skip to main content


The NSF Public Access Repository (NSF-PAR) system and access will be unavailable from 5:00 PM ET until 11:00 PM ET on Friday, June 21 due to maintenance. We apologize for the inconvenience.

Title: Wildfire Smoke Is Associated With an Increased Risk of Cardiorespiratory Emergency Department Visits in Alaska

Alaskan wildfires have major ecological, social, and economic consequences, but associated health impacts remain unexplored. We estimated cardiorespiratory morbidity associated with wildfire smoke (WFS) fine particulate matter with a diameter less than 2.5 μm (PM2.5) in three major population centers (Anchorage, Fairbanks, and the Matanuska‐Susitna Valley) during the 2015–2019 wildfire seasons. To estimate WFS PM2.5, we utilized data from ground‐based monitors and satellite‐based smoke plume estimates. We implemented time‐stratified case‐crossover analyses with single and distributed lag models to estimate the effect of WFS PM2.5on cardiorespiratory emergency department (ED) visits. On the day of exposure to WFS PM2.5, there was an increased odds of asthma‐related ED visits among 15–65 year olds (OR = 1.12, 95% CI = 1.08, 1.16), people >65 years (OR = 1.15, 95% CI = 1.01, 1.31), among Alaska Native people (OR = 1.16, 95% CI = 1.09, 1.23), and in Anchorage (OR = 1.10, 95% CI = 1.05, 1.15) and Fairbanks (OR = 1.12, 95% CI = 1.07, 1.17). There was an increased risk of heart failure related ED visits for Alaska Native people (Lag Day 5 OR = 1.13, 95% CI = 1.02, 1.25). We found evidence that rural populations may delay seeking care. As the frequency and magnitude of Alaskan wildfires continue to increase due to climate change, understanding the health impacts will be imperative. A nuanced understanding of the effects of WFS on specific demographic and geographic groups facilitates data‐driven public health interventions and fire management protocols that address these adverse health effects.

more » « less
Award ID(s):
Author(s) / Creator(s):
 ;  ;  ;  ;  
Publisher / Repository:
DOI PREFIX: 10.1029
Date Published:
Journal Name:
Medium: X
Sponsoring Org:
National Science Foundation
More Like this
  1. Abstract

    Wildfires cause elevated air pollution that can be detrimental to human health. However, health impact assessments associated with emissions from wildfire events are subject to uncertainty arising from different sources. Here, we quantify and compare major uncertainties in mortality and morbidity outcomes of exposure to fine particulate matter (PM2.5) pollution estimated for a series of wildfires in the Southeastern U.S. We present an approach to compare uncertainty in estimated health impacts specifically due to two driving factors, wildfire‐related smoke PM2.5fields and variability in concentration‐response parameters from epidemiologic studies of ambient and smoke PM2.5. This analysis, focused on the 2016 Southeastern wildfires, suggests that emissions from these fires had public health consequences in North Carolina. Using several methods based on publicly available monitor data and atmospheric models to represent wildfire‐attributable PM2.5, we estimate impacts on several health outcomes and quantify associated uncertainty. Multiple concentration‐response parameters derived from studies of ambient and wildfire‐specific PM2.5are used to assess health‐related uncertainty. Results show large variability and uncertainty in wildfire impact estimates, with comparable uncertainties due to the smoke pollution fields and health response parameters for some outcomes, but substantially larger health‐related uncertainty for several outcomes. Consideration of these uncertainties can support efforts to improve estimates of wildfire impacts and inform fire‐related decision‐making.

    more » « less
  2. null (Ed.)
    Background: Individuals affected by disasters are at risk for adverse mental health sequelae. Individuals living in the US Gulf Coast have experienced many recent major disasters, but few studies have explored the cumulative burden of experiencing multiple disasters on mental health. Objective: The objective of this study was to evaluate the relationship between disaster burden and mental health. Methods: We used data from 9278 Gulf Long-term Follow-up Study participants who completed questionnaires on perceived stress, anxiety, depression, and post-traumatic stress disorder (PTSD) in 2011-2013. We linked 2005-2010 county-level data from the Spatial Hazard Events and Losses Database for the United States, a database of loss-causing events, to participant's home address. Exposure measures included total count of loss events as well as severity quantified as property/crop losses per capita from all hazards. We used multilevel modeling to estimate odds ratios (OR) and 95% confidence intervals (CI) for each exposure-outcome relationship. Results: Total count of loss events was positively associated with perceived stress (ORQ4:1.40, 95% CI:1.21-1.61) and was inversely associated with PTSD (ORQ4:0.66, 95% CI:0.45-0.96). Total duration of exposure was also associated with stress (ORQ4:1.16, 95% CI:1.01-1.33) but not with other outcomes. Severity based on cumulative fatalities/injuries was associated with anxiety (ORQ4:1.31, 95% CI:1.05-1.63) and stress (ORQ4:1.34, 95% CI:1.15-1.57), and severity based on cumulative property/crop losses was associated with anxiety (ORQ4:1.42, 95% CI:1.12-1.81), depression (ORQ4:1.22, 95% CI:0.95-1.57) and PTSD (ORQ4:1.99, 95% CI:1.44-2.76). Keywords: PTSD; disasters; mental health; natural hazards. 
    more » « less
  3. This study initiated an exploration into how community members, specialists in housing issues, and social scientists might collaborate to address homelessness in Alaska. Through interviews and participant observation of planning meetings and related activities, the researchers are gathering insights from design experts, community organizers, and experts working on urban-rural homelessness in Alaska. This includes gathering information about cold weather design processes and issues facing urban-rural homelessness in Alaska, as well as the identification of possible research questions that can inform the development of a grant application for a multi-year research study. The study includes in-person as well as virtual research activities. Because of geographic distances, the majority of initial research activities were conducted virtually, but in-person field site visits began to take place June 15, 2021, and subsequent trips have taken place from August 2021-onward. These research trips involve site visits, participation in meetings, and in-person interviews when possible. Phase 1: 24 initial interviews were conducted with a range of stakeholders about housing insecurity in Alaska and the impacts of the COVID-19 pandemic. Includes interviewees from remote villages, from the Association of Alaskan Housing Authorities (AAHA), homeless advocates, designers, social scientists, engineers, and builders. Topics included myths about homelessness, homeless versus houseless terminology, research organizations, policies, impacts of pandemic, housing needs, and contrasting strategies. Analysis and synthesis with subsequent data is ongoing. 01: policy 02: interview with researcher 03: homelessness - Anchorage - rural communities - data sharing 04: design in rural communities 05: housing shortages in rural communities 06: technical issues in housing - collaborating with rural communities 07: homeless community in Fairbanks 08: history of Cold Climate Housing Research Center 09: design - homelessness - Anchorage 10: homelessness - rural/hub/urban - need for housing design repository 11: homelessness - Nome - Savoonga - designers need to visit villages 12: reverse interview - designer interviews researchers 13: homelessness - Anchorage - Bethel - housing costs 14: homelessness - rural/hub/urban spectrum - subsistence - houseless term 15: homelessness data and Bethel - impacts of pandemic - myths 16: homelessness data and Bethel - impacts of pandemic 17: ISERC (Integrated Security Education and Research Center) research 18: homelessness data and Bethel - CARES Act 19: homelessness data (gaps) and Bethel - CARES Act 20: homelessness data and Bethel 21: designer - public awareness and museum exhibits 22: veterans and community organizer 23: AAHA staff member 24: homelessness - Fairbanks - pandemic impacts on rescue missions Phase 2: 49 additional interviews were conducted with support from NSF funding (NSF 2103356: RAPID: COVID-19, Remote Ethnography, and the Rural Alaskan Housing Crisis). A meta-data description of the participants and topics are attached ('RAPID_interview_list___Descriptions'). 
    more » « less
  4. Abstract STUDY QUESTION To what extent does the use of mobile computing apps to track the menstrual cycle and the fertile window influence fecundability among women trying to conceive? SUMMARY ANSWER After adjusting for potential confounders, use of any of several different apps was associated with increased fecundability ranging from 12% to 20% per cycle of attempt. WHAT IS KNOWN ALREADY Many women are using mobile computing apps to track their menstrual cycle and the fertile window, including while trying to conceive. STUDY DESIGN, SIZE, DURATION The Pregnancy Study Online (PRESTO) is a North American prospective internet-based cohort of women who are aged 21–45 years, trying to conceive and not using contraception or fertility treatment at baseline. PARTICIPANTS/MATERIALS, SETTING, METHODS We restricted the analysis to 8363 women trying to conceive for no more than 6 months at baseline; the women were recruited from June 2013 through May 2019. Women completed questionnaires at baseline and every 2 months for up to 1 year. The main outcome was fecundability, i.e. the per-cycle probability of conception, which we assessed using self-reported data on time to pregnancy (confirmed by positive home pregnancy test) in menstrual cycles. On the baseline and follow-up questionnaires, women reported whether they used mobile computing apps to track their menstrual cycles (‘cycle apps’) and, if so, which one(s). We estimated fecundability ratios (FRs) for the use of cycle apps, adjusted for female age, race/ethnicity, prior pregnancy, BMI, income, current smoking, education, partner education, caffeine intake, use of hormonal contraceptives as the last method of contraception, hours of sleep per night, cycle regularity, use of prenatal supplements, marital status, intercourse frequency and history of subfertility. We also examined the impact of concurrent use of fertility indicators: basal body temperature, cervical fluid, cervix position and/or urine LH. MAIN RESULTS AND THE ROLE OF CHANCE Among 8363 women, 6077 (72.7%) were using one or more cycle apps at baseline. A total of 122 separate apps were reported by women. We designated five of these apps before analysis as more likely to be effective (Clue, Fertility Friend, Glow, Kindara, Ovia; hereafter referred to as ‘selected apps’). The use of any app at baseline was associated with 20% increased fecundability, with little difference between selected apps versus other apps (selected apps FR (95% CI): 1.20 (1.13, 1.28); all other apps 1.21 (1.13, 1.30)). In time-varying analyses, cycle app use was associated with 12–15% increased fecundability (selected apps FR (95% CI): 1.12 (1.04, 1.21); all other apps 1.15 (1.07, 1.24)). When apps were used at baseline with one or more fertility indicators, there was higher fecundability than without fertility indicators (selected apps with indicators FR (95% CI): 1.23 (1.14, 1.34) versus without indicators 1.17 (1.05, 1.30); other apps with indicators 1.30 (1.19, 1.43) versus without indicators 1.16 (1.06, 1.27)). In time-varying analyses, results were similar when stratified by time trying at study entry (<3 vs. 3–6 cycles) or cycle regularity. For use of the selected apps, we observed higher fecundability among women with a history of subfertility: FR 1.33 (1.05–1.67). LIMITATIONS, REASONS FOR CAUTION Neither regularity nor intensity of app use was ascertained. The prospective time-varying assessment of app use was based on questionnaires completed every 2 months, which would not capture more frequent changes. Intercourse frequency was also reported retrospectively and we do not have data on timing of intercourse relative to the fertile window. Although we controlled for a wide range of covariates, we cannot exclude the possibility of residual confounding (e.g. choosing to use an app in this observational study may be a marker for unmeasured health habits promoting fecundability). Half of the women in the study received a free premium subscription for one of the apps (Fertility Friend), which may have increased the overall prevalence of app use in the time-varying analyses, but would not affect app use at baseline. Most women in the study were college educated, which may limit application of results to other populations. WIDER IMPLICATIONS OF THE FINDINGS Use of a cycle app, especially in combination with observation of one or more fertility indicators (basal body temperature, cervical fluid, cervix position and/or urine LH), may increase fecundability (per-cycle pregnancy probability) by about 12–20% for couples trying to conceive. We did not find consistent evidence of improved fecundability resulting from use of one specific app over another. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by grants, R21HD072326 and R01HD086742, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA. In the last 3 years, Dr L.A.W. has served as a fibroid consultant for Dr L.A.W. has also received in-kind donations from Sandstone Diagnostics, Swiss Precision Diagnostics, and for primary data collection and participant incentives in the PRESTO cohort. Dr J.B.S. reports personal fees from Swiss Precision Diagnostics, outside the submitted work. The remaining authors have nothing to declare. TRIAL REGISTRATION NUMBER N/A. 
    more » « less
  5. Abstract

    Previous research on the health and air quality impacts of wildfire smoke has largely focused on the impact of smoke on outdoor air quality; however, many people spend a majority of their time indoors. The quality of indoor air on smoke-impacted days is largely unknown. In this analysis, we use publicly available data from an existing large network of low-cost indoor and outdoor fine particulate matter (PM2.5) monitors to quantify the relationship between indoor and outdoor particulate air quality on smoke-impacted days in 2020 across the western United States (US). We also investigate possible regional and socioeconomic trends in this relationship for regions surrounding six major cities in the western US. We find indoor PM2.5concentrations are 82% or 4.2µg m−3(median across all western US indoor monitors for the year 2020; interquartile range, IQR: 2.0–7.2µg m−3) higher on smoke-impacted days compared to smoke-free days. Indoor/outdoor PM2.5ratios show variability by region, particularly on smoke-free days. However, we find the ratio of indoor/outdoor PM2.5is less than 1 (i.e. indoor concentrations lower than outdoor) at nearly all indoor-outdoor monitor pairs on smoke-impacted days. Although typically lower than outdoor concentrations on smoke-impacted days, we find that on heavily smoke-impacted days (outdoor PM2.5> 55µg m−3), indoor PM2.5concentrations can exceed the 35µg m−324 h outdoor standard set by the US Environmental Protection Agency. Further, total daily-mean indoor PM2.5concentrations increase by 2.1µg m−3with every 10µg m−3increase in daily-mean outdoor PM2.5.(median of statistically significant linear regression slopes across all western US monitor pairs; IQR: 1.0–4.3µg m−3) on smoke-impacted days. These results show that for indoor environments in the western US included in our analysis, remaining indoors during smoke events is currently an effective, but limited, strategy to reduce PM2.5exposure.

    more » « less