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Health effects of wildfire smoke in children and public health tools: a narrative review

Journal of Exposure Science & Environmental Epidemiology volume 31, pages 1–20 (2021)Cite this article

Abstract

Wildfire smoke is an increasing environmental health threat to which children are particularly vulnerable, for both physiologic and behavioral reasons. To address the need for improved public health messaging this review summarizes current knowledge and knowledge gaps in the health effects of wildfire smoke in children, as well as tools for public health response aimed at children, including consideration of low-cost sensor data, respirators, and exposures in school environments. There is an established literature of health effects in children from components of ambient air pollution, which are also present in wildfire smoke, and an emerging literature on the effects of wildfire smoke, particularly for respiratory outcomes. Low-cost particulate sensors demonstrate the spatial variability of pollution, including wildfire smoke, where children live and play. Surgical masks and respirators can provide limited protection for children during wildfire events, with expected decreases of roughly 20%  and 80% for surgical masks and N95 respirators, respectively. Schools should improve filtration to reduce exposure of our nation’s children to smoke during wildfire events. The evidence base described may help clinical and public health authorities provide accurate information to families to improve their decision making.

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Fig. 1: How Particles Reach the Wearer of N95 Respirators and Surgical Masks.

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Acknowledgements

This review article was supported by the cooperative agreement award number 1 NU61TS000296-01-00 from the Agency for Toxic Substances and Disease Registry (ATSDR). Its contents are the responsibility of the authors and do not necessarily represent the official views of the Agency for Toxic Substances and Disease Registry (ATSDR). The US Environmental Protection Agency (EPA) supports the PEHSU by providing partial funding to ATSDR under Inter-Agency Agreement number DW-75-95877701. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications. The views expressed by the authors are their own and do not necessarily represent those of the Office of Environmental Health Hazard Assessment, the California Environmental Protection Agency, or the State of California. The authors would like to thank Martha Berger, Susan Stone, and Alison Clune at the US EPA for their tireless championing of this topic generally and this review paper specifically. The authors would also like to heartily thank the following individuals who took time from their busy schedules to share unpublished information about ongoing projects or analyses: Charles Pearson at the California Air Resources Board; Daniel Johnson at Oregon Department of Environmental Quality; Michael Ogletree at the Denver Department of Health and Environment; Nikki McCullough and Geoff Betsinger of 3 M and Julie Fox, Nancy Bernard and Orly Stampfer of the Washington Department of Health. Finally, the authors would also like to thank the following individuals for their assistance in locating key references and resources: Nnenna Okoye of the UCSF Occupational and Environmental Medicine Residency, W. Rengie Chan of the Indoor Environment Group at Lawrence Berkeley National Laboratory; and Maryann D’Alessandro, Lewis Radonovich and Jonathon Szalajda of NIOSH.

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Authors and Affiliations

  1. Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco, CA, USA

    Stephanie M. Holm, Mark D. Miller & John R. Balmes

  2. Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA, USA

    Stephanie M. Holm, Mark D. Miller & John R. Balmes

  3. Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA

    Stephanie M. Holm

  4. Children’s Environmental Health Center, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA

    Stephanie M. Holm & Mark D. Miller

  5. Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA

    John R. Balmes

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Correspondence to Stephanie M. Holm.

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Holm, S.M., Miller, M.D. & Balmes, J.R. Health effects of wildfire smoke in children and public health tools: a narrative review. J Expo Sci Environ Epidemiol 31, 1–20 (2021). https://doi.org/10.1038/s41370-020-00267-4

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