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Background: Pacific Northwest wildfire smoke events have been increasing in prevalence and severity over the past three decades, resulting in documented negative health outcomes in adults. However, there is less evidence demonstrating the effect of wildfire smoke in pediatric populations. Objectives: To evaluate the association between wildfire smoke exposure and healthcare utilization in a pediatric tertiary medical center in Seattle, WA. Methods: We utilized a case-crossover study to determine the odds of pediatric emergency department visit/ hospital admission at Seattle Children’s Hospital on wildfire smoke days versus non-wildfire smoke days during wildfire season (June to September), 2006 to 2020. Our modeling approach used a conditional logistic regression to adjust for temperature and humidity (Humidex). We stratified analyses by individual-level characteristics and examined associations for lagged exposures 0-7 days prior to admission. Results: In adjusted analyses, smoke exposure was associated with a 7.0% (95% CI: 3.0% - 12.0%) increase in odds of all-cause inpatient/observational hospital admissions and a 0.0% (95% CI: -3.0%, 3.0%) change in odds of all-cause ED visits. We also observed increases in the odds of all-cause inpatient/observational hospital admissions ranging from 4.0% - 8.0%, for lagged exposure on days 1 – 7. When stratified by health outcomes, we found a 9.0% (95% CI: 1.0% - 17.0%) and an 11.0% (95% CI:1.0% - 21.0%) increase in the odds of ED visits for respiratory and respiratory infection-related concerns, respectively. Discussion: Our results demonstrate associations between wildfire smoke and negative health effects in children. Similar to other studies, we found that wildfire smoke exposure was associated with an increase in respiratory-related ED visits and all-cause hospital admissions in a pediatric population. These results will help inform patient education and motivate interventions to reduce pediatric morbidity during wildfire season.

Heat is a dangerous hazard that causes acute heat illness, chronic disease exacerbations, adverse pregnancy outcomes, and a range of injuries. Risks are highest during extreme heat events (EHEs), which challenge the capacity of health systems and other critical infrastructure. EHEs are becoming more frequent and severe, and climate change is driving an increasing proportion of heat-related mortality, necessitating more investment in health protection. Climate-resilient health systems are better positioned for EHEs, and EHE preparedness is a form of disaster risk reduction. Preparedness activities commonly take the form of heat action plans (HAPs), with many examples at various administrative scales. HAP activities can be divided into primary prevention, most important in the pre-event phase; secondary prevention, key to risk reduction early in an EHE; and tertiary prevention, important later in the event phase. After-action reports and other postevent evaluation activities are central to adaptive management of this climate-sensitive hazard. Expected final online publication date for the

Wildfires are increasing in prevalence in western North America due to changing climate conditions. A growing number of studies examine the impact of wildfire smoke on morbidity; however, few evaluate these impacts using syndromic surveillance data that cover many emergency departments (EDs). We used syndromic surveillance data to explore the effect of wildfire smoke exposure on all-cause respiratory and cardiovascular ED visits in Washington state. Using a time-stratified case crossover design, we observed an increased odds of asthma visits immediately after and in all five days following initial exposure (lag 0 OR: 1.13; 95% CI: 1.10, 1.17; lag 1–5 ORs all 1.05 or greater with a lower CI of 1.02 or higher), and an increased odds of respiratory visits in all five days following initial exposure (lag 1 OR: 1.02; 95% CI: 1.00, 1.03; lag 2–5 ORs and lower CIs were all at least as large) comparing wildfire smoke to non-wildfire smoke days. We observed mixed results for cardiovascular visits, with evidence of increased odds emerging only several days following initial exposure. We also found increased odds across all visit categories for a 10 μg m−3 increase in smoke-impacted PM2.5. In stratified analyses, we observed elevated odds for respiratory visits among ages 19–64, for asthma visits among ages 5–64, and mixed risk estimates for cardiovascular visits by age group. This study provides evidence of an increased risk of respiratory ED visits immediately following initial wildfire smoke exposure, and increased risk of cardiovascular ED visits several days following initial exposure. These increased risks are seen particularly among children and younger to middle-aged adults.

Driven by climate change, wildfires are increasing in frequency, duration, and intensity across the Western United States. Outdoor workers are being exposed to increasing wildfire-related particulate matter and smoke. Recognizing this emerging risk, Washington adopted an emergency rule and is presently engaged in creating a permanent rule to protect outdoor workers from wildfire smoke exposure. While there are growing bodies of literature on the exposure to and health effects of wildfire smoke in the general public and wildland firefighters, there is a gap in knowledge about wildfire smoke exposure among outdoor workers generally, and construction workers specifically, a large category of outdoor workers in Washington totaling 200,000 people. In this study, several data sources were linked including state-collected employment data and national ambient air quality data to gain insight into the risk of PM2.5 exposure among construction workers and evaluate the impacts of different air quality thresholds that would have triggered a new Washington emergency wildfire smoke rule aimed at protecting workers from high PM2.5 exposure. Results indicate the number of poor air quality days has increased in August and September in recent years. Over the last decade these months with the greatest potential for particulate matter exposure coincided with an annual peak in construction employment that was typically 9.4 to 42.7% larger across Washington counties (one county was 75.8%). Lastly, the “encouraged” threshold of the Washington emergency rule (20.5 μg/m3) would have resulted in 5.5 times more days subject to the wildfire rule on average across all Washington counties compared to its “required” threshold (55.5 μg/m3), and in 2020 the rule could have created demand for 1.35 million N-95 filtering facepiece respirators among construction workers. These results have important implications for both employers and policy makers as rules are developed. The potential policy implications of wildfire smoke exposure, exposure control strategies, and data gaps that would improve understanding of construction worker exposure to wildfire smoke are also discussed.

Extreme heat is one of the most important pathways illustrating the connection between climate and human health, and climate change is expected to exacerbate this public health issue. This study first used a case-crossover analysis to characterize the historical (1980–2018) association between summertime heat and non-traumatic mortality in Washington State. A separate analysis was conducted for each of the state’s ten climate divisions to produce distinct exposure–response curves expressing odds of mortality as a function of humidex. Stratified analyses were used to assess the impact of age, sex, race/ethnicity, and select causes of death, and the reported results are pooled across all divisions using meta-analysis. The historical heat–mortality relationship was combined with climate projections to estimate the impact of climate change on heat-related deaths in 2030, 2050, and 2080 under two warming scenarios. The odds ratio (OR) and 95% confidence intervals of mortality at the 99th percentile of humidex compared to the 50th percentile did not include the null value in four climate divisions (E Olympic Cascade Foothills, NE Olympic San Juan, Northeastern, and Puget Sound Lowlands). The statewide odds of mortality are 8% higher (6%, 10%) on 99th percentile days compared to 50th percentile days, driven primarily by an OR of 1.09 (1.06, 1.11) in the Puget Sound Lowlands. Risk is higher for women than men and for Blacks than Whites. Risk increases with age and for diabetic, circulatory, cardiovascular, ischemic, cerebrovascular, and respiratory deaths. The 95% confidence intervals of projected heat-attributable mortality did not overlap with zero in three climate divisions (E Olympic Cascade Foothills, NE Olympic San Juan, and Puget Sound Lowlands). In these three divisions, the average percent increase in heat-attributable mortality across both warming scenarios is 35%, 35%, and 603% in 2030, 2050, and 2080, respectively. This research is the most extensive study of heat-related mortality in Washington to date and can help inform public health initiatives aiming to improve present and future health outcomes in the state.

In response to wildfire-related air quality issues as well as those associated with winter wood stove use and prescribed and agricultural burning, Clean Air Methow&rsquo, s Clean Air Ambassador program established a community air monitoring network (CAMN) to provide geospatially specific air quality information and supplement data generated by the two Washington State Department of Ecology nephelometers situated in the area. Clean Air Ambassadors (CAAs) were purposefully selected to host low-cost air sensors based on their geographic location and interest in air quality. All 18 CAAs were interviewed to understand their motivations for participation, experiences using the data, challenges encountered, and recommendations for future project directions. Interview transcripts were coded, and a qualitative analysis approach was used to identify the key themes in each domain. The reported motivations for participation as a CAA included reducing personal exposure, protecting sensitive populations, interest in air quality or environmental science, and providing community benefits. CAAs used CAMN data to understand air quality conditions, minimize personal or familial exposure, and engage other community members in air quality discussions. Opportunities for future project directions included use for monitoring other seasonal air quality issues, informing or reducing other pollution-generating activities, school and community educational activities, opportunities for use by and engagement of different stakeholder groups, and mobile-friendly access to CAMN information. Limited challenges associated with participation were reported. Additional research is necessary to understand the community-level impacts of the CAMN. The findings may be informative for other rural wildfire smoke-prone communities establishing similar CAMNs.

CONTEXT Wildfire events are increasing in prevalence and intensity in the Pacific Northwest. Effective communication of health risks and actions to reduce exposure to wildfire smoke is imperative. OBJECTIVE We assessed the content of wildfire smoke risk messages from government organizations and mainstream media during a major wildfire smoke event in August 2018. DESIGN We conducted a content analysis of wildfire smoke risk information communicated by local and state government organizations and the mainstream media. SETTING Eight Washington State counties during a statewide wildfire smoke event in August 2018. MAIN OUTCOME MEASURE Leveraging the Extended Parallel Process Model and information in the existing literature on wildfire smoke and health, we assessed messages for the presence of information regarding health risk, personal interventions, administrative interventions, vulnerable populations, and trusted sources of information. Summary statistics were calculated to identify common messages about recommended interventions, vulnerable populations cited, and trusted sources of public health information. RESULTS Of the 273 identified government and media messages on wildfire smoke, the majority (71% and 66%) contained information about health risks. However, only 46% and 33% of government and media messages contained information about personal interventions to reduce risk, and 37% and 14% of government and media messages contained information about administrative interventions to reduce risk. Less than half of government and media messages (28% and 31%) contained information specific to vulnerable populations, and 58% and 46% of government and media messages contained any reference to a trusted source of information. CONCLUSIONS While information about wildfire smoke and health risks was communicated during Washington's August 2018 wildfire smoke event, there remains considerable opportunity to include additional information about interventions, vulnerable populations, and trusted sources of information. We recommend several opportunities to improve and evaluate risk communication and risk reduction before, during, and after future wildfire smoke events.

Introduction Climate change is leading to increasingly severe wildfires across the United States. Over the past several years, these events have led to extreme, persistent smoke events in several urban areas across the western U.S. However, the health impacts of smoke events on urban communities are not well understood. Impacts to physical activity, including active transportation, may be a useful proxy to understand physical and mental health effects of these events. We aimed to examine the impact of wildfire smoke events, determined by fine particulate matter concentrations and administrative reporting, on physical activity, measured by pedestrian and bicycle counts at eight city counters in Seattle, WA, USA. Methods We assessed for differences in daily average bicycle and pedestrian counts between pre-, during- and post-wildfire smoke periods for two wildfire smoke events in Seattle in the summers of 2017 and 2018. Results The 2018 wildfire smoke event significantly decreased daily average bicycle counts by 14.6–36.0% across the 8 counters, and 31.7%–45.2% across the two pedestrian counters. There were no significant changes in use during the 2017 event, with the exception of a significant decrease in counts at one pedestrian counter. Conclusions Urban physical activity and active transportation may be significantly impacted by future wildfire smoke events, with cascading public health consequences. Differences in impacts across the 2017 and 2018 events may be related to increased intensity of smoke, and/or to enhanced public health messaging by state and local agencies. Additional research is needed to better understand the impact of wildfire smoke on physical activity in urban communities, and to assess and inform public health risk communication campaigns to change behavior during these events.

Background Wildfire events are increasing in prevalence in the western United States. Research has found mixed results on the degree to which exposure to wildfire smoke is associated with an increased risk of mortality. Methods We tested for an association between exposure to wildfire smoke and non-traumatic mortality in Washington State, USA. We characterized wildfire smoke days as binary for grid cells based on daily average PM2.5 concentrations, from June 1 through September 30, 2006–2017. Wildfire smoke days were defined as all days with assigned monitor concentration above a PM2.5 value of 20.4 μg/m3, with an additional set of criteria applied to days between 9 and 20.4 μg/m3. We employed a case-crossover study design using conditional logistic regression and time-stratified referent sampling, controlling for humidex. Results The odds of all-ages non-traumatic mortality with same-day exposure was 1.0% (95% CI: − 1.0 - 4.0%) greater on wildfire smoke days compared to non-wildfire smoke days, and the previous day’s exposure was associated with a 2.0% (95% CI: 0.0–5.0%) increase. When stratified by cause of mortality, odds of same-day respiratory mortality increased by 9.0% (95% CI: 0.0–18.0%), while the odds of same-day COPD mortality increased by 14.0% (95% CI: 2.0–26.0%). In subgroup analyses, we observed a 35.0% (95% CI: 9.0–67.0%) increase in the odds of same-day respiratory mortality for adults ages 45–64. Conclusions This study suggests increased odds of mortality in the first few days following wildfire smoke exposure. It is the first to examine this relationship in Washington State and will help inform local and state risk communication efforts and decision-making during future wildfire smoke events.

Ultraviolet disinfection (UVD) units enhance onsite sewage systems (OSSs) in areas where conventional treatment is limited by site characteristics. Although UVD units are efficacious under testing conditions, few studies have considered their effectiveness when installed. This study used a mixed-methods approach to examine UVD unit effluent quality and determine the association between UV bulb status and fecal coliform levels. Samples from UVD units and pump chambers were tested for bacterial and physiochemical parameters. Field data were supplemented with data from retrospective compliance samples. A multivariate Tobit regression model predicted that the geometric mean (GM) fecal coliform concentration was 122% higher when the UV bulb was deficient than when it was not deficient, adjusted for other OSS deficiencies (95% CI: 36–428, p-value

A growing body of literature suggests that restrictive public health measures implemented to control COVID-19 have had negative impacts on physical activity. We examined how Stay Home orders in Houston, New York City, and Seattle impacted outdoor physical activity patterns, measured by daily bicycle and pedestrian count data. We assessed changes in activity levels between the period before and during Stay Home orders. Across all three cities, we found significant changes in bicycle and pedestrian counts from the period before to the period during Stay Home orders. The direction of change varied by location, likely due to differing local contexts and outbreak progression. These results can inform policy around the use of outdoor public infrastructure as the COVID-19 pandemic continues.

To aid health adaptation decision-making, there are increasing efforts to provide climate projections at finer temporal and spatial scales. Relying solely on projected climate changes for longer-term decisions makes the implicit assumption that sources of vulnerability other than climate change will remain the same, which is not very probable. Over longer time horizons, this approach likely over estimates the extent to which climate change could alter the magnitude and pattern of health outcomes, introducing systematic bias into health management decisions. To balance this potential bias, decision-makers also need projections of other drivers of health outcomes that are, like climate change, recognized determinants of some disease burdens. Incorporating projections via an iterative process that allows for regular updates based on new knowledge and experience has the potential to improve the utility of fine-scale climate projections in health system adaptation to climate change.

Extreme heat has been associated with increased mortality, particularly in temperate climates. Few epidemiologic studies have considered the Pacific Northwest region in their analyses. This study quantified the historical (May to September, 1980–2010) heat-mortality relationship in the most populous Pacific Northwest County, King County, Washington. A relative risk (RR) analysis was used to explore the relationship between heat and all-cause mortality on 99th percentile heat days, while a time series analysis, using a piece-wise linear model fit, was used to estimate the effect of heat intensity on mortality, adjusted for temporal trends. For all ages, all causes, we found a 10 % (1.10 (95 % confidence interval (CI), 1.06, 1.14)) increase in the risk of death on a heat day versus non-heat day. When considering the intensity effect of heat on all-cause mortality, we found a 1.69 % (95 % CI, 0.69, 2.70) increase in the risk of death per unit of humidex above 36.0 °C. Mortality stratified by cause and age produced statistically significant results using both types of analyses for: all-cause, non-traumatic, circulatory, cardiovascular, cerebrovascular, and diabetes causes of death. All-cause mortality was statistically significantly modified by the type of synoptic weather type. These results demonstrate that heat, expressed as humidex, is associated with increased mortality on heat days, and that risk increases with heat’s intensity. While age was the only individual-level characteristic found to modify mortality risks, statistically significant increases in diabetes-related mortality for the 45–64 age group suggests that underlying health status may contribute to these risks.

Background: As climate change is expected to result in more frequent, larger fires and associated smoke impacts, creating and sustaining wildfire smoke-resilient communities is an urgent public health priority. Following two summers of persistent and extreme wildfire smoke events in Washington state, the need for additional research on wildfire smoke health impacts, risk communication, and risk reduction, and an associated greater coordination between researcher and practitioner communities, is of paramount importance. Objectives: On 30 October 2018, the University of Washington hosted a Wildfire Smoke Risk Communication Stakeholder Synthesis Symposium in Seattle, Washington. The goals of the symposium were to identify and prioritize practice-based information gaps necessary to promote effective wildfire smoke risk communication and risk reduction across Washington state, foster collaboration among practitioners and academics to address information gaps using research, and provide regional stakeholders with access to the best available health and climate science about current and future wildfire risks. Methods: Seventy-six Washington state practitioners and academics with relevant professional responsibilities or expertise in wildfire smoke and health engaged in small group discussions using the &ldquo, World Caf&eacute, Method&rdquo, to identify practice-relevant research needs related to wildfire smoke and health. Notes from each discussion were coded and qualitatively analyzed using a content analysis approach. Discussion: Washington state&rsquo, s public health and air quality practitioners need additional evidence to communicate and reduce wildfire smoke risk. Exposure, health risk, risk communication, behavior change and interventions, and legal and policy research needs were identified, along with the need to develop research infrastructure to support wildfire smoke and health science. Practice-relevant, collaborative research should be prioritized to address this increasing health threat.

Background Exposure to excessive heat kills more people than any other weather-related phenomenon, aggravates chronic diseases, and causes direct heat illness. Strong associations between extreme heat and health have been identified through increased mortality and hospitalizations and there is growing evidence demonstrating increased emergency department visits and demand for emergency medical services (EMS). The purpose of this study is to build on an existing regional assessment of mortality and hospitalizations by analyzing EMS demand associated with extreme heat, using calls as a health metric, in King County, Washington (WA), for a 6-year period. Methods Relative-risk and time series analyses were used to characterize the association between heat and EMS calls for May 1 through September 30 of each year for 2007–2012. Two EMS categories, basic life support (BLS) and advanced life support (ALS), were analyzed for the effects of heat on health outcomes and transportation volume, stratified by age. Extreme heat was model-derived as the 95th (29.7 °C) and 99th (36.7 °C) percentile of average county-wide maximum daily humidex for BLS and ALS calls respectively. Results Relative-risk analyses revealed an 8 % (95 % CI: 6–9 %) increase in BLS calls, and a 14 % (95 % CI: 9–20 %) increase in ALS calls, on a heat day (29.7 and 36.7 °C humidex, respectively) versus a non-heat day for all ages, all causes. Time series analyses found a 6.6 % increase in BLS calls, and a 3.8 % increase in ALS calls, per unit-humidex increase above the optimum threshold, 40.7 and 39.7 °C humidex respectively. Increases in “no” and “any” transportation were found in both relative risk and time series analyses. Analysis by age category identified significant results for all age groups, with the 15–44 and 45–64 year old age groups showing some of the highest and most frequent increases across health conditions. Multiple specific health conditions were associated with increased risk of an EMS call including abdominal/genito-urinary, alcohol/drug, anaphylaxis/allergy, cardiovascular, metabolic/endocrine, diabetes, neurological, heat illness and dehydration, and psychological conditions. Conclusions Extreme heat increases the risk of EMS calls in King County, WA, with effects demonstrated in relatively younger populations and more health conditions than those identified in previous analyses.

Increased morbidity and mortality have been associated with extreme heat events, particularly in temperate climates. Few epidemiologic studies have considered the impact of extreme heat events on hospitalization rates in the Pacific Northwest region. This study quantifies the historic (May to September 1990–2010) heat-morbidity relationship in the most populous Pacific Northwest County, King County, Washington. A relative risk (RR) analysis was used to explore the association between heat and all non-traumatic hospitalizations on 99th percentile heat days, whereas a time series analysis using a piecewise linear model approximation was used to estimate the effect of heat intensity on hospitalizations, adjusted for temporal trends and day of the week. A non-statistically significant 2% [95% CI: 1.02 (0.98, 1.05)] increase in hospitalization risk, on a heat day vs. a non-heat day, was noted for all-ages and all non-traumatic causes. When considering the effect of heat intensity on admissions, we found a statistically significant 1.59% (95% CI: 0.9%, 2.29%) increase in admissions per degree increase in humidex above 37.4°C. Admissions stratified by cause and age produced statistically significant results with both relative risk and time series analyses for nephritis and nephrotic syndromes, acute renal failure, and natural heat exposure hospitalizations. This study demonstrates that heat, expressed as humidex, is associated with increased hospital admissions. When stratified by age and cause of admission, the non-elderly age groups (

Climate change is predicted to increase the frequency and duration of extreme-heat events and associated health outcomes. This study used data from the historical heat-health outcome relationship, and a unique prediction model, to estimate mortality for 2025 and 2045. For each one degree change in humidex above threshold, we find a corresponding 1.83% increase in mortality for all ages, all non-traumatic causes of death in King County, Washington. Mortality is projected to increase significantly in 2025 and 2045 for the 85 and older age group (2.3-8.0 and 4.0-22.3 times higher than baseline, respectively).