State of The Air 2023 Report

Table of Contents
About this Report

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Why State of the Air? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Key Findings
Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Short-term Particle Pollution Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Year-Round Particle Pollution Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
National Air Quality Standards and the Air Quality Index . . . . . . . . . . . . . . . . . . . . . . . . . 17
Ozone Pollution Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Monitoring the State of the Air in Indian Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Populations at Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Most Polluted Places to Live . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Cleanest Places to Live . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Health Impact of Air Pollution

Health Effects of Particle Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Health Effects of Ozone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Air Pollution and COVID-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
People at Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Recommendations for Action

Individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Local Governments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
State, Territorial and Tribal Governments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Federal Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Data Tables
Understanding Grades and Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Table 1: Populations at Risk by Grade and by Pollutant . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Table 2 a-c: Populations at Risk in 25 Most Polluted Cities, by Pollutant . . . . . . . 38-40
Table 3 a-c: Cleanest Cities, by Pollutant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41-43
Table 4 a-c: Cleanest Counties, by Pollutant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44-51
State Data Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
3 Lung.org American Lung Association State of the Air 2023

Acknowledgments The American Lung Association “State of the Air” 2023 is the result of the hard work of
many.
We would like to thank: Allen S. Lefohn of A.S.L. and Associates, who compiled the
data; John Balmes, M.D., who served as expert volunteer reviewer for the health impacts
section; Randy Tibbott of Our Designs, Inc., who designed the print version; Doug
Manners, a volunteer writer/editor in Denver, CO, who helped with story collection, and
storytellers Martha Coello, Lynn de Freitas, Joanne Kilgour and Jenny Wynn.
Great appreciation goes to the National Association of Clean Air Agencies, who strove to
make this report better through comments, review and concerns. Many of its 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 members of the
Association of Air Pollution Control Agencies, who also reviewed data from their states.
We appreciate them all 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.
“State of the Air” 2023 would not have been possible but for the twenty years of
inspiration, dedication and hard work of the late Janice E. Nolen. We still miss her every day.
The American Lung Association assumes sole responsibility for the content of “State of
the Air” 2023.
American Lung Association

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Chicago, IL 60601
Advocacy Office
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Washington, DC 20004
(800) 586-4872
Lung.org/sota
Copyright ©2023 by the American Lung Association.

American Lung Association and State of the Air are registered trademarks of the American Lung Association.

A b o u t T h i s Re p o r t
Why “State of the Air”? The Clean Air Act requires the U.S. Environmental Protection Agency (EPA) to set health-
based limits, called National Ambient Air Quality Standards (NAAQS), for six dangerous
outdoor air pollutants: particulate matter, ozone, nitrogen oxides, sulfur dioxide, carbon
monoxide and lead. “State of the Air” looks at two of the most widespread and
dangerous pollutants from this group, fine particulate matter and ozone.
The NAAQS identify what is considered a safe level of each pollutant to breathe, based
on the most recent health and medical science, including an adequate margin of safety
for those most at risk. These standards alert the public when pollution levels place
Americans’ health at risk and require states and local governments to take steps to
reduce emissions to attain the standards. The standards are also used to inform families
with children, seniors, people with lung or heart disease and others when air pollution
levels are dangerous through color-coded air quality alerts, so they can take steps to
limit their exposure. Under the Clean Air Act, the standards must be based solely on
what is needed to protect health, and must be periodically updated as the science
evolves. EPA is currently reviewing both the particulate matter and ozone standards;
future editions of “State of the Air” will reflect any revisions to the standards.
Setting national health-based standards and requiring states that violate the standards
to enact plans to clean up their air pollution problems have been a great benefit to the
public health of the nation. Since the Clean Air Act was passed in 1970, emissions of
these outdoor air pollutants, including ozone and particle pollution, have fallen by 78%,
according to EPA. But as “State of the Air” 2023 shows, millions of Americans are still
breathing unhealthy air.
Purpose and history of “State of the Air”

In the year 2000, the American Lung Association launched its annual “State of the Air”
report to provide the public with easy-to-understand information about the quality of the
air in their local communities based on the credible data and sound science that EPA is
required to use to set the air quality standards.
For the first several years, “State of the Air” focused solely on ozone pollution and
included data for five populations at increased risk—children, older adults, children
with asthma, adults with asthma and people with emphysema. In 2004, changes to
the air quality standards and the deployment of air pollution monitoring enabled the
addition of short-term and year-round fine particle pollution to the report. Over time,
accumulating scientific evidence has shown significant health harms from both ozone
and particle pollution among other groups of vulnerable individuals. “State of the Air” has
accommodated this new information by gradually adding populations-at-risk categories
to its reporting. “State of the Air” 2023 now includes data for 10 vulnerable groups.
Since its inception, “State of the Air” has been tremendously successful in raising
awareness about particle pollution and ozone, two of the most dangerous and pervasive
air pollutants nationwide. The American Lung Association is proud and grateful that the
public, the media, clean air advocates and decision-makers have used this report every
day, year after year, to call attention to the work that remains to be done to protect the
health of all Americans from the threat of air pollution.
How “State of the Air” can be used

We write and release “State of the Air” every year to make information on air quality and
health clear and accessible to everyone. We show the progress each community has
made and how much more needs to be done to achieve healthy air. In this report, you’ll
find information on local air quality nationwide. You’ll also find the latest roundup of the
research on how air pollution affects health. With these tools, you can help keep your
lungs and your family’s lungs safer from unhealthy air.

This report also includes ideas for how you can become a champion for clean air.
First, we have suggestions for concrete actions you can take to reduce your own
contributions to air pollution and climate change. And second, we invite you to take
advocacy action with the American Lung Association. Our report includes policy
recommendations for every level of government. Your voice is powerful, and when you
tell your leaders that your lungs depend on stronger limits on air pollution, you make a
compelling case. Please share your story and add your name to our petition—and then,
take the next step. Reach out to your representatives at every level of government, share
the “State of the Air” results for your community, and call on them to take action to
protect public health.

State
of the Air 2023 Statistical Methodology: The Air Quality Data
Methodology
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). The American Lung Association contracted with Dr. Allen S. Lefohn,
A.S.L. & Associates, Montana, to characterize the hourly averaged ozone concentration
information and the 24-hour averaged PM2.5 concentration information for the three-year
period for 2019-2021 for each monitoring site.
Year-round particle pollution. Design values for the annual PM2.5 concentrations by
county for the period 2019-2021 were retrieved November 21, 2022 from data posted on
May 24, 2022, at the U.S. Environmental Protection Agency’s website at https://www.epa.
gov/air-trends/air-quality-design-values.
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 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.
Ozone Data Analysis

The 2019, 2020 and 2021 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 22, 2022, 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 EPA uses three
years of data to determine compliance with the ozone standard: to prevent a situation in
any single year, where anomalies of weather or other factors create air pollution levels,
which inaccurately reflect the normal conditions. The highest 8-hour daily maximum
concentration in each county for 2019, 2020 and 2021, based on 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. The EPA’s Air Quality Index reflects the 70 ppb
standard. A.S.L. & Associates prepared a table by county that summarized, for each of
the three years, the number of days the ozone level was within the ranges identified by
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.
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., 6-8 hours) had to be available for the 8-hour
period. In addition, an 8-hour daily maximum average was identified if valid 8-hour
averages were available for at least 75 percent of possible hours in the day (i.e., at least
13 of the possible 17 8-hour averages). Because 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
were available, and it was 71 ppb or higher.
As instructed by the Lung Association, A.S.L. & Associates included the exceptional
(e.g., wildfires) and natural events (e.g., stratospheric intrusions) 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). When insufficient data were available in any year, an “incomplete” was
identified for the 3-year period. Insufficient data exist for various reasons. For example,
when a specific monitor was used for a special study and the monitor was then
discontinued in other years, an “incomplete” is assigned.
Short-Term Particle Pollution Data Analysis

A.S.L. & Associates identified the maximum daily 24-hour AQS PM2.5 concentration for
each county in 2019, 2020 and 2021 with monitoring information. The 24-hour PM2.5 data
were downloaded on August 4, 2022, following the close of the authorized period for
quality review and assurance certification of data. In addition, on August 4, 2022, 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 the EPA on December 14, 2012:

24-hour PM2.5 Concentration Air Quality Index Levels

0.0 µg/m to 12.0 µg/m
3 3
n Good (Green)
12.1 µg/m to 35.4 µg/m
3 3
n Moderate (Yellow)
35.5 µg/m to 55.4 µg/m
3 3
n Unhealthy for Sensitive Groups (Orange)
55.5 µg/m to 150.4 µg/m
3 3
n Unhealthy (Red)
150.5 µg/m to 250.4 µg/m
3 3
n Very Unhealthy (Purple)
greater than or equal to 250.5 µg/m 3
n Hazardous (Maroon)
All previous data collected for 24-hour average PM2.5 were characterized using the AQI
thresholds listed above.
The goal of this report was to identify the number of days that the maximum in each
county of the daily PM2.5 concentration occurred within the defined ranges. This
approach provided an indication of the level of pollution for all monitored days, not just
those days that fell under the requirements for attaining the national ambient air quality
standards. Therefore, no data capture criteria were used to eliminate monitoring sites.
Both 24-hour averaged PM data, as well as hourly averaged PM data averaged over
24 hours were used. Included in the analysis are data collected using only FRM and
FEM methods, which reported hourly and 24-hour averaged data. As instructed by the
Lung Association, A.S.L. & Associates included the exceptional and natural events that
were identified in the database and identified for the Lung Association the dates and
monitoring sites that experienced such events. Some data have been flagged by the
state or local air pollution control agency to indicate that they had raised issues with
EPA about those data. For each day across all sites within a specific county, the highest
daily maximum 24-h PM2.5 concentration was recorded and then the results were
summarized by county for the number of days the concentration levels were within the
ranges identified 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 calculation. To determine weighted averages, the Lung Association
followed these four steps separately for each pollutant in each county:
1. Assigned weighting factors to each category of the Air Quality Index. Days of poor air
quality were given the following weighting factors:
Orange days 1.0
Red days 1.5
Purple days 2.0
Maroon days 2.5
This ensured that days when the air pollution levels were worse received appropriately
greater weight.
2. Multiplied the total number of days within each AQI category by their assigned factor,
and added all the categories to calculate a total:
Total = [Orange days x 1] + [Red days x 1.5] + [Purple days x 2] +
[Maroon days x 2.5]

3. Divided the total by three to determine the weighted average, since the monitoring
data were collected over a three-year period:
Weighted Average = Total ÷ 3
Weighted average was then used to determine each county’s grades for ozone and 24-
hour PM2 5 according to the following table:
Weighted Average Grade

0.0 A
0.3 to 0.9 B
1.0 to 2.0 C
2.1 to 3.2 D
3.3 or higher F
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 micrograms per cubic
meter (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.
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.
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 2020 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 that 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.”
A 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 2020 as defined by the OMB.
Statistical Methodology: Population Data

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, but the air
pollution also circulates to that monitor from throughout the county and metropolitan area.
Details about how the populations-at-risk numbers are derived can be found in
Understanding Grades and Tables.

Key Findings
Key Findings The “State of the Air” 2023 report finds that after decades of progress on cleaning
up sources of air pollution, nearly 36% of Americans—119.6 million people—still live in
places with failing grades for unhealthy levels of ozone or particle pollution. Overall, this
is 17.6 million fewer people breathing unhealthy air compared to last year’s report. The
improvement was seen in falling levels of ozone in many places around the country, the
continuation of a positive trend that reflects the success of the Clean Air Act. However,
the number of people living in counties with failing grades for daily spikes in deadly
particle pollution was 63.7 million, the most reported in the last ten years.
The “State of the Air” report looks at two of the most widespread and dangerous air
pollutants, fine particles and ozone. The air quality data used in the report are collected
at official monitoring sites across the United States by the federal, state, local and Tribal
governments. The Lung Association calculates values reflecting the air pollution problem
and assigns grades for daily and long-term measures of particle pollution and daily
measures of ozone. Those values are also used to rank cities (metropolitan areas) and
counties. This year’s report presents data from 2019, 2020 and 2021, the most recent
quality-assured nationwide air pollution data publicly available. See About This Report
for more detail about the methodology for data collection and analysis.
“State of the Air” 2023 is the 24th edition of this annual report, which was first published
in 2000. From the beginning, the findings in “State of the Air” have reflected the
successes of the Clean Air Act, as emissions from transportation, power plants and
manufacturing have been reduced. In recent years, however, the findings of the report
have added to the evidence that a changing climate is making it harder to protect
human health. The three years covered by “State of the Air” 2023 ranked among the
seven hottest years on record globally. High ozone days and spikes in particle pollution
related to heat, drought and wildfires are putting millions of people at risk and adding
challenges to the work that states and cities are doing across the nation to clean up air
pollution.
The combination of policy-driven reductions in emissions on the one hand and climate
change-fueled increases in pollution on the other hand is driving a widening disparity
between air quality in eastern and western states, especially for particle pollution. When
particle pollution was first added to the “State of the Air” report in 2004, 106 counties
in 30 states got failing grades for daily spikes in particle pollution. Forty-four of those
counties—fewer than half—were in 8 states west of the Rocky Mountains. In this year’s
report, 111 counties in 19 states got Fs for this measure. All but 8 counties in Indiana,
Michigan, Minnesota and Pennsylvania are in the West. A number of historically urban,
industrialized eastern and midwestern states such as New Jersey, New York and Ohio,
which dominated the list in the early years, are now getting all passing grades. A similar
story can be told for annual particle pollution. In 2004, 20 of the 22 states with counties
that got a failing grade were east of the Rockies. In 2023, all of the 17 failing counties
were in 6 western states.
Again this year, “State of the Air” finds that the burden of living with unhealthy air is
not shared equally. Although people of color are 41% of the overall population of the
U.S., they are 54% of the nearly 120 million people living in counties with at least one
failing grade. And in the counties with the worst air quality that get failing grades for all
three pollution measures, 72% of the 18 million residents affected are people of color,
compared to the 28% who are white.

Key Findings
In “State of the Air” 2023, Bakersfield, California displaced Fresno, California as

the metropolitan area with the worst short-term particle pollution while Bakersfield
continued in the most-polluted slot for year-round particle pollution, tied this year with
Visalia, California. Los Angeles remains the city with the worst ozone pollution in the
nation, as it has for all but one of the 24 years tracked by the “State of the Air” report.
Short-term Particle Pollution Trends

In the years 2019, 2020 and 2021, some 63.7 million people lived in the 111 counties that
earned an F for unhealthy spikes in particulate matter air pollution. This represents close
to half a million more people than in last year’s “State of the Air” report, and more people
in total than in any of the last ten reports.
Even compared with the past three years of “State of the Air” reports—in which many
cities and counties experienced their highest weighted average number of days ever
reported for fine particle pollution—results this year were again worse throughout much
of the western U.S. Among those cities ranked the worst 25, the average number of
days residents were exposed to high levels of fine particle pollution increased by almost
two days, to a weighted average of 18.3 days, up from 16.5 days in last year’s report.
Wildfires in the western U.S. are a major contributing factor to the increasing number of
days and places with unhealthy levels of particle pollution. They are also increasing the
severity of pollution, resulting in a sharp rise in the number of days designated as either
purple or maroon. These are the levels on the Air Quality Index that carry the strongest
health warnings. On purple very unhealthy days, “the risk of health effects is increased
for everyone.” On maroon hazardous days, a health warning of emergency conditions is
issued, saying, “Everyone is more likely to be affected.”

Key Findings
In the years 2019, 2020 and 2021, the health of nearly 32 million people across 56
counties in ten states was put at risk on “purple” or “maroon” days for fine particle
pollution. This is very similar to the findings in last year’s “State of the Air” and a
worrisome sign of a trend that is likely to continue as climate change worsens.
Seven of the 25 most polluted cities for this measure posted their highest-ever
weighted average number of days with unhealthy levels of particle pollution. Two of
those, Denver, Colorado and Fargo, North Dakota, are new on the list. The remaining five
are Visalia, California; Reno, Nevada; Yakima and Spokane, Washington; and Boise, Idaho.
Twenty-one of last year’s worst 25 cities remained listed among the worst 25 in this
year’s report, though their relative ranks often shifted by several places. Missoula,
Montana and Lancaster, Pennsylvania both rejoined the ranks of the worst 25 cities after
a short hiatus in 2022. San Luis Obispo, California; Portland, Oregon; and Seattle and
Bellingham, Washington all moved off the list of worst 25 cities.
In “State of the Air” 2023, only two cities among the 25 worst for short-term particle
pollution were not in the western U.S. Both of the eastern cities, Pittsburgh and
Lancaster, Pennsylvania, posted more days high in fine particle pollution in this year’s
report, and remained the two worst metro areas in the country east of the Mississippi
River for this pollutant measure.

Key Findings
Year-round Particle Pollution Trends

Nearly 18.8 million people live in the 17 counties where year-round particle pollution
levels do not meet the national air quality standard, and that receive a failing grade in
“State of the Air” 2023. This is 1.5 million fewer people living in counties with unhealthy
levels of year-round particle pollution compared to last year’s report, continuing a slight
downward trend over the past four years.
By its nature, the year-round measure of average particle pollution is not as volatile as
the daily measure. Changes over time may look smaller, but because they represent
recurring exposures over many days and weeks, seemingly minor differences can
have a big impact on public health. The 25 most polluted cities for year-round particle
pollution continued the worsening trend of recent years, but only slightly, by an average
of less than 0.1 micrograms per cubic meter (from 12.2 to 12.3 µg/m3).
Fourteen cities suffered worse year-round levels during 2019-2021 than in last year’s
report, with two reporting their worst ever: Sacramento, California and Yakima,
Washington for its second consecutive year. In contrast, nine of the 25 most polluted
cities had lower year-round levels this year. Although none of the cities with improved
levels achieved their best ever in “State of the Air” 2023, Fresno and San Jose-San
Francisco-Oakland, California did post their second-best results.
New on the worst 25 list this year were Birmingham, Alabama; Louisville, Kentucky; and
Laredo, Texas. Philadelphia, Pennsylvania; Redding-Red Bluff, California; Shreveport,
Louisiana; and St. Louis, Missouri all improved enough to leave the list.
When Rev. Jenny Wynn wakes up in the morning, she checks two things—the
weather and the air quality. As someone with asthma, high air pollution days force
her to limit the time she spends outdoors.
Wynn says she often has to consider whether eating a meal outside or running
errands on a day with poor air quality might trigger an asthma attack.
“In Phoenix, it seems there are more days than not with bad air quality,” said Wynn,
Senior Minister at First Christian Church in Scottsdale, Arizona.
To help improve air quality in the community over the long term, she would like to
see greater investments in public transportation and green-energy vehicles.
“As a preacher,” Wynn says, “I’m always preaching to people that when you’re
voting or making decisions, you shouldn’t be doing it for your immediate future but
thinking generationally, thinking 50+ years out.”
Rev. Jenny Wynn
First Christian Church Scottsdale

Key Findings
Unlike the worst 25 cities for the daily measure of particle pollution, the worst 25 cities
for annual particle pollution were more distributed around the country. Although cities
most affected by western drought and wildfires, including eight in California, three in
Oregon, and three others in Alaska, Arizona, and Washington, still represented the
largest share, cities with high power plant emissions as well as local industrial and
mobile sources of year-round particle pollution continued to show up on this list. These
included Indianapolis, Detroit, Pittsburgh, Augusta, Houston, Cincinnati, Birmingham,
McAllen, Louisville, Chicago and Laredo.
For the year-round average levels of fine particles, all but nine of the cities on the worst 25
list met the current national air quality standard and got a passing grade in “State of the
Air.” However, evidence shows that no threshold exists for harmful effects from particle
pollution, even below the official standard. Until the standard is strengthened, a passing
grade does not mean that the air is safe to breathe. See Recommendations for Action.

Key Findings

National Air Quality Standards and the Air Quality Index:
Sending the Wrong Message
The Air Quality Index, or AQI, is a well-designed, easy-to-understand resource to
communicate air quality information to the public. Since its inception in 1999, the
AQI has become embedded in weather and air quality forecasting. It is used every
day to help people plan their outdoor activities and make decisions about when
they need to take measures to protect themselves from air pollution that could put
their health at risk. It is also the basis of the methodology for grading used in “State
of the Air.”
The AQI’s familiar color categories are set according to the levels of air pollution
regulated by the National Ambient Air Quality Standards. The breakpoint between
the Moderate (code yellow) and Unhealthy for Sensitive Groups (code orange)
levels of concern is tied to the national standard. Air quality at levels above the
standard is considered unhealthy and triggers increasingly strong health warnings
in the AQI. Anything below the standard is considered moderate or good, and the
corresponding AQI messages say that the air quality is acceptable.
The AQI only works as the public health tool it is intended to be if the standards
accurately reflect what is known about the health harm of ozone and particle pol-
lution. Regrettably, both of these standards are currently inadequate, and the AQI
is therefore presenting a misleading picture of health risks. Research has shown
that on code yellow days, when all but “unusually sensitive individuals” are told it’s a
good day to be active outside, millions of people, including children and the elderly,
are at risk of a range of health harms from air pollution, including death.
Setting more protective national standards for ozone and fine particles will not
only drive pollution cleanup, but also result in an updated air quality index that will
provide more accurate information so families, teachers, coaches and others can
make decisions to reduce or prevent exposures to pollution levels that threaten
health. See Recommendations for Action for more information.
Ozone Pollution Trends

Exposure to unhealthy levels of ozone air pollution makes breathing difficult for more
Americans all across the country than any other single pollutant. In the years 2019,
2020 and 2021, some 103 million people lived in the 124 counties that earned an F for
ozone. More than 30% of the nation’s population, including 23.6 million children, 15.4
million people age 65 or older, and millions in other groups at high risk of health harm,
are exposed to high levels of ozone on enough days to earn the air they breathe a
failing grade.
Although ozone air pollution remains a serious threat to public health, the trend in this
year’s “State of the Air” report is continuing in a positive direction. The number of people
living in counties with a failing grade for ozone declined by more than 19 million this year.
Thirty-nine counties in 23 states dropped off the “F” list, including 8 states that left the
list completely, some for the first time in the history of the report. At the same time, the
number of counties that got an “A” increased by 26%.
Ambient ozone levels are influenced by a complex interaction of factors that can
vary from year to year. Some fluctuation is to be expected and does not necessarily
represent lasting change. However, at least some of the significant improvement in
ozone levels in this year’s report can be attributed to the fact that the Clean Air Act
has been working. Controls placed on emissions have increasingly resulted in the
replacement of more polluting engines, fuels, and processes nationwide. The transition
of the economy away from the coal, the dirtiest fossil fuel, has unquestionably had
an impact, especially in parts of the eastern United States. It is also possible that

Key Findings
pandemic-related changes in activity patterns in 2020 and 2021, such as increased

telework, have made a difference, but that is still being studied and characterized.
The list of 25 cities with the worst ozone pollution in “State of the Air” 2023 and their
order of ranking remained relatively stable compared with last year’s report. Only two
cities improved enough to move off the list: Chico, California and Detroit, Michigan. They
were replaced by Colorado Springs, Colorado and Hartford, Connecticut.
Cities in the West and the Southwest continue to dominate the list of most ozone-
polluted. California retains its historic record of being the state with the most places on
the list, with 10 of the 25 most-polluted cities. Cities in the Southwest fill most of the
remaining slots, with twelve cities spread across six states in this year’s report. New
York, Chicago and Hartford were the only three of the worst 25 cities for ozone east of
the Mississippi River.
Of the cities on the worst 25 list, 13 saw an increase in the weighted average number of
high ozone days and 12 had a decrease compared with last year’s report. Bakersfield,
Fresno, San Diego and El Centro, California, along with Las Vegas and New York, all
recorded their fewest days of high ozone in the report’s 24-year history. New York did so
for the third year in a row.

Key Findings
The geographical distribution of cities with the worst ozone problems confirms a
pattern seen over the past seven reports: nearly all are western cities and only a few
lie in the East. Although cleanup of ozone precursor pollutants has been working to
reduce ozone concentrations, the impact of climate change in the West has meant
higher temperatures, dry, sunny skies and more frequent stagnation events that
are contributing to the number of unhealthy ozone days being higher than it would
otherwise be. Simply, climate change is undercutting the progress we would have made.
Monitoring the State of the Air in Indian Country

EPA’s National Ambient Air Quality Monitoring System is a network of more than
4,300 sites in over 900 counties across the country measuring air pollutants such
as ozone and fine particle pollution. The information these monitors gather is
essential for the functioning of the Clean Air Act and protecting public health and
welfare. Many of these monitors are maintained and operated by state and local
governments with funding and direction from EPA. Tribes across the U.S. also act
as partners, conducting programs to monitor and improve air quality on Tribal lands.
As sovereign nations, Tribes have express authority under the Clean Air Act and
the Tribal Authority Rule to manage air quality in Indian country. Unlike requirements
applying to state agencies, there are no mandates for Tribes to conduct air quality
monitoring. However, many Tribes recognize the value in doing so and for decades
have been active participants in the nationwide monitoring program, following EPA’s
specific requirements to assure the quality of the data gathered.
In the years 2019-2021, 38 Tribes collected and submitted air quality data to EPA
from monitors in 37 counties across 14 states. In most of those counties, state and
local governments also contributed data from their monitoring networks. However,
in some cases the Tribal monitors were the sole source of air quality information
available to the residents of that county.
Indian Country covers a wide diversity of environments, from frontier (which is less
population-dense than rural) to semi-urban. In many places, the air quality on Tribal
lands suffers from the same threats as elsewhere in the U.S. Of the 37 counties with
data from Tribal monitors in this year’s “State of the Air” report, 15 of them, covering
a population of more than 12 million people, received at least one failing grade. They
included some of the most polluted counties in the country, including Riverside
(ranked 2nd worst for ozone), Fresno (2nd worst for short-term particle pollution),
and Kings (5th worst for annual particle pollution), all in California.
At least 46 tribes that had been active in monitoring ozone and fine particle pol-
lution at some time in the past were not identified as having collected data during
the 2019-2021 period. Resources are often spread very thin in Indian country, and
that can have a negative impact on the sustainability of air quality and other envi-
ronmental programs. Considering how important these programs are to protecting
the health and well-being of people living on Tribal lands and in the surrounding
communities, expanding and sustaining adequate investment needs to be a priority
for the nation. In particular, Congress should increase funding for Tribes’ air quality
work.
For more information about Tribal air quality programs, see the Status of Tribal Air
report published annually by the National Tribal Air Association.

Key Findings
Populations at Risk
Nearly 264 million people live in the 922 counties for which there is monitored data for
at least one pollutant in this year’s report. The proportion of the population in those
counties varies by pollutant. The majority of U.S. counties actually don’t have monitors—
which means that many communities, especially rural ones, don’t have official monitored
information on their air quality. It is important to note that the population numbers
included in this section are only for those places that collect air pollution data, and do
not reflect the entire population of these groups in the U.S.
All of the 119.6 million Americans living in places with failing grades for unhealthy levels of
ozone or particle pollution are at risk of harm to their health. But some groups of people
are especially vulnerable to illness and death from their exposure. See People at Risk for
more detail about the factors that contribute to increased risk.
The number of people in these high-risk groups in “State of the Air” 2023 are as follows:
■ People of color—Some 64 million people of color live in counties that received at
least one failing grade for ozone and/or particle pollution. Over 13 million people of
color live in counties that received failing grades on all three measures, including over
9 million Hispanics.
■ People experiencing poverty—More than 14.6 million people with incomes meeting
the federal poverty definition live in counties that received an F for at least one
pollutant. Nearly 2.6 million people in poverty live in counties failing all three measures.
■ Children and older adults—More than 27 million children under age 18 and some
18 million adults age 65 and over live in counties that received an F for at least one
pollutant. Almost 4.3 million children and 2.6 million seniors live in counties failing all
three measures.
■ People with underlying health conditions
● Asthma—1.7 million children and nearly 8.7 million adults with asthma
live in counties that received an F for at least one pollutant. More than
217,000 children and 1.2 million adults with asthma live in counties failing
all three measures.
● Chronic Obstructive Pulmonary Disease (COPD)—Over 5 million people
with COPD live in counties that received an F for at least one pollutant.
Almost 630,000 people with COPD live in counties failing all three
measures.
● Lung Cancer—More than 55,000 people diagnosed with lung cancer
in 2019 live in counties that received an F for at least one pollutant. And
nearly 6,900 people diagnosed with lung cancer live in counties failing all
three measures.

Key Findings
● Cardiovascular Disease—More than 6.6 million people with

cardiovascular disease live in counties that received an F for at least one
pollutant. Some 864,000 people live in counties failing all three measures.
● Pregnancy—Adverse impacts from air pollution have been shown both
for those who are pregnant as well as for the developing fetus. More than
1.3 million pregnancies were recorded in 2021 in counties that received at
least one F for particle pollution. Of those, nearly 198,000 are in counties
that received failing grades for all three measures.
For more detail about the number of people at risk by grade and by pollutant, see Data
Table 1. The populations at risk are also included by county in the State Data Tables.
Most Polluted Places to Live

In addition to the 25 worst cities for each pollutant listed above, the 25 most polluted
counties for ozone and particle pollution are ranked in the tables below:
Daily PM Annual PM Ozone
Ranking State County Ranking State County Ranking State County
1 CA Kern 1 CA Kern 1 CA San Bernadino
2 CA Fresno 2 CA Tulare 2 CA Riverside
3 CA Mono 3 CA Plumas 3 CA Los Angeles
4 CA Kings 4 0R Klamath 4 CA Tulare
4 OR Klamath 5 CA Kings 5 CA Kern
6 CA Inyo 6 CA Fresno 6 CA Fresno
7 AK Fairbanks North Star 7 CA San Barnadino 7 AZ Maricopa
8 CA Tulare 8 CA Riverside 8 CO Jefferson
9 CA Siskiyou 9 MT Lincoln 9 CA Placer
10 NV Douglas 10 AK Fairbanks Norh Star 10 CA San Diego
11 CA Stanislaus 11 CA Sutter 11 CO Douglas
12 CA Tehama 12 OR Jackson 12 TX Harris
13 CA Plumas 12 CA Los Angeles 13 UT Salt Lake
14 NV Washoe 12 CA Madera 14 CA Madera
15 CA Carson City 12 AZ Pinal 15 CA Nevada
15 CA Madera 16 CA Stanislaus 16 CA Stanislaus
17 Nevada 17 WA Okanogan 17 CA Orange
18 CA Butte 18 IN Marion 18 CA Kings
18 CA Los Angeles 19 CA Merced 18 NM Eddy
20 CA Colusa 20 CA San Joaguin 20 CO Arapahoe
20 WA Yakima 21 WA Yakima 21 CA Mariposa
22 CA Sutter 22 MI Wayne 22 AZ Pinal
23 CA Scramento 23 CA Butte 23 CA Sacramento
24 CA Placer 24 OR Josephine 24 CT Fairfield
25 CA San Joaquin 25 PA Allegheny 25 CA Imperial
Eleven counties received failing grades for all 3 measures of pollution: Fresno, Kern,
Kings, Los Angeles, Madera, Riverside, San Bernardino, Stanislaus, Sutter, and Tulare in
California and Pinal in Arizona.

Key Findings
Cleanest Places to Live

Many cities in the U.S. enjoy air that is considered clean for one or more of the pollution
measures tracked in “State of the Air.” In this year’s report, 59 of the cities for which
there is monitoring data had zero high short-term particle days and 80 cities had zero
ozone days. Because year-round particle pollution is scored differently, the cleanest
cities for this measure can be ranked, and the best 25 are considered cleanest. See
Data Tables 3a-c.
Seven cities rank on all three cleanest cities lists for particle pollution and ozone. They
had zero days high in particle pollution or ozone and are among the 25 cities with the
lowest year-round particle levels. Added to the list this year are Asheville and Greenville,
NC and Rochester NY. The other four repeat their appearance on the list this year. Elmira
NY, Burlington VT and Charlottesville, Harrisonburg, Roanoke and Virginia Beach, VA all
lost their place on this year’s cleanest list because of increases in either short-term or
annual particle pollution.
Listed alphabetically, the cleanest cities are:
■ Asheville-Marion-Brevard, NC
■ Bangor, ME
■ Greenville-Kinston-Washington, NC
■ Lincoln-Beatrice, NE
■ Rochester-Batavia-Seneca Falls, NY
■ Urban Honolulu, HI
■ Wilmington, NC

H e a l t h I m p a c t of A i r Po l l u t i o n
Health Effects of Years of scientific research

H e a l t h Ihave
m p a cclearly
t of A i r established
Po l l u t i o n that particle pollution and ozone
are a threat to human health at every stage of life, increasing the risk of premature
Air Pollution birth, causing or worsening lung and heart disease, and shortening lives. Some
groups of people are more at risk of illness and death than others, because they are
more likely to be exposed, or are more vulnerable to health harm, or often both.
Health Effects of Particle Pollution

Particle pollution—also known as particulate matter—is a deadly and growing threat to
public health in communities around the country. The more researchers learn about the
health effects of particle pollution, the more dangerous it is recognized to be.
What is particle pollution?

Particle pollution refers to a mixture of tiny bits of solids and liquids in the air we breathe.
Particle pollution comes from many sources. Factories, power plants, and diesel- and
gasoline-powered motor vehicles (cars, trucks and buses) and equipment either directly
emit fine particles or generate other pollutants such as nitrogen oxides (NOx), known
as precursors because they can then form into fine particles in the atmosphere. Other
sources of particle pollution include wildfires, burning wood in wood stoves or residential
fireplaces and burning biomass for electricity.
Individual particles may be too small as to be visible, but when pollution levels are high,
they can make the air appear thick and hazy. Researchers and regulators categorize
particles according to size, grouping them as coarse, fine and ultrafine. Coarse particles,
called PM10, can include wind-blown dust, ash, pollen and smoke. Fine particles, PM2.5,
are most often a by-product of burning wood or fossil fuels. The tiniest are called
ultrafine particles, or PM0.1, which are also produced by combustion.
The differences in size make a big difference in how particles affect our health. Our
bodies’ natural defenses help us to keep the coarse particles we inhale out of the
deepest parts of our lungs, although these particles do deposit in the larger airways.
However, those defenses do not keep smaller fine or ultrafine particles from penetrating
all the way into the air sacs of the lungs. Many of these particles get trapped in the
air sacs, while the smallest are so tiny that they can pass from the air sacs into the
bloodstream and disperse to other organs of the body.

What can particles

H e ado top ayour
lth Im c t of Ahealth?
i r Po l l u t i o n
Particle pollution can be very dangerous to breathe, especially at higher concentrations.

It can trigger illness, hospitalization and premature death. Researchers estimate that
PM2.5 is responsible for nearly 48,000 premature deaths in the United States every year.1
Short-Term Exposure
Short-term spikes in particle pollution that last from a few hours to a few days can kill.
Premature deaths from breathing these particles can occur on the very day that particle
levels are high, or up to a month or two afterward. Most premature deaths are from
respiratory and cardiovascular causes. Particle pollution does not just make people die
a few days earlier than they might otherwise—in many cases these deaths would not
have occurred for years if the air were cleaner.2
Studies linking short-term exposure to PM2.5 to death from all causes have been
accumulating for a number of years. Taken together, this body of research provides
consistent evidence of positive associations between particle pollution and mortality
across diverse geographic locations and in populations with a wide range of
demographic characteristics. In 2019, an international study in 499 cities across the
globe reinforced these consistent findings.3
Even low daily levels of fine particles can be deadly. Looking nationwide in a 2017 study,
researchers found that older adults faced a higher risk of premature death even when
levels of short-term particle pollution remained well within the current national standards.
This was consistent whether the older adults lived in cities, suburbs or rural areas.4
Another study published in 2018 analyzed mortality data from 135 U.S. cities and found a
causal relationship with exposure to PM2.5 at concentrations below the federal standard.5
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;6
■ increased hospital admissions for cardiovascular disease, including heart attacks and
strokes;7
■ increased hospital admissions and emergency department visits for chronic
obstructive pulmonary disease (COPD);8
■ increased severity of asthma attacks and hospitalization for asthma among
children.9,10

Year-Round Exposure
Decades of research have firmly established that breathing particle pollution day in and
day out can also be deadly. Across numerous seminal studies that looked at different
groups of people living in different parts of the country, the results consistently showed
a clear relationship between long-term exposure to particulate matter and mortality.11
Recent research using publicly available data on a cohort of more than million adults
in the U.S. reconfirmed that long-term exposure to PM2.5 was associated with elevated
risks of early death. The increased risk was primarily associated with death from
cardiovascular and respiratory causes, including heart disease, stroke, influenza and
pneumonia. Researchers also found a similar association between exposure to fine
particle pollution and an increased risk of death from lung cancer among never-
smokers.12 Another study of 68.5 million Medicare-enrolled adults in the United States
between 2000 and 2016 found a 6-8% increase in risk of all-cause mortality for every
10µg/m3 increase in PM2.5.13
Research has also linked year-round exposure to particle pollution to a wide array of
serious health effects at every stage of life, from conception through old age. Among
pregnant people, fetuses and children, long-term particle pollution exposure is linked to:
■ Increased risk of preterm birth and low birth weight;14
■ Increased fetal and infant mortality;15
■ Impaired neurological development and cognition;16
■ Reduced lung development and impaired lung function in children;17
■ Higher likelihood of children developing asthma.18
In adults, long-term particle pollution exposure is linked to:

■ Increased risk from existing cardiovascular and respiratory disease, including a
worsening of heart disease, atherosclerosis and COPD;19,20
■ Higher likelihood of developing diabetes and subsequent complications;21,22
■ Higher likelihood of getting lung cancer and of dying from it;23
■ Impaired cognitive functioning and an increased risk of Parkinson’s disease,

Alzheimer’s disease and other dementias later in life.24,25
The good news is, cleaning up particle pollution makes a difference . Research has
shown a consistent relationship between decreasing PM2 .5 concentrations and
improving respiratory health in children and adults in communities that have reduced
their levels of year-round particle pollution .26
Who is most at risk from particle pollution?

Anyone who lives where particle pollution levels are high is at risk . Some people face
greater risk, however, based on their underlying health and other characteristics . [See
the People at Risk section for more information about vulnerable groups] Research
has shown that the groups at the greatest risk from particle pollution include:
■ Pregnant people and fetuses;27
■ Infants, children and older people (>65 years of age);28
■ People with lung disease, especially asthma, but also people with COPD;29
■ People with cardiovascular disease;30
■ People with lung cancer;31
■ People of color;32
■ Current or former smokers;33
■ People with low incomes;34 and
■ People who are obese or have diabetes.35

Health Effects of Ozone Pollution
Ozone air pollution, sometimes known as smog, is one of the most widespread
pollutants in the United States. It is also one of the most dangerous. Scientists have
studied the effects of ozone on human health for decades. Hundreds of studies have
confirmed that ozone harms people at levels currently found in many parts of the United
States.
What is Ozone?
Ozone is a gas composed of molecules with three oxygen atoms. (The oxygen we
need for life is made up of molecules with two oxygen atoms). Ozone forms in the
lower atmosphere when a combination of other pollutants, usually nitrogen oxides
(NOx) and volatile organic compounds (VOCs), “cook” together in sunlight through a
series of chemical reactions. NOx and VOCs are produced primarily when fossil fuels
such as gasoline, diesel, oil, natural gas or coal are burned or when solvents and some
other chemicals evaporate. NOx is emitted from power plants, motor vehicles and other
sources of high-heat combustion. VOCs are emitted from motor vehicles, oil and gas
operations, chemical plants, refineries, factories, gas stations, paint, consumer products
and other sources.
If these ingredients are present under the right conditions, they react to form ozone.
Sunlight is key, with higher temperatures increasing ozone production. Because the
reactions take place in the atmosphere, ozone often shows up downwind of the sources
of the original emissions, sometimes many miles from where it formed.
Ozone air pollution is sometimes called ground-level ozone, to distinguish it from the
much higher-altitude stratospheric ozone layer that protects the Earth from damaging
ultraviolet rays from the sun.
What Can Ozone Pollution Do to Your Health?

Ozone gas is a powerful lung irritant. When it is inhaled into the lungs, it reacts with the
delicate lining of the airways, causing inflammation and other damage that can impact
multiple body systems. Ozone exposure can also shorten lives.
Ozone has a serious effect on the respiratory system, both in the short term and over
the course of years of exposure. When ozone levels are high, many people experience
breathing problems such as chest tightness, coughing and shortness of breath,
often within hours of exposure. Even healthy young adults may experience respiratory
symptoms and decreased lung function.36
Other breathing problems that have been tied to short-term exposure to ozone include:
■ Worsening of symptoms, increased medication use, and increased emergency
department visits and hospital admissions for people with asthma and COPD;37
■ Susceptibility to respiratory infections such as pneumonia, resulting in an increased
likelihood of emergency department visits and hospitalizations.38

H e a l t long
Living with ozone pollution h I m pterm
a c t of A i r cause
may Po l l u t i o n
lasting damage to respiratory health,
including:
■ Development of new cases of asthma in children;39
■ Damage to the airways, leading to development of COPD;40
■ Increased allergic response.41
The inflammation and systemic stress caused by short- and long-term exposure to
ozone can also do damage to tissues, DNA and proteins throughout the body, which
can cause or worsen other disease conditions over time. These include:
■ Increased risk of metabolic disorders, including glucose intolerance, hyperglycemia
and diabetes;42
■ Impact on the central nervous system, including brain inflammation, structural
changes and increased risk of cognitive decline;43,44
■ Increased likelihood of reproductive and developmental harm, including reduced
fertility, preterm birth, stillbirth and low birth weight;45,46
■ Possible cardiovascular effects.47
The damage ozone does to the body can be deadly. Recent research has affirmed
earlier findings that short-term exposure to ozone, even at levels below the current
standard, likely increases the risk of premature death, particularly for older adults.48
There is also a growing body of evidence that long-term exposures to ambient ozone
may be associated with an increased risk of cardiovascular and respiratory disease
mortality.49
Who is Most at Risk from Ozone Pollution?

Anyone who spends time outdoors where ozone pollution levels are high may be at risk .
Some people face a higher-than-average risk, however, because of their underlying
health and other characteristics . [See the People at Risk section for more information
about vulnerable groups .] Research has shown that the groups at greatest risk from
ozone pollution include:
■ Pregnant people and fetuses;50
■ Children;
■ Anyone 65 and older;
■ People with existing lung disease such as asthma and COPD;
■ People who work or exercise outdoors.51
Air Pollution and COVID-19

Both ozone and particle pollution can impact the functioning of the immune
system and increase susceptibility to respiratory infections. Air pollution
also increases the risk of chronic lung and cardiovascular diseases that
put people at higher risk of poor outcomes from COVID-19. It should come
as no surprise then, that since the pandemic began, a growing body of
research has found an association between exposure to air pollution and
an increased risk of severe illness and death from COVID-19. Short-term
exposure to both ozone and PM2.5 has been shown to increase the risk of
death among infected individuals.52 Long-term exposure to air pollution also
appears to leave people more vulnerable to severe disease outcomes. A
2022 study in California found that people living in the most polluted areas
of the state had a 20% higher risk of infection and a 51% higher risk of death
than residents in the least polluted areas.53


People at Risk
The health burden of air pollution is not evenly shared. Some people are more at risk of
illness and death from air pollution than others. Several key factors affect an individual’s
level of risk:
■ Exposure—Where someone lives, where they go to school and where they work
make a big difference in how much air pollution they breathe. In general, the higher
the exposure, the greater the risk of harm.
■ Susceptibility—Pregnant people and their fetuses, children, older adults and people
living with chronic conditions, especially heart and lung disease, may be physically
more susceptible to the health impacts of air pollution than other adults.
■ Access to healthcare—Whether or not a person has health coverage, a healthcare
provider, and access to linguistically and culturally appropriate health information may
influence their overall health status and how they are impacted by environmental
stressors like air pollution.
■ Psychosocial stress—There is increasing evidence that non-physical stressors
such as poverty, racial/ethnic discrimination and fear of deportation can amplify the
harmful effects of air pollution.
These risk factors are not mutually exclusive and often interact in ways that lead to
significant health inequities among subgroups of the population. Taken all together,
these high risk categories account for a large proportion of the U.S. population.
People of color
Research has shown that people of color are more likely to be exposed to air pollution
and more likely to suffer harm to their health from air pollution than white people.54,55
Much of this inequity can be traced to the long history of systemic racism in the United
States. Practices such as redlining, the discriminatory outlining of so-called “riskier”
neighborhoods by mortgage lenders, institutionalized residential segregation in the
20th century, impairing the ability of many people of color to build wealth and limiting
their mobility and political power. Over the years, decision-makers have found it easier
to place sources of pollution, such as power plants, industrial facilities, landfills and
highways, in economically disadvantaged communities of color than in more affluent,
predominantly white neighborhoods. The resulting disproportionate exposure to air
pollution has contributed to high rates of emergency department visits for asthma and
other diseases.56,57
People of color are also more likely than white people to be living with one or more
chronic conditions that make them more susceptible to the health impact of air pollution,
including asthma, diabetes and heart disease.58
People experiencing poverty

There is evidence that having low income or living in lower income areas puts people
at increased risk from air pollution, although the correlation is not as strong as with
race and ethnicity.59,60 People living in poverty are more likely to live in close proximity
to sources of pollution and have fewer resources to relocate than people with more
financial security.61 Poverty itself, along with the problems that beset many low-income
communities, such as lack of safety, green space, and high-quality food access, have
been associated with increased psychosocial distress and chronic stress, which in
turn make people more vulnerable to pollution-related health effects.62 People with
low income also have lower rates of health coverage and less access to quality and
affordable health care to provide relief to them when they get sick.

Children H e a l t h I m p a c t of A i r Po l l u t i o n
Children are both more susceptible to harm from air pollution and more likely to be
exposed than adults. The growth and development of a child’s lungs and breathing
ability start in utero and continue into early adulthood. Long-term exposure to particle
pollution during pregnancy and early childhood has been linked to reduced lung
growth and long-term exposure to ozone has been linked to increased potential for
the development of asthma. The developing brain and heart may also be affected, with
life-long consequences.63 In addition, the body’s defenses that help adults fight off
infections are still developing in children. Children have more respiratory infections than
adults, which also seems to increase their susceptibility to air pollution.64
Children breathe more rapidly and inhale more air relative to their size than do adults. They
are more likely to spend time outdoors, running around, being active and breathing hard.
Consequently, they are more exposed to polluted outdoor air than adults typically are.
Older adults
Much of the illness and premature death caused by air pollution occurs in older adults,
who are at increased risk of harm for several reasons. As a person ages, the normal
process of thinning and weakening of the lung tissue and the supporting muscle and
bones of the ribcage results in diminishing lung function over time. The impairment that
results from exposure to air pollutants then has an add-on effect, putting stress on the
lungs and heart. Older people are also more likely to be living with chronic diseases,
and there is evidence that co-existing chronic lung, heart or circulatory conditions may
worsen following exposure to environmental pollutants.65
The strength of the immune system also declines with age, leaving older people at
greater risk of contracting infections and less able to get them under control before they
become serious. Because exposure to air pollution increases susceptibility to respiratory
infections, it also increases the risk of severe illness and death in older adults.
People with underlying health conditions

For the millions of people in the U.S. living with illnesses such as asthma, COPD,
diabetes, heart disease and lung cancer, exposure to air pollution places them at greater
risk of harm to their health than those without disease. The cellular injury and systemic
inflammation triggered by breathing ozone and particle pollution put additional stress
on people’s lungs, heart and other organs already compromised by disease. This can
result in a worsening of symptoms, increased medication use, more frequent emergency
department visits and hospitalizations, an overall reduced quality of life and far too often
premature death.
Pregnant people and fetuses

Pregnancy is always a susceptible time for both the mother and the developing fetus.
The pregnant body undergoes dramatic physiological changes in hormone levels,
metabolism and circulation throughout months of gestation. The rapid and complex
development of the fetus is a precisely timed and sequenced process. The inflammation
and oxidative stress resulting from exposure to air pollution during pregnancy can
increase the risk of hypertensive disorders, including preeclampsia, in the mother and
lead to intrauterine inflammation and damage to the placenta that can disrupt the
growth and development of the fetus. Fetal health may also be impacted in a number of
ways by environmental contaminants that have been shown to cross the placenta.66
Exposure to both ozone and particle pollution during pregnancy is strongly associated
with premature birth, low birth weight and stillbirth. These risks are amplified in
pregnancies where the mother is already at higher risk, such as people of color and
those chronic conditions, especially asthma.67

People with a smoking

H e a l t h I mhistory
p a c t of A i r Po l l u t i o n
There is some recent evidence suggesting that current and former smokers are at
greater risk of health harm from exposure to fine particle pollution compared with never-
smokers. They are more likely to develop lung cancer and to die prematurely.68 Smoking
damages the lungs, heart, blood vessels and other organs.69 This impairment leaves the
person with a smoking history more vulnerable to the health impact of air pollution than
a never-smoker.
Endnotes
1 Health Effects Institute. State of Global Air. Boston, MA. 2020.
2 U.S. EPA. Integrated Science Assessment for Particulate Matter. December 2019 EPA/600/R-19/188. Section 11.1.
3 Liu C, Chen R, Sera RF, Vicedo‑Cabrera AM, Guo Y, Tong S, Coelho MSZS, Saldiva PHN, Lavigne E, Matus P, Valdes Ortega PN, Osorio
Garcia S, Pascal M, Stafoggia M, Scortichini M, Hashizume M, Honda Y, Hurtado‑Diaz M, Cruz J, Nunes B, Teixeira JP, Kim H,
Tobias A, Íñiguez C, Forsberg B, Åström C, Ragettli MS, Guo Y-L, Chen B-Y, Bell ML, Wright CY, Scovronick N, Garland RM,
Milojevic A, Kyselý J, Urban A, Orru H, Indermitte E, Jaakkola JJK, Ryti NRI, Katsouyanni K, Analitis A, Zanobetti A, Schwartz J,
Chen J, Wu T, Cohen A, Gasparrini A, and Kan H. Ambient Particulate Air Pollution and Daily Mortality in 652 Cities. N Engl J Med.
2019; 381(8):705-15.
4 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.
5 Schwartz J, Fong K and Zanobetti A. A national multicity analysis of the causal effect of local pollution, NO2, and PM2.5 on mortality.
Environ Health Perspect. 2018; 126(8): 087004-1- 087004-10.
6 U.S. EPA. 2019, Section 9.1.2.6.
7 U.S. EPA. 2019, Section 6.1.2.
8 U.S. EPA. 2019, Section 5.1.2.1.1.
9 U.S. EPA. 2019, Section 5.1.2.1.
10 U.S. EPA. 2019, Section 5.1.2.2.1.
11 U.S. EPA. 2019, Section 11.2.
12 Pope CA, Lefler JS, Ezzati M, Higbee JD, Marshall JD, Kim S, Bechle M, Gilliat KS, Vernon SE, Robinson AL, Burnett RT. Mortality risk and
fine particulate pollution in a large, representative cohort of U.S. Adults. Environ Health Perspect. 2019; 127(7):077007-1-077007-
9.
13 Dominici F, Zanobetti A, Schwartz J, Braun D, Sabath B, Wu X. Assessing Adverse Health Effects of Long-Term Exposure to Low Levels
of Ambient Air Pollution: Implementation of Causal Inference Methods. Health Effects Institute. 2022; Research Report 211.
14 Bekkar B Pacheco S, Basu R, DeNicola N_Association of air pollution and heat exposure with preterm birth, low birth weight and
stillbirth in the U.S.: A systemic review. JAMA Network Open. 2020; 3(6):e208243.
15 Bekkar B et al. 2020.
16 Ni Y, Loftus CT, Szpiro AA, Young MT, Hazlehurst MF, Murphy LE, Tylavsky FA, Mason WA, LeWinn KZ, Sathyanarayana S, Barrett ES,
Bush NR, Karr CJ. Associations of pre- and postnatal air pollution exposures with child behavioral problems and cognitive
performance: A U.S. multi-cohort study. Environ Health Perspect. 2022; 130(6).
17 U.S. EPA. 2019, Section 5.2.2.2.1.
18 U.S. EPA. 2019, Section 5.2.3.1.
19 U.S. EPA. 2019, Section 6.2.2.
20 U.S. EPA. 2019, Section 5.2.5.
21 Bowe B, Xie Y, Li T, Yan Y, Xian H, Al-Aly Z. The 2016 global and national burden of diabetes mellitus attributable to PM2.5 air pollution.
Lancet Planet Health. 2018; 2:e301-12.
22 Wu Y, Zhang S, Qian SE, Cai M, Li H, Wang C, Zou H, Chen H, Vaughn MG, McMillin SE and Lin H. Ambient air pollution associated with
incidence and dynamic progression of type 2 diabetes: a trajectory analysis of a population‑based cohort. BMC Med. 2022;
20:375.
23 U.S. EPA, 2019. Section 10.2.5.1.
24 Kilian J and Kitazawa M. The emerging risk of exposure to air pollution on cognitive decline and Alzheimer’s disease -- evidence from
epidemiological and animal studies. Biomed J. 2018; 41:141-162.
25 Shi L, Wu X, Danesh Yazdi M, Braun D, Abu Awad Y, Wei Y, Liu P, Di Q, Wand Y, Schwartz J, Dominici F, Kioumourtzoglou M-A, Zanobetti
A. Long-term effects of PM2.5 on neurological disorders in the American Medicare population: a longitudinal cohort study. Lancet
Planet Health. 2020; 4:e557-65.
26 U.S. EPA. 2019, Section 5.2.11.
28 U.S. EPA. 2019, Section 12.5.1.1.
29 U.S. EPA. 2019, Section 12.3.5.
30 U.S. EPA. 2019, Section 12.3.1.
31 U.S. EPA. 2019, Section 10.2.5.1.
32 U.S. EPA. 2019, Section 12.5.4.
33 U.S. EPA. 2019, Section 12.6.1.
34 U.S. EPA. 2019, Section 12.5.3.
35 U.S. EPA. 2019, Section 12.3.3.
36 U.S.EPA. Integrated Science Assessment for Ozone and Related Photochemical Oxidants. April 2020. EPA/600/R-20/012. Section
3.1.4.1.
37 U.S. EPA. 2020, Sections 3.1.5 and 3.1.6.
38 U.S. EPA. 2020, Section 3.1.7.
39 U.S. EPA. 2020, Section 3.2.4.1.
40 U.S. EPA. 2020, Section 3.2.4.3.
41 U.S. EPA. 2020, Section 3.2.4.6.
42 U.S. EPA. 2020, Section 5.1.3.
43 U.S. EPA. 2020, Sections 7.2.1 and 7.2.2.
44 Gao Q, Zang E, Bi J, Dubrow R, Lowe SR, Chen H, Zeng Y, Shi L, Chen K. Long-term ozone exposure and cognitive impairment among
Chinese older adults: A cohort study. J Env Int. 2022; 160:107072.
45 U.S. EPA. 2020, Section 7.1.3.

46 Mendola P, Ha S, Pollack AZ, ZhuH Y,eSeeni

a l t hI, Kim
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PoD.l l Chronic
u t i o n and acute ozone exposure in the week prior to delivery
is associated with risk of stillbirth. Int J Environ Res Pub Health. 2017; 14:731.
47 U.S. EPA. 2020, Sections 4.1 and 4.2.
48 Di et al. 2017.
49 Lim CC, Hayes RB. Ahn J, Shao Y, Silverman DT, Jones RR, Garcia C, Bell ML, Thurston GD. Long-term exposure to ozone and cause-
specific mortality risk in the United States. Am J Respir Crit Care Med. 2019; 200(8):1022–1031.
51 U.S. EPA. 2020, Section IS.4.4.
52 Kim H, Samet, JM, Bell ML. Association between short-term exposure to air pollution and COVID-19 mortality: A population-based
case-crossover study using individual-level mortality registry confirmed by medical examiners. Environ Health Perspect. 2022;
130(1).
53 English PB, Von Behren J, Balmes JR, Boscardin J, Carpenter C, Goldberg DE, Horiuchi S, Richardson M, Solomon G, Valle J, Reynolds
P. Association between long-term exposure to particulate air pollution with SARS-CoV-2 infections and COVID_19 deaths in
California, U.S.A. Environ Advances. 2022; 9:100270.
54 U.S. EPA. 2019, Section 12.5.4.
55 Liu J, Clark LP, Bechle MJ, Hajat A, Kim S-Y, Robinson AL, Sheppard L, Szpiro AA, Marshall JD. Disparities in air pollution exposure in the
United States by race/ethnicity and income, 1990–2010. Environ Health Perspect. 2021; 129(12).
56 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.
57 Erqou S, Clougherty JE, Olafiranye O, Magnani JW, Aiyer A, Tripathy S, Kinnee E, Kip KE, Reis SE. Particulate Matter Air Pollution and
Racial Differences in Cardiovascular Disease Risk. Arterioscler Thromb Vasc Biol. 2018; 38:00-00.
58 Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 2019. Analysis
performed by the American Lung Association Epidemiology and Statistics Unit using SPSS software.
59 U.S. EPA. 2019, Section 12.5.3.
60 Liu et al. 2021.
61 Mikati I, Benson AF, Luben TJ, Sacks JD, Richmond-Bryant J. Disparities in Distribution of Particulate Matter Emission Sources by Race
and Poverty Status. Am J Public Health. 2018; 108(4):480–485.
62 Kioumourtzoglou M-A, 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(2):221-7.
63 U.S. EPA. 2019, Section 9.1.3.
64 Johnson NM, Hoffmann AR, Behlen JC, Lau C, Pendleton D, Harvey N, Shore R, Li Y, Chen J, Tian Y, Zhang R. Air pollution and children’s
health—a review of adverse effects associated with prenatal exposure from fine to ultrafine particulate matter. Environ Health
Prev Med. 2021; 26:72.
65 Simoni M, Baldacci S, Maio S, Cerrai S, Sarno G, Viegi G. Adverse Effects of Outdoor Pollution in the Elderly. J Thorac Dis. 2015; 7(1):34-
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66 Klepak P, Locatelli I, Korošec S, Künzli N, Kukec A. Ambient air pollution and pregnancy outcomes: a comprehensive review. Environ
Research. 2018; 167:144-159. and identification of environmental public health challenges
68 U.S. EPA. 2019, Section 12.6.1.
69 U.S. Department of Health and Human Services. The Health Consequences of Smoking - 50 Years of Progress: A Report of the
Surgeon General. 2014.

Recommendations We need action at every level to clean up air pollution and address climate change.
for Action
Individuals
You can take action to protect yourself and your family from the dangers of air pollution.
Regardless of its grade or ranking in this report, any community can experience days
with unhealthy levels of air pollution. Some simple precautions will reduce your risk:
■ Check daily air pollution forecasts in your area at airnow.gov. The color-coded
forecasts let you know when the air is unhealthy in your community. When the air is
bad, move your exercise plans and other activities indoors. If you live in a fire-prone
area, learn more about using N-95 masks and creating a clean room inside your
home with our wildfire resources at Lung.org/wildfire.
■ Reduce your own contributions to air pollution. Prioritize walking, biking and public
transit over diesel or gasoline-powered vehicles. Conserve electricity and purchase
your power from clean, non-combustion sources if you can. Don’t burn leaves or
trash and avoid burning wood whenever possible.
■ Consider taking advantage of tax incentives to reduce emissions from your home
and vehicle. One of the best ways to reduce pollution is to switch from vehicles
and appliances that burn fuel—like gasoline-powered cars and natural gas stoves
and furnaces—to zero-emission versions that run on electricity. Under the Inflation
Reduction Act passed in 2022, you may be able to get tax credits for buying a new
or used electric vehicle or for upgrading your home with efficient, zero-emissions
appliances like induction stoves or heat pumps.
Poor air quality is often associated with public health impacts, such as
asthma and heart disease. Joanne Kilgour says while protecting people’s
health must be a priority, it’s important to not overlook the economic effects
of air pollution.
“It’s hard to attract new industry to a place where you can’t promise
employees their children will be free of asthma or enjoy the outdoors without
the threat of an air quality action day,” says Kilgour, executive director of the
Ohio River Valley Institute, a nonprofit focused on the greater Ohio Valley and
Western Pennsylvania.
Her region has some of the country’s worst air quality year after year, she
says. That limits the time people spend outdoors in an area where recreation
can be a powerful economic driver, she adds.
Kilgour says decarbonization is key to reducing emissions and air pollution,
with opportunities to leverage investments in fossil-free steel production as
an example of strategies that can make a difference.
“There’s a broad understanding that the status quo isn’t serving families and
residents in the community,” she says.
Joanne Kilgour
Executive Director, Ohio River Valley Institute

Local Governments
Local governments have the power to help ensure that city and county operations
are zero-emission and that residents have the ability to choose zero-emission forms
of transportation and electricity. These actions must benefit the communities most
impacted by unhealthy air.
■ Adopt a climate action plan. Reduce city- and county-wide emissions by supporting
walking, biking and transit and zero-emission-vehicle infrastructure and ensuring that
building and parking policies support these goals. Include measures to address the
impacts of climate change on residents, including health impacts. Under the Inflation
Reduction Act, municipalities can opt in to get planning grant funding to reduce
climate pollution.
■ Purchase zero-emission fleet vehicles. Commit to purchasing zero-emission
garbage and recycling trucks, transit buses, school buses and other vehicles.
■ Establish purchasing goals for renewable, non-combustion electricity. Power
city and county operations with truly clean sources of electricity like wind, solar,
geothermal or tidal.
Providing more options for transit can help reduce traffic and air pollution. As
part of the Metro’s Silver Line extension in Virginia last year, Fairfax County
added about 4,000 parking spaces in two garages to make the rapid transit
line more convenient.
Martha Coello, Special Projects Division Chief at the Fairfax County
Department of Transportation, says Park and Rides are a convenient way for
people to use public transportation for more than just commuting to work.
“People are looking at these facilities to make transit more accessible and
allow them to avoid driving to downtown D.C. for a show or a nice dinner on
a Friday,” Coello says. “There’s a good, interconnected impact in that it does
take cars off the road which helps air quality.”
The Silver Line extension included three new stations, enhanced bus service,
and pedestrian and bicycle improvements. Coello says having infrastructure
that makes it comfortable for people to access different modes is key to
encouraging public transportation use.
“It’s all about giving people options,” she says.
Martha Coello
Special Projects Division Chief, Fairfax County Department of
Transportation

State, Territorial and Tribal Governments

■ Set a clean or renewable electricity standard or clean peak standard that phases
out the use of coal, oil, methane gas (often called natural gas) and other combustion
energy sources and replaces it with wind, solar, geothermal and tidal and other non-
combustion forms of electricity. Do not allow for the increased use of biomass or
municipal solid waste for electricity because of their contributions to particle pollution.
■ Leverage Inflation Reduction Act funding available to state, territorial and Tribal
governments to reduce emissions, including reducing air pollution at ports, investing
in zero-emission heavy-duty vehicles and infrastructure and improving air quality
monitoring. Ensure that environmental justice communities that have long borne the
brunt of pollution impacts are prioritized.
■ States: Use Clean Air Act authority to adopt the California zero-emissions
standards for cars and trucks. These include California’s Low-Emission Vehicle
criteria pollutant and greenhouse gas regulations; Zero-Emission Vehicle regulations;
and Advanced Clean Trucks regulations.
Federal Government
The passage of the 2022 Inflation Reduction Act was a major victory, providing major
investments to reduce air pollution and address climate change that federal agencies
are now dolling out. However, these investments are only half the battle. Federal
agencies must also finalize strong limits on air pollution to truly protect public health and
advance environmental justice.
The Biden administration is behind on its clean air to-do list and must urgently pick up
the pace by moving on key clean air regulatory priorities. Go to Lung.org/sota to take
action now. Key priorities include:
.
■ EPA must set stronger national standards for particulate matter and ozone. For
particulate matter, the research shows that the new standard should be set at 8
micrograms per cubic meter annually, and 25 micrograms per cubic meter daily, to
protect those at greatest risk of harm. For ozone, the research shows that a standard
of no higher than 60 parts per billion would protect health. Not only will stronger
standards drive cleanup of polluting sources nationwide, they will also mean that
families across the country are better informed about when their local air quality may
put their health at risk.

■ EPA must clean up power plant pollution. EPA has proposed tighter limits on mercury
and air toxics from power plants and must see them across the finish line. This action
is critical for communities with a coal- or oil-fired plant nearby that emit dangerous
pollutants, harming health. EPA must also propose and finalize rules to limit carbon
emissions from the power sector, including for coal, oil and natural gas-fired power
plants.
■ Federal agencies must further limit pollution from the oil and gas industry. EPA must
finalize strong rules that dramatically limit emissions of methane and other harmful
air pollutants from the oil and gas industry. Additionally, burning methane gas in
appliances in homes contributes to outdoor air pollution and has harmful health
impacts indoors, especially for kids with asthma. EPA, the Consumer Product Safety
Commission and the Department of Energy must set standards improving the
efficiency of these appliances and continue to foster a transition to zero-emission,
electric appliances wherever possible.
■ The U.S. Congress must pass funding bills that adequately invest in clean air
protections, including increased funding for EPA to set and enforce these lifesaving
rules and to pass along to state, local and Tribal air agencies to monitor and clean up
harmful air pollution.

Data Tables
Understanding Grades and Tables

See Methodology for a full explanation of data sources and calculations made for state grades.
Notes for state grades tables Notes for at-risk groups tables
1. Not all counties have monitors for either ozone or particle pollution. 1. Total Population is based on 2021 U.S. Census and represents the
If a county does not have any monitors for either pollutant, that county’s at-risk populations in counties with ozone or PM2.5 pollution monitors;
name is not on the list in these tables. The decision about monitors in it does not represent the entire state’s sensitive populations.
the county is made by the state and the U.S. Environmental Protection 2. Those 18 & under and 65 & over are vulnerable to ozone and PM2.5.
Agency, not by the American Lung Association. Do not use them as population denominators for disease estimates—
2. INC (Incomplete) indicates that monitoring data is available for at least that will lead to incorrect estimates.
one year in that county, but not all three years. 3. Pediatric asthma estimates are for those under 18 years of age and
3. DNC (Data Not Collected) indicates that data on that particular represent the estimated number of people who had asthma in 2021
pollutant is not collected in that county. based on the state rates when available or national rates when not
4. The Weighted Average (Wgt. Avg) was derived by adding the three (Behavioral Risk Factor Surveillance System, or BRFSS), applied to
years of individual level data (2019-2021), multiplying the sums of county population estimates (U.S. Census).
each level by the assigned standard weights (i.e. 1=orange, 1.5=red, 4. Adult asthma estimates are for those 18 years and older and
2.0=purple and 2.5=maroon) and calculating the average. Grades are represent the estimated number of people who had asthma during
assigned based on the weighted averages as follows: A=0.0, B=0.3- 2021 based on state rates (BRFSS) applied to county population
0.9, C=1.0-2.0, D=2.1-3.2, F=3.3+. estimates (U.S. Census).
5. The Design Value is the calculated concentration of a pollutant based 5. COPD estimates are for adults 18 and over who had ever been
on the National Ambient Air Quality Standard for PM2.5, which is 12 µg/ diagnosed with chronic obstructive pulmonary disease, which
m3. Counties with design values of 12 or lower received a grade of includes chronic bronchitis and emphysema, based on state rates
“Pass” for Annual PM2.5. Counties with design values of 12.1 or higher (BRFSS) applied to county population estimates (U.S. Census).
received a grade of “Fail.” 6. Lung cancer estimates are for all ages and represent the estimated
number of people diagnosed with lung cancer in 2019 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. Pregnancy estimates are for females 18-49 and based on state rates
of pregnancies resulting in live births applied to 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, 2021. Puerto Rico poverty estimates come
from the U.S. Census Bureau’s American Community Survey, 2017-
2021.
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 2021
county population estimates (U.S. Census).
11. Adding across rows does not produce valid estimates. Adding the at-
risk categories (asthma, COPD, poverty, etc.) will double-count people
who fall into more than one category.

Data Tables
Table 1 Populations at Risk by Grade and by Pollutant
People at Risk from Short-Term Particle Pollution (Daily PM2.5)

Chronic Diseases Age Groups
Number
In Counties Where Adult Pediatric Lung CV 65 and People of Total of
the Grades Were: Asthma Asthma COPD Cancer Disease Under 18 Over Pregnancies Poverty Color Population Counties
Grade A (0.0) 3,894,015 792,057 2,807,694 29,095 3,628,440 10,837,393 9,154,039 565,400 6,646,761 20,912,987 51,591,902 201
Grade B (0.3-0.9) 5,116,583 1,078,252 3,419,289 37,373 4,272,816 15,139,596 10,708,528 767,317 8,606,513 31,296,133 67,897,198 181
Grade C (1.0-2.0) 2,585,150 564,739 1,728,708 19,539 2,209,878 7,926,089 5,307,917 408,543 4,658,924 16,617,212 35,012,717 87
Grade D (2.1-3.2) 729,612 157,009 445,360 4,931 588,034 2,337,256 1,529,864 112,989 1,340,205 4,488,927 9,866,872 33
Grade F (3.3+) 4,619,925 841,181 2,473,889 26,117 3,309,609 14,383,225 9,700,045 700,286 7,570,747 34,646,678 63,737,389 111
National Population
in Counties with
PM2.5 Monitors 17,228,739 3,496,135 11,063,041 119,108 14,245,688 51,507,725 37,004,318 2,596,848 29,278,409 109,299,287 231,900,896 641
People at Risk from Year-Round Particle Pollution (Annual PM2.5)

Number
In Counties Where Adult Pediatric Lung CV 65 and People of Total of
the Grades Were: Asthma Asthma COPD Cancer Disease Under 18 Over Pregnancies Poverty Color Population Counties
Pass 13,629,195 2,803,936 8,917,431 95,471 11,389,424 40,222,940 29,281,942 2,047,656 22,652,092 82,843,833 182,014,307 500
Fail 1,280,081 224,268 652,230 7,115 895,089 4,398,997 2,678,240 202,060 2,635,394
13,301,972 18,777,994 17
National Population
in Counties with
PM2.5 Monitors 17,228,739 3,496,135 11,063,041 119,108 14,245,688 51,507,725 37,004,318 2,596,848 29,278,409 109,299,287 231,900,896 641
People at Risk from Ozone

Number
In Counties Where Adult Pediatric CV 65 and People of Total of
the Grades Were: Asthma Asthma COPD Disease Under 18 Over Pregnancies Poverty Color Population Counties
Grade A (0.0) 3,724,203 792,445 2,845,405 3,672,420 10,712,467 9,381,259 540,232 6,327,648 17,412,682 50,782,442 302
Grade B (0.3-0.9) 3,124,597 639,568 2,159,751 2,730,778 8,927,874 6,907,495 452,681 4,949,087 15,649,867 41,003,492 170
Grade C (1.0-2.0) 2,624,418 508,597 1,628,445 2,101,592 7,271,049 5,474,479 361,246 3,617,690 12,040,309 33,049,011 117
Grade D (2.1-3.2) 1,251,042 255,556 842,334 1,070,194 3,498,280 2,579,481 186,076 2,008,450 7,710,616 16,189,161 40
Grade F (3.3+) 7,409,618 1,477,630 4,369,962 5,685,100 23,640,266 15,377,344 1,158,834 12,847,236 57,655,731 103,024,220 124
National Population
in Counties with
Ozone Monitors 18,265,858 3,702,154 11,937,305 15,378,430 54,420,489 40,027,698 2,717,094 29,973,254 110,838,705 245,723,508 782

Data Tables
Table 2a People at Risk in 25 U.S. Cities Most Polluted by Short-Term Particle Pollution (Daily PM2.5)
2023 Total 65 and Pediatric Adult Lung CV People
Rank Metropolitan Statistical Areas Population Under 18 Over Asthma Asthma COPD Cancer Disease Pregnancies of Color Poverty

1 Bakersfield, CA 917,673 263,402 104,638 13,139 57,795 27,903 346 37,178 9,412 632,525 164,169

2 Fresno-Madera-Hanford, CA 1,326,434 370,656 166,947 18,488 84,458 41,730 499 56,129 13,906 954,184 248,788

3 Fairbanks, AK 95,593 22,506 11,366 1,485 6,595 3,866 49 4,450 1,261 29,724 7,247
4 Visalia, CA 477,054 144,196 55,572 7,193 29,409 14,362 179 19,237 4,989 351,235 88,367
5 Reno-Carson City-Fernley, NV 667,301 137,452 127,206 10,813 48,769 37,703 330 44,392 6,657 241,209 69,983
6 San Jose-San Francisco-
Oakland, CA 9,545,921 2,028,372 1,520,400 101,177 665,484 346,398 3,589 482,268 101,021 6,071,450 909,294
7 Redding-Red Bluff, CA 247,637 55,298 51,533 2,759 17,057 9,749 93 14,037 2,248 62,837 35,248
8 Sacramento-Roseville, CA 2,697,399 608,540 445,410 30,355 184,931 97,656 1,013 136,361 28,177 1,325,731 317,925
9 Chico, CA 208,309 42,437 37,992 2,117 14,671 7,834 78 10,807 2,243 64,260 33,874
9 Los Angeles-Long Beach, CA 18,490,242 4,112,015 2,705,866 205,110 1,272,354 648,442 6,949 895,585 200,022 13,071,213 2,316,720
11 Yakima, WA 256,035 75,344 36,193 5,508 19,003 9,052 124 12,015 2,605 151,594 37,078

12 Eugene-Springfield, OR 383,189 68,642 78,561 4,771 35,390 19,103 180 25,578 3,785 74,138 53,989
13 Phoenix-Mesa, AZ 4,999,734 1,145,926 819,746 92,379 366,150 211,696 1,970 305,529 54,708 2,317,167 556,754
14 Spokane-Spokane Valley-
Coeur d'Alene, WA-ID 773,255 169,457 138,509 12,097 62,288 32,986 367 44,834 8,216 117,315 83,167

15 Missoula, MT 119,533 21,817 19,996 1,095 9,688 5,096 56 6,475 1,479 13,804 15,043
16 San Diego-Chula Vista-
Carlsbad, CA 3,286,069 698,371 489,101 34,835 228,821 115,946 1,237 158,242 35,582 1,848,397 340,522
17 Logan, UT-ID 152,083 45,387 15,795 2,542 10,555 4,465 43 5,738 2,254 24,513 15,911
18 Denver-Aurora, CO 3,642,145 785,279 504,471 51,802 299,680 139,933 1,383 154,061 40,646 1,297,572 316,593
19 Salt Lake City-Provo-Orem, UT 2,746,164 785,045 292,153 43,095 192,994 82,907 732 107,164 38,839 659,527 220,391
20 Pittsburgh-New Castle-
Weirton, PA-OH-WV 2,637,506 499,377 554,715 32,720 221,020 153,253 1,559 216,368 26,029 386,787 293,775
21 Boise City-Mountain Home-
Ontario, ID-OR 882,138 212,229 137,555 14,028 65,772 38,024 393 51,454 10,529 192,123 86,651

22 Fargo-Wahpeton, ND-MN 275,091 63,863 37,384 4,048 18,275 9,322 144 14,154 3,965 42,472 29,475
23 Salinas, CA 437,325 113,236 63,337 5,648 28,668 14,691 165 20,181 4,378 313,287 50,725
24 Lancaster, PA 553,652 129,256 104,237 8,421 44,025 28,838 325 40,807 5,542 108,092 47,460
25 Medford-Grants Pass, OR 312,080 63,156 74,256 4,389 27,924 16,607 146 22,984 2,601 59,577 44,396
Notes:
Cities are ranked using the highest weighted average for any county within that Combined Metropolitan Statistical Area or Metropolitan Statistical Area.
Adding across rows does not produce valid estimates. Adding the disease categories (asthma, COPD, etc.) will double-count people who fall into more than one category.

Data Tables
Table 2b People at Risk in 25 U.S. Cities Most Polluted by Year-Round Particle Pollution (Annual PM2.5)
2023 Total 65 and Pediatric Adult Lung CV People
Rank Metropolitan Statistical Areas Population Under 18 Over Asthma Asthma COPD Cancer Disease Pregnancies of Color Poverty

1 Bakersfield, CA 917,673 263,402 104,638 13,139 57,795 27,903 346 37,178 9,412 632,525 164,169

1 Visalia, CA 477,054 144,196 55,572 7,193 29,409 14,362 179 19,237 4,989 351,235 88,367
3 Fresno-Madera-Hanford, CA 1,326,434 370,656 166,947 18,488 84,458 41,730 499 56,129 13,906 954,184 248,788
4 Los Angeles-Long Beach, CA 18,490,242 4,112,015 2,705,866 205,110 1,272,354 648,442 6,949 895,585 200,022 13,071,213 2,316,720

5 Fairbanks, AK 95,593 22,506 11,366 1,485 6,595 3,866 49 4,450 1,261 29,724 7,247
6 Sacramento-Roseville, CA 2,697,399 608,540 445,410 30,355 184,931 97,656 1,013 136,361 28,177 1,325,731 317,925
7 San Jose-San Francisco-
Oakland, CA 9,545,921 2,028,372 1,520,400 101,177 665,484 346,398 3,589 482,268 101,021 6,071,450 909,294

7 Phoenix-Mesa, AZ 4,999,734 1,145,926 819,746 92,379 366,150 211,696 1,970 305,529 54,708 2,317,167 556,754
7 Medford-Grants Pass, OR 312,080 63,156 74,256 4,389 27,924 16,607 146 22,984 2,601 59,577 44,396
10 Indianapolis-Carmel-Muncie, IN 2,507,944 600,785 371,608 42,254 197,689 157,460 1,556 163,232 30,309 680,691 272,410
11 Yakima, WA 256,035 75,344 36,193 5,508 19,003 9,052 124 12,015 2,605 151,594 37,078
12 Detroit-Warren-Ann Arbor, MI 5,393,033 1,164,730 935,955 81,511 493,567 329,752 3,195 400,142 56,884 1,764,417 713,268
13 Chico, CA 208,309 42,437 37,992 2,117 14,671 7,834 78 10,807 2,243 64,260 33,874
14 Pittsburgh-New Castle-
Weirton, PA-OH-WV 2,637,506 499,377 554,715 32,720 221,020 153,253 1,559 216,368 26,029 386,787 293,775
15 Eugene-Springfield, OR 383,189 68,642 78,561 4,771 35,390 19,103 180 25,578 3,785 74,138 53,989
15 Augusta-Richmond County,
GA-SC 615,933 140,717 104,050 12,390 44,319 33,368 351 43,817 6,694 289,250 93,326
15 Houston-The Woodlands, TX 7,398,774 1,927,208 894,440 122,452 460,317 325,709 3,366 385,518 93,373 4,839,676 1,036,292
18 El Centro, CA 179,851 51,197 24,033 2,554 11,371 5,719 68 7,739 1,715 163,246 29,738
18 Cincinnati-Wilmington-
Maysville, OH-KY-IN 2,318,870 538,113 373,954 30,908 192,950 158,476 1,591 182,639 26,076 496,399 273,458
18 Birmingham-Hoover-
Talladega, AL 1,350,100 306,036 232,702 29,496 105,400 98,489 819 121,624 15,467 479,199 196,969

21 McAllen-Edinburg, TX 946,405 299,852 107,413 19,052 53,940 37,526 430 44,585 11,595 894,220 271,830
22 Louisville-Jefferson County--
Elizabethtown--Bardstown, KY-IN 1,512,785 339,875 251,417 18,500 134,917 122,682 1,209 131,898 17,569 371,818 184,842

23 Bend-Prineville, OR 230,540 44,762 48,596 3,111 20,980 11,841 108 15,935 2,053 31,515 20,737
23 Laredo, TX 267,945 85,427 26,695 5,428 15,224 10,370 122 12,044 3,287 258,388 59,771

23 Chicago-Naperville, IL-IN-WI 9,876,339 2,202,143 1,552,155 154,670 680,535 440,098 5,694 620,403 105,565 4,679,774
1,117,401
Notes:
Cities are ranked using the highest design value for any county within that Combined Metropolitan Statistical Area or Metropolitan Statistical Area.
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.

Data Tables
Table 2c People at Risk in 25 Most Ozone-Polluted Cities

2023 Total 65 and Pediatric Adult CV People
Rank Metropolitan Statistical Areas Population Under 18 Over Asthma Asthma COPD Disease Pregnancies of Color Poverty
1 Los Angeles-Long Beach, CA 18,490,242 4,112,015 2,705,866 205,110 1,272,354 648,442 895,585 200,022 13,071,213 2,316,720
2 Visalia, CA 477,054 144,196 55,572 7,193 29,409 14,362 19,237 4,989 351,235 88,367

3 Bakersfield, CA 917,673 263,402 104,638 13,139 57,795 27,903 37,178 9,412 632,525 164,169

4 Fresno-Madera-Hanford, CA 1,326,434 370,656 166,947 18,488 84,458 41,730 56,129 13,906 954,184 248,788
5 Phoenix-Mesa, AZ 4,999,734 1,145,926 819,746 92,379 366,150 211,696 305,529 54,708 2,317,167 556,754
6 Denver-Aurora, CO 3,642,145 785,279 504,471 51,802 299,680 139,933 154,061 40,646 1,297,572 316,593

7 Sacramento-Roseville, CA 2,697,399 608,540 445,410 30,355 184,931 97,656 136,361 28,177 1,325,731 317,925
8 San Diego-Chula Vista-Carlsbad, CA 3,286,069 698,371 489,101 34,835 228,821 115,946 158,242 35,582 1,848,397 340,522
9 Houston-The Woodlands, TX 7,398,774 1,927,208 894,440 122,452 460,317 325,709 385,518 93,373 4,839,676 1,036,292
10 Salt Lake City-Provo-Orem, UT 2,746,164 785,045 292,153 43,095 192,994 82,907 107,164 38,839 659,527 220,391
11 San Jose-San Francisco-Oakland, CA 9,545,921 2,028,372 1,520,400 101,177 665,484 346,398 482,268 101,021 6,071,450 909,294
12 New York-Newark, NY-NJ-CT-PA 23,216,685 4,946,442 3,913,804 314,901 1,788,239 1,000,958 1,337,984 250,084 12,213,038 2,870,717
13 El Centro, CA 179,851 51,197 24,033 2,554 11,371 5,719 7,739 1,715 163,246 29,738
14 El Paso-Las Cruces, TX-NM 1,092,742 283,266 147,908 17,962 71,440 46,479 56,620 13,159 935,784 214,015
15 Las Vegas-Henderson, NV 2,345,926 529,254 370,191 41,638 168,013 121,877 141,494 25,489 1,395,591 349,176
15 Fort Collins, CO 362,533 68,005 61,379 4,486 30,662 14,940 16,910 4,105 67,328 39,476

17 Chicago-Naperville, IL-IN-WI 9,876,339 2,202,143 1,552,155 154,670 680,535 440,098 620,403 105,565 4,679,774 1,117,401
18 Dallas-Fort Worth, TX-OK 8,255,035 2,083,340 1,018,460 132,756 521,173 370,988 440,083 105,121 4,500,196 906,907
19 Reno-Carson City-Fernley, NV 667,301 137,452 127,206 10,813 48,769 37,703 44,392 6,657 241,209 69,983
20 Colorado Springs, CO 762,793 176,921 105,976 11,671 61,320 28,699 31,692 8,086 242,008 70,686
21 San Luis Obispo-Paso Robles, CA 283,159 49,467 60,618 2,467 20,693 11,570 16,302 2,799 92,156 35,120
22 Redding-Red Bluff, CA 247,637 55,298 51,533 2,759 17,057 9,749 14,037 2,248 62,837 35,248
23 San Antonio-New Braunfels-Pearsall, TX 2,620,224 646,677 354,220 41,090 165,851 118,941 143,217 32,782 1,774,924 349,662
24 Albuquerque-Santa Fe-Las Vegas, NM 1,164,315 240,933 224,610 15,143 97,051 51,622 68,194 11,668 727,810 166,601
25 Hartford-East Hartford, CT 1,480,711 291,345 271,448 25,974 126,841 62,083 85,370 14,582 496,015 141,220
Notes:
Cities are ranked using the highest weighted average for any county within that Combined Metropolitan Statistical Area or Metropolitan Statistical Area.
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.

Data Tables
Table 3a Cleanest U.S. Cities for Short-Term Particle Pollution (Daily PM2.5)
Metropolitan Statistical Area Population Metropolitan Statistical Area Population Metropolitan Statistical Area Population
Amarillo-Pampa-Borger, TX 312,025 Hot Springs-Malvern, AR 133,478 Pensacola-Ferry Pass, FL-AL 553,087
Asheville-Marion-Brevard, NC 550,223 Houma-Thibodaux, LA 206,212 Ponce-Yauco-Coamo, PR 361,201
Bangor, ME 152,765 Huntsville-Decatur, AL 659,486 Portland-Lewiston-South Portland, ME 667,927
Baton Rouge, LA 871,905 Johnson City-Kingsport-Bristol, TN-VA 516,729 Rochester-Batavia-Seneca Falls, NY 1,176,514
Bloomington-Bedford, IN 206,391 Kokomo-Peru, IN 119,768 Rocky Mount-Wilson-
Roanoke Rapids, NC 287,305
Brunswick, GA 113,963 Lafayette-West Lafayette-Frankfort, IN 257,774
Saginaw-Midland-Bay City, MI 376,033
Burlington-Fort Madison- Lake Charles-Jennings, LA 242,707
Keokuk, IA-IL-MO 102,154 Salisbury-Cambridge, MD-DE 461,712
Lansing-East Lansing, MI 540,281
Cape Coral-Fort Myers-Naples, FL 1,214,269 San Juan-Bayamón, PR 2,344,305
Lexington-Fayette--Richmond--
Cedar Rapids-Iowa City, IA 452,674 Frankfort, KY 749,512 Scottsboro-Fort Payne, AL 124,586
Champaign-Urbana, IL 222,696 Lima-Van Wert-Celina, OH 218,852 Springfield-Jacksonville-Lincoln, IL 305,994
Charlottesville, VA 222,688 Lincoln-Beatrice, NE 363,733 Tuscaloosa, AL 268,191
Cleveland-Indianola, MS 55,710 Lynchburg, VA 262,258 Urban Honolulu, HI 1,000,890
Dayton-Springfield-Kettering, OH 1,087,422 Midland-Odessa, TX 334,271 Virginia Beach-Norfolk, VA-NC 1,895,105
Erie-Meadville, PA 352,362 Mobile-Daphne-Fairhope, AL 667,514 Waterloo-Cedar Falls, IA 167,796
Fayetteville-Springdale-Rogers, AR 560,709 Montgomery-Selma-Alexander City, AL 474,890 Wilmington, NC 291,833
Florence, SC 199,259 Morgantown-Fairmont, WV 196,746
Gadsden, AL 103,162 New Orleans-Metairie-Hammond, LA-MS 1,498,579
Greenville-Kinston-Washington, NC 271,343 North Port-Sarasota, FL 1,089,011
Gulfport-Biloxi, MS 418,082 Orlando-Lakeland-Deltona, FL 4,291,852
Harrisonburg-Staunton, VA 261,598 Owensboro, KY 121,227
Hattiesburg-Laurel, MS 256,113 Palm Bay-Melbourne-Titusville, FL 616,628
Hickory-Lenoir-Morganton, NC 366,441 Parkersburg-Marietta-Vienna, WV-OH 148,110
Note:
Monitors in these cities reported no days when PM2.5 levels reached the unhealthful range using the Air Quality Index based on the 2012 NAAQS.


Data Tables
Table 3b Top 25 Cleanest U.S. Cities for Year-Round Particle Pollution (Annual PM2.5)
2023 Design
Rank Value Metropolitan Statistical Area Population
1 3.7 Urban Honolulu, HI 1,000,890

1 3.7 Kahului-Wailuku-Lahaina, HI 164,221
3 4.1 Cheyenne, WY 100,863
3 4.1 Wilmington, NC 291,833
5 4.4 Bangor, ME 152,765
6 4.7 Bellingham, WA 228,831
7 5.3 St. George, UT 191,226
8 5.4 Duluth, MN-WI 290,780
9 5.6 Amarillo-Pampa-Borger, TX 312,025
9 5.6 Colorado Springs, CO 762,793
9 5.6 Salisbury-Cambridge, MD-DE 461,712
12 5.8 Grand Junction, CO 157,335
12 5.8 Elmira-Corning, NY 175,993
14 5.9 Asheville-Marion-Brevard, NC 550,223
14 5.9 Saginaw-Midland-Bay City, MI 376,033
16 6.0 Lubbock-Plainview-Levelland, TX 378,828
17 6.1 Lynchburg, VA 262,258
18 6.2 Syracuse-Auburn, NY 734,161
19 6.3 Greenville-Kinston-Washington, NC 271,343
19 6.3 Rochester-Austin, MN 267,309
21 6.5 Bismarck, ND 134,417
22 6.6 Johnson City-Kingsport-Bristol, TN-VA 516,729
22 6.6 Lima-Van Wert-Celina, OH 218,852
22 6.6 Lincoln-Beatrice, NE 363,733
22 6.6 Rochester-Batavia-Seneca Falls, NY 1,176,514
Notes:
Cities are ranked by using the highest design value for any county within that metropolitan area.

Data Tables
Table 3c Cleanest U.S. Cities for Ozone Air Pollution

Metropolitan Statistical Area Population Metropolitan Statistical Area Population
Albany-Schenectady, NY 1,190,312 Lawton, OK 127,543
Asheville-Marion-Brevard, NC 550,223 Lincoln-Beatrice, NE 363,733
Bangor, ME 152,765 Mayagüez-San Germán, PR 220,914
Bellingham, WA 228,831 Mobile-Daphne-Fairhope, AL 667,514
Blacksburg-Christiansburg, VA 165,293 Monroe-Ruston, LA 253,036
Bowling Green-Glasgow, KY 237,487 Morgantown-Fairmont, WV 196,746
Brownsville-Harlingen-Raymondville, TX 443,345 Myrtle Beach-Conway, SC-NC 573,715
Brunswick, GA 113,963 New Bern-Morehead City, NC 190,814
Burlington-South Burlington-Barre, VT 286,580 Palm Bay-Melbourne-Titusville, FL 616,628
Charleston-Huntington-Ashland, WV-OH-KY 771,171 Panama City, FL 179,168
Charlottesville, VA 222,688 Pittsfield, MA 128,657
Clarksville, TN-KY 328,304 Quincy-Hannibal, IL-MO 113,833
Cleveland-Indianola, MS 55,710 Raleigh-Durham-Cary, NC 2,144,608
Columbia-Moberly-Mexico, MO 262,865 Roanoke, VA 314,496
Columbus-Auburn-Opelika, GA-AL 504,754 Rochester-Austin, MN 267,309
Crestview-Fort Walton Beach-Destin, FL 293,324 Rochester-Batavia-Seneca Falls, NY 1,176,514
Decatur, IL 102,432 Rocky Mount-Wilson-Roanoke Rapids, NC 287,305
Des Moines-Ames-West Des Moines, IA 900,705 Salinas, CA 437,325
Duluth, MN-WI 290,780 San Juan-Bayamón, PR 2,344,305
Eau Claire-Menomonie, WI 218,864 Savannah-Hinesville-Statesboro, GA 605,693
Elmira-Corning, NY 175,993 Scottsboro-Fort Payne, AL 124,586
Erie-Meadville, PA 352,362 Scranton--Wilkes-Barre, PA 567,750
Fairbanks, AK 95,593 Sebring-Avon Park, FL 103,296
Fayetteville-Sanford-Lumberton, NC 842,044 Shreveport-Bossier City-Minden, LA 425,339
Flagstaff, AZ 145,052 Springfield, MO 481,483
Florence, SC 199,259 Springfield-Jacksonville-Lincoln, IL 305,994
Gadsden, AL 103,162 State College-DuBois, PA 237,609
Gainesville-Lake City, FL 412,141 Syracuse-Auburn, NY 734,161
Greensboro--Winston-Salem--High Point, NC 1,705,315 Terre Haute, IN 184,910
Greenville-Kinston-Washington, NC 271,343 Tupelo-Corinth, MS 197,511
Harrisonburg-Staunton, VA 261,598 Tuscaloosa, AL 268,191
Hickory-Lenoir-Morganton, NC 366,441 Urban Honolulu, HI 1,000,890
Jackson-Vicksburg-Brookhaven, MS 665,724 Victoria-Port Lavaca, TX 117,854
Jacksonville-St. Marys-Palatka, FL-GA 1,767,497 Virginia Beach-Norfolk, VA-NC 1,895,105
Jefferson City, MO 150,706 Waco, TX 280,428
Johnstown-Somerset, PA 205,794 Waterloo-Cedar Falls, IA 167,796
La Crosse-Onalaska, WI-MN 139,211 Watertown-Fort Drum, NY 116,295
Lafayette-Opelousas-Morgan City, LA 609,515 Wausau-Stevens Point-Wisconsin Rapids, WI 310,727
Lansing-East Lansing, MI 540,281 Williamsport-Lock Haven, PA 151,070
Laredo, TX 267,945 Wilmington, NC 291,833
Notes:
This list represents cities with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on 2015 NAAQS.

Data Tables
Table 4a Cleanest Counties for Short-Term Particle Pollution (Daily PM2.5)

County State Metropolitan Statistical Area County State Metropolitan Statistical Area
Baldwin AL Mobile-Daphne-Fairhope, AL Van Buren IA
Clay AL Champaign IL Champaign-Urbana, IL
DeKalb AL Scottsboro-Fort Payne, AL DuPage IL Chicago-Naperville, IL-IN-WI
Etowah AL Gadsden, AL Jersey IL St. Louis-St. Charles-Farmington, MO-IL
Madison AL Huntsville-Decatur, AL Madison IL St. Louis-St. Charles-Farmington, MO-IL
Mobile AL Mobile-Daphne-Fairhope, AL McHenry IL Chicago-Naperville, IL-IN-WI
Montgomery AL Montgomery-Selma-Alexander City, AL Sangamon IL Springfield-Jacksonville-Lincoln, IL
Morgan AL Huntsville-Decatur, AL St. Clair IL St. Louis-St. Charles-Farmington, MO-IL
Tuscaloosa AL Tuscaloosa, AL Bartholomew IN Indianapolis-Carmel-Muncie, IN
Arkansas AR Clark IN Louisville-Jefferson County--
Elizabethtown--Bardstown, KY-IN
Ashley AR
Delaware IN Indianapolis-Carmel-Muncie, IN
Crittenden AR Memphis-Forrest City, TN-MS-AR
Dubois IN
Garland AR Hot Springs-Malvern, AR
Greene IN
Jackson AR
Hamilton IN Indianapolis-Carmel-Muncie, IN
Polk AR
Henry IN Indianapolis-Carmel-Muncie, IN
Union AR
Howard IN Kokomo-Peru, IN
Washington AR Fayetteville-Springdale-Rogers, AR
Madison IN Indianapolis-Carmel-Muncie, IN
Apache AZ
Monroe IN Bloomington-Bedford, IN
Pima AZ Tucson-Nogales, AZ
Spencer IN
Kent DE Philadelphia-Reading-Camden, PA-NJ-DE-MD
Tippecanoe IN Lafayette-West Lafayette-Frankfort, IN
Sussex DE Salisbury-Cambridge, MD-DE
Whitley IN Fort Wayne-Huntington-Auburn, IN
Brevard FL Palm Bay-Melbourne-Titusville, FL
Campbell KY Cincinnati-Wilmington-Maysville, OH-KY-IN
Escambia FL Pensacola-Ferry Pass, FL-AL
Carter KY Charleston-Huntington-Ashland, WV-OH-KY
Lee FL Cape Coral-Fort Myers-Naples, FL
Christian KY Clarksville, TN-KY
Orange FL Orlando-Lakeland-Deltona, FL
Daviess KY Owensboro, KY
Palm Beach FL Miami-Port St. Lucie-Fort Lauderdale, FL
Fayette KY Lexington-Fayette--Richmond--Frankfort, KY
Pinellas FL Tampa-St. Petersburg-Clearwater, FL
Hardin KY Louisville-Jefferson County--
Polk FL Orlando-Lakeland-Deltona, FL
Elizabethtown--Bardstown, KY-IN
Sarasota FL North Port-Sarasota, FL
Perry KY
Seminole FL Orlando-Lakeland-Deltona, FL
Calcasieu Parish LA Lake Charles-Jennings, LA
Volusia FL Orlando-Lakeland-Deltona, FL
East Baton Rouge
Clayton GA Atlanta--Athens-Clarke County-- Parish LA Baton Rouge, LA
Sandy Springs, GA-AL
Iberville Parish LA Baton Rouge, LA
Cobb GA Atlanta--Athens-Clarke County--
Jefferson Parish LA New Orleans-Metairie-Hammond, LA-MS
Orleans Parish LA New Orleans-Metairie-Hammond, LA-MS
Fulton GA Atlanta--Athens-Clarke County--
Sandy Springs, GA-AL St. Bernard Parish LA New Orleans-Metairie-Hammond, LA-MS
Glynn GA Brunswick, GA Tangipahoa Parish LA New Orleans-Metairie-Hammond, LA-MS
Hall GA Atlanta--Athens-Clarke County-- Terrebonne Parish LA Houma-Thibodaux, LA
West Baton Rouge
Hawaii HI Parish LA Baton Rouge, LA
Honolulu HI Urban Honolulu, HI Bristol MA Boston-Worcester-Providence, MA-RI-NH-CT
Kauai HI Franklin MA Springfield, MA
Black Hawk IA Waterloo-Cedar Falls, IA Hampshire MA Springfield, MA
Clinton IA Davenport-Moline, IA-IL Dorchester MD Salisbury-Cambridge, MD-DE
Johnson IA Cedar Rapids-Iowa City, IA Garrett MD
Lee IA Burlington-Fort Madison-Keokuk, IA-IL-MO Harford MD Washington-Baltimore-Arlington, DC-MD-VA-WV-PA
Linn IA Cedar Rapids-Iowa City, IA Howard MD Washington-Baltimore-Arlington, DC-MD-VA-WV-PA
Montgomery IA Kent MD
Notes:
Monitors in these counties reported no days when PM2.5 levels reached the unhealthful range using the Air Quality Index based on the 2012 NAAQS.

Data Tables
Table 4a Cleanest Counties for Short-Term Particle Pollution (24-hour PM2.5) (cont.)
Montgomery MD Washington-Baltimore-Arlington, DC-MD-VA-WV-PA New York NY New York-Newark, NY-NJ-CT-PA

Prince George's MD Washington-Baltimore-Arlington, DC-MD-VA-WV-PA Orange NY New York-Newark, NY-NJ-CT-PA
Washington MD Washington-Baltimore-Arlington, DC-MD-VA-WV-PA Richmond NY New York-Newark, NY-NJ-CT-PA
Androscoggin ME Portland-Lewiston-South Portland, ME Suffolk NY New York-Newark, NY-NJ-CT-PA
Cumberland ME Portland-Lewiston-South Portland, ME Allen OH Lima-Van Wert-Celina, OH
Hancock ME Athens OH
Kennebec ME Belmont OH Wheeling, WV-OH
Penobscot ME Bangor, ME Clark OH Dayton-Springfield-Kettering, OH
Allegan MI Grand Rapids-Kentwood-Muskegon, MI Harrison OH
Bay MI Saginaw-Midland-Bay City, MI Lake OH Cleveland-Akron-Canton, OH
Genesee MI Detroit-Warren-Ann Arbor, MI Lawrence OH Charleston-Huntington-Ashland, WV-OH-KY
Ingham MI Lansing-East Lansing, MI Medina OH Cleveland-Akron-Canton, OH
Lenawee MI Detroit-Warren-Ann Arbor, MI Montgomery OH Dayton-Springfield-Kettering, OH
Macomb MI Detroit-Warren-Ann Arbor, MI Portage OH Cleveland-Akron-Canton, OH
Manistee MI Preble OH
Missaukee MI Scioto OH Charleston-Huntington-Ashland, WV-OH-KY
Oakland MI Detroit-Warren-Ann Arbor, MI Erie PA Erie-Meadville, PA
Cedar MO Adjuntas PR Ponce-Yauco-Coamo, PR
Clay MO Kansas City-Overland Park-Kansas City, MO-KS Bayamón PR San Juan-Bayamón, PR
Bolivar MS Cleveland-Indianola, MS Caguas PR San Juan-Bayamón, PR
DeSoto MS Memphis-Forrest City, TN-MS-AR Fajardo PR San Juan-Bayamón, PR
Forrest MS Hattiesburg-Laurel, MS Guaynabo PR San Juan-Bayamón, PR
Hancock MS Gulfport-Biloxi, MS Ponce PR Ponce-Yauco-Coamo, PR
Harrison MS Gulfport-Biloxi, MS Washington RI Boston-Worcester-Providence, MA-RI-NH-CT
Jackson MS Gulfport-Biloxi, MS Chesterfield SC
Buncombe NC Asheville-Marion-Brevard, NC Edgefield SC Augusta-Richmond County, GA-SC
Catawba NC Hickory-Lenoir-Morganton, NC Florence SC Florence, SC
Davidson NC Greensboro--Winston-Salem--High Point, NC Richland SC Columbia-Orangeburg-Newberry, SC
Durham NC Raleigh-Durham-Cary, NC Spartanburg SC Greenville-Spartanburg-Anderson, SC
Guilford NC Greensboro--Winston-Salem--High Point, NC York SC Charlotte-Concord, NC-SC
Jackson NC Lawrence TN Nashville-Davidson--Murfreesboro, TN
Johnston NC Raleigh-Durham-Cary, NC Loudon TN Knoxville-Morristown-Sevierville, TN
New Hanover NC Wilmington, NC McMinn TN Chattanooga-Cleveland-Dalton, TN-GA
Northampton NC Rocky Mount-Wilson-Roanoke Rapids, NC Roane TN Knoxville-Morristown-Sevierville, TN
Pitt NC Greenville-Kinston-Washington, NC Sullivan TN Johnson City-Kingsport-Bristol, TN-VA
Rowan NC Charlotte-Concord, NC-SC Ector TX Midland-Odessa, TX
Lancaster NE Lincoln-Beatrice, NE Ellis TX Dallas-Fort Worth, TX-OK
Atlantic NJ Philadelphia-Reading-Camden, PA-NJ-DE-MD Potter TX Amarillo-Pampa-Borger, TX
Cumberland NJ Philadelphia-Reading-Camden, PA-NJ-DE-MD Albemarle VA Charlottesville, VA
Gloucester NJ Philadelphia-Reading-Camden, PA-NJ-DE-MD Arlington VA Washington-Baltimore-Arlington, DC-MD-VA-WV-PA
Hudson NJ New York-Newark, NY-NJ-CT-PA Bristol City VA Johnson City-Kingsport-Bristol, TN-VA
Hunterdon NJ New York-Newark, NY-NJ-CT-PA Charles City VA Richmond, VA
Morris NJ New York-Newark, NY-NJ-CT-PA Chesterfield VA Richmond, VA
Chautauqua NY Frederick VA Washington-Baltimore-Arlington, DC-MD-VA-WV-PA
Essex NY Hampton City VA Virginia Beach-Norfolk, VA-NC
Kings NY New York-Newark, NY-NJ-CT-PA Loudoun VA Washington-Baltimore-Arlington, DC-MD-VA-WV-PA
Monroe NY Rochester-Batavia-Seneca Falls, NY Lynchburg City VA Lynchburg, VA
Notes:

Data Tables
Table 4a Cleanest Counties for Short-Term Particle Pollution (24-hour PM2.5) (cont.)
County State Metropolitan Statistical Area
Norfolk City VA Virginia Beach-Norfolk, VA-NC

Rockingham VA Harrisonburg-Staunton, VA
Salem City VA Roanoke, VA
Virginia Beach City VA Virginia Beach-Norfolk, VA-NC
Skagit WA Seattle-Tacoma, WA
Dane WI Madison-Janesville-Beloit, WI
Dodge WI Milwaukee-Racine-Waukesha, WI
Ozaukee WI Milwaukee-Racine-Waukesha, WI
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
Monongalia WV Morgantown-Fairmont, WV
Ohio WV Wheeling, WV-OH
Wood WV Parkersburg-Marietta-Vienna, WV-OH
Sheridan WY
Notes:

Data Tables
Table 4b Top 25 Cleanest Counties for Year-Round Particle Pollution (Annual PM2.5)
2023
Rank County State Design Value Metropolitan Statistical Area
1 Fremont WY 2.4
2 Hawaii HI 2.7
3 Carlton MN 2.8 Duluth, MN-WI
4 Gallatin MT 3.0
5 Kauai HI 3.1
6 Hancock ME 3.2
6 Essex NY 3.2
8 Cook MN 3.3
9 Sublette WY 3.5
9 Hillsborough NH 3.5 Boston-Worcester-Providence, MA-RI-NH-CT
11 Custer SD 3.6
12 Honolulu HI 3.7 Urban Honolulu, HI
12 Maui HI 3.7 Kahului-Wailuku-Lahaina, HI
12 Hughes SD 3.7
15 La Paz AZ 3.8
16 New Hanover NC 4.1 Wilmington, NC
16 Laramie WY 4.1 Cheyenne, WY
18 Billings ND 4.2
18 Belknap NH 4.2 Boston-Worcester-Providence, MA-RI-NH-CT
20 Park WY 4.3
20 Santa Fe NM 4.3 Albuquerque-Santa Fe-Las Vegas, NM
22 Penobscot ME 4.4 Bangor, ME
22 Teton WY 4.4
22 Aroostook ME 4.4
25 Washington RI 4.5 Boston-Worcester-Providence, MA-RI-NH-CT
Notes:
Counties are ranked by Design Value.

Data Tables
Table 4c Cleanest Counties for Ozone Air Pollution

Denali Borough AK Polk FL Orlando-Lakeland-Deltona, FL
Fairbanks North Star Santa Rosa FL Pensacola-Ferry Pass, FL-AL
Borough AK Fairbanks, AK
Sarasota FL North Port-Sarasota, FL
Baldwin AL Mobile-Daphne-Fairhope, AL
Seminole FL Orlando-Lakeland-Deltona, FL
DeKalb AL Scottsboro-Fort Payne, AL
St. Lucie FL Miami-Port St. Lucie-Fort Lauderdale, FL
Elmore AL Montgomery-Selma-Alexander City, AL
Volusia FL Orlando-Lakeland-Deltona, FL
Etowah AL Gadsden, AL
Wakulla FL Tallahassee, FL
Mobile AL Mobile-Daphne-Fairhope, AL
Chatham GA Savannah-Hinesville-Statesboro, GA
Morgan AL Huntsville-Decatur, AL
Chattooga GA Chattanooga-Cleveland-Dalton, TN-GA
Russell AL Columbus-Auburn-Opelika, GA-AL
Clarke GA Atlanta--Athens-Clarke County--
Sumter AL Sandy Springs, GA-AL
Tuscaloosa AL Tuscaloosa, AL Columbia GA Augusta-Richmond County, GA-SC
Clark AR Glynn GA Brunswick, GA
Newton AR Murray GA Chattanooga-Cleveland-Dalton, TN-GA
Coconino AZ Flagstaff, AZ Muscogee GA Columbus-Auburn-Opelika, GA-AL
Colusa CA Sumter GA
Glenn CA Honolulu HI Urban Honolulu, HI
Humboldt CA Bremer IA Waterloo-Cedar Falls, IA
Lake CA Clinton IA Davenport-Moline, IA-IL
Mendocino CA Harrison IA Omaha-Council Bluffs-Fremont, NE-IA
Monterey CA Salinas, CA Montgomery IA
Santa Cruz CA San Jose-San Francisco-Oakland, CA Palo Alto IA
Siskiyou CA Polk IA Des Moines-Ames-West Des Moines, IA
Sonoma CA San Jose-San Francisco-Oakland, CA Van Buren IA
Archuleta CO Adams IL Quincy-Hannibal, IL-MO
Delta CO Clark IL
Sussex DE Salisbury-Cambridge, MD-DE Effingham IL
Alachua FL Gainesville-Lake City, FL Jo Daviess IL
Baker FL Jacksonville-St. Marys-Palatka, FL-GA Macon IL Decatur, IL
Bay FL Panama City, FL Macoupin IL St. Louis-St. Charles-Farmington, MO-IL
Brevard FL Palm Bay-Melbourne-Titusville, FL Sangamon IL Springfield-Jacksonville-Lincoln, IL
Broward FL Miami-Port St. Lucie-Fort Lauderdale, FL Bartholomew IN Indianapolis-Carmel-Muncie, IN
Collier FL Cape Coral-Fort Myers-Naples, FL Brown IN Indianapolis-Carmel-Muncie, IN
Columbia FL Gainesville-Lake City, FL Delaware IN Indianapolis-Carmel-Muncie, IN
Duval FL Jacksonville-St. Marys-Palatka, FL-GA Elkhart IN South Bend-Elkhart-Mishawaka, IN-MI
Flagler FL Orlando-Lakeland-Deltona, FL Greene IN
Highlands FL Sebring-Avon Park, FL Hendricks IN Indianapolis-Carmel-Muncie, IN
Holmes FL Vigo IN Terre Haute, IN
Indian River FL Miami-Port St. Lucie-Fort Lauderdale, FL Sumner KS Wichita-Winfield, KS
Liberty FL Trego KS
Martin FL Miami-Port St. Lucie-Fort Lauderdale, FL Bell KY
Okaloosa FL Crestview-Fort Walton Beach-Destin, FL Boone KY Cincinnati-Wilmington-Maysville, OH-KY-IN
Orange FL Orlando-Lakeland-Deltona, FL Boyd KY Charleston-Huntington-Ashland, WV-OH-KY
Palm Beach FL Miami-Port St. Lucie-Fort Lauderdale, FL Carter KY Charleston-Huntington-Ashland, WV-OH-KY
Pasco FL Tampa-St. Petersburg-Clearwater, FL Christian KY Clarksville, TN-KY
Pinellas FL Tampa-St. Petersburg-Clearwater, FL Edmonson KY Bowling Green-Glasgow, KY
Note:
This list represents counties with no monitored ozone air pollution in unhealthful ranges using the Air Quality Index based on 2015 NAAQS.

Data Tables
Table 4c Cleanest Counties for Ozone Air Pollution (cont.)

Fayette KY Lexington-Fayette--Richmond--Frankfort, KY Clinton MO Kansas City-Overland Park-Kansas City, MO-KS
Greenup KY Charleston-Huntington-Ashland, WV-OH-KY Greene MO Springfield, MO
Hancock KY Owensboro, KY Monroe MO
Morgan KY Ste. Genevieve MO
Perry KY Bolivar MS Cleveland-Indianola, MS
Pike KY Hancock MS Gulfport-Biloxi, MS
Pulaski KY Hinds MS Jackson-Vicksburg-Brookhaven, MS
Simpson KY Lauderdale MS
Trigg KY Clarksville, TN-KY Lee MS Tupelo-Corinth, MS
Warren KY Bowling Green-Glasgow, KY Yalobusha MS
Washington KY Flathead MT
Bossier Parish LA Shreveport-Bossier City-Minden, LA Rosebud MT
Caddo Parish LA Shreveport-Bossier City-Minden, LA Alexander NC Hickory-Lenoir-Morganton, NC
Lafayette Parish LA Lafayette-Opelousas-Morgan City, LA Avery NC
Ouachita Parish LA Monroe-Ruston, LA Buncombe NC Asheville-Marion-Brevard, NC
St. Bernard Parish LA New Orleans-Metairie-Hammond, LA-MS Caldwell NC Hickory-Lenoir-Morganton, NC
St. James Parish LA New Orleans-Metairie-Hammond, LA-MS Carteret NC New Bern-Morehead City, NC
St. Martin Parish LA Lafayette-Opelousas-Morgan City, LA Caswell NC
St. Tammany Parish LA New Orleans-Metairie-Hammond, LA-MS Cumberland NC Fayetteville-Sanford-Lumberton, NC
Berkshire MA Pittsfield, MA Durham NC Raleigh-Durham-Cary, NC
Franklin MA Springfield, MA Edgecombe NC Rocky Mount-Wilson-Roanoke Rapids, NC
Hampshire MA Springfield, MA Forsyth NC Greensboro--Winston-Salem--High Point, NC
Middlesex MA Boston-Worcester-Providence, MA-RI-NH-CT Graham NC
Garrett MD Granville NC Raleigh-Durham-Cary, NC
Androscoggin ME Portland-Lewiston-South Portland, ME Guilford NC Greensboro--Winston-Salem--High Point, NC
Aroostook ME Haywood NC Asheville-Marion-Brevard, NC
Kennebec ME Johnston NC Raleigh-Durham-Cary, NC
Oxford ME Lenoir NC Greenville-Kinston-Washington, NC
Penobscot ME Bangor, ME Lincoln NC Charlotte-Concord, NC-SC
Washington ME Macon NC
Clinton MI Lansing-East Lansing, MI Martin NC
Ingham MI Lansing-East Lansing, MI Montgomery NC
Carlton MN Duluth, MN-WI New Hanover NC Wilmington, NC
Goodhue MN Minneapolis-St. Paul, MN-WI Person NC Raleigh-Durham-Cary, NC
Hennepin MN Minneapolis-St. Paul, MN-WI Pitt NC Greenville-Kinston-Washington, NC
Lake MN Duluth, MN-WI Rockingham NC Greensboro--Winston-Salem--High Point, NC
Lyon MN Rowan NC Charlotte-Concord, NC-SC
Mille Lacs MN Minneapolis-St. Paul, MN-WI Swain NC
Olmsted MN Rochester-Austin, MN Wake NC Raleigh-Durham-Cary, NC
Scott MN Minneapolis-St. Paul, MN-WI Yancey NC
St. Louis MN Duluth, MN-WI Burke ND
Stearns MN Minneapolis-St. Paul, MN-WI Burleigh ND Bismarck, ND
Andrew MO Kansas City-Overland Park-Kansas City, MO-KS McKenzie ND
Boone MO Columbia-Moberly-Mexico, MO Ward ND
Callaway MO Jefferson City, MO Lancaster NE Lincoln-Beatrice, NE
Cedar MO Belknap NH Boston-Worcester-Providence, MA-RI-NH-CT
Note:

Data Tables

Cheshire NH Lawrence PA Pittsburgh-New Castle-Weirton, PA-OH-WV
Grafton NH Lehigh PA Allentown-Bethlehem-Easton, PA-NJ
Hillsborough NH Boston-Worcester-Providence, MA-RI-NH-CT Luzerne PA Scranton--Wilkes-Barre, PA
Morris NJ New York-Newark, NY-NJ-CT-PA Lycoming PA Williamsport-Lock Haven, PA
Warren NJ Allentown-Bethlehem-Easton, PA-NJ Monroe PA New York-Newark, NY-NJ-CT-PA
Albany NY Albany-Schenectady, NY Somerset PA Johnstown-Somerset, PA
Hamilton NY Tioga PA
Jefferson NY Watertown-Fort Drum, NY Washington PA Pittsburgh-New Castle-Weirton, PA-OH-WV
Monroe NY Rochester-Batavia-Seneca Falls, NY Westmoreland PA Pittsburgh-New Castle-Weirton, PA-OH-WV
Onondaga NY Syracuse-Auburn, NY York PA Harrisburg-York-Lebanon, PA
Orange NY New York-Newark, NY-NJ-CT-PA Bayamón PR San Juan-Bayamón, PR
Oswego NY Syracuse-Auburn, NY Cataño PR San Juan-Bayamón, PR
Saratoga NY Albany-Schenectady, NY Mayagüez PR Mayagüez-San Germán, PR
Steuben NY Elmira-Corning, NY Aiken SC Augusta-Richmond County, GA-SC
Wayne NY Rochester-Batavia-Seneca Falls, NY Berkeley SC Charleston-North Charleston, SC
Clinton OH Cincinnati-Wilmington-Maysville, OH-KY-IN Chesterfield SC
Fayette OH Columbus-Marion-Zanesville, OH Darlington SC Florence, SC
Greene OH Dayton-Springfield-Kettering, OH Edgefield SC Augusta-Richmond County, GA-SC
Knox OH Columbus-Marion-Zanesville, OH Horry SC Myrtle Beach-Conway, SC-NC
Lawrence OH Charleston-Huntington-Ashland, WV-OH-KY Jackson SD
Licking OH Columbus-Marion-Zanesville, OH Claiborne TN
Lorain OH Cleveland-Akron-Canton, OH DeKalb TN
Madison OH Columbus-Marion-Zanesville, OH Jefferson TN Knoxville-Morristown-Sevierville, TN
Mahoning OH Youngstown-Warren, OH-PA Knox TN Knoxville-Morristown-Sevierville, TN
Medina OH Cleveland-Akron-Canton, OH Loudon TN Knoxville-Morristown-Sevierville, TN
Miami OH Dayton-Springfield-Kettering, OH Sevier TN Knoxville-Morristown-Sevierville, TN
Noble OH Williamson TN Nashville-Davidson--Murfreesboro, TN
Wood OH Toledo-Findlay-Tiffin, OH Wilson TN Nashville-Davidson--Murfreesboro, TN
Adair OK Brewster TX
Cleveland OK Oklahoma City-Shawnee, OK Cameron TX Brownsville-Harlingen-Raymondville, TX
Comanche OK Lawton, OK Harrison TX Longview, TX
Dewey OK Hunt TX Dallas-Fort Worth, TX-OK
Mayes OK Kaufman TX Dallas-Fort Worth, TX-OK
Osage OK Tulsa-Muskogee-Bartlesville, OK McLennan TX Waco, TX
Columbia OR Portland-Vancouver-Salem, OR-WA Navarro TX Dallas-Fort Worth, TX-OK
Marion OR Portland-Vancouver-Salem, OR-WA Polk TX
Bradford PA Victoria TX Victoria-Port Lavaca, TX
Cambria PA Johnstown-Somerset, PA Webb TX Laredo, TX
Centre PA State College-DuBois, PA Albemarle VA Charlottesville, VA
Clearfield PA State College-DuBois, PA Charles City VA Richmond, VA
Dauphin PA Harrisburg-York-Lebanon, PA Fauquier VA Washington-Baltimore-Arlington, DC-MD-VA-WV-PA
Elk PA Frederick VA Washington-Baltimore-Arlington, DC-MD-VA-WV-PA
Erie PA Erie-Meadville, PA Giles VA Blacksburg-Christiansburg, VA
Fayette PA Pittsburgh-New Castle-Weirton, PA-OH-WV Hampton City VA Virginia Beach-Norfolk, VA-NC
Franklin PA Washington-Baltimore-Arlington, DC-MD-VA-WV-PA Hanover VA Richmond, VA
Lackawanna PA Scranton--Wilkes-Barre, PA Henrico VA Richmond, VA
Note:

Data Tables

County State Metropolitan Statistical Area
Madison VA Washington-Baltimore-Arlington, DC-MD-VA-WV-PA
Prince Edward VA
Roanoke VA Roanoke, VA
Rockbridge VA
Rockingham VA Harrisonburg-Staunton, VA
Suffolk City VA Virginia Beach-Norfolk, VA-NC
Wythe VA
Bennington VT
Chittenden VT Burlington-South Burlington-Barre, VT
Rutland VT
Clallam WA
Clark WA Portland-Vancouver-Salem, OR-WA
Skagit WA Seattle-Tacoma, WA
Whatcom WA Bellingham, WA
Eau Claire WI Eau Claire-Menomonie, WI
Forest WI
La Crosse WI La Crosse-Onalaska, WI-MN
Marathon WI Wausau-Stevens Point-Wisconsin Rapids, WI
Taylor WI
Vilas WI
Berkeley WV Washington-Baltimore-Arlington, DC-MD-VA-WV-PA
Cabell WV Charleston-Huntington-Ashland, WV-OH-KY
Gilmer WV
Greenbrier WV
Kanawha WV Charleston-Huntington-Ashland, WV-OH-KY
Monongalia WV Morgantown-Fairmont, WV
Tucker WV
Wood WV Parkersburg-Marietta-Vienna, WV-OH
Note:

State Tables
ALABAMA
American Lung Association in Alabama
HIGH OZONE DAYS 2019–2021 HIGH PARTICLE POLLUTION DAYS 2019–2021

24-Hour Annual
Wgt. Wgt. Design Pass/
County Orange Red Purple Avg. Grade Orange Red Purple Maroon Avg. Grade Value Fail
Baldwin 0 0 0 0.0 A 0 0 0 0 0.0 A 7.6 Pass
Clay DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.0 Pass
Colbert INC INC INC INC INC INC INC INC INC INC INC INC INC
DeKalb 0 0 0 0.0 A 0 0 0 0 0.0 A 7.5 Pass
Elmore 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Etowah 0 0 0 0.0 A 0 0 0 0 0.0 A 8.2 Pass
Houston INC INC INC INC INC INC INC INC INC INC INC INC INC
Jefferson 13 0 0 4.3 F 1 0 0 0 0.3 B 11.0 Pass
Madison 2 0 0 0.7 B 0 0 0 0 0.0 A 7.3 Pass
Mobile 0 0 0 0.0 A 0 0 0 0 0.0 A 8.0 Pass
Montgomery 1 0 0 0.3 B 0 0 0 0 0.0 A 8.2 Pass
Morgan 0 0 0 0.0 A 0 0 0 0 0.0 A 7.3 Pass
Russell 0 0 0 0.0 A 3 0 0 0 1.0 C 9.3 Pass
Shelby 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Sumter 0 0 0 0.0 A INC INC INC INC INC INC INC INC
Tuscaloosa 0 0 0 0.0 A 0 0 0 0 0.0 A 7.7 Pass

State Tables
ALABAMA
American Lung Association in Alabama
AT-RISK GROUPS
Lung Diseases
Total 65 & Pediatric Adult Lung CV People
County Population Under 18 Over Asthma Asthma COPD Cancer Disease Pregnancies Poverty of Color
Baldwin 239,294 50,774 51,376 4,893 19,042 19,008 145 24,205 2,430 25,526 40,324
Clay 14,190 2,908 3,012 280 1,143 1,142 9 1,455 144 2,560 2,780
Colbert 57,474 12,211 11,641 1,177 4,568 4,461 35 5,626 610 9,396 13,055
DeKalb 71,813 17,290 12,694 1,666 5,519 5,268 44 6,567 749 13,783 15,079
Elmore 89,304 19,665 14,554 1,895 7,051 6,528 54 8,016 1,048 10,138 24,278
Etowah 103,162 22,336 19,957 2,153 8,169 7,905 63 9,923 1,117 17,605 23,831
Houston 107,458 24,532 19,938 2,364 8,368 7,993 65 9,978 1,199 20,210 37,262
Jefferson 667,820 153,073 111,386 14,752 51,824 47,597 403 58,326 8,040 110,131 341,184
Madison 395,211 85,610 61,262 8,250 31,350 28,593 241 34,850 4,563 39,316 141,436
Mobile 413,073 96,569 70,330 9,307 31,905 29,652 250 36,537 4,809 74,061 181,944
Montgomery 227,434 54,005 36,348 5,205 17,461 15,889 137 19,380 2,757 47,309 156,663
Morgan 123,668 28,618 22,348 2,758 9,620 9,209 75 11,496 1,284 16,459 31,662
Russell 58,722 14,264 8,889 1,375 4,497 4,099 36 4,996 697 12,620 32,398
Shelby 226,902 51,805 37,385 4,993 17,746 16,577 138 20,442 2,610 17,306 54,330
Sumter 12,164 2,369 2,415 228 978 914 7 1,132 153 4,005 9,085
Tuscaloosa 227,007 47,984 32,306 4,624 17,936 15,403 138 18,247 3,092 31,735 90,707

State Tables
ALASKA
American Lung Association in Alaska

24-Hour Annual
Anchorage Municipality DNC DNC DNC DNC DNC 6 4 0 0 4.0 F 6.7 Pass
Denali Borough 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Fairbanks North Star
Borough 0 0 0 0.0 A 43 39 1 3 37.0 F 13.2 Fail
Juneau City and Borough DNC DNC DNC DNC DNC 4 0 0 0 1.3 C 5.4 Pass
Matanuska-Susitna
Borough DNC DNC DNC DNC DNC 4 1 0 0 1.8 C 5.2 Pass

State Tables
ALASKA
American Lung Association in Alaska
AT-RISK GROUPS
Lung Diseases
Anchorage Municipality 288,121 68,780 35,974 4,537 19,890 12,277 149 14,192 3,919 26,920 126,653
Denali Borough 1,593 279 204 18 120 76 1 88 21 115 383
Fairbanks North Star
Borough 95,593 22,506 11,366 1,485 6,595 3,866 49 4,450 1,261 7,247 29,724
Juneau City and Borough 31,973 6,596 4,863 435 2,306 1,545 17 1,810 421 2,378 11,587
Matanuska-Susitna
Borough 110,686 405 175 27 92 60 1 70 17
11,453
24,585

State Tables
ARIZONA
American Lung Association in Arizona

24-Hour Annual
Apache DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Cochise 3 0 0 1.0 C INC INC INC INC INC INC INC INC
Coconino 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Gila 30 4 0 12.0 F DNC DNC DNC DNC DNC DNC DNC DNC
La Paz 1 0 0 0.3 B 1 0 0 0 0.3 B 3.8 Pass
Maricopa 111 7 1 41.2 F 12 3 1 0 6.2 F 9.8 Pass
Navajo 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Pima 11 0 0 3.7 F 0 0 0 0 0.0 A 5.0 Pass
Pinal 52 1 0 17.8 F 35 2 0 0 12.7 F 13.0 Fail
Santa Cruz DNC DNC DNC DNC DNC 7 2 0 0 3.3 F 10.0 Pass
Yavapai 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Yuma 3 0 0 1.0 C 2 0 0 0 0.7 B 8.8 Pass

State Tables
ARIZONA
American Lung Association in Arizona
AT-RISK GROUPS
Lung Diseases
Apache 65,623 17,469 10,706 1,408 4,568 2,710 26 3,947 640 18,422 53,761
Cochise 126,050 26,564 29,889 2,141 9,305 6,244 50 9,468 1,105 20,618 57,472
Coconino 145,052 28,909 20,390 2,331 11,101 5,790 57 8,027 1,927 22,677 67,427
Gila 53,589 10,389 16,017 838 3,991 3,034 21 4,763 406 8,900 20,718
La Paz 16,408 2,664 6,697 215 1,242 1,089 6 1,768 110 3,303 7,303
Maricopa 4,496,588 1,036,370 709,277 83,547 329,205 187,686 1,771 269,474 50,129 502,224 2,094,356
Navajo 108,147 27,876 20,899 2,247 7,564 4,802 43 7,157 974 26,324 62,696
Pima 1,052,030 213,306 217,441 17,196 79,018 49,196 414 72,863 11,223 151,169 523,375
Pinal 449,557 99,167 94,452 7,994 32,954 20,976 178 31,292 4,173 45,630 202,093
Santa Cruz 47,883 12,566 9,175 1,013 3,328 2,101 19 3,126 478 9,723 40,473
Yavapai 242,253 38,015 81,576 3,065 18,772 14,905 95 23,653 1,756 29,766 50,105
Yuma 206,990 51,894 40,569 4,183 14,601 8,993 82 13,272 1,983 34,270 146,493

State Tables
ARKANSAS
American Lung Association in Arkansas

24-Hour Annual
Arkansas DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.6 Pass
Ashley DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Benton DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Clark 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Craighead DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Crittenden 7 0 0 2.3 D 0 0 0 0 0.0 A 8.0 Pass
Garland DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Jackson DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Newton 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Polk 1 0 0 0.3 B 0 0 0 0 0.0 A 8.1 Pass
Pulaski 3 0 0 1.0 C 1 0 0 0 0.3 B 9.0 Pass
Union DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Washington 1 0 0 0.3 B 0 0 0 0 0.0 A 7.7 Pass

State Tables
ARKANSAS
American Lung Association in Arkansas
AT-RISK GROUPS
Lung Diseases
Arkansas 16,722 3,925 3,382 259 1,164 1,340 12 1,585 181 2,923 5,310
Ashley 18,674 4,236 3,961 279 1,311 1,535 14 1,829 196 3,950 5,998
Benton 293,692 75,519 39,888 4,982 20,124 19,800 218 21,975 3,649 22,890 84,247
Clark 21,321 4,176 3,567 275 1,567 1,534 16 1,769 302 3,699 6,776
Craighead 112,218 28,057 15,690 1,851 7,747 7,544 83 8,440 1,472 19,674 29,464
Crittenden 47,525 12,873 6,942 849 3,192 3,313 35 3,718 576 10,706 28,727
Garland 100,330 20,002 24,475 1,319 7,233 8,684 74 10,635 1,032 14,319 18,990
Jackson 16,811 3,451 3,084 228 1,221 1,309 12 1,517 193 3,316 4,010
Newton 7,204 1,389 1,972 92 520 660 5 824 63 1,366 541
Polk 19,353 4,390 4,449 290 1,351 1,624 14 1,971 188 3,697 2,445
Pulaski 397,821 92,461 65,692 6,099 27,998 29,236 293 33,421 4,985 68,564 196,104
Union 38,340 9,180 7,230 606 2,660 2,970 28 3,476 418 6,726 15,206
Washington 250,057 59,699 30,796 3,938 17,587 16,167 186 17,677 3,415 30,035 75,674

State Tables
CALIFORNIA
American Lung Association in California

24-Hour Annual
Alameda 21 2 0 8.0 F 9 10 1 0 8.7 F 8.8 Pass
Amador 8 1 0 3.2 D DNC DNC DNC DNC DNC DNC DNC DNC
Butte 17 2 0 6.7 F 21 22 2 1 20.2 F 11.4 Pass
Calaveras 9 1 0 3.5 F 14 16 0 0 12.7 F 8.9 Pass
Colusa 0 0 0 0.0 A 18 27 0 0 19.5 F 10.4 Pass
Contra Costa 13 0 0 4.3 F 9 11 0 0 8.5 F 9.3 Pass
El Dorado 41 6 0 16.7 F DNC DNC DNC DNC DNC DNC DNC DNC
Fresno 136 16 1 54.0 F 77 42 5 0 50.0 F 15.3 Fail
Glenn 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Humboldt 0 0 0 0.0 A 2 0 0 0 0.7 B 7.4 Pass
Imperial 45 4 0 17.0 F 8 1 0 0 3.2 D 11.0 Pass
Inyo 19 0 0 6.3 F 32 34 8 6 38.0 F 8.4 Pass
Kern 201 38 1 86.7 F 107 29 2 0 51.5 F 17.8 Fail
Kings 54 3 0 19.5 F 85 23 0 0 39.8 F 15.9 Fail
Lake 0 0 0 0.0 A 1 4 0 0 2.3 D 6.3 Pass
Los Angeles 175 86 16 112.0 F 39 13 1 0 20.2 F 13.0 Fail
Madera 59 6 0 22.7 F 30 21 1 0 21.2 F 13.0 Fail
Marin 1 0 0 0.3 B 4 4 1 0 4.0 F 7.3 Pass
Mariposa 45 7 0 18.5 F DNC DNC DNC DNC DNC DNC DNC DNC
Mendocino 0 0 0 0.0 A 15 12 1 2 13.3 F 9.2 Pass
Merced 44 3 0 16.2 F 24 16 0 0 16.0 F 11.9 Pass
Mono DNC DNC DNC DNC DNC 23 27 10 18 42.8 F INC INC
Monterey 0 0 0 0.0 A 5 9 2 0 7.5 F 7.0 Pass
Napa 3 0 0 1.0 C 6 8 0 0 6.0 F INC INC
Nevada 51 7 1 21.2 F 14 27 4 0 20.8 F 9.7 Pass
Orange 42 9 2 19.8 F 24 2 0 0 9.0 F 11.1 Pass
Placer 69 8 0 27.0 F 19 23 0 0 17.8 F 10.4 Pass
Plumas DNC DNC DNC DNC DNC 22 28 1 1 22.8 F 16.5 Fail
Riverside 232 89 10 128.5 F 36 7 0 0 15.5 F 13.9 Fail
Sacramento 48 3 0 17.5 F 22 21 0 1 18.7 F 11.1 Pass
San Benito 3 0 0 1.0 C 6 8 0 0 6.0 F 6.5 Pass
San Bernardino 194 176 37 177.3 F 36 9 0 0 16.5 F 14.2 Fail
San Diego 65 6 0 24.7 F 17 10 0 0 10.7 F 9.6 Pass
San Francisco 1 0 0 0.3 B 3 5 0 0 3.5 F 8.5 Pass
San Joaquin 11 0 0 3.7 F 29 16 0 0 17.7 F 11.8 Pass
San Luis Obispo 32 0 1 11.3 F 5 8 2 0 7.0 F 7.7 Pass
San Mateo 3 0 0 1.0 C 4 5 0 0 3.8 F 7.6 Pass
Santa Barbara 7 1 0 2.8 D 7 3 0 0 3.8 F 7.6 Pass
Santa Clara 15 1 0 5.5 F 12 8 0 0 8.0 F 10.3 Pass

State Tables
CALIFORNIA (cont.)

24-Hour Annual
Santa Cruz 0 0 0 0.0 A 6 10 2 2 10.0 F 7.1 Pass
Shasta 12 0 0 4.0 F 9 17 2 0 12.8 F 9.5 Pass
Siskiyou 0 0 0 0.0 A 19 35 2 1 26.0 F 10.5 Pass
Solano 7 0 0 2.3 D 6 5 1 0 5.2 F 9.7 Pass
Sonoma 0 0 0 0.0 A 1 6 0 0 3.3 F INC INC
Stanislaus 56 3 0 20.2 F 42 19 0 0 23.5 F 13.0 Fail
Sutter 19 3 0 7.8 F 24 19 1 1 19.0 F 13.1 Fail
Tehama 31 1 0 10.8 F 16 36 0 0 23.3 F 9.8 Pass
Tulare 220 35 2 92.2 F 59 21 1 1 31.7 F 17.8 Fail
Tuolumne 9 0 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC
Ventura 35 3 0 13.2 F 5 2 0 0 2.7 D 7.9 Pass
Yolo 5 0 0 1.7 C 3 1 0 0 1.5 C INC INC

State Tables
CALIFORNIA
AT-RISK GROUPS
Lung Diseases
Alameda 1,648,556 331,885 246,049 16,555 116,489 59,149 619 81,390 18,725 152,654 1,166,367
Amador 41,259 6,274 11,315 313 3,109 1,920 16 2,850 275 4,104 9,918
Butte 208,309 42,437 37,992 2,117 14,671 7,834 78 10,807 2,243 33,874 64,260
Calaveras 46,221 8,019 13,189 400 3,398 2,160 17 3,243 340 6,198 9,996
Colusa 21,917 5,843 3,375 291 1,423 746 8 1,037 216 2,466 14,676
Contra Costa 1,161,413 257,360 193,929 12,837 80,121 42,768 436 60,672 11,808 100,948 687,016
El Dorado 193,221 37,909 43,677 1,891 13,797 8,114 73 11,958 1,637 16,839 46,513
Fresno 1,013,581 285,552 127,785 14,243 64,336 31,839 381 42,872 10,688 193,449 737,794
Glenn 28,805 7,721 4,806 385 1,867 1,006 11 1,413 268 4,397 14,659
Humboldt 136,310 25,812 26,105 1,288 9,779 5,295 51 7,379 1,470 25,781 37,374
Imperial 179,851 51,197 24,033 2,554 11,371 5,719 68 7,739 1,715 29,738 163,246
Inyo 18,970 3,959 4,567 197 1,333 800 7 1,173 158 2,382 7,678
Kern 917,673 263,402 104,638 13,139 57,795 27,903 346 37,178 9,412 164,169 632,525
Kings 153,443 41,404 16,422 2,065 9,887 4,641 58 6,050 1,471 24,295 107,456
Lake 68,766 15,010 15,864 749 4,773 2,839 26 4,162 567 11,196 22,911
Los Angeles 9,829,544 2,071,174 1,436,518 103,311 686,458 348,045 3,693 479,386 109,039 1,365,808 7,341,491
Madera 159,410 43,700 22,740 2,180 10,235 5,250 60 7,207 1,747 31,044 108,934
Marin 260,206 49,948 61,011 2,491 18,693 11,172 98 16,638 2,139 19,734 77,769
Mariposa 17,147 2,926 4,937 146 1,264 803 6 1,199 129 2,387 3,863
Mendocino 91,305 19,251 21,599 960 6,395 3,812 34 5,561 796 14,539 33,860
Merced 286,461 83,121 32,980 4,146 17,962 8,697 108 11,590 3,025 61,359 215,404
Mono 13,247 2,291 2,340 114 971 517 5 731 132 1,278 4,581
Monterey 437,325 113,236 63,337 5,648 28,668 14,691 165 20,181 4,378 50,725 313,287
Napa 136,207 26,875 27,529 1,341 9,695 5,436 51 7,806 1,309 11,814 67,511
Nevada 103,487 17,560 29,469 876 7,639 4,824 39 7,195 826 12,141 16,609
Orange 3,167,809 679,361 498,753 33,887 220,403 115,006 1,190 161,384 33,179 309,402 1,947,681
Placer 412,300 90,599 82,552 4,519 28,538 16,143 155 23,318 3,858 26,816 125,701
Plumas 19,915 3,446 6,029 172 1,465 951 7 1,428 149 2,545 3,557
Riverside 2,458,395 604,518 364,844 30,154 164,045 84,491 925 116,774 25,573 282,068 1,670,925
Sacramento 1,588,921 369,843 234,117 18,448 107,853 55,118 597 75,886 17,210 203,413 920,382
San Benito 66,677 17,076 8,818 852 4,388 2,201 25 3,020 680 5,899 46,310
San Bernardino 2,194,710 570,561 265,519 28,460 143,564 70,097 825 94,581 23,805 285,474
1,637,602
San Diego 3,286,069 698,371 489,101 34,835 228,821 115,946 1,237 158,242 35,582 340,522 1,848,397
San Francisco 815,201 114,402 142,810 5,706 61,981 32,058 307 44,000 9,597 90,898 503,920
San Joaquin 789,410 210,579 103,226 10,504 51,190 25,611 297 34,953 8,246 95,382 566,055
San Luis Obispo 283,159 49,467 60,618 2,467 20,693 11,570 107 16,302 2,799 35,120 92,156
San Mateo 737,888 146,863 128,911 7,326 52,366 28,013 277 39,608 7,561 49,900 461,621
Santa Barbara 446,475 99,487 71,397 4,962 30,669 15,811 168 21,484 4,867 65,029 256,024
Santa Clara 1,885,508 399,419 272,913 19,923 131,500 66,599 710 91,842 20,111 128,955 1,340,823

State Tables
CALIFORNIA (CONT.)
AT-RISK GROUPS
Lung Diseases
Santa Cruz 267,792 49,800 48,935 2,484 19,296 10,318 101 14,397 2,915 27,132 117,215
Shasta 182,139 39,609 38,317 1,976 12,639 7,227 68 10,396 1,672 25,141 40,316
Siskiyou 44,118 8,941 11,872 446 3,126 1,957 17 2,904 341 7,301 11,403
Solano 451,716 99,168 76,314 4,947 31,219 16,588 170 23,259 4,505 44,037 292,229
Sonoma 485,887 92,864 102,618 4,632 34,856 19,779 182 28,486 4,664 43,661 187,104
Stanislaus 552,999 149,012 74,357 7,433 35,728 18,009 208 24,607 5,736 76,921 342,106
Sutter 99,063 25,360 15,896 1,265 6,525 3,454 37 4,821 983 15,224 56,125
Tehama 65,498 15,689 13,216 783 4,418 2,522 25 3,641 576 10,107 22,521
Tulare 477,054 144,196 55,572 7,193 29,409 14,362 179 19,237 4,989 88,367 351,235
Tuolumne 55,810 9,479 15,200 473 4,114 2,538 21 3,735 412 6,848 12,113
Ventura 839,784 186,401 140,232 9,298 57,884 30,803 316 43,460 8,426 73,968 473,514
Yolo 216,986 44,343 28,690 2,212 15,233 7,334 81 9,582 2,801 30,708 120,110

State Tables
COLORADO
American Lung Association in Colorado

24-Hour Annual
Adams 31 1 0 10.8 F 5 1 0 0 2.2 D INC INC
Arapahoe 49 5 0 18.8 F 1 0 0 0 0.3 B 6.4 Pass
Archuleta 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Boulder 42 2 0 15.0 F 23 3 0 0 9.2 F 9.0 Pass
Clear Creek 16 0 0 5.3 F DNC DNC DNC DNC DNC DNC DNC DNC
Delta 0 0 0 0.0 A 2 0 0 0 0.7 B INC INC
Denver 38 2 0 13.7 F 19 3 0 0 7.8 F 10.2 Pass
Douglas 55 10 0 23.3 F 8 2 0 0 3.7 F 7.0 Pass
El Paso 34 1 0 11.8 F 1 0 0 0 0.3 B 5.6 Pass
Garfield 3 0 0 1.0 C 2 1 0 0 1.2 C INC INC
Gilpin 28 1 0 9.8 F DNC DNC DNC DNC DNC DNC DNC DNC
Gunnison 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Jefferson 83 15 0 35.2 F DNC DNC DNC DNC DNC DNC DNC DNC
La Plata 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Larimer 44 3 0 16.2 F 15 1 0 0 5.5 F 7.5 Pass
Mesa 3 0 0 1.0 C 2 0 0 0 0.7 B 5.8 Pass
Montezuma 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC
Pueblo DNC DNC DNC DNC DNC 1 0 0 0 0.3 B INC INC
Rio Blanco 5 0 0 1.7 C 4 1 0 0 1.8 C 8.6 Pass
Weld 37 1 0 12.8 F 17 0 0 0 5.7 F 9.5 Pass

State Tables
COLORADO
American Lung Association in Colorado
AT-RISK GROUPS
Lung Diseases
Adams 522,140 131,824 57,667 8,696 41,033 18,148 198 19,350 5,838 51,680 272,817
Arapahoe 654,900 149,417 91,930 9,856 53,064 25,102 249 27,810 7,126 56,744 274,381
Archuleta 13,790 2,411 3,768 159 1,186 721 5 894 104 1,556 3,289
Boulder 329,543 59,649 52,488 3,935 28,249 13,591 125 15,224 3,685 34,103 74,923
Clear Creek 9,446 1,316 2,077 87 857 470 4 556 82 712 1,184
Delta 31,661 6,175 8,628 407 2,642 1,606 12 1,999 241 4,325 6,107
Denver 711,463 132,461 86,480 8,738 60,368 26,094 270 27,648 9,286 82,086 320,102
Douglas 368,990 88,461 48,765 5,835 29,721 14,205 140 15,710 3,770 10,490 73,629
El Paso 737,867 172,817 99,824 11,400 59,131 27,420 280 30,135 7,894 68,718 238,652
Garfield 62,161 15,298 8,980 1,009 4,929 2,391 24 2,679 612 5,667 20,798
Gilpin 5,873 828 1,144 55 537 287 2 335 52 406 833
Gunnison 17,281 2,791 2,470 184 1,516 693 7 756 197 2,016 2,371
Jefferson 579,581 109,740 100,613 7,239 49,233 24,695 220 28,212 5,989 41,422 132,397
La Plata 56,250 10,116 11,179 667 4,826 2,540 21 2,970 560 5,521 12,248
Larimer 362,533 68,005 61,379 4,486 30,662 14,940 138 16,910 4,105 39,476 67,328
Mesa 157,335 32,844 32,236 2,167 12,958 6,945 60 8,213 1,517 16,238 30,760
Montezuma 26,175 5,526 6,270 365 2,148 1,242 10 1,516 221 3,957 7,395
Pueblo 169,622 37,569 32,384 2,478 13,776 7,242 64 8,479 1,649 26,839 83,171
Rio Blanco 6,476 1,518 1,183 100 518 270 2 315 59 632 1,060
Weld 340,036 87,313 42,986 5,760 26,516 12,224 129 13,364 3,641 32,543 122,743

State Tables
CONNECTICUT
American Lung Association in Connecticut

24-Hour Annual
Fairfield 38 9 0 17.2 F 6 0 0 0 2.0 C 8.1 Pass
Hartford 6 0 0 2.0 C 2 0 0 0 0.7 B 7.5 Pass
Litchfield 1 0 0 0.3 B 2 0 0 0 0.7 B 5.1 Pass
Middlesex 18 2 0 7.0 F DNC DNC DNC DNC DNC DNC DNC DNC
New Haven 32 5 0 13.2 F 4 0 0 0 1.3 C 8.2 Pass
New London 16 1 0 5.8 F 1 0 0 0 0.3 B 6.9 Pass
Tolland 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Windham 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
CONNECTICUT
American Lung Association in Connecticut
AT-RISK GROUPS
Lung Diseases
Fairfield 959,768 210,680 158,603 18,782 80,138 38,463 533 52,573 9,356 85,452 386,212
Hartford 896,854 186,592 158,512 16,635 75,878 36,692 498 50,405 8,927 92,542 371,285
Litchfield 185,000 32,664 42,169 2,912 15,915 8,942 103 12,359 1,542 15,713 25,753
Middlesex 164,759 27,712 35,695 2,471 14,418 7,744 91 10,686 1,509 10,537 29,067
New Haven 863,700 172,492 156,201 15,378 73,777 35,898 479 49,344 8,832 100,433 345,820
New London 268,805 51,417 51,843 4,584 23,099 11,596 149 15,974 2,497 23,102 69,656
Tolland 150,293 25,624 25,398 2,284 13,446 6,051 84 8,305 1,649 15,039 26,007
Windham 116,418 22,529 20,814 2,008 10,020 4,886 65 6,700 1,132 13,043 21,471

State Tables
DELAWARE
American Lung Association in Delaware

24-Hour Annual
Kent 2 0 0 0.7 B 0 0 0 0 0.0 A INC INC
New Castle 7 0 0 2.3 D 2 0 0 0 0.7 B INC INC
Sussex 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC

State Tables
DELAWARE
American Lung Association in Delaware
AT-RISK GROUPS
Lung Diseases
Kent 184,149 42,116 33,033 2,778 14,216 8,563 98 13,358 2,027 21,961 75,860
New Castle 571,708 121,570 94,971 8,019 45,331 26,572 304 41,232 6,410 63,059 258,618
Sussex 247,527 44,608 73,642 2,943 19,557 15,165 132 24,267 1,954 28,006 60,853

State Tables
DISTRICT OF COLUMBIA
American Lung Association in the District of Columbia

24-Hour Annual
District of Columbia 10 0 0 3.3 F 1 3 0 0 1.8 C 8.8 Pass

State Tables
DISTRICT OF COLUMBIA
American Lung Association in the District of Columbia
AT-RISK GROUPS
Lung Diseases
District of Columbia 670,050 125,835 85,838 12,162 62,995 25,184 302 29,575 8,591 107,307 420,299

State Tables
FLORIDA
American Lung Association in Florida

24-Hour Annual
Alachua 0 0 0 0.0 A 1 0 0 0 0.3 B 7.2 Pass
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 0 0 0 0.0 A 0 0 0 0 0.0 A 7.5 Pass
Broward 0 0 0 0.0 A 3 0 0 0 1.0 C 9.2 Pass
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 0 0 0 0.0 A 1 0 0 0 0.3 B 8.6 Pass
Escambia 1 0 0 0.3 B 0 0 0 0 0.0 A 9.2 Pass
Flagler 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Highlands 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Hillsborough 8 0 0 2.7 D 1 0 0 0 0.3 B INC INC
Holmes 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Indian River 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Lake 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Lee 1 0 0 0.3 B 0 0 0 0 0.0 A 7.4 Pass
Leon 1 0 0 0.3 B 1 0 0 0 0.3 B 7.4 Pass
Liberty 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Manatee 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Marion 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Martin 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Miami-Dade 1 0 0 0.3 B 1 0 0 0 0.3 B 7.1 Pass
Okaloosa 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Orange 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC
Osceola 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC
Palm Beach 0 0 0 0.0 A 0 0 0 0 0.0 A 6.8 Pass
Pasco 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Pinellas 0 0 0 0.0 A 0 0 0 0 0.0 A 7.8 Pass
Polk 0 0 0 0.0 A 0 0 0 0 0.0 A 8.2 Pass
St. Lucie 0 0 0 0.0 A 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 0 0 0 0.0 A 0 0 0 0 0.0 A 7.6 Pass
Seminole 0 0 0 0.0 A 0 0 0 0 0.0 A 7.3 Pass
Volusia 0 0 0 0.0 A 0 0 0 0 0.0 A 8.1 Pass
Wakulla 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
FLORIDA
American Lung Association in Florida
AT-RISK GROUPS
Lung Diseases
Alachua 279,238 50,734 42,493 3,382 16,695 13,655 148 17,790 3,722 50,668 111,555
Baker 28,715 6,822 4,179 455 1,615 1,445 15 1,857 270 4,187 5,975
Bay 179,168 37,257 33,098 2,483 10,465 10,232 95 13,367 1,741 24,383 43,941
Brevard 616,628 112,182 149,343 7,478 37,097 40,242 328 53,770 5,364 68,879 167,351
Broward 1,930,983 404,724 338,380 26,978 112,602 107,885 1,025 140,272 20,030 244,519 1,283,111
Collier 385,980 63,943 127,681 4,262 23,483 28,874 205 39,894 2,879 39,843 147,665
Columbia 70,385 15,292 13,850 1,019 4,049 4,009 38 5,296 610 10,722 20,147
Duval 999,935 225,827 149,041 15,053 56,983 50,379 531 65,001 11,179 146,090 491,477
Escambia 322,390 67,752 56,000 4,516 18,705 17,291 171 22,617 3,360 56,350 117,082
Flagler 120,932 19,834 37,642 1,322 7,405 8,968 64 12,257 934 12,373 31,372
Highlands 103,296 17,538 36,883 1,169 6,228 7,912 55 11,055 744 15,428 36,333
Hillsborough 1,478,194 325,550 219,177 21,700 84,933 75,284 785 96,889 16,716 208,765 790,956
Holmes 19,784 4,104 3,951 274 1,154 1,158 11 1,526 161 3,613 2,866
Indian River 163,662 25,084 56,134 1,672 10,112 12,657 87 17,495 1,186 18,938 41,911
Lake 395,804 76,020 104,866 5,067 23,417 26,219 210 35,526 3,491 39,022 132,091
Lee 787,976 136,094 228,930 9,072 47,668 55,147 419 75,252 6,631 95,012 277,671
Leon 292,817 54,936 42,438 3,662 17,397 14,088 155 18,263 4,028 45,137 131,225
Liberty 7,900 1,345 1,260 90 483 427 4 551 56 1,391 2,343
Manatee 412,703 72,883 117,219 4,858 24,895 28,802 219 39,144 3,426 40,642 122,748
Marion 385,915 72,422 110,887 4,827 22,904 26,484 205 36,203 3,284 50,984 123,301
Martin 159,942 25,753 51,121 1,717 9,817 11,981 85 16,430 1,130 17,768 36,345
Miami-Dade 2,662,777 537,115 448,951 35,803 156,874 147,358 1,414 190,773 28,191 398,855 2,301,562
Okaloosa 213,255 47,896 34,873 3,193 12,153 11,052 114 14,398 2,131 20,091 59,200
Orange 1,422,746 307,342 182,193 20,487 82,184 68,405 756 87,009 17,215 208,064 870,854
Osceola 403,282 97,524 53,935 6,501 22,536 19,397 214 24,807 4,574 53,195 286,609
Palm Beach 1,497,987 284,075 367,614 18,936 89,021 96,065 795 129,121 13,765 171,280 709,479
Pasco 584,067 119,378 128,954 7,957 34,160 35,693 310 47,485 5,573 67,129 174,217
Pinellas 956,615 150,259 247,356 10,016 59,258 65,267 507 87,533 8,660 115,468 257,365
Polk 753,520 166,777 149,543 11,117 43,042 42,396 400 56,215 7,651 115,547 347,066
St. Lucie 343,579 67,814 83,980 4,520 20,229 21,944 182 29,492 3,088 38,819 158,382
Santa Rosa 193,998 42,530 31,824 2,835 11,177 10,467 103 13,547 1,864 16,609 36,643
Sarasota 447,057 62,639 166,393 4,175 28,009 36,345 237 50,564 3,105 37,895 80,356
Seminole 470,093 97,789 77,037 6,518 27,435 25,248 249 32,707 5,173 43,726 200,067
Volusia 564,412 99,330 141,305 6,621 34,136 37,109 300 49,824 5,045 75,803 173,318
Wakulla 34,690 7,182 5,586 479 2,033 1,897 19 2,444 309 3,164 7,416

State Tables
GEORGIA
American Lung Association in Georgia

24-Hour Annual
Bibb 2 0 0 0.7 B 3 0 0 0 1.0 C 9.0 Pass
Chatham 0 0 0 0.0 A 1 0 0 0 0.3 B 9.3 Pass
Chattooga 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Clarke 0 0 0 0.0 A 1 0 0 0 0.3 B 9.4 Pass
Clayton DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.6 Pass
Cobb 1 0 0 0.3 B 0 0 0 0 0.0 A 8.6 Pass
Coffee DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 6.9 Pass
Dawson 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
DeKalb 5 1 0 2.2 D 1 0 0 0 0.3 B 8.8 Pass
Dougherty DNC DNC DNC DNC DNC 8 0 0 0 2.7 D 9.5 Pass
Douglas 7 0 0 2.3 D DNC DNC DNC DNC DNC DNC DNC DNC
Fulton 8 1 0 3.2 D 0 0 0 0 0.0 A 9.6 Pass
Glynn 0 0 0 0.0 A 0 0 0 0 0.0 A 7.7 Pass
Gwinnett 3 0 0 1.0 C 2 0 0 0 0.7 B INC INC
Hall DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 9.0 Pass
Henry 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC DNC
Houston DNC DNC DNC DNC DNC 6 1 0 0 2.5 D 9.4 Pass
Lowndes DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 8.0 Pass
Murray 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Muscogee 0 0 0 0.0 A 0 1 0 0 0.5 B 8.6 Pass
Pike 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Richmond 2 0 0 0.7 B 8 0 0 0 2.7 D 11.1 Pass
Rockdale 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC
Sumter 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Walker DNC DNC DNC DNC DNC 1 0 0 0 0.3 B INC INC
Washington DNC DNC DNC DNC DNC 6 0 0 0 2.0 C 9.2 Pass

State Tables
GEORGIA
American Lung Association in Georgia
AT-RISK GROUPS
Lung Diseases
Bibb 156,762 37,774 25,410 3,669 11,096 8,046 88 11,191 1,804 36,780 100,015
Chatham 296,329 61,197 48,992 5,944 22,071 15,583 168 21,604 3,542 43,618 156,167
Chattooga 24,932 5,517 4,600 536 1,779 1,382 14 1,951 229 4,768 4,456
Clarke 128,711 21,671 15,512 2,105 10,517 6,061 73 7,968 2,020 25,418 57,574
Clayton 297,100 80,878 30,968 7,855 20,612 13,636 167 17,924 3,721 55,143 272,109
Cobb 766,802 173,944 102,037 16,894 55,740 39,095 434 52,658 9,038 72,765 381,797
Coffee 43,386 10,516 6,126 1,021 3,088 2,172 25 2,959 441 10,440 18,766
Columbia 159,639 39,977 23,038 3,883 11,202 7,998 91 10,947 1,775 11,580 55,183
Dawson 28,497 5,750 5,787 558 2,065 1,663 16 2,373 276 2,556 2,973
DeKalb 757,718 171,248 102,893 16,632 55,413 38,071 428 51,429 9,393 108,081 534,270
Dougherty 84,844 20,156 14,263 1,958 6,032 4,376 48 6,119 1,004 21,155 64,969
Douglas 145,814 37,128 17,814 3,606 10,194 7,221 82 9,660 1,708 18,540 95,967
Fulton 1,065,334 223,838 131,928 21,739 80,097 53,333 603 70,935 13,702 142,028 650,233
Glynn 84,739 17,781 18,144 1,727 6,065 4,923 48 7,102 862 13,760 30,811
Gwinnett 964,546 253,649 106,230 24,635 67,109 46,283 547 61,183 11,138 102,953 644,227
Hall 207,369 50,165 32,873 4,872 14,585 10,796 118 14,956 2,179 24,666 84,380
Henry 245,235 61,677 30,050 5,990 17,192 12,250 138 16,386 2,890 23,188 157,996
Houston 166,829 42,832 22,191 4,160 11,678 8,132 94 11,015 1,914 19,058 77,190
Lowndes 119,276 29,193 15,320 2,835 8,653 5,536 67 7,449 1,506 27,652 57,043
Murray 39,951 9,532 6,168 926 2,813 2,108 23 2,906 422 6,208 7,555
Muscogee 205,617 51,098 29,153 4,963 14,612 10,003 116 13,661 2,369 40,496 125,582
Pike 19,477 4,582 3,127 445 1,370 1,050 11 1,454 207 1,859 2,509
Richmond 205,673 46,802 30,764 4,545 14,998 10,341 116 14,178 2,382 41,249 138,402
Rockdale 94,082 22,564 14,447 2,191 6,594 5,001 53 6,887 1,029 12,697 69,794
Sumter 29,283 6,668 5,124 648 2,103 1,542 17 2,165 331 7,727 17,899
Walker 68,510 14,789 13,068 1,436 4,911 3,850 39 5,457 686 9,524 6,878
Washington 19,785 4,297 3,538 417 1,424 1,093 11 1,534 177 4,057 11,430

State Tables
HAWAII
American Lung Association in Hawaii

24-Hour Annual
Hawaii DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 2.7 Pass
Honolulu 0 0 0 0.0 A 0 0 0 0 0.0 A 3.7 Pass
Kauai DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 3.1 Pass
Maui DNC DNC DNC DNC DNC 2 1 0 0 1.2 C 3.7 Pass

State Tables
HAWAII
American Lung Association in Hawaii
AT-RISK GROUPS
Lung Diseases
Hawaii 202,906 43,074 46,047 2,204 13,063 6,075 83 11,583 2,050 29,361 141,490
Honolulu 1,000,890 210,112 187,935 10,753 64,603 26,936 411 50,829 10,998 96,646 824,798
Kauai 73,454 15,866 15,755 812 4,706 2,140 30 4,067 748 8,101 51,891
Maui 164,221 35,347 32,525 1,809 10,532 4,662 67 8,811 1,730 18,548 115,119

State Tables
IDAHO
American Lung Association in Idaho

24-Hour Annual
Ada 12 0 0 4.0 F 5 1 0 0 2.2 D 7.3 Pass
Bannock INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Benewah DNC DNC DNC DNC DNC 13 12 0 1 11.2 F 10.2 Pass
Butte 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Canyon DNC DNC DNC DNC DNC 13 7 0 0 7.8 F INC INC
Franklin DNC DNC DNC DNC DNC 11 1 0 0 4.2 F 6.5 Pass
Idaho 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Jerome DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Lemhi DNC DNC DNC DNC DNC 9 0 0 0 3.0 D 9.8 Pass
Shoshone DNC DNC DNC DNC DNC 11 9 3 1 11.0 F 10.6 Pass

State Tables
IDAHO
American Lung Association in Idaho
AT-RISK GROUPS
Lung Diseases
Ada 511,931 115,384 79,691 7,611 38,743 22,435 227 30,293 6,308 43,285 84,020
Bannock 88,263 22,550 13,344 1,488 6,390 3,609 39 4,904 1,102 11,121 15,423
Benewah 9,931 2,218 2,317 146 756 520 4 745 92 1,348 1,599
Butte 2,654 608 667 40 200 140 1 204 24 417 255
Canyon 243,115 65,926 34,527 4,349 17,276 9,774 108 13,162 2,970 26,280 73,878
Franklin 14,666 4,532 2,144 299 990 582 6 792 159 1,192 1,398
Idaho 17,040 3,341 4,920 220 1,336 976 8 1,447 135 2,232 1,667
Jerome 24,662 7,309 3,287 482 1,694 959 11 1,283 273 3,088 10,074
Lemhi 8,162 1,467 2,564 97 652 488 4 731 69 974 555
Shoshone 13,612 2,862 3,159 189 1,052 714 6 1,020 130 2,404 1,248

State Tables
ILLINOIS
American Lung Association in Illinois

24-Hour Annual
Adams 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Champaign 2 0 0 0.7 B 0 0 0 0 0.0 A 7.8 Pass
Clark 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Cook 39 5 0 15.5 F 4 0 0 0 1.3 C 10.4 Pass
DuPage 7 2 0 3.3 F 0 0 0 0 0.0 A INC INC
Effingham 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Hamilton 2 0 0 0.7 B 2 0 0 0 0.7 B 8.8 Pass
Jersey 5 0 0 1.7 C 0 0 0 0 0.0 A 8.0 Pass
Jo Daviess 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Kane 10 1 0 3.8 F 1 0 0 0 0.3 B 8.9 Pass
Lake 21 1 0 7.5 F DNC DNC DNC DNC DNC DNC DNC DNC
McHenry 12 0 0 4.0 F 0 0 0 0 0.0 A 8.4 Pass
McLean 3 0 0 1.0 C 1 0 0 0 0.3 B 9.0 Pass
Macon 0 0 0 0.0 A 3 0 0 0 1.0 C 9.4 Pass
Macoupin 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Madison 10 2 0 4.3 F 0 0 0 0 0.0 A 10.2 Pass
Peoria 4 0 0 1.3 C 1 0 0 0 0.3 B 8.7 Pass
Randolph 1 0 0 0.3 B 2 0 0 0 0.7 B INC INC
Rock Island 4 0 0 1.3 C 2 0 0 0 0.7 B 8.7 Pass
St. Clair 2 1 0 1.2 C 0 0 0 0 0.0 A 9.7 Pass
Sangamon 0 0 0 0.0 A 0 0 0 0 0.0 A 8.2 Pass
Will 4 0 0 1.3 C 1 1 0 0 0.8 B 9.9 Pass
Winnebago 1 0 0 0.3 B 1 0 0 0 0.3 B INC INC

State Tables
ILLINOIS
American Lung Association in Illinois
AT-RISK GROUPS
Lung Diseases
Adams 64,954 14,712 13,463 1,035 4,316 3,137 37 4,711 590 7,424 5,877
Champaign 205,943 39,315 28,273 2,767 14,910 7,918 118 11,011 2,641 28,582 70,591
Clark 15,300 3,475 3,077 245 1,010 740 9 1,115 135 1,533 586
Cook 5,173,146 1,111,446 807,186 78,216 354,509 218,829 2,959 318,460 57,451 703,874 3,027,779
DuPage 924,885 206,835 155,352 14,556 61,984 40,994 530 60,688 9,197 62,952 323,625
Effingham 34,430 8,255 6,396 581 2,253 1,571 20 2,344 307 3,158 1,606
Hamilton 7,911 1,743 1,753 123 527 400 5 605 69 1,032 394
Jersey 21,333 4,319 4,280 304 1,456 1,046 12 1,572 197 1,914 1,005
Jo Daviess 21,939 4,020 6,417 283 1,508 1,317 13 2,034 159 1,877 1,289
Kane 515,588 125,987 76,629 8,866 33,686 21,462 295 31,585 5,141 43,982 226,500
Lake 711,239 167,217 109,313 11,768 46,972 30,287 408 44,687 6,926 58,626 289,459
McHenry 311,122 71,178 49,322 5,009 20,607 13,645 178 20,274 2,963 18,456 65,299
McLean 170,889 36,154 24,260 2,544 11,903 6,790 98 9,669 2,070 21,514 36,526
Macon 102,432 23,011 21,285 1,619 6,833 4,940 59 7,406 1,003 16,893 25,821
Macoupin 44,406 9,252 9,422 651 3,001 2,227 25 3,363 403 6,702 1,889
Madison 264,490 57,401 47,890 4,040 17,853 12,139 151 18,048 2,639 29,596 42,541
Peoria 179,432 42,902 32,182 3,019 11,838 7,942 103 11,743 1,813 28,357 56,304
Randolph 30,142 5,779 5,816 407 2,103 1,441 17 2,142 227 3,909 5,065
Rock Island 142,909 32,070 28,843 2,257 9,559 6,778 82 10,124 1,341 22,803 43,467
St. Clair 254,796 59,630 43,039 4,196 16,858 11,197 146 16,578 2,572 33,300 99,924
Sangamon 194,734 42,966 36,600 3,024 13,067 9,061 111 13,514 1,931 27,610 40,620
Will 697,252 167,087 97,936 11,759 45,832 28,649 399 42,060 7,120 54,149 271,606
Winnebago 283,119 66,417 51,801 4,674 18,675 12,867 162 19,164 2,749 39,659 95,369

State Tables
INDIANA
American Lung Association in Indiana

24-Hour Annual
Allen 1 0 0 0.3 B 2 0 0 0 0.7 B INC INC
Bartholomew 0 0 0 0.0 A 0 0 0 0 0.0 A 7.1 Pass
Boone 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Brown 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Carroll 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Clark 1 0 0 0.3 B 0 0 0 0 0.0 A 7.5 Pass
Delaware 0 0 0 0.0 A 0 0 0 0 0.0 A 8.4 Pass
Dubois DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.8 Pass
Elkhart 0 0 0 0.0 A 0 2 0 0 1.0 C 8.3 Pass
Floyd 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Greene 0 0 0 0.0 A 0 0 0 0 0.0 A 7.9 Pass
Hamilton 2 0 0 0.7 B 0 0 0 0 0.0 A 9.8 Pass
Hendricks 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Henry DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.7 Pass
Howard 4 0 0 1.3 C 0 0 0 0 0.0 A 7.3 Pass
Huntington INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Jackson INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Knox 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Lake 10 0 0 3.3 F 2 1 0 0 1.2 C 9.7 Pass
LaPorte 14 1 0 5.2 F 1 0 0 0 0.3 B 8.1 Pass
Madison 1 0 0 0.3 B 0 0 0 0 0.0 A 8.8 Pass
Marion 4 0 0 1.3 C 12 0 0 0 4.0 F 12.0 Pass
Monroe DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.9 Pass
Morgan INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Perry 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Porter 13 1 0 4.8 F 1 0 0 0 0.3 B 8.2 Pass
Posey 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
St. Joseph 4 0 0 1.3 C 1 1 0 0 0.8 B 9.2 Pass
Shelby 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Spencer DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.2 Pass
Sullivan DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Tippecanoe DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.9 Pass
Vanderburgh 1 0 0 0.3 B 2 0 0 0 0.7 B 9.1 Pass
Vigo 0 0 0 0.0 A 2 0 0 0 0.7 B 9.1 Pass
Wabash 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Warrick 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Whitley DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.0 Pass

State Tables
INDIANA
American Lung Association in Indiana
AT-RISK GROUPS
Lung Diseases
Allen 388,608 99,204 59,043 6,977 29,992 23,994 241 25,043 4,614 50,086 108,774
Bartholomew 82,475 19,928 13,666 1,402 6,460 5,337 51 5,642 913 6,624 16,599
Boone 73,052 18,850 10,392 1,326 5,605 4,551 45 4,718 841 3,980 8,597
Brown 15,552 2,673 4,005 188 1,300 1,304 10 1,471 137 1,670 757
Carroll 20,444 4,502 4,079 317 1,629 1,476 13 1,608 206 1,730 1,443
Clark 122,738 27,277 19,985 1,918 9,854 8,159 76 8,575 1,445 12,668 22,464
Delaware 111,871 20,266 19,288 1,425 9,521 7,438 69 7,779 1,527 19,056 15,460
Dubois 43,549 10,606 8,065 746 3,375 2,995 27 3,237 431 3,187 4,926
Elkhart 206,921 56,653 31,560 3,984 15,544 12,648 129 13,277 2,307 22,950 55,536
Floyd 80,454 18,316 13,589 1,288 6,401 5,404 50 5,725 920 7,237 10,721
Greene 30,786 6,665 6,167 469 2,465 2,237 19 2,438 311 4,349 1,276
Hamilton 356,650 91,973 47,301 6,469 27,422 21,843 221 22,392 4,292 13,447 65,880
Hendricks 179,355 43,719 26,056 3,075 14,042 11,296 112 11,701 2,075 9,294 35,093
Henry 48,935 9,924 9,454 698 4,002 3,511 31 3,786 471 6,831 3,431
Howard 83,687 19,222 16,501 1,352 6,609 5,849 52 6,364 905 9,771 13,611
Huntington 36,717 7,997 6,551 562 2,954 2,529 23 2,698 403 3,758 2,161
Jackson 46,067 11,308 7,800 795 3,575 3,061 29 3,258 487 6,443 6,366
Knox 35,956 7,734 6,673 544 2,910 2,449 22 2,623 383 5,092 3,005
Lake 498,558 116,192 86,040 8,172 39,384 33,327 309 35,456 5,707 68,461 234,549
LaPorte 112,390 23,966 21,047 1,686 9,091 7,831 70 8,412 1,109 12,934 24,698
Madison 130,782 27,875 24,339 1,960 10,582 9,101 81 9,765 1,417 19,464 20,939
Marion 971,102 240,146 127,538 16,890 76,236 57,218 601 58,033 12,711 143,143 459,565
Monroe 139,875 21,809 19,577 1,534 12,444 8,437 87 8,374 2,179 26,549 24,029
Morgan 72,206 16,148 12,862 1,136 5,745 5,064 45 5,420 761 7,344 3,429
Perry 19,316 4,042 3,667 284 1,571 1,351 12 1,453 176 2,271 1,300
Porter 174,243 37,647 30,441 2,648 14,071 11,890 108 12,631 2,003 16,533 32,562
Posey 25,116 5,603 5,077 394 1,994 1,813 16 1,981 249 2,268 1,132
St. Joseph 272,212 63,777 44,824 4,485 21,584 17,432 169 18,347 3,294 37,269 78,993
Shelby 45,039 10,140 8,125 713 3,580 3,138 28 3,364 474 4,382 3,992
Spencer 19,798 4,292 4,045 302 1,582 1,454 12 1,590 195 1,582 1,132
Sullivan 20,758 3,910 3,839 275 1,736 1,466 13 1,562 196 2,998 1,834
Tippecanoe 187,076 37,975 22,636 2,671 15,735 10,486 117 10,255 2,635 30,391 48,027
Vanderburgh 179,987 38,959 31,728 2,740 14,568 12,038 112 12,781 2,141 24,050 31,888
Vigo 105,994 21,684 17,752 1,525 8,756 6,889 66 7,210 1,263 19,709 15,974
Wabash 30,816 6,440 6,450 453 2,496 2,233 19 2,444 330 3,253 1,927
Warrick 64,514 15,076 11,578 1,060 5,076 4,414 40 4,734 699 4,311 5,693
Whitley 34,430 7,889 6,509 555 2,719 2,411 21 2,606 354 2,494 1,836

State Tables
IOWA
American Lung Association in Iowa

24-Hour Annual
Black Hawk DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.1 Pass
Bremer 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Clinton 0 0 0 0.0 A 0 0 0 0 0.0 A 8.9 Pass
Harrison 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Johnson DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.9 Pass
Lee DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.3 Pass
Linn 1 0 0 0.3 B 0 0 0 0 0.0 A 8.3 Pass
Montgomery 0 0 0 0.0 A 0 0 0 0 0.0 A 6.9 Pass
Muscatine DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 8.3 Pass
Palo Alto 0 0 0 0.0 A 0 1 0 0 0.5 B 7.1 Pass
Polk 0 0 0 0.0 A 1 2 0 0 1.3 C 7.6 Pass
Pottawattamie DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 8.3 Pass
Scott 1 0 0 0.3 B 1 1 0 0 0.8 B 8.7 Pass
Van Buren 0 0 0 0.0 A 0 0 0 0 0.0 A 7.3 Pass
Woodbury DNC DNC DNC DNC DNC 0 1 0 0 0.5 B 8.1 Pass

State Tables
IOWA
American Lung Association in Iowa
AT-RISK GROUPS
Lung Diseases
Black Hawk 130,368 28,669 22,667 1,650 9,411 6,375 80 7,291 1,659 17,005 26,534
Bremer 25,081 5,690 4,886 328 1,774 1,299 15 1,521 289 1,681 1,455
Clinton 46,463 10,640 9,367 612 3,258 2,527 29 2,977 485 5,261 4,545
Harrison 14,669 3,461 2,865 199 1,020 796 9 933 146 1,491 679
Johnson 154,748 30,510 19,936 1,756 11,764 6,725 95 7,191 2,361 21,477 35,587
Lee 33,215 7,094 7,101 408 2,368 1,860 21 2,209 330 4,511 3,256
Linn 228,939 52,191 38,163 3,004 16,348 11,414 141 12,964 2,742 21,754 36,027
Montgomery 10,322 2,355 2,274 136 719 580 6 696 102 1,179 734
Muscatine 42,688 10,386 7,549 598 2,968 2,165 26 2,497 464 4,666 10,297
Palo Alto 8,906 2,073 2,000 119 616 492 6 594 86 1,024 658
Polk 496,844 121,504 67,875 6,994 35,142 22,700 307 24,916 6,263 49,300 120,633
Pottawattamie 93,304 21,857 17,045 1,258 6,552 4,840 58 5,603 1,028 11,207 12,947
Scott 174,170 41,016 29,754 2,361 12,281 8,737 107 9,989 2,033 22,074 37,282
Van Buren 7,243 1,701 1,609 98 499 408 4 490 67 917 286
Woodbury 105,607 27,657 16,110 1,592 7,235 4,928 65 5,550 1,229 15,992 32,659

State Tables
KANSAS
American Lung Association in Kansas

24-Hour Annual
Johnson 1 0 0 0.3 B 4 0 0 0 1.3 C INC INC
Leavenworth 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Neosho 1 0 0 0.3 B 4 0 0 0 1.3 C 9.3 Pass
Sedgwick 2 0 0 0.7 B 5 0 0 0 1.7 C INC INC
Shawnee 0 1 0 0.5 B 5 3 0 0 3.2 D INC INC
Sumner 0 0 0 0.0 A 5 0 0 0 1.7 C 9.2 Pass
Trego 0 0 0 0.0 A 3 0 0 0 1.0 C INC INC
Wyandotte 4 0 0 1.3 C 9 0 0 0 3.0 D INC INC

State Tables
KANSAS
American Lung Association in Kansas
AT-RISK GROUPS
Lung Diseases
Johnson 613,219 145,167 95,115 10,752 49,814 29,414 331 40,413 7,482 36,111 130,693
Leavenworth 82,184 19,346 12,673 1,433 6,690 3,936 45 5,404 861 6,637 17,886
Neosho 15,784 3,900 3,170 289 1,243 831 9 1,172 162 2,288 1,813
Sedgwick 523,828 132,197 80,926 9,792 41,601 24,401 283 33,584 6,326 68,690 173,524
Shawnee 178,264 41,503 34,100 3,074 14,371 9,246 96 12,953 2,028 25,426 48,389
Sumner 22,385 5,409 4,435 401 1,780 1,188 12 1,670 228 2,694 2,623
Trego 2,793 522 738 39 234 177 2 254 24 286 176
Wyandotte 167,046 46,014 21,918 3,408 12,949 7,240 90 9,842 2,027 27,959 100,928

State Tables
KENTUCKY
American Lung Association in Kentucky

24-Hour Annual
Bell 0 0 0 0.0 A 2 0 0 0 0.7 B 8.5 Pass
Boone 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Boyd 0 0 0 0.0 A 1 0 0 0 0.3 B 7.9 Pass
Bullitt 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Campbell 2 0 0 0.7 B 0 0 0 0 0.0 A 7.8 Pass
Carter 0 0 0 0.0 A 0 0 0 0 0.0 A 5.9 Pass
Christian 0 0 0 0.0 A 0 0 0 0 0.0 A 8.9 Pass
Daviess 2 0 0 0.7 B 0 0 0 0 0.0 A INC INC
Edmonson 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Fayette 0 0 0 0.0 A 0 0 0 0 0.0 A 8.1 Pass
Greenup 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Hancock 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Hardin 1 0 0 0.3 B 0 0 0 0 0.0 A 7.7 Pass
Henderson DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Jefferson 11 0 0 3.7 F 4 0 0 0 1.3 C 10.5 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 1 0 0 0.3 B 2 0 0 0 0.7 B 9.2 Pass
Morgan 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Oldham 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Perry 0 0 0 0.0 A 0 0 0 0 0.0 A 7.2 Pass
Pike 0 0 0 0.0 A 0 1 0 0 0.5 B 6.9 Pass
Pulaski 0 0 0 0.0 A 1 0 0 0 0.3 B 7.8 Pass
Simpson 0 0 0 0.0 A 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 2 0 0 0 0.7 B 8.3 Pass
Washington 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
KENTUCKY
American Lung Association in Kentucky
AT-RISK GROUPS
Lung Diseases
Bell 23,858 5,099 4,713 258 2,210 2,147 20 2,405 251 7,388 1,600
Boone 137,412 35,293 19,746 1,785 12,134 11,078 116 11,707 1,562 8,664 19,179
Boyd 47,899 10,369 9,772 525 4,417 4,332 40 4,893 483 9,672 3,379
Bullitt 82,918 17,624 13,968 892 7,761 7,306 70 7,896 941 9,146 5,646
Campbell 93,050 19,132 15,671 968 8,700 7,966 79 8,572 1,117 10,009 7,663
Carter 26,412 5,940 5,151 300 2,415 2,353 22 2,636 278 6,592 967
Christian 72,357 19,967 9,127 1,010 6,039 4,917 62 5,009 806 11,046 25,472
Daviess 103,063 25,200 18,018 1,275 9,162 8,622 87 9,470 1,137 13,621 13,324
Edmonson 12,291 2,220 2,583 112 1,188 1,164 10 1,310 134 2,237 725
Fayette 321,793 66,736 46,434 3,376 29,819 25,620 271 26,550 4,372 45,319 97,083
Greenup 35,649 7,676 7,745 388 3,289 3,291 30 3,771 363 5,124 1,447
Hancock 9,064 2,216 1,610 112 811 779 8 859 95 1,135 480
Hardin 111,607 27,549 16,414 1,394 9,934 8,969 94 9,483 1,264 12,683 27,241
Henderson 44,329 10,089 8,340 510 4,038 3,889 37 4,325 482 5,388 6,393
Jefferson 777,874 171,542 131,961 8,678 71,247 65,503 655 70,896 9,329 110,325 271,190
Jessamine 53,626 12,650 8,688 640 4,842 4,478 45 4,824 633 7,179 6,643
Livingston 8,959 1,865 1,992 94 839 855 8 983 87 1,283 490
McCracken 67,454 14,974 13,964 757 6,154 6,032 57 6,847 732 11,491 11,790
Morgan 13,820 2,486 2,391 126 1,341 1,243 12 1,338 124 3,138 1,105
Oldham 68,685 17,107 9,734 865 6,165 5,678 58 5,980 705 3,118 8,276
Perry 27,929 6,472 5,018 327 2,544 2,448 24 2,699 298 8,164 1,432
Pike 57,391 11,849 11,416 599 5,390 5,284 48 5,918 604 16,831 1,866
Pulaski 65,423 14,553 12,691 736 6,010 5,860 55 6,554 694 12,339 4,124
Simpson 19,718 4,662 3,320 236 1,783 1,679 17 1,826 217 2,638 2,933
Trigg 14,192 3,087 3,251 156 1,311 1,352 12 1,570 130 2,431 1,809
Warren 137,212 31,827 18,298 1,610 12,334 10,489 116 10,756 1,832 19,324 32,010
Washington 12,072 2,803 2,249 142 1,097 1,064 10 1,183 124 1,532 1,460

State Tables
LOUISIANA
American Lung Association in Louisiana

24-Hour Annual
Ascension Parish 2 1 0 1.2 C 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 1 0 0 0 0.3 B 9.9 Pass
Calcasieu Parish 0 1 0 0.5 B 0 0 0 0 0.0 A 7.1 Pass
East Baton Rouge Parish 7 1 0 2.8 D 0 0 0 0 0.0 A 8.6 Pass
Iberville Parish 10 0 0 3.3 F 0 0 0 0 0.0 A 7.9 Pass
Jefferson Parish 2 0 0 0.7 B 0 0 0 0 0.0 A 7.6 Pass
Lafayette Parish 0 0 0 0.0 A 1 0 0 0 0.3 B 7.9 Pass
Lafourche Parish 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Livingston Parish 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Orleans Parish DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.7 Pass
Ouachita Parish 0 0 0 0.0 A 1 0 0 0 0.3 B 7.3 Pass
Pointe Coupee Parish 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Rapides Parish DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 7.4 Pass
St. Bernard Parish 0 0 0 0.0 A 0 0 0 0 0.0 A 7.7 Pass
St. James Parish 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
St. John the Baptist Parish 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
St. Martin Parish 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
St. Tammany Parish 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Tangipahoa Parish DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.5 Pass
Terrebonne Parish DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.2 Pass
West Baton Rouge Parish 6 0 0 2.0 C 0 0 0 0 0.0 A 8.8 Pass

State Tables
LOUISIANA
American Lung Association in Louisiana
AT-RISK GROUPS
Lung Diseases
Ascension Parish 128,369 33,918 16,504 2,968 9,286 8,044 81 8,710 1,621 14,512 43,036
Bossier Parish 129,144 31,916 19,689 2,793 9,499 8,322 82 9,284 1,607 19,266 45,683
Caddo Parish 233,092 54,738 42,920 4,790 17,256 16,060 146 18,781 2,814 53,728 131,442
Calcasieu Parish 205,282 50,853 32,862 4,450 15,044 13,551 130 15,358 2,446 36,850 67,257
East Baton Rouge Parish 453,301 102,982 69,434 9,011 34,271 29,378 285 32,476 6,212 84,936 256,138
Iberville Parish 29,824 5,945 5,066 520 2,326 2,109 19 2,392 352 5,927 15,631
Jefferson Parish 433,688 96,493 79,658 8,444 32,654 30,516 273 35,573 5,134 75,278 213,095
Lafayette Parish 244,205 58,104 35,003 5,084 18,244 15,770 154 17,294 3,181 42,273 86,806
Lafourche Parish 97,504 22,441 15,958 1,964 7,311 6,673 62 7,582 1,159 15,052 23,042
Livingston Parish 145,830 37,242 19,976 3,259 10,653 9,287 92 10,165 1,847 17,350 22,644
Orleans Parish 376,971 74,460 62,665 6,516 29,519 26,051 236 29,242 5,249 92,262 259,233
Ouachita Parish 158,768 39,073 25,015 3,419 11,673 10,411 100 11,733 2,011 38,985 67,729
Pointe Coupee Parish 20,356 4,391 4,465 384 1,529 1,519 13 1,853 213 3,817 8,025
Rapides Parish 128,654 31,891 21,811 2,791 9,396 8,630 81 9,933 1,499 24,885 50,843
St. Bernard Parish 44,258 11,617 5,586 1,017 3,213 2,743 28 2,948 580 9,531 17,892
St. James Parish 19,742 4,413 3,712 386 1,482 1,405 12 1,650 222 3,327 10,079
St. John the Baptist Parish 42,094 10,235 6,469 896 3,110 2,824 27 3,177 502 6,976 28,846
St. Martin Parish 51,540 12,310 8,535 1,077 3,816 3,513 33 4,016 593 9,377 18,382
St. Tammany Parish 269,388 63,859 48,491 5,588 19,900 18,811 170 21,967 3,077 34,095 63,377
Tangipahoa Parish 135,217 33,209 20,479 2,906 9,969 8,759 85 9,762 1,721 23,496 50,637
Terrebonne Parish 108,708 27,316 16,656 2,390 7,944 7,157 69 8,051 1,284 18,132 37,158
West Baton Rouge Parish 27,792 6,830 4,110 598 2,051 1,804 18 2,002 341 4,127 12,798

State Tables
MAINE
American Lung Association in Maine

24-Hour Annual
Androscoggin 0 0 0 0.0 A 0 0 0 0 0.0 A 5. 5 Pass
Aroostook 0 0 0 0.0 A 1 3 0 0 1.8 C 4.4 Pass
Cumberland 3 0 0 1.0 C 0 0 0 0 0.0 A 7.1 Pass
Hancock 5 0 0 1.7 C 0 0 0 0 0.0 A 3.2 Pass
Kennebec 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC
Knox 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Oxford 0 0 0 0.0 A 1 0 0 0 0.3 B 5.1 Pass
Penobscot 0 0 0 0.0 A 0 0 0 0 0.0 A 4.4 Pass
Washington 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
York 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
MAINE
American Lung Association in Maine
AT-RISK GROUPS
Lung Diseases
Androscoggin 111,034 23,686 20,318 1,697 11,145 7,465 75 8,394 1,013 15,136 11,544
Aroostook 66,859 12,416 16,754 889 6,807 5,173 45 6,033 505 9,666 4,469
Cumberland 305,231 55,405 59,680 3,969 31,816 21,350 207 24,085 2,918 22,937 31,800
Hancock 56,192 9,331 14,693 668 5,849 4,462 38 5,217 448 6,077 3,308
Kennebec 124,486 23,630 25,774 1,693 12,790 8,931 85 10,166 1,096 13,702 7,471
Knox 41,084 7,083 11,100 507 4,228 3,271 28 3,845 304 4,171 2,159
Oxford 58,629 10,575 13,389 758 6,058 4,459 40 5,133 465 8,728 3,126
Penobscot 152,765 27,168 29,618 1,946 16,010 10,736 104 12,092 1,424 21,301 10,455
Washington 31,121 5,970 7,973 428 3,136 2,413 21 2,825 237 5,602 3,474
York 214,591 38,878 46,398 2,785 22,232 15,753 146 18,007 1,846 17,548 14,082

State Tables
MARYLAND
American Lung Association in Maryland

24-Hour Annual
Anne Arundel 10 0 0 3.3 F DNC DNC DNC DNC DNC DNC DNC DNC
Baltimore 20 0 0 6.7 F 2 0 0 0 0.7 B 7.9 Pass
Calvert 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Carroll 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Cecil 6 0 0 2.0 C 1 0 0 0 0.3 B 6.7 Pass
Charles 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Dorchester 4 0 0 1.3 C 0 0 0 0 0.0 A 5.6 Pass
Frederick 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Garrett 0 0 0 0.0 A 0 0 0 0 0.0 A 5.3 Pass
Harford 19 0 0 6.3 F 0 0 0 0 0.0 A 6.9 Pass
Howard DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.1 Pass
Kent 2 0 0 0.7 B 0 0 0 0 0.0 A 5.4 Pass
Montgomery 3 0 0 1.0 C 0 0 0 0 0.0 A 6.4 Pass
Prince George's 12 0 0 4.0 F 0 0 0 0 0.0 A 6.4 Pass
Washington 1 0 0 0.3 B 0 0 0 0 0.0 A 7.2 Pass
Baltimore City 5 0 0 1.7 C 1 0 0 0 0.3 B 7.5 Pass

State Tables
MARYLAND
American Lung Association in Maryland
AT-RISK GROUPS
Lung Diseases
Anne Arundel 590,336 131,557 91,036 8,941 43,411 21,859 303 32,832 6,412 35,719 206,129
Baltimore 849,316 185,454 151,951 12,603 62,549 33,085 434 50,676 9,416 81,334 389,215
Calvert 93,928 21,789 14,829 1,481 6,850 3,570 48 5,422 944 5,419 22,155
Carroll 173,873 38,015 30,464 2,583 12,866 6,904 89 10,603 1,703 9,212 22,087
Cecil 103,905 23,135 17,309 1,572 7,659 4,043 53 6,172 1,056 11,243 16,926
Charles 168,698 40,457 22,412 2,749 12,228 6,056 86 9,007 1,868 11,263 110,215
Dorchester 32,489 6,838 7,315 465 2,406 1,407 17 2,230 314 4,807 12,300
Frederick 279,835 65,091 42,173 4,424 20,361 10,309 143 15,501 3,016 18,065 85,996
Garrett 28,702 5,225 6,715 355 2,206 1,302 15 2,068 261 3,095 1,143
Harford 262,977 58,596 44,411 3,982 19,341 10,180 135 15,536 2,711 19,813 68,270
Howard 334,529 80,475 49,186 5,469 24,114 12,200 171 18,329 3,670 20,724 171,825
Kent 19,270 2,991 5,198 203 1,514 915 10 1,470 185 2,154 4,272
Montgomery 1,054,827 241,287 175,037 16,398 76,964 40,252 540 61,300 11,386 88,627 609,510
Prince George's 955,306 210,915 138,655 14,334 70,604 34,964 489 52,127 10,884 106,832 842,091
Washington 154,937 33,573 27,331 2,282 11,462 6,083 80 9,318 1,490 21,284 37,453
Baltimore City 576,498 117,030 86,276 7,953 43,312 20,826 294 30,787 7,403 126,488 417,615

State Tables
MASSACHUSETTS
American Lung Association in Massachusetts

24-Hour Annual
Barnstable 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC
Berkshire 0 0 0 0.0 A 1 0 0 0 0.3 B 7.6 Pass
Bristol 5 0 0 1.7 C 0 0 0 0 0.0 A 6.6 Pass
Dukes 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC
Essex 1 0 0 0.3 B 1 0 0 0 0.3 B 6.0 Pass
Franklin 0 0 0 0.0 A 0 0 0 0 0.0 A 7.6 Pass
Hampden 1 0 0 0.3 B 1 0 0 0 0.3 B 8.5 Pass
Hampshire 0 0 0 0.0 A 0 0 0 0 0.0 A 6.0 Pass
Middlesex 0 0 0 0.0 A 1 1 0 0 0.8 B 6.8 Pass
Norfolk 2 0 0 0.7 B INC INC INC INC INC INC INC INC
Plymouth 1 0 0 0.3 B 1 0 0 0 0.3 B 7.5 Pass
Suffolk 1 0 0 0.3 B 2 0 0 0 0.7 B 7.9 Pass
Worcester 1 0 0 0.3 B 2 0 0 0 0.7 B 8.4 Pass

State Tables
MASSACHUSETTS
American Lung Association in Massachusetts
AT-RISK GROUPS
Lung Diseases
Barnstable 232,411 33,438 73,864 3,243 23,296 14,224 135 19,479 1,537 18,293 25,500
Berkshire 128,657 20,956 31,686 2,033 12,698 6,964 75 9,175 1,068 13,454 16,681
Bristol 580,164 119,193 101,390 11,561 54,637 26,925 337 33,826 5,446 67,318 115,665
Dukes 21,097 3,701 5,391 359 2,044 1,157 12 1,537 161 1,601 2,870
Essex 807,074 168,869 144,299 16,379 75,644 37,543 469 47,372 7,494 75,743 261,263
Franklin 71,015 11,950 17,113 1,159 6,962 3,806 41 5,001 588 7,464 7,298
Hampden 462,718 97,909 81,804 9,496 43,362 21,171 269 26,667 4,436 76,268 184,521
Hampshire 161,572 22,958 30,300 2,227 16,621 7,706 94 9,651 1,936 16,221 27,785
Middlesex 1,614,742 316,295 257,427 30,678 154,771 72,218 938 89,158 16,422 120,205 487,544
Norfolk 724,505 149,057 125,480 14,457 68,253 33,445 421 41,955 6,938 48,469 203,314
Plymouth 533,003 111,004 101,907 10,767 49,825 25,644 309 32,714 4,614 39,035 105,743
Suffolk 771,245 125,596 99,444 12,182 78,054 31,818 448 37,579 9,899 133,563 427,452
Worcester 862,029 178,225 142,282 17,286 81,111 39,271 501 48,903 8,111 83,218 220,141

State Tables
MICHIGAN
American Lung Association in Michigan

24-Hour Annual
Allegan 19 0 0 6.3 F 0 0 0 0 0.0 A 6.7 Pass
Bay DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 5.9 Pass
Benzie 1 1 0 0.8 B DNC DNC DNC DNC DNC DNC DNC DNC
Berrien 12 0 0 4.0 F DNC DNC DNC DNC DNC DNC DNC DNC
Cass 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Chippewa DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Clinton 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Genesee 4 0 0 1.3 C 0 0 0 0 0.0 A 6.8 Pass
Huron 9 0 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC
Ingham 0 0 0 0.0 A 0 0 0 0 0.0 A 8.0 Pass
Kalamazoo 5 0 0 1.7 C 1 0 0 0 0.3 B 8.5 Pass
Kent 9 0 0 3.0 D 1 0 0 0 0.3 B 8.7 Pass
Lenawee 2 0 0 0.7 B 0 0 0 0 0.0 A 8.4 Pass
Macomb 16 0 0 5.3 F 0 0 0 0 0.0 A 7.7 Pass
Manistee 4 0 0 1.3 C 0 0 0 0 0.0 A INC INC
Mason 4 1 0 1.8 C DNC DNC DNC DNC DNC DNC DNC DNC
Missaukee 1 0 0 0.3 B 0 0 0 0 0.0 A 7.6 Pass
Muskegon 15 0 0 5.0 F DNC DNC DNC DNC DNC DNC DNC DNC
Oakland 9 0 0 3.0 D 0 0 0 0 0.0 A 7.8 Pass
Ottawa 9 0 0 3.0 D 1 0 0 0 0.3 B 8.6 Pass
St. Clair 10 0 0 3.3 F 1 0 0 0 0.3 B 7.9 Pass
Schoolcraft 5 0 0 1.7 C 1 0 0 0 0.3 B INC INC
Tuscola 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Washtenaw 5 0 0 1.7 C 0 1 0 0 0.5 B 8.5 Pass
Wayne 11 0 0 3.7 F 11 1 0 0 4.2 F 11.5 Pass
Wexford 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
MICHIGAN
American Lung Association in Michigan
AT-RISK GROUPS
Lung Diseases
Allegan 120,950 28,566 21,313 1,999 10,741 7,353 72 8,992 1,164 11,306 14,910
Bay 102,985 20,247 22,094 1,417 9,512 6,805 61 8,579 986 12,865 11,021
Benzie 18,223 3,229 4,968 226 1,686 1,323 11 1,746 149 1,673 1,198
Berrien 153,101 32,994 31,806 2,309 13,820 9,840 91 12,385 1,461 24,171 38,764
Cass 51,483 10,583 11,389 741 4,677 3,458 31 4,391 457 5,849 7,245
Chippewa 36,816 6,646 6,959 465 3,519 2,321 22 2,844 325 5,697 11,606
Clinton 79,426 17,338 14,531 1,213 7,214 4,937 47 6,057 799 6,121 8,613
Genesee 404,208 90,299 73,750 6,319 36,467 24,957 239 30,642 4,156 65,045 113,792
Huron 31,252 5,938 8,272 416 2,849 2,238 19 2,942 246 3,655 1,621
Ingham 284,034 55,848 41,014 3,908 27,157 15,783 168 18,419 3,693 42,168 87,741
Kalamazoo 261,108 56,121 41,262 3,928 24,199 14,779 155 17,638 3,138 35,688 61,408
Kent 658,046 155,887 95,764 10,909 59,362 36,632 390 43,214 7,476 64,334 180,614
Lenawee 98,956 20,564 19,516 1,439 9,067 6,315 59 7,847 935 10,508 13,832
Macomb 876,792 182,263 156,609 12,755 80,904 54,846 519 66,771 9,109 100,776 205,454
Manistee 25,350 4,286 6,832 300 2,375 1,840 15 2,418 190 3,139 2,939
Mason 29,383 5,921 7,453 414 2,652 2,031 17 2,657 249 4,010 2,713
Missaukee 15,130 3,383 3,218 237 1,347 979 9 1,240 131 1,773 990
Muskegon 176,511 40,223 31,756 2,815 15,856 10,712 105 13,138 1,759 24,759 42,348
Oakland 1,270,017 259,750 226,572 18,178 117,751 79,521 753 96,716 13,146 98,665 369,309
Ottawa 299,157 70,266 47,583 4,917 26,916 16,986 177 20,388 3,338 21,846 50,744
St. Clair 160,053 32,843 31,756 2,298 14,677 10,501 95 13,032 1,490 17,579 14,778
Schoolcraft 8,030 1,406 2,271 98 740 606 5 803 59 1,103 1,183
Tuscola 52,917 10,680 11,386 747 4,844 3,538 31 4,463 473 6,758 3,884
Washtenaw 369,390 68,042 55,925 4,762 35,764 21,244 219 24,944 4,677 43,132 110,720
Wayne 1,774,816 420,338 287,907 29,417 158,651 103,913 1,050 125,121 19,261 344,903 901,944
Wexford 33,901 7,840 6,792 549 3,001 2,137 20 2,680 310 5,097 2,162

State Tables
MINNESOTA
American Lung Association in Minnesota

24-Hour Annual
Anoka 4 0 0 1.3 C 2 2 0 0 1.7 C 6.8 Pass
Becker 2 0 0 0.7 B 6 5 0 0 4.5 F 7.1 Pass
Beltrami DNC DNC DNC DNC DNC 6 4 1 0 4.7 F 6.6 Pass
Carlton 0 0 0 0.0 A 4 0 0 0 1.3 C 2.8 Pass
Cass DNC DNC DNC DNC DNC 7 4 1 0 5.0 F 7.3 Pass
Cook DNC DNC DNC DNC DNC 3 1 0 0 1.5 C 3.3 Pass
Crow Wing 1 0 0 0.3 B 2 2 1 0 2.3 D 5.1 Pass
Dakota DNC DNC DNC DNC DNC 2 2 0 0 1.7 C 7.6 Pass
Goodhue 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Hennepin 0 0 0 0.0 A 1 4 0 0 2.3 D 8.0 Pass
Lake 0 0 0 0.0 A 3 1 0 0 1.5 C 4.8 Pass
Lyon 0 0 0 0.0 A 3 2 0 0 2.0 C 6.2 Pass
Mille Lacs 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Olmsted 0 0 0 0.0 A 3 0 0 0 1.0 C 6.3 Pass
Ramsey DNC DNC DNC DNC DNC 3 1 0 0 1.5 C 7.6 Pass
St. Louis 0 0 0 0.0 A 8 2 0 0 3.7 F 5.4 Pass
Scott 0 0 0 0.0 A 1 0 0 0 0.3 B 6.4 Pass
Stearns 0 0 0 0.0 A 3 2 1 0 2.7 D 6.8 Pass
Washington 1 0 0 0.3 B INC INC INC INC INC INC INC INC
Wright 2 0 0 0.7 B 2 2 0 0 1.7 C 6.8 Pass

State Tables
MINNESOTA
American Lung Association in Minnesota
AT-RISK GROUPS
Lung Diseases
Anoka 367,018 87,315 54,698 5,156 24,658 12,775 187 19,613 4,065 24,537 83,818
Becker 35,219 8,449 7,722 499 2,326 1,412 18 2,297 329 3,929 4,943
Beltrami 46,380 11,755 7,773 694 3,055 1,581 24 2,486 523 6,816 13,305
Carlton 36,409 8,107 6,547 479 2,480 1,375 19 2,163 348 3,605 4,426
Cass 30,639 6,355 8,165 375 2,089 1,393 16 2,314 249 3,566 5,310
Cook 5,617 831 1,678 49 411 278 3 466 49 540 869
Crow Wing 67,270 14,124 15,719 834 4,610 2,842 34 4,639 629 7,114 3,704
Dakota 442,038 106,797 67,549 6,307 29,548 15,362 224 23,697 4,963 22,043 107,949
Goodhue 47,968 10,602 9,840 626 3,257 1,910 24 3,063 474 3,771 4,170
Hennepin 1,267,416 276,004 190,925 16,299 87,793 43,397 644 66,614 15,617 124,666 409,588
Lake 10,986 2,119 2,964 125 764 504 6 837 95 953 559
Lyon 25,231 6,592 4,280 389 1,640 875 13 1,379 275 2,555 4,482
Mille Lacs 26,867 6,305 4,889 372 1,799 1,013 14 1,600 268 2,869 3,171
Olmsted 163,436 39,802 26,300 2,351 10,906 5,641 83 8,784 1,915 12,458 36,279
Ramsey 543,257 126,318 83,123 7,460 36,930 18,244 276 28,169 6,740 68,409 217,637
St. Louis 199,182 37,587 41,064 2,220 14,159 7,893 101 12,626 2,213 26,441 18,652
Scott 153,268 40,316 18,229 2,381 10,001 4,910 78 7,334 1,768 7,034 33,358
Stearns 158,947 37,474 25,124 2,213 10,741 5,409 81 8,396 1,841 20,682 27,390
Washington 272,256 65,874 43,297 3,890 18,143 9,699 138 15,038 2,931 13,900 55,247
Wright 144,845 39,728 19,335 2,346 9,284 4,707 74 7,164 1,583 7,005 13,545

State Tables
MISSISSIPPI
American Lung Association in Mississippi

24-Hour Annual
Bolivar 0 0 0 0.0 A 0 0 0 0 0.0 A 8.6 Pass
DeSoto 2 0 0 0.7 B 0 0 0 0 0.0 A 8.4 Pass
Forrest DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 9.4 Pass
Hancock 0 0 0 0.0 A 0 0 0 0 0.0 A 8.3 Pass
Harrison 1 0 0 0.3 B 0 0 0 0 0.0 A 9.2 Pass
Hinds 0 0 0 0.0 A 1 0 0 0 0.3 B 10.1 Pass
Jackson 1 0 0 0.3 B 0 0 0 0 0.0 A 8.4 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

State Tables
MISSISSIPPI
American Lung Association in Mississippi
AT-RISK GROUPS
Lung Diseases
Bolivar 30,308 7,530 5,171 761 2,302 2,086 21 2,847 359 9,905 20,591
DeSoto 188,633 47,463 25,312 4,796 14,504 12,396 131 16,550 2,378 20,337 77,492
Forrest 77,875 18,354 10,997 1,854 6,004 5,100 54 6,616 1,066 15,097 33,521
Hancock 46,055 9,016 9,838 911 3,775 3,633 32 5,209 476 7,913 7,366
Harrison 209,396 49,718 33,403 5,023 16,244 14,412 146 19,532 2,471 36,796 78,386
Hinds 222,679 52,918 34,980 5,347 17,208 15,156 154 20,339 2,843 54,213 170,357
Jackson 143,987 33,226 23,962 3,357 11,316 10,177 100 13,997 1,661 21,019 47,454
Lauderdale 72,088 16,840 13,057 1,701 5,592 5,144 50 7,107 795 15,632 35,429
Lee 82,883 20,779 12,726 2,099 6,345 5,611 58 7,626 981 12,446 30,296
Yalobusha 12,415 2,710 2,629 274 984 951 9 1,359 131 2,733 5,229

State Tables
MISSOURI
American Lung Association in Missouri

24-Hour Annual
Andrew 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Boone 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Buchanan DNC DNC DNC DNC DNC 3 0 0 0 1.0 C 8.2 Pass
Callaway 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Cass 2 0 0 0.7 B 1 0 0 0 0.3 B 6.5 Pass
Cedar 0 0 0 0.0 A 0 0 0 0 0.0 A 7.2 Pass
Clay 5 0 0 1.7 C 0 0 0 0 0.0 A 6.2 Pass
Greene 0 0 0 0.0 A 1 0 0 0 0.3 B INC INC
Jackson DNC DNC DNC DNC DNC 7 1 0 0 2.8 D 7.9 Pass
Jasper 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Jefferson 7 0 0 2.3 D 1 1 0 0 0.8 B 7.4 Pass
Lincoln 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Monroe 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Perry 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
St. Charles 9 1 0 3.5 F DNC DNC DNC DNC DNC DNC DNC DNC
Ste. Genevieve 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
St. Louis 10 0 0 3.3 F 2 0 0 0 0.7 B 7.9 Pass
St. Louis City 6 1 0 2.5 D 7 1 0 0 2.8 D 9.2 Pass

State Tables
MISSOURI
American Lung Association in Missouri
AT-RISK GROUPS
Lung Diseases
Andrew 18,002 4,133 3,576 294 1,302 1,261 12 1,449 179 1,543 1,197
Boone 185,840 38,206 24,910 2,722 14,477 10,924 125 11,607 2,662 29,264 40,951
Buchanan 83,853 18,858 14,417 1,343 6,203 5,513 57 6,167 882 14,831 14,975
Callaway 44,638 9,271 7,674 660 3,379 3,002 30 3,346 480 4,312 4,676
Cass 109,638 25,984 19,210 1,851 7,938 7,328 74 8,251 1,165 7,893 15,090
Cedar 14,496 3,562 3,284 254 1,011 1,039 10 1,228 127 2,598 887
Clay 255,518 60,831 38,021 4,333 18,763 15,965 172 17,470 3,011 20,470 53,140
Clinton 21,287 4,903 3,906 349 1,547 1,465 14 1,661 211 2,104 1,466
Greene 300,865 62,477 50,876 4,451 22,920 19,339 202 21,462 3,736 38,292 40,420
Jackson 716,862 167,396 112,332 11,925 52,830 45,242 481 49,879 8,512 92,796 273,390
Jasper 123,155 30,413 19,831 2,167 8,889 7,711 83 8,567 1,402 20,272 20,983
Jefferson 227,771 51,849 36,846 3,694 16,802 15,142 153 16,789 2,447 19,654 14,465
Lincoln 61,586 15,660 8,794 1,116 4,423 3,812 41 4,161 676 5,657 4,539
Monroe 8,712 1,923 2,087 137 625 655 6 777 75 1,288 662
Perry 18,922 4,330 3,695 308 1,373 1,314 13 1,506 190 1,890 1,072
St. Charles 409,981 93,314 66,775 6,647 30,293 26,860 276 29,798 4,561 21,239 58,393
Ste. Genevieve 18,588 4,085 3,887 291 1,354 1,346 13 1,558 172 1,885 790
St. Louis 997,187 220,665 187,634 15,720 73,507 67,980 668 77,219 11,079 102,288 352,013
St. Louis City 293,310 54,137 44,145 3,857 23,233 18,697 197 20,225 3,973 60,908 159,847

State Tables
MONTANA
American Lung Association in Montana

24-Hour Annual
Fergus 5 0 0 1.7 C 11 3 0 0 5.2 F 5.0 Pass
Flathead 0 0 0 0.0 A 12 6 0 0 7.0 F 7.1 Pass
Gallatin DNC DNC DNC DNC DNC 12 0 0 0 4.0 F 3.0 Pass
Lewis and Clark 1 0 0 0.3 B 16 7 0 0 8.8 F 8.5 Pass
Lincoln DNC DNC DNC DNC DNC 14 10 2 1 11.8 F 13.3 Fail
Missoula INC INC INC INC INC 20 9 0 0 11.2 F 9.3 Pass
Phillips 1 0 0 0.3 B 4 0 0 0 1.3 C 5.5 Pass
Powder River 2 0 0 0.7 B 13 3 0 0 5.8 F 7.5 Pass
Ravalli DNC DNC DNC DNC DNC 21 10 0 0 12.0 F 6.5 Pass
Richland 1 0 0 0.3 B 3 0 0 0 1.0 C 5.0 Pass
Rosebud 0 0 0 0.0 A 14 4 0 0 6.7 F INC INC
Silver Bow DNC DNC DNC DNC DNC 19 9 0 0 10.8 F 7.0 Pass
Yellowstone DNC DNC DNC DNC DNC 11 3 0 0 5.2 F INC INC

State Tables
MONTANA
American Lung Association in Montana
AT-RISK GROUPS
Lung Diseases
Fergus 11,617 2,440 2,872 123 876 598 5 803 100 1,359 775
Flathead 108,454 23,532 22,209 1,182 8,211 5,150 51 6,721 1,051 10,183 8,572
Gallatin 122,713 23,646 16,318 1,187 9,946 4,733 57 5,830 1,527 10,517 11,514
Lewis and Clark 72,223 15,359 14,247 771 5,518 3,377 34 4,382 724 6,389 6,747
Lincoln 20,525 3,791 6,133 190 1,566 1,198 10 1,641 156 3,409 1,629
Missoula 119,533 21,817 19,996 1,095 9,688 5,096 56 6,475 1,479 15,043 13,804
Phillips 4,192 1,008 990 51 303 211 2 281 31 600 720
Powder River 1,702 285 512 14 133 101 1 138 12 184 132
Ravalli 45,959 8,560 12,257 430 3,543 2,524 21 3,405 377 4,323 3,694
Richland 11,283 2,840 1,851 143 826 479 5 609 109 1,022 1,298
Rosebud 8,124 2,400 1,372 121 557 336 4 432 74 1,419 3,806
Silver Bow 35,411 7,233 6,852 363 2,746 1,633 17 2,114 353 4,471 3,526
Yellowstone 167,146 38,877 29,349 1,952 12,549 7,265 78 9,317 1,757 18,523 24,740

State Tables
NEBRASKA
American Lung Association in Nebraska

24-Hour Annual
Douglas 2 0 0 0.7 B 4 1 0 0 1.8 C 7.6 Pass
Hall DNC DNC DNC DNC DNC 2 0 0 0 0.7 B INC INC
Knox 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC
Lancaster 0 0 0 0.0 A 0 0 0 0 0.0 A 6.6 Pass
Sarpy DNC DNC DNC DNC DNC 4 0 0 0 1.3 C 8.1 Pass
Scotts Bluff DNC DNC DNC DNC DNC 1 0 0 0 0.3 B INC INC
Washington DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 6.9 Pass

State Tables
NEBRASKA
American Lung Association in Nebraska
AT-RISK GROUPS
Lung Diseases
Douglas 585,008 148,214 80,663 8,381 36,429 23,217 305 28,214 7,839 67,277 186,815
Hall 61,979 17,037 9,548 963 3,718 2,544 32 3,187 722 7,341 22,573
Knox 8,401 2,114 2,113 120 507 427 4 587 76 1,009 1,370
Lancaster 324,514 72,895 48,228 4,122 21,033 13,222 170 16,140 4,509 37,132 64,683
Sarpy 193,418 51,845 24,105 2,932 11,819 7,429 101 8,899 2,537 10,533 40,691
Scotts Bluff 35,745 8,872 7,035 502 2,203 1,637 19 2,138 408 4,773 10,517
Washington 20,969 5,015 3,883 284 1,306 971 11 1,252 230 1,303 1,236

State Tables
NEVADA
American Lung Association in Nevada

24-Hour Annual
Churchill 11 1 0 4.2 F DNC DNC DNC DNC DNC DNC DNC DNC
Clark 47 1 0 16.2 F 9 5 0 0 5.5 F 10.0 Pass
Douglas DNC DNC DNC DNC DNC 13 31 6 0 23.8 F 8.8 Pass
Lyon 9 0 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC
Washoe 34 2 0 12.3 F 17 27 5 0 22.5 F 9.7 Pass
White Pine 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Carson City 13 0 0 4.3 F 20 21 6 0 21.2 F 8.3 Pass

State Tables
NEVADA
American Lung Association in Nevada
AT-RISK GROUPS
Lung Diseases
Churchill 25,723 5,897 4,916 464 1,821 1,422 13 1,678 242 2,636 7,370
Clark 2,292,476 520,341 353,819 40,937 163,964 117,991 1,131 136,741 25,109 341,367 1,381,272
Douglas 49,870 7,745 15,612 609 3,830 3,698 25 4,526 363 3,991 10,017
Lyon 60,903 12,728 13,026 1,001 4,422 3,615 30 4,302 551 5,682 17,070
Washoe 493,392 104,538 84,784 8,224 35,860 26,559 244 31,002 5,192 53,423 192,770
White Pine 9,182 1,842 1,746 145 676 519 5 611 71 1,042 2,726
Carson City 58,993 11,918 12,411 938 4,327 3,506 29 4,163 521 6,597 20,615

State Tables
NEW HAMPSHIRE
American Lung Association in New Hampshire

24-Hour Annual
Belknap 0 0 0 0.0 A 1 0 0 0 0.3 B 4.2 Pass
Cheshire 0 0 0 0.0 A 1 0 0 0 0.3 B 6.2 Pass
Coos 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Grafton 0 0 0 0.0 A 1 0 0 0 0.3 B 5.1 Pass
Hillsborough 0 0 0 0.0 A 2 0 0 0 0.7 B 3.5 Pass
Merrimack 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Rockingham 3 0 0 1.0 C 2 0 0 0 0.7 B 5.7 Pass

State Tables
NEW HAMPSHIRE
American Lung Association in New Hampshire
AT-RISK GROUPS
Lung Diseases
Belknap 64,460 11,494 14,942 857 6,400 4,076 40 4,579 510 4,840 3,537
Cheshire 77,329 13,769 16,545 1,027 7,754 4,637 47 5,102 706 7,283 5,047
Coos 31,289 5,079 7,764 379 3,157 2,047 19 2,322 222 3,650 1,800
Grafton 92,201 14,505 20,389 1,082 9,485 5,638 57 6,204 872 7,288 9,255
Hillsborough 424,079 84,196 70,614 6,281 41,944 23,427 260 24,715 3,990 30,217 73,147
Merrimack 155,238 28,784 29,979 2,147 15,494 9,047 95 9,790 1,402 12,908 12,893
Rockingham 316,947 59,511 60,938 4,439 31,462 18,749 194 20,360 2,728 14,449 26,591

State Tables
NEW JERSEY
American Lung Association in New Jersey

24-Hour Annual
Atlantic 1 0 0 0.3 B 0 0 0 0 0.0 A 6.5 Pass
Bergen 15 0 0 5.0 F 1 0 0 0 0.3 B INC INC
Camden 7 0 0 2.3 D 2 0 0 0 0.7 B 9.4 Pass
Cumberland 5 0 0 1.7 C 0 0 0 0 0.0 A INC INC
Essex 2 0 0 0.7 B 2 0 0 0 0.7 B 8.6 Pass
Gloucester 4 0 0 1.3 C 0 0 0 0 0.0 A INC INC
Hudson 3 0 0 1.0 C 0 0 0 0 0.0 A INC INC
Hunterdon 1 0 0 0.3 B 0 0 0 0 0.0 A 7.6 Pass
Mercer 10 0 0 3.3 F 2 0 0 0 0.7 B 7.8 Pass
Middlesex 7 0 0 2.3 D 2 0 0 0 0.7 B 7.9 Pass
Monmouth 3 1 0 1.5 C DNC DNC DNC DNC DNC DNC DNC DNC
Morris 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC
Ocean 4 0 0 1.3 C 2 0 0 0 0.7 B 6.7 Pass
Passaic 1 0 0 0.3 B INC INC INC INC INC INC INC INC
Union DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 9.0 Pass
Warren 0 0 0 0.0 A 2 0 0 0 0.7 B 7.5 Pass

State Tables
NEW JERSEY
American Lung Association in New Jersey
AT-RISK GROUPS
Lung Diseases
Atlantic 274,966 57,527 53,009 3,101 19,507 12,959 140 16,959 2,840 40,786 122,364
Bergen 953,819 200,450 170,005 10,804 67,811 43,732 484 56,603 10,241 70,847 442,450
Camden 523,771 118,921 85,226 6,410 36,704 22,438 266 28,879 5,903 62,053 238,062
Cumberland 153,627 37,252 24,356 2,008 10,562 6,408 78 8,247 1,552 20,814 85,614
Essex 854,917 202,467 121,017 10,913 59,442 34,690 434 43,884 10,070 126,387 600,349
Gloucester 304,477 65,563 50,933 3,534 21,585 13,511 155 17,371 3,337 23,243 71,616
Hudson 702,463 143,110 88,631 7,714 51,714 26,777 357 33,464 9,189 109,996 503,134
Hunterdon 129,924 24,433 26,126 1,317 9,399 6,514 66 8,496 1,236 5,115 21,931
Mercer 385,898 82,001 61,675 4,420 27,585 16,660 196 21,329 4,429 38,024 205,744
Middlesex 860,807 185,765 136,471 10,013 61,287 36,950 438 47,283 9,752 67,146 517,233
Monmouth 645,354 133,923 120,504 7,219 45,809 30,590 328 39,724 6,499 47,491 162,143
Morris 510,981 105,047 90,781 5,662 36,499 23,668 260 30,554 5,325 28,395 156,906
Ocean 648,998 160,695 145,271 8,662 43,459 31,077 329 41,942 5,820 73,139 105,968
Passaic 518,117 122,623 79,154 6,609 35,944 21,500 263 27,491 5,829 71,951 313,494
Union 572,114 134,052 85,188 7,226 39,754 23,930 291 30,406 6,360 52,354 352,959
Warren 110,731 21,226 21,266 1,144 8,015 5,365 56 6,976 1,114 10,140 24,240

State Tables
NEW MEXICO
American Lung Association in New Mexico

24-Hour Annual
Bernalillo 22 1 0 7.8 F 4 2 0 0 2.3 D 9.1 Pass
Doña Ana 41 6 0 16.7 F 8 3 0 0 4.2 F 8.4 Pass
Eddy 53 3 0 19.2 F DNC DNC DNC DNC DNC DNC DNC DNC
Lea 5 1 0 2.2 D 1 0 0 0 0.3 B 6.5 Pass
Rio Arriba 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Sandoval 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC DNC
San Juan 12 0 0 4.0 F DNC DNC DNC DNC DNC DNC DNC DNC
Santa Fe 4 0 0 1.3 C 1 0 0 0 0.3 B 4.3 Pass
Taos DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 5.6 Pass
Valencia 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
NEW MEXICO
American Lung Association in New Mexico
AT-RISK GROUPS
Lung Diseases
Bernalillo 674,393 141,116 117,181 8,870 56,103 28,308 211 37,323 7,178 100,775 423,025
Doña Ana 221,508 52,853 36,602 3,322 17,850 8,697 69 11,371 2,419 41,993 163,692
Eddy 60,911 16,182 9,016 1,017 4,708 2,280 19 3,002 599 8,329 34,403
Lea 73,004 21,885 8,320 1,376 5,382 2,380 23 3,127 738 13,332 49,608
Rio Arriba 40,179 9,168 8,381 576 3,251 1,843 13 2,443 361 8,138 35,064
Sandoval 151,369 33,858 28,924 2,128 12,330 6,648 47 8,801 1,468 14,144 88,921
San Juan 120,993 30,930 19,514 1,944 9,464 4,770 38 6,298 1,202 29,043 77,440
Santa Fe 155,201 26,175 41,328 1,645 13,557 8,334 49 11,035 1,351 18,790 88,049
Taos 34,623 5,825 9,930 366 3,025 1,941 11 2,573 277 6,387 22,184
Valencia 77,190 17,960 14,185 1,129 6,215 3,306 24 4,376 727 14,188 53,456

State Tables
NEW YORK
American Lung Association in New York

24-Hour Annual
Albany 0 0 0 0.0 A 5 0 0 0 1.7 C 7.4 Pass
Bronx 11 0 0 3.7 F 0 1 0 0 0.5 B 8.3 Pass
Chautauqua 2 0 0 0.7 B 0 0 0 0 0.0 A 6.0 Pass
Dutchess 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Erie 1 0 0 0.3 B 0 1 0 0 0.5 B 7.2 Pass
Essex 1 0 0 0.3 B 0 0 0 0 0.0 A 3.2 Pass
Hamilton 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Herkimer INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Jefferson 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Kings DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Monroe 0 0 0 0.0 A 0 0 0 0 0.0 A 6.6 Pass
New York 9 0 0 3.0 D 0 0 0 0 0.0 A INC INC
Niagara 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Onondaga 0 0 0 0.0 A 1 0 0 0 0.3 B 6.2 Pass
Orange 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC
Oswego 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Putnam 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Queens 15 0 0 5.0 F 0 1 0 0 0.5 B 7.0 Pass
Richmond 7 0 0 2.3 D 0 0 0 0 0.0 A INC INC
Rockland 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Saratoga 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Steuben 0 0 0 0.0 A 1 0 0 0 0.3 B 5.8 Pass
Suffolk 25 1 0 8.8 F 0 0 0 0 0.0 A INC INC
Tompkins 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Wayne 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Westchester 7 0 0 2.3 D DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
NEW YORK
American Lung Association in New York
AT-RISK GROUPS
Lung Diseases
Albany 313,743 56,968 56,130 3,724 25,691 13,712 175 18,612 3,604 35,631 91,250
Bronx 1,424,948 349,664 199,098 22,855 108,299 55,298 792 73,422 16,120 366,448 1,297,316
Chautauqua 126,807 25,769 26,810 1,684 10,073 5,955 71 8,360 1,173 20,925 17,001
Dutchess 297,112 54,596 55,005 3,569 24,342 13,642 166 18,736 2,968 27,106 90,129
Erie 950,683 191,836 178,176 12,539 75,925 42,445 529 58,438 9,716 126,486 243,431
Essex 37,268 5,887 9,263 385 3,118 1,947 21 2,781 299 4,022 3,046
Hamilton 5,119 676 1,695 44 437 312 3 463 35 491 290
Herkimer 59,937 12,231 12,887 799 4,757 2,852 33 4,019 538 7,806 3,788
Jefferson 116,295 28,010 16,962 1,831 8,851 4,435 65 5,883 1,140 13,592 21,753
Kings 2,641,052 599,746 400,082 39,201 204,903 105,060 1,468 140,229 31,101 501,895 1,663,807
Monroe 755,160 154,850 138,000 10,121 60,083 33,218 420 45,565 7,952 96,950 227,993
New York 1,576,876 231,694 288,916 15,144 134,490 70,557 876 95,319 20,124 264,938 854,444
Niagara 211,653 42,114 42,745 2,753 16,954 9,898 118 13,806 2,000 27,106 32,898
Onondaga 473,236 99,935 85,517 6,532 37,382 20,704 263 28,400 4,933 64,695 112,821
Orange 404,525 103,760 58,564 6,782 30,316 16,030 226 21,518 3,963 47,939 157,302
Oswego 117,387 24,557 20,566 1,605 9,328 5,195 65 7,113 1,140 17,710 7,641
Putnam 97,936 18,844 18,213 1,232 7,954 4,564 55 6,300 909 6,398 24,232
Queens 2,331,143 465,509 404,630 30,427 187,325 102,371 1,298 139,458 24,844 312,866 1,759,091
Richmond 493,494 107,326 83,869 7,015 38,817 21,413 275 29,222 5,027 57,909 206,019
Rockland 339,227 99,127 53,162 6,479 24,077 13,192 189 18,011 3,142 50,989 126,426
Saratoga 237,359 45,819 45,926 2,995 19,199 11,033 132 15,286 2,312 18,123 24,220
Steuben 92,948 20,047 18,850 1,310 7,284 4,298 52 6,018 839 12,570 6,272
Suffolk 1,526,344 316,216 269,092 20,669 121,698 68,368 850 93,778 14,801 95,569 522,831
Tompkins 105,162 15,127 16,554 989 9,011 4,336 59 5,679 1,434 14,936 23,787
Wayne 90,923 19,295 18,218 1,261 7,170 4,243 51 5,935 805 8,981 9,650
Westchester 997,895 213,838 177,508 13,977 78,728 44,198 555 60,708 10,050 91,529 475,252

State Tables
NORTH CAROLINA
American Lung Association in North Carolina

24-Hour Annual
Alexander 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Avery 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Buncombe 0 0 0 0.0 A 0 0 0 0 0.0 A 5.9 Pass
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 DNC DNC DNC DNC DNC DNC DNC DNC
Catawba DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.3 Pass
Cumberland 0 0 0 0.0 A 1 0 0 0 0.3 B 7.6 Pass
Davidson DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 8.7 Pass
Durham 0 0 0 0.0 A 0 0 0 0 0.0 A 7.6 Pass
Edgecombe 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Forsyth 0 0 0 0.0 A 3 0 0 0 1.0 C 8.8 Pass
Graham 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Granville 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Guilford 0 0 0 0.0 A 0 0 0 0 0.0 A 7.0 Pass
Haywood 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Jackson DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Johnston 0 0 0 0.0 A 0 0 0 0 0.0 A 7.6 Pass
Lenoir 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Lincoln 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Macon 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Martin 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Mecklenburg 11 0 0 3.7 F 3 0 0 0 1.0 C 9.1 Pass
Mitchell DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 5.7 Pass
Montgomery 0 0 0 0.0 A 1 0 0 0 0.3 B 7.8 Pass
New Hanover 0 0 0 0.0 A 0 0 0 0 0.0 A 4.1 Pass
Northampton DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Person 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Pitt 0 0 0 0.0 A 0 0 0 0 0.0 A 6.3 Pass
Rockingham 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Rowan 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC
Swain 0 0 0 0.0 A 2 0 0 0 0.7 B 6.5 Pass
Union 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC
Wake 0 0 0 0.0 A 1 0 0 0 0.3 B 8.1 Pass
Yancey 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
NORTH CAROLINA
American Lung Association in North Carolina
AT-RISK GROUPS
Lung Diseases
Alexander 36,644 7,269 7,562 835 2,589 2,430 23 3,199 339 4,443 5,178
Avery 17,864 2,632 4,036 302 1,336 1,256 11 1,663 154 2,630 2,166
Buncombe 271,534 48,562 57,129 5,581 19,485 17,862 168 23,501 3,076 30,954 46,312
Caldwell 80,463 16,076 16,727 1,847 5,683 5,377 50 7,090 777 11,804 11,414
Carteret 68,541 11,729 18,006 1,348 4,977 5,083 43 6,965 592 7,997 9,276
Caswell 22,714 4,184 5,277 481 1,628 1,588 14 2,132 193 4,463 8,886
Catawba 161,723 35,195 29,924 4,044 11,176 10,173 101 13,177 1,677 21,477 41,996
Cumberland 335,508 84,258 42,320 9,683 21,955 16,987 209 20,574 4,050 50,499 198,193
Davidson 170,637 36,955 32,013 4,247 11,829 10,872 106 14,116 1,749 22,945 37,228
Durham 326,126 64,873 46,762 7,455 22,893 18,265 202 22,402 4,398 41,987 184,435
Edgecombe 48,359 10,930 10,202 1,256 3,277 3,106 30 4,136 508 10,671 31,151
Forsyth 385,523 87,513 64,413 10,057 26,237 22,813 239 29,043 4,479 53,575 172,846
Graham 8,043 1,618 1,995 186 560 558 5 763 73 1,361 1,234
Granville 61,986 12,611 11,103 1,449 4,381 3,954 39 5,074 614 8,231 26,813
Guilford 542,410 120,161 86,256 13,808 37,181 31,627 336 39,830 6,613 70,898 282,433
Haywood 62,476 11,152 15,654 1,282 4,486 4,472 39 6,085 591 8,521 5,347
Jackson 43,410 7,136 8,890 820 3,148 2,776 27 3,621 524 7,364 8,672
Johnston 226,504 56,582 31,141 6,502 15,115 12,722 141 15,724 2,552 26,562 80,019
Lenoir 54,706 12,408 11,416 1,426 3,712 3,521 34 4,678 540 11,414 28,388
Lincoln 89,670 18,632 16,864 2,141 6,312 5,841 56 7,572 892 7,830 14,341
Macon 37,564 6,874 10,931 790 2,656 2,811 23 3,948 316 5,289 4,534
Martin 21,754 4,443 5,472 511 1,511 1,527 13 2,093 200 4,336 10,522
Mecklenburg 1,122,276 256,417 133,280 29,466 76,558 59,687 696 71,345 14,757 113,013 614,019
Mitchell 14,963 2,761 3,781 317 1,066 1,071 9 1,462 133 2,223 1,395
Montgomery 25,798 5,510 5,566 633 1,781 1,705 16 2,272 253 4,407 9,592
New Hanover 229,018 40,818 43,236 4,691 16,469 14,443 142 18,601 2,798 26,307 52,066
Northampton 17,129 3,011 4,845 346 1,230 1,292 11 1,800 139 3,962 10,450
Person 39,127 7,998 8,168 919 2,748 2,613 24 3,452 381 6,772 13,538
Pitt 172,169 36,620 24,602 4,208 11,836 9,387 106 11,535 2,382 35,969 80,800
Rockingham 91,266 18,404 19,308 2,115 6,430 6,133 57 8,117 896 16,319 26,070
Rowan 148,150 32,414 26,663 3,725 10,214 9,174 92 11,824 1,546 24,540 43,959
Swain 14,136 3,222 2,677 370 959 876 9 1,142 151 2,427 5,850
Union 243,648 63,171 32,148 7,259 16,161 13,731 152 16,908 2,663 18,556 73,677
Wake 1,150,204 266,436 144,469 30,618 78,373 62,881 714 76,065 14,409 105,694 473,760
Yancey 18,757 3,420 4,956 393 1,336 1,360 12 1,872 169 3,230 1,528

State Tables
NORTH DAKOTA
American Lung Association in North Dakota

24-Hour Annual
Billings 1 0 0 0.3 B 3 1 0 0 1.5 C 4.2 Pass
Burke 0 0 0 0.0 A 7 2 0 0 3.3 F 5.4 Pass
Burleigh 0 0 0 0.0 A 11 5 0 0 6.2 F 6.5 Pass
Cass 1 0 0 0.3 B 8 10 0 0 7.7 F 7.9 Pass
Dunn 1 0 0 0.3 B 6 3 0 0 3.5 F 5.3 Pass
McKenzie 0 0 0 0.0 A 6 2 0 0 3.0 D 4.8 Pass
Mercer 1 0 0 0.3 B 5 4 0 0 3.7 F 5.7 Pass
Oliver 2 0 0 0.7 B 9 6 0 0 6.0 F 6.2 Pass
Ward 0 0 0 0.0 A 10 4 0 0 5.3 F 5.9 Pass
Williams INC INC INC INC INC INC INC INC INC INC INC INC INC

State Tables
NORTH DAKOTA
American Lung Association in North Dakota
AT-RISK GROUPS
Lung Diseases
Billings 955 198 233 13 62 43 1 74 9 103 84
Burke 2,158 535 467 35 133 91 1 153 21 191 188
Burleigh 98,933 23,395 16,993 1,522 6,340 3,767 52 6,045 1,268 7,923 12,428
Cass 186,562 42,265 23,926 2,750 12,398 6,368 99 9,554 2,855 19,208 30,356
Dunn 4,035 1,049 698 68 249 153 2 248 42 440 828
McKenzie 13,819 4,430 1,354 288 807 408 7 599 174 1,254 3,545
Mercer 8,323 1,942 1,816 126 522 357 4 602 81 655 678
Oliver 1,873 460 443 30 115 82 1 141 17 207 120
Ward 69,071 16,561 9,274 1,078 4,500 2,359 37 3,583 941 6,234 13,083
Williams 38,484 11,693 3,799 761 2,305 1,155 20 1,690 492 3,239 8,837

State Tables
OHIO
American Lung Association in Ohio

24-Hour Annual
Allen 1 0 0 0.3 B 0 0 0 0 0.0 A 6.6 Pass
Ashtabula 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Athens DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.2 Pass
Belmont DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Butler 7 0 0 2.3 D 1 0 0 0 0.3 B INC INC
Clark 3 0 0 1.0 C 0 0 0 0 0.0 A 9.0 Pass
Clermont 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC
Cuyahoga 14 0 0 4.7 F 3 1 0 0 1.5 C 9.5 Pass
Delaware 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Fayette 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Franklin 2 0 0 0.7 B 1 0 0 0 0.3 B 9.1 Pass
Geauga 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Greene 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Hamilton 15 0 0 5.0 F 3 0 0 0 1.0 C 11.0 Pass
Harrison DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Jefferson 1 0 0 0.3 B 2 1 0 0 1.2 C INC INC
Knox 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Lake 18 0 0 6.0 F 0 0 0 0 0.0 A 6.5 Pass
Lawrence 0 0 0 0.0 A 0 0 0 0 0.0 A 7.7 Pass
Licking 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Lorain 0 0 0 0.0 A 0 1 0 0 0.5 B INC INC
Lucas 13 0 0 4.3 F 1 0 0 0 0.3 B INC INC
Madison 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Mahoning 0 0 0 0.0 A 1 0 0 0 0.3 B INC INC
Medina 0 0 0 0.0 A 0 0 0 0 0.0 A 7.1 Pass
Miami 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Montgomery 5 0 0 1.7 C 0 0 0 0 0.0 A 9.6 Pass
Noble 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Portage 2 0 0 0.7 B 0 0 0 0 0.0 A INC INC
Preble 1 0 0 0.3 B 0 0 0 0 0.0 A 8.2 Pass
Scioto DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Stark 5 0 0 1.7 C 2 0 0 0 0.7 B 9.5 Pass
Summit 4 0 0 1.3 C 5 0 0 0 1.7 C 8.7 Pass
Trumbull 1 0 0 0.3 B 4 1 0 0 1.8 C 7.4 Pass
Warren 9 0 0 3.0 D DNC DNC DNC DNC DNC DNC DNC DNC
Washington 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Wood 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
OHIO
American Lung Association in Ohio
AT-RISK GROUPS
Lung Diseases
Allen 101,670 23,580 18,538 1,385 8,206 6,737 66 8,179 1,030 14,686 20,537
Ashtabula 97,337 21,431 19,487 1,258 7,941 6,882 63 8,510 916 14,787 11,055
Athens 62,056 8,988 8,850 528 5,678 3,884 40 4,341 916 11,068 6,326
Belmont 65,849 12,579 14,258 739 5,552 4,857 43 6,051 599 9,903 5,104
Butler 390,234 91,164 60,391 5,353 31,771 24,687 253 29,044 4,483 43,595 84,692
Clark 135,633 30,506 26,868 1,791 10,993 9,382 88 11,573 1,408 21,066 22,653
Clermont 209,642 47,087 37,072 2,765 17,150 14,157 136 17,099 2,194 19,702 15,343
Clinton 42,004 9,547 7,550 561 3,419 2,829 27 3,427 444 4,908 3,062
Cuyahoga 1,249,387 257,093 237,540 15,096 104,219 85,945 807 104,522 14,044 197,374 524,714
Delaware 220,740 55,911 32,199 3,283 17,573 13,921 143 16,363 2,429 9,056 39,348
Fayette 28,906 6,851 5,272 402 2,319 1,951 19 2,378 298 4,622 2,433
Franklin 1,321,414 307,247 167,632 18,041 108,789 77,450 855 87,277 17,026 184,504 518,044
Geauga 95,565 21,467 20,522 1,260 7,709 6,961 62 8,747 849 5,915 4,645
Greene 168,412 34,830 30,239 2,045 14,077 11,245 109 13,503 1,910 16,474 28,402
Hamilton 826,139 189,950 132,980 11,153 67,402 52,440 534 61,999 9,626 126,383 295,187
Harrison 14,477 3,040 3,204 179 1,188 1,074 9 1,351 136 2,008 830
Jefferson 64,789 12,744 14,402 748 5,408 4,787 42 6,003 655 10,783 6,637
Knox 62,897 14,397 11,844 845 5,087 4,233 41 5,170 663 7,421 3,151
Lake 232,023 45,224 48,888 2,655 19,507 16,977 150 21,064 2,332 16,007 31,181
Lawrence 57,445 12,452 11,092 731 4,721 4,026 37 4,939 592 9,767 3,214
Licking 180,401 41,509 30,888 2,437 14,678 11,999 117 14,421 1,925 19,460 22,695
Lorain 315,595 68,738 60,747 4,036 25,900 21,967 204 26,922 3,227 39,308 72,161
Lucas 429,191 99,025 73,312 5,815 34,867 28,074 278 33,657 4,801 73,260 140,009
Madison 44,386 8,990 7,149 528 3,764 2,988 29 3,528 414 5,356 5,573
Mahoning 226,762 45,650 49,529 2,680 18,830 16,461 147 20,574 2,238 42,174 56,883
Medina 183,092 39,676 34,890 2,330 15,071 12,888 119 15,785 1,833 11,016 12,873
Miami 109,264 25,194 20,926 1,479 8,812 7,488 71 9,195 1,100 8,915 9,608
Montgomery 535,840 118,514 98,142 6,959 43,877 35,789 346 43,346 5,968 79,459 163,279
Noble 14,176 2,671 4,069 157 1,168 1,175 9 1,550 103 1,877 827
Portage 162,382 29,736 28,680 1,746 14,027 11,105 105 13,229 1,957 19,241 18,656
Preble 40,867 9,127 8,120 536 3,322 2,883 27 3,564 399 4,448 1,699
Scioto 73,346 15,995 13,770 939 6,025 5,019 48 6,115 759 16,807 5,278
Stark 373,834 80,334 75,216 4,717 30,684 26,235 242 32,381 3,869 46,583 53,862
Summit 537,633 112,034 101,679 6,578 44,733 37,248 348 45,344 5,799 65,938 132,425
Trumbull 201,335 41,532 44,519 2,439 16,597 14,741 130 18,509 1,955 30,583 27,466
Warren 246,553 59,025 37,492 3,466 19,965 15,918 160 18,786 2,572 14,184 39,325
Washington 59,423 11,769 12,998 691 4,958 4,362 38 5,454 595 7,871 3,132
Wood 132,472 26,902 21,289 1,580 11,199 8,449 86 9,886 1,647 13,773 16,782

State Tables
OKLAHOMA
American Lung Association in Oklahoma

24-Hour Annual
Adair 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Canadian 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC
Carter INC INC INC INC INC 2 0 0 0 0.7 B 8.7 Pass
Choctaw INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Cleveland 0 0 0 0.0 A 5 0 0 0 1.7 C 10.3 Pass
Comanche 0 0 0 0.0 A 3 0 0 0 1.0 C 8.1 Pass
Creek 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Dewey 0 0 0 0.0 A 1 0 0 0 0.3 B 7.7 Pass
Johnston INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Kay INC INC INC INC INC 10 1 0 0 3.8 F 9.7 Pass
Kiowa INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Le Flore DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Love INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
McClain INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Mayes 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Nowata INC INC INC INC INC INC INC INC INC INC INC INC INC
Oklahoma 5 0 0 1.7 C 5 0 0 0 1.7 C 10.1 Pass
Osage 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Ottawa 3 0 0 1.0 C 13 3 0 0 5.8 F INC INC
Pittsburg 2 0 0 0.7 B 4 0 0 0 1.3 C 8.7 Pass
Sequoyah 1 0 0 0.3 B 1 0 0 0 0.3 B 7.9 Pass
Tulsa 5 1 0 2.2 D 5 1 0 0 2.2 D 9.1 Pass
Washington INC INC INC INC INC INC INC INC INC INC INC INC INC

State Tables
OKLAHOMA
American Lung Association in Oklahoma
AT-RISK GROUPS
Lung Diseases
Adair 19,414 5,278 3,052 517 1,550 1,139 13 1,538 215 4,015 11,936
Canadian 161,737 41,717 21,811 4,088 13,210 8,940 107 11,781 2,030 12,976 43,941
Carter 48,291 12,204 8,281 1,196 3,941 2,903 32 3,953 548 6,725 15,620
Choctaw 14,307 3,509 2,977 344 1,170 930 9 1,301 150 2,630 5,992
Cleveland 297,597 62,198 43,181 6,094 25,861 17,148 197 22,601 4,039 35,293 90,690
Comanche 122,063 29,367 16,082 2,877 10,199 6,630 81 8,669 1,481 21,533 54,784
Creek 72,029 16,776 13,210 1,644 6,029 4,559 48 6,245 792 10,191 18,545
Dewey 4,417 1,183 829 116 352 272 3 376 44 715 923
Johnston 10,301 2,491 1,992 244 849 650 7 898 110 2,108 3,410
Kay 43,732 10,981 8,479 1,076 3,555 2,704 29 3,747 465 6,745 12,269
Kiowa 8,410 2,038 1,672 200 693 543 6 754 83 1,701 2,328
Le Flore 48,476 11,842 8,673 1,160 3,996 2,985 32 4,083 520 11,053 14,732
Love 10,216 2,517 1,888 247 838 632 7 868 114 1,551 3,214
McClain 43,516 10,999 6,802 1,078 3,568 2,584 29 3,474 503 3,987 9,940
Mayes 39,159 9,169 7,304 898 3,270 2,485 26 3,413 429 5,656 14,525
Nowata 9,303 2,135 1,806 209 781 608 6 839 96 1,429 3,266
Oklahoma 798,575 202,515 114,342 19,843 65,462 44,761 527 59,408 10,129 127,511 363,617
Osage 45,772 9,756 9,626 956 3,910 3,083 30 4,292 457 5,441 17,075
Ottawa 30,340 7,687 5,479 753 2,467 1,841 20 2,526 338 6,023 11,215
Pittsburg 43,633 9,946 8,702 975 3,659 2,801 29 3,879 441 7,506 14,173
Sequoyah 39,508 9,457 7,292 927 3,278 2,500 26 3,431 434 7,656 15,603
Tulsa 672,858 169,015 101,361 16,561 55,266 38,603 444 51,586 8,314 97,613 269,714
Washington 52,772 12,766 10,368 1,251 4,343 3,317 35 4,598 582 8,693 15,368

State Tables
OREGON
American Lung Association in Oregon

24-Hour Annual
Clackamas 4 1 0 1.8 C DNC DNC DNC DNC DNC DNC DNC DNC
Crook DNC DNC DNC DNC DNC 2 1 0 2 2.8 D 10.4 Pass
Harney DNC DNC DNC DNC DNC 12 12 0 1 10.8 F 11.1 Pass
Jackson 3 0 0 1.0 C 5 8 1 1 7.2 F 13.0 Fail
Josephine DNC DNC DNC DNC DNC 1 2 0 1 2.2 D 11.3 Pass
Klamath DNC DNC DNC DNC DNC 45 45 1 2 39.8 F 16.2 Fail
Lake DNC DNC DNC DNC DNC 8 3 0 0 4.2 F INC INC
Lane 1 0 0 0.3 B 16 10 2 6 16.7 F 11.1 Pass
Marion 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Multnomah 2 0 0 0.7 B 0 1 0 1 1.3 C 7.9 Pass
Umatilla 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Washington 1 0 0 0.3 B 1 0 1 1 1.8 C 7.8 Pass

State Tables
OREGON
American Lung Association in Oregon
AT-RISK GROUPS
Lung Diseases
Clackamas 422,537 89,411 80,783 6,214 37,768 20,777 198 27,510 3,800 35,044 84,966
Columbia 53,074 10,850 10,583 754 4,791 2,695 25 3,587 447 5,361 6,896
Crook 25,739 5,130 6,490 357 2,314 1,430 12 1,995 198 3,056 3,234
Harney 7,575 1,515 1,898 105 679 415 4 579 57 1,200 1,075
Jackson 223,734 46,008 50,848 3,197 19,960 11,615 105 15,947 1,930 29,803 46,828
Josephine 88,346 17,148 23,408 1,192 7,964 4,992 41 7,037 671 14,593 12,749
Klamath 70,164 15,409 15,399 1,071 6,155 3,557 33 4,865 581 13,193 16,635
Lake 8,276 1,603 2,193 111 747 470 4 662 56 1,232 1,422
Lane 383,189 68,642 78,561 4,771 35,390 19,103 180 25,578 3,785 53,989 74,138
Marion 347,119 83,212 56,436 5,783 29,916 15,351 163 19,875 3,230 44,959 127,030
Multnomah 803,377 144,371 115,272 10,034 74,998 35,540 377 44,234 9,167 97,458 255,966
Umatilla 79,988 19,882 12,871 1,382 6,813 3,497 38 4,528 681 9,968 28,731
Washington 600,811 131,757 85,870 9,157 53,434 26,015 282 32,636 6,196 51,019 221,258

State Tables
PENNSYLVANIA
American Lung Association in Pennsylvania

24-Hour Annual
Adams 1 0 0 0.3 B 2 0 0 0 0.7 B INC INC
Allegheny 6 0 0 2.0 C 17 5 0 0 8.2 F 11.2 Pass
Armstrong 3 0 0 1.0 C 1 0 0 0 0.3 B 8.3 Pass
Beaver 1 0 0 0.3 B 4 0 0 0 1.3 C 8.9 Pass
Berks 6 0 0 2.0 C 5 1 0 0 2.2 D 8.3 Pass
Blair 1 0 0 0.3 B 1 0 0 0 0.3 B 8.6 Pass
Bradford 0 0 0 0.0 A 1 0 0 0 0.3 B 7.3 Pass
Bucks 17 0 0 5.7 F DNC DNC DNC DNC DNC DNC DNC DNC
Cambria 0 0 0 0.0 A 1 0 0 0 0.3 B 9.2 Pass
Centre 0 0 0 0.0 A 1 0 0 0 0.3 B 8.4 Pass
Chester 1 0 0 0.3 B 4 0 0 0 1.3 C 8.9 Pass
Clearfield 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Cumberland DNC DNC DNC DNC DNC 8 0 0 0 2.7 D 8.0 Pass
Dauphin 0 0 0 0.0 A 8 1 0 0 3.2 D 9.5 Pass
Delaware 5 0 0 1.7 C 7 0 0 0 2.3 D 8.6 Pass
Elk 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Erie 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC
Fayette 0 0 0 0.0 A 1 0 0 0 0.3 B 7.8 Pass
Franklin 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Greene 1 0 0 0.3 B 1 0 0 0 0.3 B 7.0 Pass
Indiana 2 0 0 0.7 B INC INC INC INC INC INC INC INC
Lackawanna 0 0 0 0.0 A 1 0 0 0 0.3 B INC INC
Lancaster 2 0 0 0.7 B 19 2 0 0 7.3 F 9.5 Pass
Lawrence 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Lebanon INC INC INC INC INC 6 0 0 0 2.0 C INC INC
Lehigh 0 0 0 0.0 A 3 1 0 0 1.5 C 8.8 Pass
Luzerne 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Lycoming 0 0 0 0.0 A 2 0 0 0 0.7 B INC INC
Mercer 1 0 0 0.3 B 1 0 0 0 0.3 B INC INC
Monroe 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Montgomery 5 0 0 1.7 C 2 0 0 0 0.7 B 8.1 Pass
Northampton 4 0 0 1.3 C 4 0 0 0 1.3 C 7.9 Pass
Philadelphia 18 1 0 6.5 F 2 1 0 0 1.2 C 8.9 Pass
Somerset 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Susquehanna DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 6.7 Pass
Tioga 0 0 0 0.0 A 1 0 0 0 0.3 B 6.2 Pass
Washington 0 0 0 0.0 A 1 0 0 0 0.3 B 8.6 Pass
Westmoreland 0 0 0 0.0 A 1 0 0 0 0.3 B 7.8 Pass
Wyoming DNC DNC DNC DNC DNC 1 0 0 0 0.3 B INC INC
York 0 0 0 0.0 A 2 0 0 0 0.7 B 9.6 Pass

State Tables
PENNSYLVANIA
American Lung Association in Pennsylvania
AT-RISK GROUPS
Lung Diseases
Adams 104,127 20,561 22,390 1,340 8,544 6,003 61 8,638 965 8,622 12,044
Allegheny 1,238,090 232,418 243,967 15,142 104,584 67,638 726 95,494 13,161 136,011 278,320
Armstrong 65,093 12,493 15,091 814 5,324 3,914 38 5,710 562 7,580 2,125
Beaver 166,624 32,351 37,181 2,108 13,695 9,715 98 14,087 1,528 18,184 19,193
Berks 429,342 95,285 76,104 6,208 34,745 22,572 252 31,374 4,334 53,947 134,239
Blair 121,767 24,788 26,092 1,615 9,934 6,908 71 9,960 1,144 14,059 7,173
Bradford 59,892 13,311 13,229 867 4,734 3,412 35 4,974 520 8,085 2,757
Bucks 646,098 129,748 128,047 8,453 53,027 36,645 379 51,788 6,070 41,492 113,916
Cambria 132,167 25,521 31,020 1,663 10,829 7,824 78 11,474 1,186 16,322 10,716
Centre 157,527 23,261 24,568 1,515 14,398 7,936 93 10,548 1,895 21,124 23,054
Chester 538,649 120,158 92,653 7,828 43,525 28,345 316 39,130 5,408 34,996 118,853
Clearfield 80,082 14,517 16,994 946 6,719 4,679 47 6,681 659 10,556 6,037
Cumberland 262,919 54,039 49,533 3,521 21,722 14,075 155 19,758 2,681 20,156 45,108
Dauphin 287,400 65,000 50,819 4,235 23,163 14,931 169 20,778 2,965 33,359 106,831
Delaware 573,849 126,550 98,430 8,245 46,746 29,646 336 40,921 6,124 55,843 204,908
Elk 30,783 5,965 7,084 389 2,507 1,864 18 2,713 252 3,061 890
Erie 269,011 56,508 51,394 3,682 22,043 14,461 158 20,381 2,695 40,564 45,183
Fayette 126,931 24,387 28,156 1,589 10,454 7,440 75 10,762 1,132 19,633 11,081
Franklin 156,289 34,445 31,410 2,244 12,522 8,591 92 12,264 1,500 14,695 21,040
Greene 35,369 6,755 7,155 440 2,950 1,996 21 2,830 316 4,803 2,486
Indiana 82,886 14,973 16,954 976 7,050 4,592 49 6,527 863 10,735 5,345
Lackawanna 215,663 44,520 43,733 2,901 17,639 11,929 127 17,010 2,134 28,502 38,563
Lancaster 553,652 129,256 104,237 8,421 44,025 28,838 325 40,807 5,542 47,460 108,092
Lawrence 85,497 17,104 19,475 1,114 6,957 4,990 50 7,282 773 10,145 7,636
Lebanon 143,493 32,461 28,506 2,115 11,443 7,737 84 11,046 1,381 12,565 28,839
Lehigh 375,539 85,430 64,265 5,566 30,316 19,227 220 26,581 3,935 40,827 148,669
Luzerne 326,053 65,882 64,903 4,292 26,855 18,051 192 25,596 3,139 40,126 76,346
Lycoming 113,605 23,509 22,834 1,532 9,300 6,243 67 8,889 1,128 11,647 11,808
Mercer 109,972 21,065 24,834 1,372 9,065 6,435 65 9,352 1,000 13,461 11,418
Monroe 169,273 32,940 31,234 2,146 14,099 9,446 100 13,124 1,662 18,697 63,247
Montgomery 860,578 184,327 157,894 12,009 70,154 46,138 505 64,464 8,688 58,621 224,040
Northampton 313,628 61,579 62,047 4,012 26,054 17,396 184 24,598 3,128 29,433 82,377
Philadelphia 1,576,251 340,070 227,367 22,156 131,954 74,821 922 99,512 19,571 341,533 1,044,529
Somerset 73,627 13,326 17,027 868 6,128 4,422 44 6,436 587 8,898 4,470
Susquehanna 38,389 7,210 9,445 470 3,137 2,365 23 3,492 310 4,561 1,669
Tioga 40,929 8,083 9,417 527 3,340 2,399 24 3,506 372 5,266 1,629
Washington 209,470 41,277 44,721 2,689 17,218 12,025 123 17,278 1,957 18,667 17,755
Westmoreland 353,057 64,384 83,505 4,195 29,246 21,384 207 31,280 3,111 38,934 23,983
Wyoming 26,034 5,056 5,843 329 2,137 1,526 15 2,215 238 2,944 1,370
York 458,696 100,560 83,727 6,552 37,115 24,545 270 34,293 4,515 41,594 85,494

State Tables
PUERTO RICO
American Lung Association in Puerto Rico

24-Hour Annual
Adjuntas DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Bayamón 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC
Caguas DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Cataño 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Fajardo DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Guayama DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Guaynabo DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Juncos INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Mayagüez 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Ponce DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC

State Tables
PUERTO RICO
American Lung Association in Puerto Rico
AT-RISK GROUPS
Lung Diseases
Adjuntas 17,987 3,196 3,979 332 1,690 769 3 1,628 101 12,084 17,980
Bayamón 182,673 28,837 43,441 2,993 17,530 7,932 29 16,819 1,061 61,089 184,839
Caguas 126,756 20,920 27,885 2,171 12,080 5,431 20 11,381 776 47,847 126,545
Cataño 22,861 3,962 5,305 411 2,154 973 4 2,061 134 10,834 23,310
Fajardo 31,590 5,425 7,357 563 2,986 1,362 5 2,905 187 13,758 32,250
Guayama 36,511 6,285 7,423 652 3,446 1,515 6 3,100 212 17,659 37,275
Guaynabo 89,195 12,738 22,197 1,322 8,726 4,009 14 8,619 496 22,468 88,900
Juncos 37,279 6,861 6,578 712 3,472 1,498 6 2,981 252 14,874 37,203
Mayagüez 71,939 11,309 18,723 1,174 6,887 3,129 11 6,717 409 39,204 73,711
Ponce 135,084 23,708 33,075 2,460 12,690 5,808 21 12,483 735 68,951 138,725

State Tables
RHODE ISLAND
American Lung Association in Rhode Island

24-Hour Annual
Kent 3 0 0 1.0 C 1 0 0 0 0.3 B 4.6 Pass
Providence 5 0 0 1.7 C 1 0 0 0 0.3 B 8.2 Pass
Washington 5 1 0 2.2 D 0 0 0 0 0.0 A 4.5 Pass

State Tables
RHODE ISLAND
American Lung Association in Rhode Island
AT-RISK GROUPS
Lung Diseases
Kent 170,715 31,451 33,783 2,075 17,602 8,375 109 10,812 1,501 13,635 23,984
Providence 658,221 133,834 105,211 8,828 66,630 29,103 422 35,998 6,572 90,405 270,169
Washington 130,592 20,520 29,158 1,354 13,869 6,743 84 8,882 1,160 11,421 12,499

State Tables
SOUTH CAROLINA
American Lung Association in South Carolina

24-Hour Annual
Aiken 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Anderson 1 0 0 0.3 B 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 1 0 0 0 0.3 B 7.1 Pass
Chesterfield 0 0 0 0.0 A 0 0 0 0 0.0 A 7.0 Pass
Darlington 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Edgefield 0 0 0 0.0 A 0 0 0 0 0.0 A 7.5 Pass
Florence DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.3 Pass
Greenville 2 0 0 0.7 B 1 0 0 0 0.3 B 8.3 Pass
Horry 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Lexington DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 7.8 Pass
Oconee INC INC INC INC INC INC INC INC INC INC INC INC INC
Pickens INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Richland 3 0 0 1.0 C 0 0 0 0 0.0 A 7.2 Pass
Spartanburg 3 0 0 1.0 C 0 0 0 0 0.0 A 8.1 Pass
York 8 0 0 2.7 D 0 0 0 0 0.0 A 7.2 Pass

State Tables
SOUTH CAROLINA
American Lung Association in South Carolina
AT-RISK GROUPS
Lung Diseases
Aiken 170,776 36,457 34,894 2,405 12,406 10,426 99 12,535 1,775 26,041 59,289
Anderson 206,908 46,680 38,059 3,079 14,843 12,193 120 14,445 2,207 32,461 48,744
Berkeley 236,701 56,246 34,962 3,710 16,758 12,744 138 14,589 2,669 23,708 88,944
Charleston 413,024 79,967 71,813 5,275 30,826 23,900 239 27,816 4,939 55,612 140,531
Chesterfield 43,268 9,524 8,355 628 3,127 2,635 25 3,145 430 8,658 17,622
Darlington 62,755 13,945 12,520 920 4,512 3,791 36 4,548 670 12,886 28,957
Edgefield 26,153 4,516 5,235 298 2,003 1,654 15 1,965 233 4,047 11,060
Florence 136,504 32,246 24,168 2,127 9,655 7,813 79 9,215 1,530 25,173 67,784
Greenville 533,834 121,953 88,092 8,045 38,193 30,017 310 34,928 6,056 56,924 174,431
Horry 365,579 63,249 95,413 4,172 27,805 25,322 212 31,480 3,409 45,501 81,797
Lexington 300,137 68,695 50,129 4,532 21,485 17,169 174 20,037 3,286 32,988 81,478
Oconee 79,203 15,424 19,070 1,017 5,877 5,259 46 6,477 717 12,882 12,761
Pickens 132,229 24,897 22,588 1,642 9,930 7,577 77 8,777 1,564 21,938 20,057
Richland 418,307 90,089 57,180 5,943 30,454 21,891 242 24,573 5,426 66,286 248,688
Spartanburg 335,864 78,166 54,898 5,156 23,906 18,824 195 21,895 3,751 44,859 111,083
York 288,595 68,801 43,313 4,539 20,452 15,973 167 18,371 3,311 27,670 91,111

State Tables
SOUTH DAKOTA
American Lung Association in South Dakota

24-Hour Annual
Brookings 8 0 0 2.7 D 3 1 1 0 2.2 D 5.1 Pass
Brown DNC DNC DNC DNC DNC 0 3 0 0 1.5 C INC INC
Codington INC INC INC INC INC 2 2 1 0 2.3 D 7.4 Pass
Custer 2 0 0 0.7 B 2 1 0 0 1.2 C 3.6 Pass
Hughes DNC DNC DNC DNC DNC 1 0 1 0 1.0 C 3.7 Pass
Jackson 0 0 0 0.0 A 0 1 1 0 1.2 C 4.6 Pass
Meade 7 0 0 2.3 D DNC DNC DNC DNC DNC DNC DNC DNC
Minnehaha 1 0 0 0.3 B 3 2 0 0 2.0 C INC INC
Pennington DNC DNC DNC DNC DNC 3 1 0 0 1.5 C 7.0 Pass
Union 1 0 0 0.3 B 2 2 0 0 1.7 C INC INC

State Tables
SOUTH DAKOTA
American Lung Association in South Dakota
AT-RISK GROUPS
Lung Diseases
Brookings 34,639 7,336 4,514 484 2,246 1,302 18 1,792 565 3,952 3,808
Brown 38,101 9,068 6,828 598 2,437 1,696 20 2,538 498 4,281 5,764
Codington 28,427 6,725 5,302 444 1,831 1,308 15 1,978 341 2,712 2,607
Custer 8,609 1,255 2,780 83 624 546 4 886 75 822 1,013
Hughes 17,694 4,352 3,153 287 1,126 794 9 1,195 230 1,652 3,501
Jackson 2,878 1,055 384 70 154 104 1 154 33 801 1,850
Meade 30,173 6,616 4,915 436 1,974 1,306 16 1,914 393 2,733 4,116
Minnehaha 199,685 50,571 27,266 3,336 12,542 8,018 103 11,552 2,728 18,377 38,577
Pennington 111,806 25,456 21,583 1,679 7,275 5,227 58 7,924 1,350 12,746 23,631
Union 16,872 4,092 3,175 270 1,080 779 9 1,183 199 1,086 1,621

State Tables
TENNESSEE
American Lung Association in Tennessee

24-Hour Annual
Anderson 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Blount 2 0 0 0.7 B 1 0 0 0 0.3 B 6.9 Pass
Claiborne 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Davidson 2 0 0 0.7 B 5 0 0 0 1.7 C 9.1 Pass
DeKalb 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Dyer DNC DNC DNC DNC DNC 2 0 0 0 0.7 B 7.0 Pass
Hamilton 1 0 0 0.3 B 0 1 0 0 0.5 B 8.7 Pass
Jefferson 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Knox 0 0 0 0.0 A 5 0 0 0 1.7 C 9.1 Pass
Lawrence DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.3 Pass
Loudon 0 0 0 0.0 A 0 0 0 0 0.0 A 6.9 Pass
McMinn DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.3 Pass
Madison DNC DNC DNC DNC DNC 2 0 0 0 0.7 B INC INC
Maury DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 6.5 Pass
Montgomery DNC DNC DNC DNC DNC 3 0 0 0 1.0 C INC INC
Putnam DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 6.6 Pass
Roane DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.1 Pass
Sevier 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Shelby 7 0 0 2.3 D 0 1 0 0 0.5 B 8.6 Pass
Sullivan 1 0 0 0.3 B 0 0 0 0 0.0 A 6.6 Pass
Sumner 1 0 0 0.3 B 2 0 0 0 0.7 B 7.3 Pass
Williamson 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Wilson 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
TENNESSEE
American Lung Association in Tennessee
AT-RISK GROUPS
Lung Diseases
Anderson 77,576 16,418 15,764 1,599 6,326 6,825 54 7,817 806 10,945 8,796
Blount 137,605 27,345 28,998 2,663 11,402 12,472 95 14,309 1,426 13,065 13,447
Claiborne 32,267 6,271 6,606 611 2,691 2,890 22 3,304 343 5,291 1,749
Davidson 703,953 142,262 92,397 13,855 58,722 51,500 486 56,188 9,997 101,651 306,953
DeKalb 20,478 4,421 3,864 431 1,668 1,779 14 2,016 210 3,140 2,658
Dyer 36,615 8,735 6,513 851 2,895 3,014 25 3,409 404 5,767 7,865
Hamilton 369,135 76,661 66,898 7,466 30,348 30,758 255 34,783 4,348 45,470 108,366
Jefferson 55,624 10,739 11,341 1,046 4,655 5,081 39 5,790 575 7,962 4,685
Knox 486,677 101,563 79,519 9,891 40,073 38,801 337 43,379 6,026 57,580 89,954
Lawrence 44,828 11,174 7,943 1,088 3,495 3,665 31 4,149 463 5,998 3,184
Loudon 56,690 10,828 15,513 1,055 4,680 5,648 39 6,703 492 5,365 7,676
McMinn 54,059 11,492 10,890 1,119 4,406 4,761 37 5,444 571 7,651 6,289
Madison 98,775 22,110 17,714 2,153 7,955 8,128 68 9,198 1,159 16,124 44,370
Maury 104,760 24,030 17,650 2,340 8,398 8,456 72 9,499 1,207 10,695 22,663
Montgomery 227,900 61,609 22,341 6,000 17,466 14,448 158 15,414 3,015 24,078 89,261
Putnam 81,188 16,960 13,599 1,652 6,672 6,456 56 7,248 959 10,745 10,212
Roane 53,992 10,008 12,700 975 4,532 5,183 37 6,012 526 7,003 4,286
Sevier 99,517 20,247 20,405 1,972 8,210 8,964 69 10,247 1,014 12,973 11,490
Shelby 924,454 231,748 133,989 22,570 72,298 69,280 637 76,751 11,333 163,230 605,437
Sullivan 159,265 30,265 35,409 2,948 13,311 14,766 110 17,040 1,639 26,800 11,696
Sumner 200,557 46,697 32,818 4,548 16,042 16,302 139 18,219 2,267 17,062 36,494
Williamson 255,735 67,005 36,153 6,526 19,799 20,039 177 22,044 2,826 10,137 42,701
Wilson 151,917 35,365 24,251 3,444 12,168 12,324 105 13,725 1,708 11,297 26,021

State Tables
TEXAS
American Lung Association in Texas
24-Hour Annual
Atascosa DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Bell 5 0 0 1.7 C 1 0 0 0 0.3 B INC INC
Bexar 24 0 0 8.0 F 1 1 0 0 0.8 B 8.7 Pass
Bowie DNC DNC DNC DNC DNC 3 0 0 0 1.0 C 9.6 Pass
Brazoria 19 3 0 7.8 F DNC DNC DNC DNC DNC DNC DNC DNC
Brazos DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Brewster 0 0 0 0.0 A 1 0 0 0 0.3 B 5.4 Pass
Cameron 0 0 0 0.0 A 6 3 0 0 3.5 F 9.7 Pass
Collin 16 3 0 6.8 F DNC DNC DNC DNC DNC DNC DNC DNC
Culberson 13 0 0 4.3 F DNC DNC DNC DNC DNC DNC DNC DNC
Dallas 20 1 0 7.2 F 1 0 0 0 0.3 B 9.1 Pass
Denton 37 3 0 13.8 F 1 0 0 0 0.3 B INC INC
Ector DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.4 Pass
Ellis 1 0 0 0.3 B 0 0 0 0 0.0 A INC INC
El Paso 39 1 0 13.5 F 1 0 0 0 0.3 B 8.9 Pass
Galveston 12 0 0 4.0 F 1 0 0 0 0.3 B 7.7 Pass
Gregg 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Harris 51 11 1 23.2 F 3 2 0 0 2.0 C 11.1 Pass
Harrison 0 0 0 0.0 A 0 1 0 0 0.5 B INC INC
Hidalgo 1 0 0 0.3 B 6 2 0 0 3.0 D 10.6 Pass
Hood 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Hunt 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Jefferson 10 0 0 3.3 F 1 0 0 0 0.3 B 8.3 Pass
Johnson 15 0 0 5.0 F DNC DNC DNC DNC DNC DNC DNC DNC
Kaufman 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Kleberg DNC DNC DNC DNC DNC 5 2 0 0 2.7 D INC INC
Lubbock DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 6.0 Pass
McLennan 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Maverick DNC DNC DNC DNC DNC 0 1 0 0 0.5 B 7.8 Pass
Montgomery 13 1 0 4.8 F INC INC INC INC INC INC INC INC
Navarro 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Nueces 1 0 0 0.3 B 1 2 0 0 1.3 C 8.6 Pass
Orange 1 0 0 0.3 B 1 0 0 0 0.3 B 8.2 Pass
Parker 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Polk 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Potter DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 5.6 Pass
Randall 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC
Rockwall 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Smith 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Tarrant 37 4 1 15.0 F 2 0 0 0 0.7 B 9.2 Pass
Travis 2 0 0 0.7 B 1 1 0 0 0.8 B 9.5 Pass
Victoria 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Webb 0 0 0 0.0 A 3 1 0 0 1.5 C 10.4 Pass

State Tables
TEXAS
American Lung Association in Texas
AT-RISK GROUPS
Lung Diseases
Atascosa 49,939 13,575 7,409 863 3,083 2,307 23 2,841 573 8,151 34,363
Bell 379,617 104,738 43,456 6,655 22,804 15,520 173 18,284 4,873 52,868 214,614
Bexar 2,028,236 508,429 254,331 32,305 127,064 88,953 923 105,803 26,238 293,859 1,498,029
Bowie 92,581 21,930 15,842 1,393 6,003 4,600 42 5,769 1,011 15,460 35,252
Brazoria 379,689 98,396 47,141 6,252 23,742 16,994 173 20,197 4,620 33,053 215,814
Brazos 237,032 49,177 23,861 3,125 15,224 9,411 108 10,663 3,698 50,154 107,978
Brewster 9,450 1,691 2,327 107 667 558 4 741 96 1,250 4,804
Cameron 423,029 123,932 59,236 7,875 25,179 18,462 192 22,642 4,963 103,230 387,136
Collin 1,109,462 279,040 126,015 17,730 70,315 49,914 505 58,297 14,253 72,757 524,183
Culberson 2,193 507 457 32 144 117 1 152 21 427 1,717
Dallas 2,586,050 660,039 297,660 41,939 161,276 111,844 1,176 131,129 33,777 368,709 1,881,922
Denton 941,647 223,263 104,586 14,186 60,541 42,240 428 49,004 12,670 68,494 418,018
Ector 161,091 49,640 15,700 3,154 9,244 6,172 74 7,123 1,957 26,375 115,676
Ellis 202,678 53,626 26,437 3,407 12,631 9,210 92 11,053 2,459 17,641 90,495
El Paso 867,947 229,713 110,826 14,596 53,375 37,630 395 45,064 10,701 171,242 769,302
Galveston 355,062 84,994 54,033 5,400 23,003 17,332 161 21,248 4,209 42,174 157,503
Gregg 124,201 32,069 19,580 2,038 7,794 5,856 56 7,273 1,452 19,426 54,649
Harris 4,728,030 1,240,902 537,117 78,846 292,122 202,685 2,152 237,486 61,038 767,505 3,419,691
Harrison 69,150 17,065 12,443 1,084 4,459 3,516 31 4,456 761 10,198 25,753
Hidalgo 880,356 278,386 99,917 17,688 50,219 34,929 400 41,493 10,815 251,220 830,323
Hood 64,222 13,231 16,258 841 4,426 3,830 29 5,128 610 6,484 11,314
Hunt 103,394 24,845 16,524 1,579 6,686 5,078 47 6,286 1,207 13,902 32,431
Jefferson 253,704 61,836 38,049 3,929 16,217 11,998 116 14,707 2,816 45,633 157,260
Johnson 187,280 48,594 26,661 3,088 11,773 8,741 85 10,643 2,167 17,978 60,720
Kaufman 157,768 44,850 17,591 2,850 9,482 6,629 72 7,781 1,997 13,916 72,988
Kleberg 30,635 7,489 4,124 476 1,904 1,297 14 1,564 412 7,233 24,623
Lubbock 314,451 74,448 40,525 4,730 19,843 13,545 143 16,160 4,317 48,593 152,242
McLennan 263,115 64,243 39,346 4,082 16,656 12,070 119 14,816 3,374 37,352 119,229
Maverick 58,056 17,923 6,866 1,139 3,352 2,349 26 2,806 681 11,691 56,500
Montgomery 648,886 168,407 88,311 10,700 40,816 30,111 295 36,356 7,728 67,809 245,536
Navarro 53,591 14,303 9,071 909 3,357 2,619 24 3,298 578 8,469 25,016
Nueces 353,079 85,527 53,930 5,434 22,575 16,692 161 20,532 4,286 62,967 254,286
Orange 84,742 21,359 13,560 1,357 5,401 4,126 39 5,123 958 10,515 17,987
Parker 156,764 38,840 24,590 2,468 10,098 7,753 71 9,569 1,754 12,227 29,291
Polk 51,899 10,516 9,844 668 3,581 2,882 24 3,639 457 8,117 14,987
Potter 116,547 31,375 15,686 1,994 7,167 5,180 53 6,266 1,314 22,716 66,728
Randall 143,854 34,668 22,151 2,203 9,188 6,763 65 8,334 1,776 12,785 46,395
Rockwall 116,381 31,070 14,495 1,974 7,253 5,290 53 6,297 1,392 5,880 39,986
Smith 237,186 57,701 40,558 3,666 15,212 11,617 108 14,600 2,850 30,154 98,518
Tarrant 2,126,477 547,327 254,934 34,777 132,875 93,864 966 110,853 27,418 242,783 1,197,695
Travis 1,305,154 269,709 138,888 17,137 85,918 57,020 596 65,263 18,755 143,340 673,317
Victoria 90,964 23,090 15,235 1,467 5,741 4,360 41 5,475 1,060 14,471 52,336
Webb 267,945 85,427 26,695 5,428 15,224 10,370 122 12,044 3,287 59,771 258,388

State Tables
UTAH
American Lung Association in Utah

24-Hour Annual
Box Elder 7 0 0 2.3 D INC INC INC INC INC INC INC INC
Cache 3 0 0 1.0 C 27 2 0 0 10.0 F 7.6 Pass
Carbon 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC
Davis 35 1 0 12.2 F 14 1 0 0 5.2 F 7.0 Pass
Duchesne 13 4 0 6.3 F 8 1 0 0 3.2 D 7.0 Pass
Garfield 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Iron 2 0 0 0.7 B 2 1 0 0 1.2 C 5.4 Pass
Salt Lake 57 8 0 23.0 F 19 5 0 0 8.8 F 9.9 Pass
San Juan 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC
Tooele 11 1 0 4.2 F 11 3 0 0 5.2 F 6.8 Pass
Uintah 21 4 1 9.7 F 4 1 0 0 1.8 C 6.3 Pass
Utah 17 0 0 5.7 F 14 0 0 0 4.7 F 7.2 Pass
Washington 4 1 0 1.8 C 1 1 0 0 0.8 B 5.3 Pass
Weber 17 0 0 5.7 F 8 0 0 0 2.7 D INC INC

State Tables
UTAH
American Lung Association in Utah
AT-RISK GROUPS
Lung Diseases
Box Elder 59,688 18,466 7,675 1,014 4,020 1,860 16 2,539 742 4,712 8,081
Cache 137,417 40,855 13,651 2,243 9,565 3,883 37 4,946 2,095 14,719 23,115
Carbon 20,372 5,181 3,786 284 1,463 743 5 1,093 250 3,166 3,636
Davis 367,285 113,162 39,135 6,212 24,957 10,909 98 14,216 4,948 23,286 65,161
Duchesne 19,790 6,498 2,545 357 1,294 606 5 833 236 2,555 3,089
Garfield 5,129 1,156 1,222 63 378 209 1 325 53 490 607
Iron 60,519 16,921 8,219 929 4,267 1,920 16 2,628 848 7,906 9,171
Salt Lake 1,186,421 306,977 138,009 16,851 86,331 37,869 316 49,569 16,946 103,046 360,327
San Juan 14,489 4,144 2,164 227 1,001 491 4 689 173 3,832 8,043
Tooele 76,640 24,168 7,086 1,327 5,166 2,212 20 2,799 1,047 4,289 14,836
Uintah 36,204 11,507 4,345 632 2,415 1,094 10 1,473 460 4,285 6,802
Utah 684,986 220,721 53,903 12,116 46,184 18,037 183 21,954 10,260 54,542 130,573
Washington 191,226 47,707 42,202 2,619 13,732 7,321 51 11,261 2,219 17,782 32,190
Weber 267,066 72,498 32,373 3,980 19,056 8,520 71 11,311 3,646 24,635 65,769

State Tables
VERMONT
American Lung Association in Vermont

24-Hour Annual
Bennington 0 0 0 0.0 A 1 0 0 0 0.3 B 5.8 Pass
Chittenden 0 0 0 0.0 A 1 0 0 0 0.3 B 6.9 Pass
Rutland 0 0 0 0.0 A 1 0 0 0 0.3 B 7.6 Pass

State Tables
VERMONT
American Lung Association in Vermont
AT-RISK GROUPS
Lung Diseases
Bennington 37,312 6,992 8,842 309 3,560 2,158 20 2,615 274 4,471 2,544
Chittenden 168,865 29,439 27,292 1,300 16,849 8,265 90 9,206 1,701 15,931 20,789
Rutland 60,591 10,508 14,307 464 5,892 3,526 32 4,254 448 6,135 3,031

State Tables
VIRGINIA
American Lung Association in Virginia

24-Hour Annual
Albemarle 0 0 0 0.0 A 0 0 0 0 0.0 A 6.9 Pass
Arlington 4 0 0 1.3 C 0 0 0 0 0.0 A 7.5 Pass
Caroline 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Charles City 0 0 0 0.0 A 0 0 0 0 0.0 A 6.4 Pass
Chesterfield 1 0 0 0.3 B 0 0 0 0 0.0 A 6.4 Pass
Fairfax 5 0 0 1.7 C 1 0 0 0 0.3 B 8.7 Pass
Fauquier 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Frederick 0 0 0 0.0 A 0 0 0 0 0.0 A 7.6 Pass
Giles 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Hanover 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Henrico 0 0 0 0.0 A 1 0 0 0 0.3 B 7.4 Pass
Loudoun 3 0 0 1.0 C 0 0 0 0 0.0 A 6.9 Pass
Madison 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Prince Edward 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Prince William 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Roanoke 0 0 0 0.0 A 1 0 0 0 0.3 B 7.1 Pass
Rockbridge 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Rockingham 0 0 0 0.0 A 0 0 0 0 0.0 A 6.8 Pass
Stafford 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC
Wythe 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Bristol City DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.6 Pass
Hampton City 0 0 0 0.0 A 0 0 0 0 0.0 A 6.4 Pass
Lynchburg City DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.1 Pass
Norfolk City DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.8 Pass
Richmond City DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 7.8 Pass
Salem City DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.5 Pass
Suffolk City 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Virginia Beach City DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.8 Pass

State Tables
VIRGINIA
American Lung Association in Virginia
AT-RISK GROUPS
Lung Diseases
Albemarle 113,535 22,352 22,416 1,474 8,898 6,033 58 7,879 1,279 7,465 26,931
Arlington 232,965 42,477 27,006 2,802 18,779 10,632 119 12,703 3,245 18,150 92,160
Caroline 31,332 7,061 5,322 466 2,391 1,585 16 2,060 321 3,357 11,548
Charles City 6,594 941 1,740 62 554 425 3 587 54 753 3,708
Chesterfield 370,688 87,796 58,505 5,792 27,895 18,119 189 23,325 4,103 26,947 151,831
Fairfax 1,139,720 263,571 165,344 17,387 86,612 54,725 583 69,594 12,672 79,572 580,355
Fauquier 73,815 17,043 12,621 1,124 5,609 3,778 38 4,953 718 4,780 16,426
Frederick 93,717 21,346 17,066 1,408 7,115 4,841 48 6,359 926 6,980 18,385
Giles 16,562 3,245 3,665 214 1,305 945 8 1,274 153 1,934 943
Hanover 111,603 24,073 20,835 1,588 8,621 5,923 57 7,822 1,099 7,297 19,167
Henrico 333,554 74,241 54,923 4,897 25,516 16,625 170 21,408 3,751 23,099 163,226
Loudoun 427,592 115,849 43,443 7,642 31,092 18,290 219 22,522 4,942 15,315 200,645
Madison 13,942 2,785 3,221 184 1,092 806 7 1,094 127 1,294 2,142
Prince Edward 21,932 3,522 3,686 232 1,795 1,108 11 1,381 270 3,407 8,456
Prince William 484,472 128,947 52,455 8,506 35,338 20,895 248 25,746 5,508 30,613 290,988
Roanoke 96,589 18,993 21,361 1,253 7,585 5,455 49 7,320 953 7,597 15,280
Rockbridge 22,641 3,959 6,131 261 1,815 1,407 12 1,941 194 2,254 1,937
Rockingham 84,394 18,641 16,704 1,230 6,438 4,476 43 5,924 841 6,848 11,206
Stafford 160,877 41,803 17,528 2,758 11,834 6,988 83 8,602 1,779 8,443 70,043
Wythe 28,178 5,482 6,265 362 2,225 1,616 14 2,182 263 4,727 1,842
Bristol City 17,054 3,453 3,753 228 1,328 953 9 1,276 168 3,098 2,123
Hampton City 137,746 29,506 22,128 1,946 10,611 6,732 70 8,535 1,607 16,442 87,749
Lynchburg City 79,009 15,026 11,305 991 6,233 3,646 40 4,404 1,142 12,216 30,025
Norfolk City 235,089 45,560 28,169 3,005 18,576 10,445 121 12,375 2,864 34,150 133,572
Richmond City 226,604 38,768 31,900 2,557 18,421 10,883 115 13,281 3,192 45,409 129,112
Salem City 25,373 4,806 4,938 317 2,013 1,361 13 1,778 285 2,469 4,181
Suffolk City 96,194 22,771 14,539 1,502 7,249 4,648 49 5,949 1,043 10,069 49,994
Virginia Beach City 457,672 100,780 69,529 6,648 35,092 22,048 234 27,866 5,209 41,912 182,232

State Tables
WASHINGTON
American Lung Association in Washington

24-Hour Annual
Benton 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Clallam 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Clark 0 0 0 0.0 A 2 1 2 5 6.7 F 8.9 Pass
Columbia INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
King 2 2 0 1.7 C 5 5 3 0 6.2 F 8.3 Pass
Kitsap DNC DNC DNC DNC DNC 4 3 3 0 4.8 F 5.9 Pass
Kittitas DNC DNC DNC DNC DNC 7 4 3 1 7.2 F 7.5 Pass
Okanogan DNC DNC DNC DNC DNC 13 11 7 2 16.2 F 12.4 Fail
Pierce 1 0 0 0.3 B 6 4 3 0 6.0 F 7.9 Pass
Skagit 0 0 0 0.0 A 0 0 0 0 0.0 A INC INC
Snohomish DNC DNC DNC DNC DNC 7 6 1 0 6.0 F 8.7 Pass
Spokane 3 0 0 1.0 C 1 9 1 3 8.0 F INC INC
Stevens DNC DNC DNC DNC DNC 7 13 1 3 12.0 F INC INC
Thurston INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Whatcom 0 0 0 0.0 A 3 6 1 0 4.7 F 4.7 Pass
Yakima DNC DNC DNC DNC DNC 21 17 1 4 19.5 F 11.8 Pass

State Tables
WASHINGTON
American Lung Association in Washington
AT-RISK GROUPS
Lung Diseases
Benton 210,025 55,177 32,606 4,033 16,257 7,954 102 10,628 2,133 22,043 67,666
Clallam 78,209 12,959 24,237 947 6,694 4,338 38 6,196 611 9,204 14,690
Clark 511,404 117,552 83,476 8,593 41,318 20,591 247 27,595 5,385 45,938 123,174
Columbia 4,042 724 1,156 53 341 215 2 306 34 529 706
King 2,252,305 445,849 309,960 32,591 190,746 85,718 1,091 111,773 26,732 205,784 989,428
Kitsap 274,314 54,566 52,523 3,989 22,979 11,858 133 16,080 2,657 23,100 67,344
Kittitas 45,499 7,659 7,756 560 3,981 1,859 22 2,464 551 6,195 7,644
Okanogan 42,634 9,791 9,722 716 3,404 1,976 21 2,753 367 6,748 15,313
Pierce 925,708 214,751 133,409 15,698 74,885 35,006 448 46,160 10,117 74,284 334,152
Skagit 130,696 27,830 28,464 2,034 10,697 5,946 63 8,209 1,232 15,073 35,339
Snohomish 833,540 185,638 119,706 13,570 68,228 32,277 404 42,603 9,006 59,505 284,840
Spokane 546,040 118,778 91,795 8,682 44,833 22,096 264 29,590 5,837 59,848 92,139
Stevens 47,426 10,087 11,708 737 3,858 2,342 23 3,288 383 6,392 6,570
Thurston 297,977 62,966 54,080 4,603 24,606 12,496 144 16,871 3,189 29,197 81,106
Whatcom 228,831 43,098 41,938 3,150 19,472 9,620 111 12,927 2,618 29,011 51,342
Yakima 256,035 75,344 36,193 5,508 19,003 9,052 124 12,015 2,605 37,078 151,594

State Tables
WEST VIRGINIA
American Lung Association in West Virginia

24-Hour Annual
Berkeley 0 0 0 0.0 A 2 0 0 0 0.7 B 8.4 Pass
Brooke DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 9.1 Pass
Cabell 0 0 0 0.0 A 0 0 0 0 0.0 A 7.2 Pass
Gilmer 0 0 0 0.0 A 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 0 0 0 0 0.0 A INC INC
Harrison DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 7.1 Pass
Kanawha 0 0 0 0.0 A 0 0 0 0 0.0 A 7.5 Pass
Marion DNC DNC DNC DNC DNC 0 0 0 0 0.0 A INC INC
Marshall DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 9.3 Pass
Monongalia 0 0 0 0.0 A 0 0 0 0 0.0 A 7.0 Pass
Ohio 1 0 0 0.3 B 0 0 0 0 0.0 A 7.8 Pass
Tucker 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Wood 0 0 0 0.0 A 0 0 0 0 0.0 A 7.5 Pass

State Tables
WEST VIRGINIA
American Lung Association in West Virginia
AT-RISK GROUPS
Lung Diseases
Berkeley 126,069 28,915 19,145 2,722 11,929 12,052 93 12,400 1,310 12,365 22,403
Brooke 22,140 3,878 5,433 365 2,201 2,511 16 2,776 193 2,776 1,095
Cabell 93,418 18,612 17,986 1,752 9,079 9,275 69 9,926 1,012 17,022 9,557
Gilmer 7,377 1,117 1,309 105 764 743 6 777 60 1,455 1,421
Greenbrier 32,608 6,365 7,794 599 3,164 3,613 24 3,993 286 6,037 2,464
Hancock 28,656 5,357 6,850 504 2,814 3,236 21 3,563 251 4,223 1,916
Harrison 65,158 14,005 12,994 1,319 6,218 6,760 48 7,259 615 9,405 4,129
Kanawha 177,952 35,421 38,514 3,335 17,257 18,939 130 20,595 1,704 27,810 22,201
Marion 56,001 11,216 11,000 1,056 5,439 5,694 41 6,102 568 8,257 4,142
Marshall 30,115 5,727 7,138 539 2,944 3,363 22 3,703 254 4,826 1,154
Monongalia 106,387 17,578 14,352 1,655 10,895 9,549 79 9,594 1,362 18,293 12,870
Ohio 41,776 8,135 9,428 766 4,060 4,442 31 4,875 402 5,793 3,426
Tucker 6,672 934 1,831 88 690 818 5 914 56 954 196
Wood 83,624 17,611 17,574 1,658 8,008 8,861 61 9,591 773 12,172 4,272

State Tables
WISCONSIN
American Lung Association in Wisconsin

24-Hour Annual
Ashland 1 0 0 0.3 B 2 1 0 0 1.2 C 5.6 Pass
Brown 1 0 0 0.3 B 3 0 0 0 1.0 C 7.8 Pass
Columbia 4 0 0 1.3 C DNC DNC DNC DNC DNC DNC DNC DNC
Dane 3 0 0 1.0 C 0 0 0 0 0.0 A 8.3 Pass
Dodge 3 0 0 1.0 C 0 0 0 0 0.0 A 8.0 Pass
Door 8 0 0 2.7 D DNC DNC DNC DNC DNC DNC DNC DNC
Eau Claire 0 0 0 0.0 A 4 1 0 0 1.8 C 8.2 Pass
Fond du Lac 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
Forest 0 0 0 0.0 A 3 1 0 0 1.5 C 5.9 Pass
Grant DNC DNC DNC DNC DNC 1 0 0 0 0.3 B 8.8 Pass
Jackson DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Jefferson 5 0 0 1.7 C DNC DNC DNC DNC DNC DNC DNC DNC
Kenosha 22 1 0 7.8 F 1 0 0 0 0.3 B 7.7 Pass
Kewaunee 2 0 0 0.7 B DNC DNC DNC DNC DNC DNC DNC DNC
La Crosse 0 0 0 0.0 A 1 0 0 0 0.3 B 7.9 Pass
Manitowoc 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Marathon 0 0 0 0.0 A DNC DNC DNC DNC DNC DNC DNC DNC
Milwaukee 13 1 0 4.8 F 1 0 0 0 0.3 B 8.9 Pass
Monroe DNC DNC DNC DNC DNC INC INC INC INC INC INC INC INC
Outagamie 3 0 0 1.0 C 4 0 0 0 1.3 C 8.1 Pass
Ozaukee 14 1 0 5.2 F 0 0 0 0 0.0 A 7.0 Pass
Racine 16 1 0 5.8 F DNC DNC DNC DNC DNC DNC DNC DNC
Rock 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Sauk 1 0 0 0.3 B 1 0 0 0 0.3 B 7.7 Pass
Sheboygan 11 2 0 4.7 F DNC DNC DNC DNC DNC DNC DNC DNC
Taylor 0 0 0 0.0 A 2 2 0 0 1.7 C 6.8 Pass
Vilas 0 0 0 0.0 A 3 0 0 0 1.0 C 5.3 Pass
Walworth 6 0 0 2.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Waukesha 6 0 0 2.0 C 1 0 0 0 0.3 B 9.4 Pass

State Tables
WISCONSIN
American Lung Association in Wisconsin
AT-RISK GROUPS
Lung Diseases
Ashland 16,107 3,507 3,335 219 1,373 749 9 1,034 150 2,266 2,967
Brown 269,591 62,787 42,776 3,914 22,662 11,246 155 14,781 2,891 24,355 56,164
Columbia 58,488 12,198 11,083 760 5,089 2,686 34 3,642 550 4,415 5,065
Dane 563,951 112,552 82,750 7,016 48,951 22,918 324 29,232 7,060 62,409 122,418
Dodge 89,313 17,326 16,392 1,080 7,925 4,105 52 5,511 799 7,043 10,141
Door 30,369 4,891 9,437 305 2,741 1,743 17 2,576 231 2,604 2,167
Eau Claire 106,452 21,475 17,428 1,339 9,165 4,441 61 5,790 1,306 12,739 11,774
Fond du Lac 104,362 22,087 20,106 1,377 8,996 4,759 60 6,470 1,054 8,168 12,438
Forest 9,258 1,773 2,166 111 819 467 5 658 78 1,250 1,940
Grant 52,110 10,941 9,303 682 4,449 2,247 30 2,994 527 6,039 2,892
Jackson 21,121 4,553 4,152 284 1,814 971 12 1,328 175 2,497 3,069
Jefferson 84,943 17,246 15,545 1,075 7,442 3,861 49 5,191 875 6,203 9,619
Kenosha 168,732 37,117 25,585 2,314 14,545 7,132 97 9,286 1,842 17,554 43,765
Kewaunee 20,543 4,293 4,436 268 1,777 987 12 1,373 184 1,567 1,279
La Crosse 120,433 23,505 20,945 1,465 10,474 5,195 69 6,855 1,457 13,944 13,466
Manitowoc 81,505 16,785 17,747 1,046 7,086 3,946 47 5,496 728 8,665 8,988
Marathon 137,648 31,227 25,622 1,947 11,667 6,152 79 8,344 1,335 10,345 17,021
Milwaukee 928,059 222,246 132,643 13,854 76,921 36,585 532 47,022 11,124 161,890 472,561
Monroe 46,193 11,643 8,224 726 3,789 1,989 27 2,691 427 5,119 4,911
Outagamie 191,545 44,488 30,229 2,773 16,163 8,033 110 10,555 2,005 13,789 26,169
Ozaukee 92,497 19,563 19,187 1,220 7,977 4,357 53 6,015 880 4,244 9,041
Racine 196,896 44,950 34,390 2,802 16,702 8,616 113 11,548 1,950 23,827 59,293
Rock 164,381 37,374 28,507 2,330 13,943 7,158 94 9,574 1,693 16,283 30,689
Sauk 65,697 14,838 12,814 925 5,558 2,977 38 4,073 628 6,305 6,659
Sheboygan 117,747 25,658 22,395 1,599 10,092 5,341 68 7,259 1,119 10,013 20,770
Taylor 19,923 4,596 4,063 287 1,688 932 11 1,291 171 2,027 912
Vilas 23,520 3,960 7,271 247 2,120 1,358 14 2,010 154 2,677 3,465
Walworth 106,799 21,162 20,389 1,319 9,357 4,893 61 6,615 1,101 10,644 16,066
Waukesha 408,756 86,561 80,160 5,396 35,384 18,950 235 25,891 3,965 20,035 53,259

State Tables
WYOMING
American Lung Association in Wyoming

24-Hour Annual
Albany 12 0 0 4.0 F 4 1 0 0 1.8 C INC INC
Big Horn 3 0 0 1.0 C DNC DNC DNC DNC DNC DNC DNC DNC
Campbell 11 0 0 3.7 F 5 0 0 0 1.7 C INC INC
Carbon INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Converse 7 0 0 2.3 D INC INC INC INC INC INC INC INC
Fremont 9 0 0 3.0 D 6 1 0 0 2.5 D 2.4 Pass
Johnson 7 0 0 2.3 D DNC DNC DNC DNC DNC DNC DNC DNC
Laramie 10 0 0 3.3 F 4 2 0 0 2.3 D 4.1 Pass
Lincoln INC INC INC INC INC INC INC INC INC INC INC INC INC
Natrona 6 0 0 2.0 C 5 0 0 0 1.7 C INC INC
Park INC INC INC INC INC 2 0 0 0 0.7 B 4.3 Pass
Sheridan DNC DNC DNC DNC DNC 0 0 0 0 0.0 A 6.3 Pass
Sublette 18 3 0 7.5 F 4 1 0 0 1.8 C 3.5 Pass
Sweetwater 9 0 0 3.0 D 1 0 0 0 0.3 B INC INC
Teton 3 0 0 1.0 C 17 5 0 0 8.2 F 4.4 Pass
Uinta INC INC INC INC INC DNC DNC DNC DNC DNC DNC DNC DNC
Weston 1 0 0 0.3 B DNC DNC DNC DNC DNC DNC DNC DNC

State Tables
WYOMING
American Lung Association in Wyoming
AT-RISK GROUPS
Lung Diseases
Albany 37,608 5,998 4,884 515 3,099 1,579 17 1,700 556 6,309 6,710
Big Horn 11,632 2,844 2,532 244 860 647 5 768 106 1,440 1,542
Campbell 46,401 12,511 5,669 1,075 3,352 2,011 20 2,161 519 3,882 6,085
Carbon 14,649 3,312 2,606 285 1,114 749 6 855 142 1,706 3,503
Converse 13,672 3,336 2,482 287 1,017 712 6 815 137 1,321 1,608
Fremont 39,336 9,944 7,694 854 2,882 2,062 17 2,408 384 5,683 12,151
Johnson 8,623 1,834 2,297 158 662 542 4 662 75 855 805
Laramie 100,863 22,942 17,183 1,971 7,659 5,017 44 5,689 1,101 9,765 22,344
Lincoln 20,153 5,131 3,901 441 1,476 1,074 9 1,247 189 1,522 1,673
Natrona 79,555 19,108 13,135 1,642 5,946 3,890 35 4,395 873 8,349 11,303
Park 30,108 6,196 7,490 532 2,334 1,827 13 2,204 280 3,372 2,771
Sheridan 31,646 6,654 6,942 572 2,448 1,805 14 2,131 317 2,929 2,824
Sublette 8,697 1,831 1,923 157 673 505 4 595 82 612 1,019
Sweetwater 41,614 10,468 5,886 899 3,072 1,909 18 2,100 471 3,761 8,704
Teton 23,575 4,142 3,984 356 1,914 1,227 10 1,370 281 1,392 4,522
Uinta 20,635 5,729 3,280 492 1,468 977 9 1,104 214 1,917 2,742
Weston 6,745 1,354 1,523 116 529 398 3 470 57 666 687

State of The Air 2023 Report

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State of The Air 2023 Report

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Table of Contents

About this Report

Health Impact of Air Pollution

Recommendations for Action

3 Lung.org American Lung Association State of the Air 2023

American Lung Association

Copyright ©2023 by the American Lung Association.

4 Lung.org American Lung Association State of the Air 2023

Purpose and history of “State of the Air”

How “State of the Air” can be used

5 Lung.org American Lung Association State of the Air 2023

6 Lung.org American Lung Association State of the Air 2023

Ozone Data Analysis

8-hour Ozone Concentration Air Quality Index Levels

7 Lung.org American Lung Association State of the Air 2023

Short-Term Particle Pollution Data Analysis

8 Lung.org American Lung Association State of the Air 2023

24-hour PM2.5 Concentration Air Quality Index Levels

Description of County Grading System.

9 Lung.org American Lung Association State of the Air 2023

Weighted Average Grade

All counties with a weighted average of zero (corresponding to no exceedances of the

10 Lung.org American Lung Association State of the Air 2023

Year-Round Particle Pollution (Annual PM2.5)

Statistical Methodology: Population Data

11 Lung.org American Lung Association State of the Air 2023

12 Lung.org American Lung Association State of the Air 2023

In “State of the Air” 2023, Bakersfield, California displaced Fresno, California as

Short-term Particle Pollution Trends

13 Lung.org American Lung Association State of the Air 2023

14 Lung.org American Lung Association State of the Air 2023

Year-round Particle Pollution Trends

15 Lung.org American Lung Association State of the Air 2023

16 Lung.org American Lung Association State of the Air 2023

Ozone Pollution Trends

17 Lung.org American Lung Association State of the Air 2023

pandemic-related changes in activity patterns in 2020 and 2021, such as increased

18 Lung.org American Lung Association State of the Air 2023

Monitoring the State of the Air in Indian Country

19 Lung.org American Lung Association State of the Air 2023

20 Lung.org American Lung Association State of the Air 2023

● Cardiovascular Disease—More than 6.6 million people with

Most Polluted Places to Live

21 Lung.org American Lung Association State of the Air 2023

Cleanest Places to Live

22 Lung.org American Lung Association State of the Air 2023

Health Effects of Years of scientific research

Health Effects of Particle Pollution

What is particle pollution?

23 Lung.org American Lung Association State of the Air 2023

What can particles

Particle pollution can be very dangerous to breathe, especially at higher concentrations.

24 Lung.org American Lung Association State of the Air 2023

In adults, long-term particle pollution exposure is linked to:

■ Higher likelihood of getting lung cancer and of dying from it;23

■ Impaired cognitive functioning and an increased risk of Parkinson’s disease,

Who is most at risk from particle pollution?

25 Lung.org American Lung Association State of the Air 2023

What Can Ozone Pollution Do to Your Health?

26 Lung.org American Lung Association State of the Air 2023

■ Increased allergic response.41

Who is Most at Risk from Ozone Pollution?

Air Pollution and COVID-19