 3,280 20,229 12,911 Josephine 87,393 17,118 22,709 1,241 8,094 5,581 44 8,032 31,670 14,655 11,623 Klamath 67,653 14,706 14,340 1,066 6,153 3,903 34 5,512 23,338 12,310 15,294 Lake 7,879 1,513 1,987 111 18,265 76,940 32,137 42,944 110 735 503 4 722 2,864 1,360 1,233 Lane 379,611 69,868 73,392 5,065 36,150 21,366 192 29,676 133,980 67,217 70,215 Marion 346,868 85,432 54,349 6,194 30,699 17,436 176 23,937 112,048 48,997 121,561 Multnomah 811,880 152,901 109,080 11,085 77,901 40,721 411 54,594 276,833 95,543 249,344 Umatilla 77,516 19,551 12,120 Wasco 26,505 5,871 5,458 Washington Totals 134 597,695 136,614 80,268 3,122,212 655,619 514,803 Lung.org 1,417 6,806 3,878 39 426 2,399 1,500 9,905 54,488 29,286 47,533 289,656 165,074 5,328 24,864 11,557 26,729 13 2,112 9,059 3,467 6,873 302 1,580 American Lung Association State of the Air 2020 39,553 195,075 51,789 208,815 226,797 1,058,144 378,494 841,426 State Tables OREGON American Lung Association in Oregon www.Lung.org/oregon HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Clackamas Columbia Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail 10 1 1 4.5 F DNC DNC DNC DNC DNC DNC DNC DNC 1 1 0 0.8 B DNC DNC DNC DNC DNC DNC DNC DNC Crook DNC DNC DNC DNC DNC 5 5 0 0 4.2 F 9.1 PASS Harney DNC DNC DNC DNC DNC 6 2 0 0 3.0 D 9.8 PASS Jackson 11 0 0 3.7 F 3 11 3 0 8.5 F INC INC 0 7 0 0 10.3 PASS Josephine DNC DNC DNC DNC DNC 3.5 F Klamath DNC DNC DNC DNC DNC 6 9 2 0 7.8 F 12.4 FAIL Lake DNC DNC DNC DNC DNC 12 7 0 0 7.5 F 10 4 0 1 6.2 F INC INC Lane 2 2 0 1.7 C Marion 6 0 0 2.0 C Multnomah 3 1 0 1.5 C Umatilla 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC DNC Wasco 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Washington 4 2 0 2.3 D 135 Lung.org DNC DNC DNC DNC DNC DNC 9.6 PASS DNC DNC 4 0 0 0 1.3 C 7.0 PASS 6 0 0 0 2.0 C 7.4 PASS American Lung Association State of the Air 2020 State Tables PENNSYLVANIA American Lung Association in Pennsylvania www.Lung.org/pennsylvania AT-RISK GROUPS Lung Diseases County Adams Allegheny Armstrong Total Population Under 18 65 & Over Pediatric Asthma 102,811 20,554 20,954 Adult Asthma COPD Lung Cancer 2,001 8,300 6,227 1,218,452 227,749 230,377 66 22,168 99,742 70,310 778 Ever Smoked Poverty People of Color 8,622 35,826 7,919 11,291 96,971 424,109 138,397 263,512 65,263 12,510 14,338 1,218 5,322 4,133 Beaver 164,742 31,988 35,412 3,114 13,373 10,199 105 14,214 57,942 18,061 17,483 Berks 420,152 93,834 72,352 9,133 32,976 23,183 269 Blair 122,492 25,017 25,445 2,435 9,809 7,349 Bradford 60,833 13,362 12,955 42 Heart Disease 5,756 23,164 5,917 1,959 31,654 140,195 46,762 122,246 78 10,240 42,311 17,156 6,675 1,301 4,782 3,696 39 628,195 128,216 117,060 Cambria 131,730 25,309 29,736 2,463 10,694 8,264 84 11,606 46,467 18,520 9,567 Centre 162,805 24,461 23,195 2,381 13,913 8,286 105 11,136 57,038 25,901 24,046 Chester 522,046 118,139 85,335 Clearfield 12,480 50,664 37,204 402 5,160 20,788 7,495 2,549 Bucks 11,499 40,938 28,596 334 38,704 173,851 34,311 108,918 79,388 14,453 16,291 1,407 6,554 4,882 Cumberland 251,423 50,918 46,545 4,956 20,199 14,275 161 19,667 85,944 17,469 37,225 Dauphin 277,097 62,355 47,002 6,069 21,700 15,153 177 20,668 92,113 35,730 96,578 Delaware 564,751 123,908 92,607 Elk 51 50,819 217,670 35,350 102,058 12,061 44,571 30,589 30,169 5,870 6,640 361 571 2,456 1,935 6,749 28,240 11,323 5,584 41,541 188,466 47,800 190,290 19 2,687 10,733 2,742 817 Erie 272,061 58,156 48,900 5,661 21,578 15,252 174 20,938 91,833 39,839 42,933 Fayette 130,441 25,011 27,603 2,434 10,630 8,059 84 11,199 45,994 18,475 10,877 Franklin 154,835 34,405 30,425 3,349 12,132 8,978 99 12,455 52,182 16,759 19,006 Greene Indiana 36,506 7,075 6,896 689 2,971 2,136 24 2,935 12,694 5,334 2,389 84,501 15,312 16,480 1,490 6,954 4,917 Lackawanna 210,793 43,243 42,061 4,209 16,869 12,398 135 17,208 72,434 28,929 33,043 Lancaster 543,557 127,967 97,560 12,456 41,843 29,653 348 40,927 178,138 42,131 100,253 Lawrence 54 86,184 17,086 18,951 1,663 6,952 5,352 Lebanon 141,314 32,143 27,397 3,129 10,986 8,049 90 11,180 47,133 13,802 26,209 Lehigh 368,100 83,207 61,507 8,099 28,764 19,842 235 27,070 121,744 42,991 134,641 Luzerne 317,646 62,610 63,184 6,094 25,696 18,827 203 26,071 110,264 43,839 62,210 Lycoming 113,664 23,267 21,935 2,265 9,111 6,611 73 9,135 39,007 14,054 10,740 Mercer 110,683 21,463 23,991 2,089 8,977 6,834 71 9,548 38,872 15,985 11,023 Monroe 169,507 33,306 29,181 Montgomery 828,604 178,218 147,124 Northampton Philadelphia 55 6,814 29,585 12,356 5,220 3,242 13,828 9,821 109 13,274 58,959 20,202 59,228 17,347 65,743 46,770 304,807 60,926 57,955 5,930 24,602 17,747 1,584,138 343,970 216,276 33,481 125,116 77,536 7,490 30,187 13,319 7,038 530 63,941 280,276 47,317 204,331 195 24,442 105,196 29,917 73,337 1,009 103,994 517,325 372,322 1,039,969 Somerset 73,952 13,224 16,535 Susquehanna 40,589 7,498 9,604 1,287 6,115 4,706 730 3,335 2,676 48 26 3,752 14,634 5,128 1,525 6,574 26,551 8,289 4,324 Tioga 40,763 8,140 8,983 792 3,280 2,522 26 3,534 14,236 5,894 1,601 Washington 207,346 40,332 42,617 3,926 16,847 12,623 133 17,492 72,688 18,274 16,532 Westmoreland 350,611 64,117 79,652 6,241 28,867 22,565 224 31,543 125,835 31,749 21,836 York Totals 136 448,273 99,020 78,216 11,421,224 2,378,339 2,049,277 Lung.org 9,638 35,336 25,144 231,498 912,526 643,300 287 34,297 150,669 38,582 76,751 7,304 American Lung Association State of the Air 2020 882,008 3,881,295 1,356,340 2,965,814 State Tables PENNSYLVANIA American Lung Association in Pennsylvania www.Lung.org/pennsylvania HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Adams 7 0 0 2.3 D Allegheny 23 Armstrong 1 0 8.2 F Wgt. Avg. Grade Design Value Pass/ Fail 1 0 0 0 0.3 B 7.6 PASS 26 2 0 0 9.7 F 12.6 FAIL 6 0 0 2.0 C 0 0 0 0 0.0 A 9.3 PASS Beaver 12 0 0 4.0 F 1 0 0 0 0.3 B 9.1 PASS Berks 13 0 0 4.3 F 4 0 0 0 1.3 C 8.5 PASS 2 0 0 0.7 B 1 0 0 0 0.3 B 8.1 PASS Blair Bradford Bucks 0 0 0 0.0 A 30 3 0 11.5 F 0 0 0 0 0.0 A 7.0 PASS DNC DNC DNC DNC DNC DNC DNC DNC Cambria 0 0 0 0.0 A 0 0 0 0 0.0 A 9.7 PASS Centre 2 0 0 0.7 B 2 0 0 0 0.7 B 8.1 PASS Chester 15 0 0 5.0 F Clearfield Cumberland 2 0 0 0.7 B 0 0 0 0 0.0 A 9.7 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 8.1 PASS Dauphin 5 0 0 1.7 C 3 0 0 0 1.0 C 8.6 PASS Delaware 11 0 0 3.7 F 2 0 0 0 0.7 B 10.7 PASS Elk 3 Erie 3 0 0 1.0 C Fayette 0 0 1.0 C INC INC INC INC INC INC INC INC INC INC INC INC INC DNC DNC Greene 1 0 0 0.3 B Indiana 5 Lackawanna 4 0 0 1.3 C Lancaster 9 0 0 3.0 D Lawrence 1 Lebanon 7 0 0 2.3 D 3 0 0 0 1.0 C 9.3 PASS Lehigh 8 0 0 2.7 D 1 0 0 0 0.3 B 9.0 PASS Luzerne 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC Lycoming 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Mercer 8 0 0 2.7 D 0 A DNC DNC DNC DNC DNC DNC 0 0 0 0.0 DNC DNC 0 0 0 0 0.0 A 8.1 PASS Franklin Monroe 0 DNC DNC DNC DNC DNC DNC 0 1.7 C 0 0.3 B 5 0 0 1.7 C DNC DNC 0 0 0 0 0.0 A 8.3 PASS 6 0 0 0 2.0 C 9.8 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 9.3 PASS 0 0 0 0 0.0 A INC INC Montgomery 19 0 Northampton 13 0 0 4.3 F 2 0 0 0 0.7 B 8.4 PASS Philadelphia 28 3 0 10.8 F 0 0 0 0 0.0 A 10.1 PASS Somerset Susquehanna 1 0 0 6.3 F 0 0 0 0 0.0 A 6.2 PASS DNC DNC DNC DNC DNC DNC 0 0.3 B DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC Tioga 2 0 0 0.7 B 0 0 0 0 0.0 A 7.7 PASS Washington 5 0 0 1.7 C 0 0 0 0 0.0 A 8.5 PASS Westmoreland 7 0 0 2.3 D 0 0 0 0 0.0 A 8.7 PASS York 6 0 0 2.0 C 0 0 0 0 0.0 A 9.3 PASS 137 Lung.org American Lung Association State of the Air 2020 State Tables RHODE ISLAND American Lung Association in Rhode Island www.Lung.org/rhodeisland AT-RISK GROUPS Lung Diseases County Kent Total Population Under 18 65 & Over 163,861 30,623 30,962 Providence 636,084 130,676 97,217 Washington 126,179 20,842 26,164 Totals 926,124 182,141 154,343 138 Lung.org Pediatric Asthma Adult Asthma COPD 2,407 15,783 9,707 10,272 59,838 33,355 1,638 12,462 7,734 14,318 88,083 50,796 Lung Cancer Heart Disease Ever Smoked Poverty People of Color 113 13,087 57,341 12,620 19,509 439 44,070 210,372 98,431 248,891 87 10,569 45,415 9,507 11,430 640 American Lung Association State of the Air 2020 67,726 313,129 120,558 279,830 State Tables RHODE ISLAND American Lung Association in Rhode Island www.Lung.org/rhodeisland HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Kent 16 0 0 5.3 F 0 0 0 0 0.0 A 5.0 PASS Providence 16 0 0 5.3 F 0 0 0 0 0.0 A 8.8 PASS Washington 12 2 0 5.0 F 0 0 0 0 0.0 A 5.1 PASS 139 Lung.org American Lung Association State of the Air 2020 State Tables SOUTH CAROLINA American Lung Association in South Carolina www.Lung.org/southcarolina AT-RISK GROUPS Lung Diseases County Abbeville Total Population Under 18 65 & Over Pediatric Asthma 24,541 4,924 5,343 Adult Asthma COPD Lung Cancer 352 1,769 1,736 Heart Disease Ever Smoked Poverty People of Color 15 2,238 8,735 4,545 7,624 Aiken 169,401 36,849 32,901 2,637 11,999 11,369 103 14,426 58,536 25,095 57,686 Anderson 200,482 45,852 36,185 3,282 14,036 13,075 121 16,433 68,045 28,843 45,645 Berkeley 221,091 52,749 30,410 3,775 15,382 13,089 135 15,752 72,505 27,687 80,553 Charleston 405,905 79,933 66,621 5,721 29,612 25,751 246 31,548 140,850 55,971 142,289 Cherokee 57,078 13,140 9,598 940 3,999 3,645 35 Chesterfield 45,754 10,032 8,395 718 3,249 3,070 28 3,867 15,796 9,453 18,154 Colleton 37,660 8,390 7,595 600 2,647 2,562 23 3,277 12,998 7,440 16,190 Darlington 66,802 14,817 12,678 1,060 4,713 4,459 40 5,644 22,963 15,356 30,255 Edgefield 27,052 4,894 5,074 Florence 350 2,014 1,866 4,529 19,241 9,394 15,558 17 2,337 9,741 4,489 11,716 138,159 32,590 23,471 2,332 9,591 8,729 83 10,871 46,178 24,375 66,992 Greenville 514,213 118,364 81,136 8,471 36,044 31,886 312 Horry 344,147 61,715 82,431 4,417 25,384 25,499 209 33,265 126,421 48,595 77,287 Lexington 179 22,867 98,995 36,432 75,300 39,169 171,994 55,837 163,199 295,032 68,294 46,581 4,888 20,688 18,574 Oconee 78,374 15,615 18,196 1,118 5,647 5,684 Pickens 124,937 23,712 20,660 1,697 9,181 7,896 Richland 414,576 88,630 52,790 6,343 29,740 23,817 251 190 24,257 105,176 41,706 100,392 Spartanburg 313,888 72,501 50,812 5,189 21,970 19,654 York 274,118 66,495 39,236 4,759 19,001 16,696 Totals 140 3,753,210 819,496 630,113 Lung.org 58,651 266,667 239,056 48 76 7,409 28,123 11,159 12,423 9,657 43,583 19,471 18,028 28,023 138,156 64,210 239,888 166 20,296 90,243 26,453 81,682 2,277 American Lung Association State of the Air 2020 295,868 1,278,280 516,511 1,260,861 State Tables SOUTH CAROLINA American Lung Association in South Carolina www.Lung.org/southcarolina HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Abbeville Wgt. Avg. Grade Orange Red Purple Maroon INC INC INC INC INC Wgt. Avg. Grade Design Value Pass/ Fail DNC DNC DNC DNC DNC DNC DNC DNC Aiken 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Anderson 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Berkeley 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Charleston 1 0 0 0.3 B Cherokee INC INC INC INC INC 1 2 0 0 1.3 C 7.2 PASS DNC DNC DNC DNC DNC DNC DNC DNC Chesterfield 1 0 0 0.3 B Colleton 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Darlington 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Edgefield 1 0 0 0.3 B Florence 1 0 0 0.3 B Horry 0 0 0 0.0 A 3 2 0 0 2.0 C 8.3 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 2 0 0 1.0 C 8.5 PASS Oconee 1 0 0 0.3 B Pickens 1 Richland 5 0 0 1.7 C Spartanburg 3 0 0 1.0 C York 5 141 1 1 0 0 0.8 B 8.2 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC Greenville Lexington 0 0 0 0 0.0 A INC INC 0 0 0 0.3 B 0 1.7 C Lung.org 0 0 0 0 0.0 A INC INC DNC DNC DNC DNC DNC DNC DNC DNC 0 2 0 0 1.0 C 7.8 PASS 0 0 0 0 0.0 A 8.0 PASS INC INC INC INC INC INC American Lung Association State of the Air 2020 INC INC State Tables SOUTH DAKOTA American Lung Association in South Dakota www.Lung.org/southdakota AT-RISK GROUPS Lung Diseases County Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Heart Disease Ever Smoked Poverty People of Color Brookings 35,232 7,223 4,195 517 2,227 985 Brown 39,316 9,416 6,747 674 2,348 1,375 23 2,753 13,167 4,195 5,537 Codington 28,015 6,724 4,949 481 1,669 1,013 17 2,032 9,404 3,115 2,082 Custer 8,726 1,343 2,621 96 568 450 Hughes 17,650 4,251 3,057 304 1,051 632 Jackson 3,307 1,105 442 Meade 28,294 6,463 4,316 79 173 463 1,721 940 192,876 49,051 25,229 3,511 11,371 5,934 Pennington 111,729 25,603 20,087 1,832 6,753 4,072 Totals 142 15,619 3,779 2,832 480,764 114,958 74,475 Lung.org 5 2 192 967 1,070 2,003 17 1,849 9,567 2,309 3,665 114 11,455 62,848 18,035 35,825 66 270 927 574 8,227 28,810 16,073 953 3,335 853 830 10 1,264 5,914 1,590 3,212 97 Minnehaha Union 21 1,873 12,098 3,744 3,614 8,179 38,016 14,567 22,323 9 1,155 5,238 915 1,257 284 American Lung Association State of the Air 2020 31,703 160,553 50,393 80,348 State Tables SOUTH DAKOTA American Lung Association in South Dakota www.Lung.org/southdakota HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Brookings Wgt. Avg. Grade Orange Red Purple Maroon 2 0 0 0.7 B Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0 0.0 A 4.6 PASS Brown DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 6.0 PASS Codington DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 6.8 PASS Custer Hughes 0 0 0 0.0 A Jackson 0 0 0 0.0 A Meade 0 Minnehaha 4 0 0 1.3 C Pennington Union 143 2 1 0 0 1.2 C 3.6 PASS DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 4.0 PASS 0 0 0.0 A 3 0 0 0 1.0 C 3.7 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 5.9 PASS DNC DNC DNC DNC DNC 6 1 0 0 2.5 D 6.8 PASS 2 0 0 0.7 B Lung.org 2 0 0 0 0.7 B 6.2 PASS American Lung Association State of the Air 2020 State Tables TENNESSEE American Lung Association in Tennessee www.Lung.org/tennessee AT-RISK GROUPS Lung Diseases County Anderson Blount Claiborne Davidson Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer Heart Disease Ever Smoked Poverty People of Color 76,482 16,078 15,356 1,566 6,003 6,909 55 131,349 26,559 26,575 2,587 10,429 12,028 95 14,202 48,512 12,816 12,028 31,756 6,060 6,334 692,587 144,027 84,795 590 2,544 2,896 14,027 52,537 52,557 8,161 27,938 12,433 8,366 23 3,399 11,836 7,129 1,496 501 56,480 242,197 102,623 303,675 DeKalb 20,138 4,351 3,699 424 1,571 1,789 15 2,082 7,280 3,435 2,531 Dyer 37,320 8,927 6,566 869 2,806 3,149 27 3,653 13,019 6,735 7,549 Hamilton Jefferson Knox 364,286 75,645 64,030 7,367 28,313 31,175 54,012 10,618 10,818 1,034 4,328 4,995 264 39 35,859 131,428 46,021 105,494 5,881 20,102 7,241 4,307 465,289 97,591 73,661 9,505 35,804 38,307 Lawrence 43,734 10,932 7,794 1,065 3,248 3,676 32 4,287 15,084 7,643 2,822 Loudon 53,054 10,295 14,026 1,003 4,279 5,223 39 6,482 20,171 4,754 6,681 McMinn 53,285 11,306 10,458 1,101 4,177 4,802 39 5,651 19,413 8,307 5,825 Madison 97,605 21,872 16,615 2,130 7,444 8,212 70 9,430 34,515 16,631 43,222 68 8,886 32,888 10,032 19,819 Maury 94,340 22,094 15,014 2,152 7,114 7,808 205,950 54,985 19,005 5,355 14,325 13,727 Putnam 78,843 16,455 13,134 1,603 6,043 6,452 Roane 53,140 9,981 12,108 Montgomery Sevier 97,892 20,173 19,341 337 43,213 165,829 59,817 82,453 150 14,232 65,815 24,251 76,668 57 972 4,337 5,169 1,965 7,742 8,916 71 10,492 35,969 13,466 10,050 Shelby 935,764 232,721 127,099 Sullivan 157,668 30,362 34,529 2,957 12,684 14,830 114 17,731 59,195 25,549 10,570 Sumner 187,149 43,922 29,664 4,278 14,164 15,653 136 17,819 65,383 16,426 30,336 Williamson 231,729 63,088 30,480 6,144 16,798 18,454 168 20,589 76,951 8,794 36,349 Wilson Totals 144 140,625 33,332 22,065 4,303,997 971,374 663,166 Lung.org 22,665 68,612 72,650 7,334 28,094 10,996 9,378 39 6,222 20,223 7,779 3,928 3,246 10,622 11,749 94,604 325,922 351,123 675 80,599 316,259 198,554 602,781 102 13,362 49,002 10,888 21,561 3,116 American Lung Association State of the Air 2020 396,045 1,507,103 622,320 1,407,889 State Tables TENNESSEE American Lung Association in Tennessee www.Lung.org/tennessee HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Anderson 0 Blount 5 0 0 1.7 C Claiborne 1 Davidson 8 1 0 3.2 D DeKalb 0 Dyer 0 Wgt. Avg. Grade Orange Red Purple Maroon 0 0 0 0.0 0 0.3 0 0.0 A B A 5 0 0 1.7 C Jefferson 3 Lawrence Loudon DNC DNC DNC DNC DNC DNC Design Value Pass/ Fail DNC DNC 1 2 0 0 1.3 C 7.8 PASS DNC DNC DNC DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 8.4 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.9 PASS Hamilton Knox Wgt. Avg. Grade 0 0 1.0 C 3 0 0 1.0 C 0 1 0 0 0.5 B 8.3 PASS DNC DNC DNC DNC DNC DNC DNC DNC 2 3 0 0 2.2 D 9.3 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.6 PASS 8 0 0 2.7 D 0 2 0 0 1.0 C 7.4 PASS McMinn DNC DNC DNC DNC DNC 0 1 0 0 0.5 B 8.1 PASS Madison DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.7 PASS Maury DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.9 PASS Montgomery DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.9 PASS Putnam DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.2 PASS Roane DNC DNC DNC DNC DNC 0 1 0 0 0.5 B 7.6 PASS Sevier 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC DNC Shelby 17 1 0 6.2 F Sullivan 3 0 0 1.0 C 1 0 0 0 0.3 B 7.3 PASS Sumner 2 0 0 0.7 B 0 0 0 0 0.0 A 7.4 PASS Williamson 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC Wilson 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC 145 Lung.org 0 0 0 0 0.0 A 8.4 PASS American Lung Association State of the Air 2020 State Tables TEXAS American Lung Association in Texas www.Lung.org/texas AT-RISK GROUPS Lung Diseases County Bell Bexar Bowie Brazoria Brewster Cameron Total Population Under 18 65 & Over Pediatric Asthma 355,642 98,517 38,585 Adult Asthma COPD Lung Cancer 7,796 19,075 14,784 1,986,049 507,669 240,621 People of Color 983 129,620 525,960 334,215 1,442,742 1,772 5,410 4,910 370,200 97,945 43,678 7,751 20,416 16,784 9,267 1,744 2,144 Ever Smoked Poverty 176 21,459 90,216 44,865 196,139 40,173 110,192 88,909 94,324 22,392 15,605 423,908 128,553 57,415 Heart Disease 47 7,256 26,496 16,794 34,759 184 24,485 98,047 36,342 199,319 138 568 574 10,173 22,072 18,937 5 859 2,847 1,475 4,601 209 27,830 106,653 117,193 386,787 497 66,141 268,418 64,180 442,771 Collin 1,005,146 260,476 110,655 20,612 55,957 45,454 Dallas 2,637,772 689,692 283,154 54,576 145,314 114,140 Denton 859,064 211,996 87,414 16,776 48,448 37,934 Ector 162,124 48,856 15,760 3,866 8,401 6,381 81 Ellis 179,436 47,950 22,981 3,794 9,893 8,426 89 12,341 47,889 15,609 71,985 El Paso 840,758 228,000 103,092 Galveston 337,890 81,893 48,605 Gregg Harris Harrison Hidalgo 1,305 165,674 690,633 368,310 1,882,256 425 18,042 45,680 37,224 416 6,480 19,293 16,919 123,707 31,951 19,016 99,047 257,086 201,143 66,726 16,865 11,277 61 2,328 1,335 3,765 3,506 865,939 281,965 96,025 9,232 39,595 20,485 110,649 54,345 218,435 169,120 742,873 167 24,872 93,965 40,109 145,198 2,528 6,889 6,126 4,698,619 1,251,684 494,264 54,957 230,539 62,151 357,924 33 22,312 43,404 34,745 9,034 33,583 18,108 53,082 291,795 1,220,954 767,367 3,331,840 428 5,194 18,563 9,584 24,559 50,647 206,610 256,985 813,576 Hood 60,537 12,905 14,870 1,021 3,624 3,874 30 5,825 18,450 6,108 9,997 Hunt 96,493 23,183 15,282 1,835 5,529 5,001 48 7,381 27,097 12,715 28,005 Jefferson 255,001 61,181 36,809 4,841 14,538 12,545 127 18,429 70,443 44,682 153,437 Johnson 171,361 44,541 24,219 3,525 9,548 8,358 85 12,288 46,465 17,965 49,428 Kaufman 128,622 35,656 15,367 2,822 6,979 5,805 64 Kleberg 31,129 7,540 4,029 597 1,739 1,363 8,480 33,601 14,539 48,638 16 1,986 8,213 7,369 24,948 Lubbock 307,412 73,288 38,200 5,799 17,342 13,670 152 19,906 82,197 52,037 144,425 McLennan 254,607 62,861 36,615 4,974 14,300 12,114 126 17,783 68,872 46,457 112,971 58,485 18,246 6,916 1,444 2,996 2,445 Maverick Montgomery 590,925 155,734 77,263 12,323 32,775 28,127 29 293 Navarro 49,565 13,139 8,429 1,040 2,751 2,582 Nueces 362,265 88,977 52,215 7,041 20,476 17,631 25 3,571 14,321 14,859 56,911 41,232 158,939 54,400 206,109 3,829 13,586 9,739 22,112 179 25,902 99,120 57,694 257,166 Orange 83,572 20,764 13,466 1,643 4,739 4,328 41 Parker 138,371 34,364 21,302 2,719 7,876 7,176 69 10,589 38,720 11,289 23,629 Polk 6,396 23,270 11,101 16,403 50,031 10,088 9,422 798 3,035 2,924 25 4,342 15,111 6,834 14,622 Potter 119,648 32,848 14,922 2,599 6,489 5,377 60 7,862 31,166 22,262 67,678 Randall 136,271 32,501 20,536 2,572 7,765 6,729 67 9,898 37,611 11,343 39,839 Rockwall 100,657 27,150 12,594 2,148 5,543 4,733 50 6,930 26,873 5,125 29,939 Smith 230,221 56,582 38,010 4,477 13,044 11,827 Tarrant 2,084,931 549,063 235,187 43,448 114,981 92,803 Travis 1,248,743 270,726 123,395 21,423 72,560 53,877 Victoria Webb Totals 146 1,030 135,089 549,979 248,032 1,127,499 621 92,035 23,330 14,822 1,846 5,156 4,636 275,910 90,830 26,087 7,187 13,761 10,588 21,943,363 5,753,645 2,550,248 Lung.org 455,293 1,209,410 975,407 114 17,486 63,841 33,744 93,682 45 77,667 340,744 146,724 638,924 6,849 25,181 13,855 51,251 136 15,337 65,071 69,860 266,071 10,864 American Lung Association State of the Air 2020 1,420,798 5,778,268 3,261,625 13,724,744 State Tables TEXAS American Lung Association in Texas www.Lung.org/texas HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Bell Bexar Bowie Brazoria 10 0 Wgt. Avg. Grade Orange Red Purple Maroon 0 3.3 F 19 1 0 6.8 F 13 2 0 5.3 0 0 0 0.0 A Cameron 0 0 0 0.0 A 27 Dallas 23 1 0 8.2 F Ellis 33 0 1 0 9.0 F Collin Ector DNC DNC DNC DNC DNC DNC Design Value Pass/ Fail DNC DNC 1 0 0 0 0.3 B 8.1 PASS DNC DNC DNC DNC DNC 1 0 0 0 0.3 B INC INC Brewster Denton Wgt. Avg. Grade F 0 11.5 F DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC 1 0 0 0 0.3 B 9.9 PASS DNC DNC DNC DNC DNC DNC DNC DNC 3 2 0 0 2.0 C 8.9 PASS DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC 8 0 0 2.7 D 1 0 0 0 0.3 B 8.4 PASS El Paso 28 2 0 10.3 F 1 0 0 0 0.3 B 9.1 PASS Galveston 20 0 1 7.3 F 1 0 0 0 0.3 B 6.6 PASS Gregg Harris 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC 50 10 1 22.3 F 3 0 0 0 1.0 C 10.2 PASS Harrison 0 0 0 0.0 A 1 0 0 0 0.3 B 8.5 PASS Hidalgo 0 0 0 0.0 A 4 0 0 0 1.3 C 10.7 PASS Hood 9 0 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC Hunt 3 1 0 1.5 C DNC DNC DNC DNC DNC DNC DNC DNC Jefferson 12 1 0 4.5 F INC INC INC INC INC INC INC INC Johnson 19 1 0 6.8 F DNC DNC DNC DNC DNC DNC DNC DNC Kaufman 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC Kleberg DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC Lubbock DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC McLennan Maverick Montgomery 1 0 0 0.3 B DNC DNC DNC DNC DNC 21 1 0 7.5 F DNC DNC DNC DNC DNC DNC DNC DNC Navarro 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC Nueces 0 0 0 0.0 A Orange 7 0 0 2.3 D INC INC INC INC INC INC INC INC Parker 6 2 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC Polk Potter Randall Rockwall Smith DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 9.1 PASS 11 0 0 3.7 F DNC DNC DNC DNC DNC DNC DNC DNC 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC DNC 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC Tarrant 34 4 0 13.3 F 0 0 0 0 0.0 A 8.6 PASS Travis 10 0 0 3.3 F 4 0 0 0 1.3 C 9.8 PASS Victoria 2 0 0 0.7 Webb 0 0 0 0.0 A 147 Lung.org B DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC American Lung Association State of the Air 2020 State Tables UTAH American Lung Association in Utah www.Lung.org/utah AT-RISK GROUPS Lung Diseases County Box Elder Cache Carbon Davis Duchesne Garfield Iron Salt Lake Total Population Under 18 65 & Over Pediatric Asthma 54,950 17,430 7,109 127,068 38,511 12,009 20,269 5,227 3,530 351,713 112,970 35,317 Adult Asthma COPD 957 3,530 1,692 2,113 8,181 3,394 32 4,570 21,648 15,830 21,173 5 1,119 3,912 2,853 3,437 90 13,898 60,011 19,798 58,000 369 1,244 587 5 852 3,370 2,335 3,002 65 372 208 1 335 1,036 551 604 52,775 15,317 6,700 1,152,633 312,889 125,157 15,449 4,719 2,187 69,907 22,807 6,403 Uintah 35,438 11,754 3,855 841 3,498 1,606 17,171 78,549 35,187 622,213 207,710 48,050 11,399 38,230 15,362 171,700 44,808 36,844 256,359 72,484 29,897 Lung.org 2,459 12,001 6,463 3,978 17,237 7,912 47,993 194,234 86,599 49,059 211,172 102,660 338,240 4 18 645 2,219 1,016 Washington 2,955,518 874,529 320,641 13 2,310 9,418 7,444 7,456 294 259 1,014 502 1,252 4,409 1,955 Utah 148 People of Color 5,080 1,183 1,175 Tooele Totals Ever Smoked Poverty 14 2,478 9,591 3,986 7,168 287 1,424 731 6,200 22,328 9,983 Heart Disease 19,964 6,720 2,408 San Juan Weber Lung Cancer 747 2,772 3,419 8,706 2,687 11,849 4,744 11,984 9 1,442 5,985 4,031 6,636 159 20,064 100,766 57,136 111,686 44 10,322 33,138 16,435 27,119 65 11,229 46,518 23,839 62,335 753 American Lung Association State of the Air 2020 121,112 521,185 265,061 667,546 State Tables UTAH American Lung Association in Utah www.Lung.org/utah HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Cache 2 0 0 0.7 Carbon 5 0 0 1.7 C Davis 39 1 0 13.5 F Duchesne 19 6 0 9.3 F Garfield INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC Iron INC INC INC INC INC INC INC INC INC INC INC INC INC Salt Lake 74 27 8.8 San Juan F 0 0 0 0.0 A Tooele 27 1 0 9.5 F Uintah 11 11 4 11.8 F Utah 35 Washington Weber 149 2 0 12.7 F 2 0 0 0.7 B 40 1 0 13.8 F Lung.org 0 26 4 0 0 5.8 F PASS 0 25.7 1 7.7 1 B 16 Pass/ Fail 7 0 D Design Value Box Elder 2 2.8 Wgt. Avg. Grade 0 10.7 F DNC DNC DNC DNC DNC DNC 15 0 0 0 5.0 F 7.6 PASS DNC DNC 8.3 PASS 4 0 0 0 1.3 C 6.3 PASS 5 0 0 11.5 F DNC DNC DNC DNC DNC DNC 7 0 0 0 2.3 D PASS DNC DNC 7.0 PASS 0 0 0 0 0.0 A INC INC 22 10 0 0 12.3 F 8.3 PASS 0 0 0 0 0.0 A 5.2 PASS 18 3 0 American Lung Association State of the Air 2020 0 7.5 F 8.3 PASS State Tables VERMONT American Lung Association in Vermont www.Lung.org/vermont AT-RISK GROUPS Lung Diseases County Bennington Chittenden Rutland Totals 150 Total Population Under 18 65 & Over Pediatric Asthma 35,631 6,756 8,162 Adult Asthma COPD Lung Cancer 594 3,459 1,970 Heart Disease Ever Smoked Poverty People of Color 22 2,515 13,048 3,905 2,237 164,572 29,165 24,673 2,565 16,693 7,144 100 8,950 58,135 16,039 19,535 58,672 10,438 12,955 918 5,799 3,220 36 4,097 21,696 5,842 2,844 258,875 46,359 45,790 4,078 25,951 12,335 Lung.org 157 15,562 92,878 25,786 24,616 American Lung Association State of the Air 2020 State Tables VERMONT American Lung Association in Vermont www.Lung.org/vermont HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Bennington 3 0 0 1.0 C 0 0 0 0 0.0 A 5.4 PASS Chittenden 0 0 0 0.0 A 0 0 0 0 0.0 A 5.7 PASS Rutland 0 0 0 0.0 A 0 0 0 0 0.0 A 6.9 PASS 151 Lung.org American Lung Association State of the Air 2020 State Tables 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 Albemarle 108,718 21,528 20,248 1,541 7,402 5,761 Arlington 237,521 42,959 25,209 3,075 16,811 10,477 Caroline Charles City Chesterfield Fairfax Lung Cancer 62 507 2,023 1,573 6,941 1,052 1,708 75 497 450 348,556 82,795 52,028 Ever Smoked Poverty People of Color 7,598 33,294 8,912 25,438 137 12,482 70,137 14,842 92,122 30,772 7,079 5,050 1,150,795 269,162 154,840 Heart Disease 5,926 22,775 17,231 18 2,046 9,070 2,930 11,221 4 617 2,358 851 3,976 200 22,099 101,027 26,093 135,536 19,264 75,830 55,228 663 69,580 331,792 69,377 572,332 Fauquier 70,675 16,513 11,620 1,182 4,632 3,700 41 4,821 20,927 4,260 14,578 Frederick 88,355 20,386 15,264 1,459 5,793 4,610 51 6,050 26,189 6,107 15,357 Giles 16,844 3,486 3,681 249 1,127 971 10 1,320 5,258 2,064 916 Hanover 107,239 23,572 19,032 1,687 7,135 5,786 Henrico 329,261 74,272 51,045 5,316 21,816 16,448 188 21,162 96,753 29,502 155,803 Loudoun 406,850 115,028 37,802 8,232 25,338 17,141 234 20,642 107,899 14,700 181,773 Madison Prince Edward Prince William 13,295 2,706 2,959 22,950 3,767 3,779 194 894 783 270 1,635 1,148 468,011 127,210 46,319 9,104 29,535 19,997 Roanoke 94,073 18,648 20,151 1,335 6,372 5,386 Rockbridge 22,752 3,985 5,909 Rockingham Stafford Wythe Bristol City Hampton City Lynchburg City 62 28,754 5,672 6,213 16,482 3,323 3,476 8 1,067 4,192 1,330 2,060 13 1,467 7,110 3,782 8,956 270 24,216 125,932 29,545 271,371 54 285 1,571 1,431 81,244 17,785 15,472 1,273 5,384 4,367 149,960 39,088 15,674 2,798 9,603 6,614 47 5,811 24,549 6,909 9,513 8,062 41,164 7,822 59,400 17 2,270 9,087 4,391 1,841 238 1,111 927 2,010 9,084 6,645 7,282 29,518 6,145 13,644 13 1,991 7,502 2,670 1,850 87 406 1,951 1,677 134,313 28,086 20,745 7,612 32,443 5,509 17,456 9 1,250 5,126 3,324 2,002 77 8,504 39,923 19,954 83,471 47 4,677 24,116 14,789 30,887 82,126 15,946 11,823 1,141 5,651 3,731 Norfolk City 244,076 47,785 27,334 3,420 16,914 10,590 142 12,740 70,764 41,471 138,496 Richmond City 228,783 40,064 30,172 2,867 16,219 10,813 131 13,347 69,163 48,424 133,599 Salem City 25,643 5,115 4,836 Suffolk City 91,185 22,132 13,164 Virginia Beach City Totals 152 450,189 99,573 64,004 5,056,363 1,158,717 689,557 Lung.org 366 1,743 1,382 1,584 5,924 4,454 7,126 30,059 21,541 82,929 334,827 240,861 15 1,828 7,886 2,280 3,845 52 259 2,908 American Lung Association State of the Air 2020 5,689 26,212 9,846 46,396 27,256 131,107 33,084 174,180 303,486 1,460,496 420,913 2,208,019 State Tables VIRGINIA American Lung Association in Virginia www.Lung.org/virginia HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Albemarle 1 0 0 0.3 B Arlington 12 0 0 4.0 F 0 0 0 0 0.0 A 6.5 PASS 1 0 0 0 0.3 B 7.5 PASS Charles City 2 0 0 0.7 B 0 0 0 0 0.0 A 6.6 PASS Chesterfield 1 0 0 0.3 B 0 0 0 0 0.0 A INC INC Fairfax 7 0 0 2.3 D 1 0 0 0 0.3 B 6.8 PASS Fauquier 0 Frederick 0 0 0 0.0 A Giles 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC Hanover 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC Henrico 4 1 0 1.8 C 0 0 0 0 0.0 A 7.1 PASS Loudoun 1 0 0 0.3 B 0 0 0 0 0.0 A 7.1 PASS Madison 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Prince Edward 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Prince William 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC Roanoke 0 0 0 0.0 A Rockbridge 0 Rockingham 1 0 0 0.3 B Stafford 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Bristol City Hampton City 0 0 0.0 0 0.0 B Pass/ Fail 1 0 0 0.3 Design Value Caroline Wythe 0 Wgt. Avg. Grade A A DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.4 PASS 0 0 0 0 0.0 A 6.7 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.0 PASS DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 7.3 PASS 2 0 0 0.7 B 0 0 0 0 0.0 A 6.2 PASS Lynchburg City DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.5 PASS Norfolk City DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.7 PASS Richmond City DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC Salem City DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.2 PASS Suffolk City Virginia Beach City 153 2 DNC 0 DNC 0 0.7 DNC Lung.org DNC B DNC DNC DNC DNC DNC DNC DNC 0 0 0 American Lung Association State of the Air 2020 0 0.0 A DNC DNC 6.7 PASS State Tables WASHINGTON American Lung Association in Washington www.Lung.org/washington AT-RISK GROUPS Lung Diseases County Benton Total Population Under 18 65 & Over Pediatric Asthma Adult Asthma COPD Lung Cancer 201,877 54,000 30,097 3,947 14,191 7,540 Chelan 77,036 18,022 14,696 1,317 5,705 3,281 41 Clallam 76,737 13,055 22,720 954 6,220 4,140 41 Clark King Kitsap 481,857 115,356 74,530 8,432 35,315 19,006 2,233,163 452,859 295,110 33,103 169,665 83,663 269,805 55,252 48,094 Heart Disease Ever Smoked Poverty People of Color 109 11,647 56,098 19,597 61,006 259 5,208 22,956 8,283 25,025 6,931 25,971 9,968 13,411 29,262 139,895 41,980 106,021 1,202 125,808 660,298 202,628 918,713 4,039 20,627 11,319 145 17,733 82,143 23,613 64,009 Kittitas 47,364 8,096 7,592 592 3,720 1,867 25 2,890 14,557 7,049 7,694 Okanogan 42,132 9,769 9,094 714 3,150 1,916 23 3,087 12,841 7,049 14,878 Pierce 891,299 209,270 123,135 Skagit 128,206 27,977 26,591 15,297 65,285 33,364 Snohomish 814,901 184,547 109,768 13,490 60,643 31,252 439 47,028 237,856 60,590 253,858 Spokane 514,631 114,051 83,279 8,337 38,439 20,536 277 31,830 152,153 65,365 80,882 2,045 9,695 5,695 479 69 9,131 39,219 12,239 33,368 Stevens 45,260 9,761 10,542 714 3,486 2,207 Thurston 286,419 61,378 49,514 4,487 21,625 11,787 154 18,417 85,986 24,459 72,841 Whatcom 225,685 43,910 39,158 3,210 17,350 9,201 121 14,405 68,644 32,753 48,048 Yakima Totals 154 251,446 74,480 34,524 6,587,818 1,451,783 978,444 Lung.org 5,444 16,911 8,764 106,123 492,026 255,539 24 50,668 255,881 76,391 300,347 3,565 14,335 6,045 6,148 135 13,490 66,527 40,961 144,155 3,544 American Lung Association State of the Air 2020 391,100 1,935,360 638,970 2,150,404 State Tables WASHINGTON American Lung Association in Washington www.Lung.org/washington HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Benton Chelan Clallam Clark King 16 0 Wgt. Avg. Grade Orange Red Purple Maroon 0 5.3 F DNC DNC DNC DNC DNC 0 0 0 0.0 A 4 0 0 1.3 C 12 6 0 7.0 F Wgt. Avg. Grade DNC DNC DNC DNC DNC DNC Design Value Pass/ Fail DNC DNC INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC 9 3 0 0 4.5 F 7.5 PASS 11 7 0 0 7.2 F 8.4 PASS Kitsap DNC DNC DNC DNC DNC 6 3 0 0 3.5 F 4.6 PASS Kittitas DNC DNC DNC DNC DNC 17 6 2 0 10.0 F 8.1 PASS Okanogan DNC DNC DNC DNC DNC 7 22 1 1 14.8 F INC INC Pierce 4 0 0 1.3 C 9 9 0 0 7.5 F 7.7 PASS Skagit 0 0 0 0.0 A 3 3 0 0 2.5 D 5.8 PASS Snohomish Spokane Stevens DNC DNC DNC DNC DNC 5 0 0 1.7 C DNC DNC DNC DNC DNC Thurston 2 Whatcom 2 0 0 0.7 B Yakima 155 1 0 1.2 C DNC DNC DNC DNC DNC Lung.org 21 7 0 0 13 7 4 0 10.5 F 10.5 F 7.4 PASS 9.6 PASS INC INC INC INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC 6 3 0 0 3.5 F 5.1 PASS 25 15 3 American Lung Association State of the Air 2020 0 17.8 F 9.8 PASS State Tables WEST VIRGINIA American Lung Association in West Virginia www.Lung.org/westvirginia AT-RISK GROUPS Lung Diseases County Berkeley Total Population Under 18 65 & Over Pediatric Asthma 117,123 27,230 17,175 Brooke 22,203 3,930 5,290 Cabell 93,224 18,395 17,542 Gilmer 8,026 1,150 1,405 Adult Asthma COPD Lung Cancer 2,564 11,106 13,146 370 2,254 2,944 1,732 9,088 10,935 Heart Disease Ever Smoked Poverty People of Color 90 12,598 44,556 13,275 18,798 17 3,065 9,087 2,930 960 71 10,978 36,949 17,242 9,240 108 832 963 6 942 3,388 1,521 1,521 Greenbrier 34,786 6,747 8,099 635 3,462 4,526 27 4,707 13,947 5,389 2,629 Hancock 29,094 5,507 6,722 518 2,928 3,844 22 3,977 11,751 3,788 1,887 Harrison 67,554 14,434 13,140 1,359 6,564 8,245 Kanawha 180,454 36,012 37,272 3,390 17,804 22,511 Marion 56,097 11,260 10,963 1,060 5,486 6,757 Marshall 30,785 5,950 6,886 Monongalia Ohio Tucker Wood Totals 156 106,420 17,326 13,448 560 3,077 3,999 1,631 10,630 11,212 52 8,303 26,388 11,089 3,999 138 22,891 71,723 30,248 22,283 43 6,819 22,200 9,084 3,920 24 4,117 12,362 4,200 1,036 82 10,415 43,605 18,156 12,690 41,755 7,937 9,105 747 4,149 5,265 32 5,413 16,774 4,953 3,266 6,955 1,077 1,821 101 729 978 5 1,030 2,930 907 192 84,203 17,621 17,209 878,679 174,576 166,077 Lung.org 1,659 8,236 10,477 16,436 86,344 105,803 64 10,640 33,099 12,449 4,141 672 105,894 348,757 135,231 86,562 American Lung Association State of the Air 2020 State Tables WEST VIRGINIA American Lung Association in West Virginia www.Lung.org/westvirginia HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Berkeley Brooke Wgt. Avg. Grade Orange Red Purple Maroon 1 0 0 0.3 B Wgt. Avg. Grade Design Value Pass/ Fail 0 0 0 0 0.0 A 8.4 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.9 PASS Cabell 3 0 0 1.0 C Gilmer 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC Greenbrier 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC Hancock 1 0 0 0.3 B Harrison Kanawha 0 0 0 0 0.0 A 7.9 PASS 0 0 0 0 0.0 A 8.1 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.4 PASS 4 0 0 1.3 C 0 0 0 0 0.0 A 8.0 PASS Marion DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC Marshall DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 9.1 PASS Monongalia 0 0 0 0.0 A 0 0 0 0 0.0 A 7.2 PASS Ohio 4 0 0 1.3 C 0 0 0 0 0.0 A 7.9 PASS Tucker 1 Wood 1 0 0 0.3 B 157 0 0 0.3 Lung.org B DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.9 PASS American Lung Association State of the Air 2020 State Tables WISCONSIN American Lung Association in Wisconsin www.Lung.org/wisconsin AT-RISK GROUPS Lung Diseases County Ashland Brown Columbia Dane Total Population Under 18 65 & Over Pediatric Asthma 15,600 3,409 3,055 Adult Asthma COPD 288 1,106 688 263,378 62,704 39,133 5,291 18,474 10,344 57,358 12,182 10,250 1,028 4,125 2,509 542,364 110,624 74,433 Dodge 87,847 17,436 15,497 Door 27,610 4,489 8,215 Lung Cancer Heart Disease Ever Smoked Poverty People of Color 9 1,008 5,289 2,356 2,770 155 14,360 85,354 21,944 50,989 34 9,334 39,978 20,486 3,570 19,536 4,255 4,325 320 1,471 6,440 3,857 28,078 180,405 57,062 112,124 52 379 2,040 1,508 5,459 30,355 7,283 9,064 16 2,383 10,381 2,289 1,729 Eau Claire 104,534 21,327 16,374 1,800 7,656 4,078 62 5,768 34,984 12,906 10,793 Fond du Lac 103,066 22,030 19,083 1,859 7,382 4,488 61 6,473 35,010 9,513 11,054 Forest 8,991 1,751 2,064 148 651 435 Grant 51,554 10,762 8,895 908 3,733 2,096 Jefferson 85,129 17,958 14,436 1,515 6,152 3,632 50 5,123 28,874 6,701 8,972 Kenosha 169,290 38,674 23,925 3,263 12,062 6,735 100 9,173 55,586 19,819 41,338 Kewaunee 20,383 4,385 4,168 370 1,448 930 5 652 3,186 1,294 1,912 31 3,020 17,323 6,595 2,645 12 1,366 6,989 1,472 1,176 La Crosse 118,230 23,386 19,399 1,973 8,710 4,767 70 6,773 40,093 12,334 12,189 Manitowoc 79,074 16,260 16,193 1,372 5,689 3,654 47 5,346 27,450 8,124 7,699 Marathon 135,428 30,846 23,980 Milwaukee 948,201 227,422 129,003 Outagamie 187,365 44,129 27,589 3,724 13,195 7,426 89,147 18,995 17,603 1,603 6,365 4,025 Racine 196,584 45,351 32,460 3,827 13,852 8,200 Rock 163,129 37,701 27,022 3,181 11,486 6,747 96 9,539 53,847 17,477 28,620 Sauk 64,249 14,644 11,900 1,236 4,514 2,766 38 4,005 21,463 5,416 5,915 115,456 25,431 20,789 2,146 8,211 4,980 68 7,138 38,889 8,432 18,681 Ozaukee Sheboygan Taylor Vilas 20,412 4,776 3,905 21,938 3,711 6,758 2,603 9,542 5,763 53 5,862 30,559 3,674 7,944 116 11,550 65,051 24,084 55,689 13 1,949 8,256 2,359 3,337 Waukesha 403,072 86,695 75,190 7,315 28,805 17,877 Lung.org 111 10,252 61,012 13,196 23,793 313 1,602 1,230 1,806 7,523 4,444 158 8,252 45,138 10,027 15,552 48,385 303,032 177,263 464,911 12 1,312 6,826 2,072 929 103,718 21,406 18,334 4,183,107 928,484 669,653 558 403 1,419 905 Walworth Totals 80 19,190 66,630 35,206 78,344 298,787 169,775 61 6,344 35,358 10,114 15,220 238 25,691 137,354 19,937 47,618 2,467 American Lung Association State of the Air 2020 238,831 1,387,600 467,998 966,988 State Tables WISCONSIN American Lung Association in Wisconsin www.Lung.org/wisconsin HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Ashland 0 0 0 0.0 A Brown 4 0 0 1.3 C Columbia 4 Dane 1 0 0 0.3 B 1 0 0 0 0.3 B 8.1 PASS Dodge 5 0 0 1.7 C 2 0 0 0 0.7 B 6.8 PASS Door 15 0 0 0 1.3 C 0 5.0 F Eau Claire 1 0 0 0.3 B Fond du Lac 4 Forest Grant Jefferson 0 0 1.3 C 0 0 0 0.0 A 6 0 0 2.0 C 34 5 0 13.8 F Kewaunee 11 Manitowoc Marathon Milwaukee Outagamie 0 0 0 0 0.0 A 6.4 PASS DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.8 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 4.2 PASS DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.3 PASS Kenosha La Crosse 0 0 0 0 0.0 A 4.2 PASS 1 0 4.2 F 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.1 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.8 PASS 16 2 0 6.3 F DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC 15 2 0 6.0 F 0 0 0 0 0.0 A 8.0 PASS 3 0 0 1.0 C 0 0 0 0 0.0 A 6.3 PASS Ozaukee 21 3 0 8.5 F 0 0 0 0 0.0 A 6.3 PASS Racine 28 3 0 10.8 F DNC DNC DNC DNC DNC DNC DNC DNC Rock 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC DNC Sauk 2 0 0 0.7 B Sheboygan Taylor 32 4 0 12.7 F 0 0 0 0.0 A Vilas 0 0 0 0.0 A Walworth 7 Waukesha 3 0 0 1.0 C 159 0 0 2.3 Lung.org D 0 0 0 0 0.0 A 6.5 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 5.5 PASS 0 0 0 0 0.0 A 4.5 PASS DNC DNC DNC DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.3 PASS American Lung Association State of the Air 2020 State Tables 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 Heart Disease Ever Smoked Poverty People of Color Albany 38,601 6,287 4,530 540 2,795 1,629 17 2,041 14,217 7,451 6,920 Big Horn 11,881 3,003 2,495 258 773 650 Campbell 46,140 12,611 4,642 1,083 2,912 1,944 Carbon 14,971 3,419 2,563 294 1,005 766 Converse 13,640 3,354 2,267 288 895 699 Fremont 39,531 10,104 7,222 868 2,561 2,041 Goshen 13,376 2,685 2,934 231 931 769 6 997 4,878 1,567 1,952 Johnson 8,460 1,854 2,004 159 576 506 4 659 3,038 859 737 5 843 4,060 1,519 1,463 21 2,333 14,942 4,200 5,814 7 6 18 969 5,222 1,894 3,412 876 4,662 1,287 1,571 2,605 13,369 6,070 12,039 Laramie 98,976 23,032 15,864 1,979 6,600 4,891 45 6,161 34,216 8,839 21,278 Natrona 79,115 19,040 12,180 1,636 5,222 3,850 36 4,826 27,052 7,677 10,602 Park 29,324 6,039 6,805 519 2,028 1,733 13 2,256 10,669 2,921 2,664 Sheridan 30,233 6,462 6,347 555 2,069 1,704 14 2,196 10,842 2,551 2,575 9,813 2,209 1,911 190 662 540 Sweetwater 43,051 11,290 5,214 970 2,759 1,909 19 2,338 14,206 3,540 8,906 Teton 23,081 4,239 3,558 364 1,637 1,177 10 1,464 8,461 1,443 4,269 Uinta 20,299 5,844 2,858 502 1,257 933 9 1,161 6,514 2,010 2,558 6,967 1,447 1,429 124 481 401 3 Sublette Weston Totals 160 527,459 122,919 84,823 10,561 35,162 26,143 Lung.org 4 688 3,464 658 1,077 511 2,522 777 700 238 32,923 182,333 55,263 88,537 American Lung Association State of the Air 2020 State Tables WYOMING American Lung Association in Wyoming www.Lung.org/wyoming HIGH OZONE DAYS 2016–2018 HIGH PARTICLE POLLUTION DAYS 2016–2018 24-Hour Annual County Orange Red Purple Wgt. Avg. Grade Orange Red Purple Maroon Wgt. Avg. Grade Design Value Pass/ Fail Albany 4 0 0 1.3 C Big Horn 0 Campbell 2 0 0 0.7 B Carbon 0 Converse 0 0 0 0.0 A 1 0 0 0 0.3 B INC INC Fremont 0 0 0 0.0 A 2 0 0 0 0.7 B 7.2 PASS 0 0 0 0.0 A 0 0.0 A 0 1 0 0 0.5 B 4.6 PASS DNC DNC DNC DNC DNC DNC DNC DNC 3 3 0 0 2.5 D 4.5 PASS INC INC INC INC INC INC INC INC Goshen INC INC INC INC INC INC INC INC INC INC INC INC INC Johnson INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC Laramie 1 0 0 0.3 B 1 2 0 0 1.3 C 4.4 PASS Natrona 0 0 0 0.0 A 2 0 0 0 0.7 B 5.0 PASS Park INC INC INC INC INC 2 0 0 0 0.7 B 4.3 PASS Sheridan INC INC INC INC INC 4 1 0 0 1.8 C 7.2 PASS Sublette 7 0 0 2.3 D 2 0 0 0 0.7 B 5.3 PASS Sweetwater 2 0 0 0.7 B 0 0 0 0 0.0 A 5.3 PASS Teton 0 0 0 0.0 A 2 0 0 0 0.7 B 4.8 PASS Uinta 1 0 0 0.3 Weston 1 0 0 0.3 B 161 Lung.org B DNC DNC DNC DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC American Lung Association State of the Air 2020 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 education, advocacy and research. The work of the American Lung Association is focused on four strategic imperatives: to defeat lung cancer; to champion clean air for all; to improve the quality of life for those with lung disease and their families; and to create a tobacco-free future. For more information about the American Lung Association, a holder of the coveted 4-star rating from Charity Navigator and a Gold-Level GuideStar Member, or to support the work it does, call 1-800-LUNGUSA (1-800-586-4872) or visit: Lung.org. 162 Lung.org American Lung Association State of the Air 2020