Air Health Our Health

Dr. Neeta Thakur is a pulmonary and critical care physician at the University of California San Francisco, where she serves as the Medical Director of the San Francisco General Hospital Chest Clinic, and studies how social and environmental stress negatively affect people suffering from asthma and COPD.  She is working hard to help us understand the history of race adjustment in lung function testing and what we should do going forward to provide better health for all. 

To Do:

1- To learn more about the history of air pollution’s impact on health, you can go back to the first season for a host of episodes. For example, podcast Episode 2 with Dr. Matt Drake and Episode 17 with Dr. Ritz. Learn about how red-lining can affect those asthma risk in Episode 27 with Prof. Shandas.

2- I am serious about the importance of hope! Learn more about how policy can work- listen to Episode 12 about cleaning up diesel school buses with Dr. Adar and Episode 16 with the American Lung Association’s analysis of the economic stimulus and decrease in asthma we might see with a transition to electric vehicles

3- Listen about one person’s story with asthma growing up in a previously red-lined district by listening to Ashia Allen, a patient of mine.

4- For more about air pollution and air toxics in the Portland Metro area, listen to Episode 5 with Mary Peveto and Episode 7 with Prof. Linda George

5- If you haven’t read “The Fire Next Time,” be sure to do so. If you are in healthcare and care for those with respiratory illness, “Breathing Race into the Machine” is certainly worth reading.

6- Finally, consider a donation to the American Thoracic Society, which works tirelessly for clean air and has funded research like that done by Dr. Thakur early in her career. Full disclosure, I volunteer as a member of the ATS Environmental Health Policy Committee.

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So many people begin their cigarette or e-cigarette addiction by using mint flavors such as menthol. Why is this? What does it do? To answer that question on the pod today, I talk to Dr. Sven Jordt PhD, who is a scientist at Duke who studies menthol and shares his own journey with cigarette addiction and empathizes with the difficulty of quitting. He also is a member of the Tobacco Action Committee of the American Thoracic Society.

Menthol numbs the lungs to let you inhale more toxins and not realize how irritating the chemicals you are inhaling are. This fuels new nicotine addictions. The tobacco industry is trying to get around flavor bans by making chemicals with this property but without the flavor smell. It also turns out that the chemicals that go into an e-cigarette are not the only chemicals that come out after all those chemicals have been sitting in the device at room temperature and mixing over time. 

Flavors, especially menthol, are designed to mask the harshness and danger of inhaled nicotine. 

So what can you do?

To hear more about Carrie’s story and about a county trying to protect its youth, listen to “A County vs Big Tobacco” from last season. Talk to your local or state policymakers to see if you can introduce a comprehensive flavor ban in your county or state. Don’t forget to include those new synthetic compounds that numb the lungs like mint but try to escape the “flavor” label! 

For more on the history of menthol and its targeting of children in general and the black community in particular, listen to the episode  “A Heartbreaking Trap” with youth pastor Ritney Castine.

For more on the odd shapes of e-cigs designed to be hidden in schools, you can look at the Tobacco Education Resource Library. 

To learn how to talk to young people in your life about e-cigarettes, listen to the first episode from this season, #DotheVapeTalk. You can also go to talkaboutvaping.org  for more resources. 

If you already use a flavored or menthol inhaled tobacco device and think it’s finally time to quit, check out the “Quit, Don’t Switch” campaign from the American Lung Association for other resources to help quit smoking.

Finally, please consider a donation to the American Lung Association, who employs wonderful people like Carrie, fighting hard to rid our communities of the scourge of Big Tobacco.

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Today on the podcast, I provide a bit of the history of the Air Health Our Health podcast, why I started it, and what ties it all together. I hope you can use this as a guide to catch up on topics of interest, find podcasts that may be of use to you, and pick an action item or two to make the air in your community cleaner.

FYI- the episode art is part of a selfie my sister sent me while wearing an Air Health Our Health T-shirt while her town was blanketed in unhealthy air from wildfires.

To Do-

1- Twitchy Airways Clubs Members- learn about how the air you breathe affects your health and what you can do to keep your airways open.

2- Rate and review this podcast in whatever software you use. It helps spread the word.

3- Tell a friend about the podcast and share it to help more people learn about the importance of clean air.

4- Pick an episode and look at the “To Do” items for ideas on making you or your community more healthy.

5- Purchase an Air Health Our Health mug, T-shirt, tote, water bottle or more to spread the word about healthy air- find the items on the website under the “Invest-Stuff” tab. Proceeds go to clean up the air.

6- Consider a donation to the American Lung Association, who continues to fight for clean air.

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We think that if a flavor is safe to eat, it is safe to inhale. This is sadly not true, but many e-cigarette users, especially kids, think that if something is fruity-flavored and being sold to them, it must be safe. It is often not.

Join me in this podcast episode to hear from Professor Ilona Jaspers, PHD, of the departments of pediatrics, microbiology and immunology, environmental sciences and engineering at the University of North Carolina at Chapel Hill. She is also the director there for the curriculum in toxicology and environmental medicine. She studies a host of toxins that affect the lungs, from air pollution to inhaling flavoring chemicals.

1- If you have a young person in your life age 10 and up, listen to the first episode from the season, #DotheVapeTalk to learn about how to have these conversations. You can also go to talkaboutvaping.org  for more resources. You can learn more about what different e-cigarettes might look like here.

2- If you are struggling to quit inhaling nicotine, whether from combustible or electronic cigarettes, check out the “Quit, Don’t Switch” campaign from the American Lung Association for other resources to help quit smoking.

3- If you really don’t want to or can’t quit, and want to try an e-cigarette for potential harm reduction, in general avoid inhaling flavored ones if possible.

4- Read the “Get the Facts” guide from the ALA. If you want more details on the specifics of e-cigarette biology, listen to the “Gambling with your lungs” episode with Dr. Jeff Gotts from Season One.

5- If you want to get involved on the policy side, listen to the “A Teen Talks Vaping” episode about tobacco retail licensing and ensure there is robust tobacco retail licensing in your community.

6- For more on the dangers of flavors and their history, especially among kids and in the black community, listen to “A Heartbreaking Trap” and “A County vs Big Tobacco.” You can learn more about the specifics of flavor dangers at airhealthourhealth.org/FlavorFree.

7- Don't forget to donate to the American Lung Association, who  is working hard to help people understand how to break free of nicotine.

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Ozone is a highly reactive gas and forms a significant portion of the air pollution that affects all of us. For this episode, I was joined by Dr. Nicholas Nassikas of Harvard University to discuss the links between ozone and health, as well as to review the staggering amount of money we are spending in terms of the health toll of air pollution. We are spending more on the health toll of air pollution now than the cost of transitioning off of fossil fuels to help decrease the pollution we all breathe. Listen and learn!

What can you do?

1- Download the Airnow app or go to the airnow.gov website to become familiar with the Air Quality index, which incorporates ozone and PM2.5.

2- To learn more about PM2.5 standards and history, listen to the “What’s in a Standard” episode with Dan Costa from Season Two.

3- For more on how to use the Air Quality Index, listen to the “What’s in an Index” episode with Dr. Franziska Rosser from last season.

4- Vote for elected officials committed to addressing climate change. Write to them regularly about your concern regarding topics like ozone, which causes disease and can increase in the setting of rising temperatures.

5- Advocate for policies in your communities that can reduce ozone by decreasing use of combustion for transportation, such as more bike lanes, public transit, increased walkability and more.

6- Consider a donation to the American Lung Association, who advocates tirelessly for clean air.

7- Consider buying an Air Health Our Health T-shirt, mug, hat or tote that emphasizes the health benefits of clean air. This can help spark a conversation with those in your community. Proceeds go to the American Lung Association as well.

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I was fortunate to speak with Dr. Gillian Goobie of the Center for Heart Lung Innovation at St Paul’s Hospital in Vancouver as well as the Division of Respiratory Medicine at the University of British Columbia. She is the lead author on a groundbreaking paper exploring the risk of death from exposure to air pollution as well as the source of the pollution, and how it changes the risk to those breathing it. We talk about everything from the different pollution sources in more industrially exposed areas to pollution sources in areas affected by wildfire, what to do with the knowledge of this risk, how it can affect those who are most vulnerable with lung scarring or pulmonary fibrosis, and more! She also shares her gratitude for the people who participate in this trial and so many others. They help us understand more about the world around https://airhealthourhealth.org/whats-burning-pollution-sources-and-lung-scarring-with-dr-gillian-goobie/us!

So what can you do?

1- Download the AirNow.gov app and become familiar with it.

2- To learn more about PM2.5 standards and history, listen to the “What’s in a Standard” episode with Dan Costa from Season Two.

3- For more on how to use the Air Quality Index, listen to the “What’s in an Index” episode with Dr. Franziska Rosser from last season.

4- For those in the West, particularly affected by PM2.5 and wildfire smoke, listen to the “Our Health in Wildfire Season” episode from Season Two and the “Air Inside when the smoke is outside” episode with Prof Elliot Gall from Season One.

5- Finally, consider a donation to the American Thoracic Society, whose scientific membership includes clinician-scientists like Dr. Goobie who do such important research and work hard  to highlight the importance of clean air.

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Can we fight fire with fire? The American Lung Association has released a report suggesting that this is a healthy way forward, and our Native communities have used ceremonial burns on our lands for generations. I wanted to talk to someone who lives at the intersection of all of this. 

For this episode, I was honored to be joined by Bodie Shaw. He is a member of the Confederated Tribes of the Warm Springs Indian Reservation, and previously served as the national wildland fire director for the Bureau of Indian Affairs and has worked as the acting Chief of the National Interagency Fire Center in Boise, ID. He is a veteran of the US Air Force, and previously taught at Oregon State University. He has lectured widely on tribal interests as they pertain to natural resource management. In 2008, Shaw was the first to participate in an international exchange program between the U.S. and Australian governments and lived Down Under with his family from August 2008 to March 2009 while developing a new trilateral wildland fire/bushfire agreement between the U.S., Australia and New Zealand. He currently serves as the Bureau of Indian Affairs deputy regional director of Trust Services for the Northwest Region.

Today, we talk about balancing the perils and the promise of prescribed burns in wildfire-prone areas.

To Do

Got to Firewise.org to learn how to protect your home and family. Learn more about health impacts from prescribed burns from the ALA report “Can Prescribed Fires Mitigate Health Harm.” Tell your representatives how important it is to ensure a professional and well-funded, year round proactive approach to decreasing the risk of catastrophic wildfire. Learn more about the health of our wildland firefighters and outdoor workers by listening to “The Health of Our Heroes” episode from Season One. Learn more about the impact of wildfire smoke and how to keep you and your family safe during smoke events by listening to the “Our Health in Wildfire Season” episode from Season Two. Donate to the American Lung Association who works hard to help navigate challenging health concerns such as their evaluation of health effects of prescribed burns.

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The loud drone of gas powered lawn equipment is often part of the background noise in any community, but what do these machines cost us in terms of our health, the health of our children, and especially, the health of those who use these machines professionally? It turns out, they cost us a great deal.

Today I am joined by two doctors for children to talk about the impact of these machines in terms of their noise, emissions, and more. Dr. Elliot Krane, MD   joined the faculty of Stanford University in 1994 as the Chief of Pediatric Anesthesiology and is currently the chief of pain management.  Dr. David Axelrod, MD is a professor of medicine at Stanford University in the division of pediatric cardiology who has developed the Stanford Virtual Heart to teach about heart disease in children. 

We talk about two stroke engines, why they emit as much in a 30 minute period as a Ford F150 driving for 64 hours, and the impact on all of us, especially professional landscapers and their families. We also talk about potential equitable community solutions. Imagine, less noise and pollution and better health for all!

So what can you do?

1- If you are using gas powered lawn equipment, look into mechanical or electric alternatives, like an electric lawn mower or a good old fashioned rake. Learn more about the Ford F150 vs leafblower analysis here.

2- With climate change and increasing water scarcity as well as the need to avoid additional pollution, look into whether maintaining a grass lawn is really worth it in your area. There are often a host of alternatives that require less mowing and maintenance.

3- Consider getting together with neighbors to retire gas powered equipment and obtain your own or shared electric equipment. My personal goal is to work on reaching out to my own neighbors this fall to see if they would be interested.

4- Advocate in your own neighborhood, county, city or state to put programs in place to retire gas powered lawn equipment while ensuring those whose livelihoods depend on yard care are not penalized. For example, equipment swaps, purchasing and retiring old equipment, vouchers and grants for new equipment, etc are all options to consider.

5- Finally, consider a donation to the American Thoracic Society, who works tirelessly on research into the air we breathe, how it affects our health, and informing policy makers to make health-centered policy.

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Welcome to Season Three of the Air Health Our Health podcast! It is back to school season, and across the country, kids will be exposed to vaping and e-cigarette devices from their peers. About 1-2 kids per middle school class and around 5 kids per high school classroom will be using e-cigarettes. These devices can look like pens, USBs and more, so you want your kid to be prepared when they encounter these in the classroom or in the school yard or on the bus.

The American Lung Association has released a very helpful guide on how to talk to kids 10 and over about vaping and e-cigarettes, and I walk through it today on the podcast so you can be prepared!

So what should you be doing?

1- Do you have a kid in your life 10 and up? Go to talkaboutvaping.org and talk to other important grownups in their lives about having the Vape Talk.

2- Read the “Get the Facts” guide from the ALA. If you want more details on the specifics of e-cigarettes, listen to the “Gambling with your lungs” episode from Dr. Jeff Gotts.

3-  Read the ALA’s Vaping Conversation guide, and practice having a vape conversation with teens in your life. Share how important this is with the #DotheVapeTalk.

4- If you want to get involved on the policy side, listen to the “A Teen Talks Vaping” episode about tobacco retail licensing and ensure there is robust tobacco retail licensing in your community.

5- For more on the dangers of flavors and their history, especially among kids and in the black community, listen to “A Heartbreaking Trap” and “A County vs Big Tobacco.” You can learn more about the specifics of flavor dangers at airhealthourhealth.org/FlavorFree.

6- Raise your voice about the importance of flavor bans, secret shopper enforcement programs and more. We all pay for the long-term health impacts of e-cigarette addiction!

Go to the post for this episode airhealthourhealth.org/dothevapetalk for links and more information!

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I had a few weeks set aside in May to record and wrap up some final podcasts for the season, but COVID 19 had other plans. I instead became the head counselor at “Camp COVID” for my three rambunctious children who rapidly bounced back from their infections with no respect for the time their mother might need to finally taste her coffee again.

Enjoy the end of the season thoughts, and will see you next Fall with more Air Health Our Health!

To Do over the Summer:

Catch up on any podcasts you missed from the first two seasons. Get involved in advocacy at your local, state and federal level to be a voice for clean air, whether working now to get your county or state to consider a flavored nicotine ban in the next legislative session or encouraging a transition away from combustion engines for transportation or from combustion in your own home. Please also consider a donation to the many organizations working hard for clean air! Neighbors for Clean Air- Ashia Allen from “Ashia, Albina & Asthma” is now on the board! American Thoracic Society- I am a member of the Environmental Health Policy Committee, and we work hard to convey the importance of the science of healthy air to our state and federal government, the EPA, Supreme Court, and more Campaign for Tobacco Free Kids- keep working to protect kids from Big Tobacco Look through previous podcast notes for more donation ideas! Join the Air Health Our Health Fight for Air Climb team- climb is on June 26th, though we will be “climbing” virtually, so you can join from anywhere in the world! Take steps on your own time and raise money for the American Lung Association!

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I know we have talked about how Big Tobacco fights flavoring bans at the local level, and today on the podcast, we talk about a county trying to fight back against flavored tobacco. Flavors are designed to hook new users to nicotine products. On this episode, I am joined by Carrie Nyssen of the American Lung Association, who describes the current battle for the health of kids that is on the May ballot in Washington County. Dr. Lisa Reynolds has practiced pediatrics for over 20 years in Washington County, serves in the OR legislature, and shares her perspective. Dr. Maxine Dexter is a fellow lung and ICU doctor for adults, and represents many of the people in Washington County in the Oregon House. Today we cover a specific example of a population of kids affected by flavored tobacco, the toll of flavored nicotine products, and what we can do about it. We also walk through many of the arguments opposed to these bans and why they are often misleading.

To Do:

- If you are in Washington County, OR, please vote NO on measure 34-314 on the May 2022 ballot and encourage your friends and neighbors to do the same. If you live outside Washington County but know voters inside it, please reach out to make sure they vote.  Go to FlavorsHookOregonKids.org to learn more.

- Post on social media and consider writing an Op-Ed about why you support a ban on flavored nicotine products.

- Find out if there is a flavor ban being considered in your county or state, and do what you can to support it.

- Write to your members of Congress and ask them to take action against flavored nicotine at the national level.

- Learn more about flavored tobacco, the history of menthol and targeting of the black community, as well as other tactics by Big Tobacco by listening to the podcast episode “A Heartbreaking Trap” and reading accompanying materials here.

-  Learn more about health effects of e-cigarettes in the podcast episode “Gambling with Your Lungs” and reading more here. Learn more about the impact of flavors here.

- Learn more about how you or a loved one can break free of the nicotine habit here.

- Donate to the American Lung Association to help amazing people like Carrie keep advocating for the health of our communities.

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Those of you who listen to this podcast know that my main slogan is “Don’t light things on fire and breathe them into your lungs.” But what about when we cook with fire with gas stoves? Today I am joined by Dr. Laura Paulin MD, MHS of Dartmouth College who researches this very topic. She has studied the impact of indoor air quality in homes and studying home interventions aimed at decreasing indoor nitrogen dioxide concentrations. She has studied indoor particulate matter and NO2 exposures and asthma outcomes as well as their impact on others with lung disease and pregnant women.  She has published multiple articles in leading respiratory and environmental journals, and currently serves on the Environmental Health Policy Committee of the American Thoracic Society. Today we talk about gas stoves, their health impacts, and what to do if you are one of the 35% of American homes using gas stoves.

To Do- especially if a member of the Twitchy Airways Club

1- If you are looking for a new home or thinking of a change of kitchen, electric is likely a better choice than gas for the health of your family and community.

2- If you already have a gas stove, think through your options. If you have the means to replace it, consider doing so. Obviously, multiple variables go into that decision. If you can’t, make sure to ventilate as best you can. If you have a hood, run it on its highest setting, ensure it ventilates to the outdoors, and try to use the back burners. Consider using an air filter with a carbon component to absorb NO2.

3- Contact your county, state and national representatives and advocate for policies to reduce the use of gas in indoor settings or help people transition away from gas while keeping energy and cooking costs clean and affordable. This is likely a complex issue that will require multiple stakeholders, but it is important to be a voice for health.

4- Consider a donation to the American Thoracic Society, who works hard to support research into clean air and to inform policy around the importance of clean air.

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Dr Franziska J. Rosser  is a lung doctor for children at UPMC Children's Hospital of Pittsburgh, and an asthma researcher. She has studied the impact of the Air Quality Index on hospitalization of children. Many doctors concerned about air quality struggle with how to balance advice to get outside and exercise with concern about ensuring we don’t overdose ourselves or our families on pollution, which we often cannot see or smell. If you have struggled with this, this is the episode for you! We discuss honestly what is known and what is unknown about the AQI, and how to navigate the uncertainty.

To Do: (Especially members of the Twitchy Airways Club)

1- Download the AirNow app or become familiar with AirNow.Gov.

2- Pay attention to the AQI, and when it is in the yellow or orange category and you or your child is active outside, pay attention to whether you or your child coughs more in the days following. Discuss your observations with your doctor or your child’s pediatrician.

3- Learn more about redlining and impacts by listening to the podcast with Vivek Shandas.

4- Listen about one person’s story with asthma growing up in a previously red-lined district by listening to Ashia Allen, a patient of mine.

5- If you smoke and have kids, do what you can to quit! If you need help, you can find more in the resources on this post, or by listening to the podcast episode with Brandy Carpenter.

6- Donate to the American Thoracic Society, working to fund important research about air quality and health.

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On this podcast, I talk to Dr. Dan Costa, who has his doctorate in toxicology and occupational health toxicology and occupational health. He has worked for the Department of Energy in the Brookhaven National Laboratory conducting research on the impact of fossil fuel related air pollutants on the lung and heart. He also served at the Environmental Protection Agency for over 34 years, conducting research on health science to inform critical policy questions. For his last 12 years at the EPA, he was the National Program Director for research on air, climate and energy issues. Today we talk about PM2.5, the history of understanding its impact on health, and the short and long-term standards. 

To Do:

1- Find out about the short and long term PM2.5 levels where you live. Review the American Lung Association's State of the Air report.

2- Make it a habit to check Airnow.gov to help determine when it is safe for you to exercise.

3- Avoid exercising by busy roads at rush hour- try to commute by bike or walk on less-trafficked paths if you can. Find parks or other “clean air islands” for play and exercise

4- Don’t contribute to PM2.5 if you can help it. Avoid burning things in your home, don’t burn decorative fires, don’t burn garbage or leaves to dispose of them. I guarantee my patients will thank you.

5- Consider a donation to the American Lung Association to support their work for healthy air for everyone.

Please Note- due to the omicron surge and heavier clinical burden, I am only releasing one podcast for the month of February. February 14th seemed appropriate, because the best gift you can give yourself and loved ones is a healthy heart by decreasing PM2.5! Please be sure to get your COVID19 vaccine and booster if you are eligible and have not already done so! 

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Enero es el Mes de Acción del Radón y hoy explico qué es el radón y como puede quedar atrapado en los edificios y aumentar a niveles insalubres. Como médico de pulmón que atiende a pacientes con cáncer de pulmón, definitivamente he visto que no preguntamos lo suficiente sobre la exposición al radón en los hogares, especialmente si alguien alquila una casa y no la posee.  ¿Cómo aumentamos la conciencia sobre el radón y reducimos los riesgos en la población?  La salud pública es muy importante.  Así que para este Mes de Acción del Radón, hablo con Mateo Olmos, un estudiante de salud pública de Oregon State University que está trabajando para llegar a comunidades que a veces están menos conscientes de las amenazas a su salud.

1- Asegúrese de que su casa se someta a pruebas de radón.  Puede encontrar pruebas que cuestan entre $ 10 y $ 30 o contratar a un profesional.  Ocasionalmente, hay kits gratuitos o de precio reducido de organizaciones como la Asociación Americana del Pulmón o la autoridad de salud local (el sitio tiene opción a traducir a español).  Quiere que su nivel sea menor que el límite de acción de la EPA de 4.0 pCi / L o mejor aún, el límite de la OMS de 2.7 Pci / L.

2- La EPA estima que alrededor de 1 de cada 5 escuelas pueden tener niveles elevados de radón.  Averigüe si su escuela ha sido examinada para detectar radón y si los niveles son superiores a 4.0 Pci / L, si se ha mitigado.

3- Mire y comparta el excelente video educativo breve de Mateo sobre la importancia de las pruebas de radón (está en inglés). Puede aprender mas sobre radón con el sitio de EPA en español.

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January is Radon Action Month. By the time someone meets me in the clinic with a lung cancer, it is too late for the intervention that should have taken place years before. How do we increase awareness about radon and reduce the risks in the population? This is exactly where the field of public health is so important, so for this Radon Action Month, I wanted to highlight two individuals in the public health pipeline- a teacher and student of public health. I am joined by Dr. Karen Elliott of Oregon State University as well as Mateo Olmos, one of her students.

To Do:

- Ensure your home is tested for radon– test every 2 years if you have not mitigated radon and after home upgrades. More information here

- Watch and share Mateo’s video educating about the importance of radon testing and action.

- The EPA estimates around 1 in 5 schools may have elevated radon levels in at least one  frequently-occupied room. Find out if your child’s school has been tested for radon and whether it has been mitigated, particularly if close to or over the EPA action level of 4.0 pCi/L

- If you are a health professional, learn more about patient outreach with this guide to radon.

- For more on the science of radon and how we know it causes cancer, listen to last year’s January podcast with Professor Bill Fields.

- To hear a personal story about someone affected by radon, listen to the podcast with the home inspector Will Graff on Season 1 episode 22.

- Learn more about the Northwest Radon Coalition here, and consider a donation to the American Lung Association here.

References

EPA Resources on Radon

American Lung Association Radon Resources

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In this episode, I share my thoughts about COVID while we are in the season of Advent, a time to look for hope in the darkness. I also provide some resources on what to consider for your holiday gatherings.

Happy Holidays! Will be back in 2022!

To Do:

1- Encourage loved ones to be vaccinated. For more on the science behind vaccines, listen to Episode 3 with Dr. Gigi Gronvall. For more on how to have those conversations, listen to Episode 4 with Destiny Aman and a behavioral science perspective.

2- Think about the 4D’s of safe shared air- Density, Distance, Duration and Dilution. For more information, listen to Episode 8 of this season with Ken Martinez.

3- Consider a rapid home test for COVID on the same day of planned gatherings with family. They are helpful at catching folks most likely to be spreading virus.

4- Please donate to the American Lung Association. They do great work on clean air, education, and COVID19 safety.

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Today, I am delighted to be joined by Ken Martinez, who is a certified Industrial Hygienist and Environmental Engineer with a long and illustrious career in biosecurity and research. His career has spanned over 33 year with the CDC, responding to crises such as the first SARS1 outbreak in Toronto, responding to the World Trade Center collapse, working on anthrax, multi-drug resistant TB and more. He shares what we have learned from responding to previous biological threats and pandemics, and how we can apply them now.

We talk today about the “4 Ds” of keeping air safe- Density, Distance, Duration, and Dilution. In addition to vaccination, we talk about what is known and what is unproven in terms of indoor air cleaning technology.

In particular, we talk about technology such as chemical foggers, ionizers, and hydroxyl radical generators, which have been heavily marketed to schools and homes across the country. I have received pitches for these myself, and understanding what is actually proven vs unproven technology is helpful.

To Do-

1- Remember the “Four Ds”- Density, Duration, Distance, and Dilution in your upcoming holiday gatherings. Encourage anyone who is not vaccinated who is eligible to be vaccinated. Listen to earlier podcast episodes this season on how to have those conversations.

2-  Commit to Care to reduce COVID spread by checking out the post on the website for information on how to optimize both HVAC and portable air filters for indoor safety.

3- Do you already have a portable air cleaner? If so, check to see whether it is a filter that is removing particles from the air, like a certified HEPA filter, vs something that is adding something to the air, such as ionizing technology or hydroxyl radical generation. Until we know more, focus on removing particles from the air and ventilating well rather than introducing new things into your air. Learn more about selecting and sizing an air filter for your space- this post is geared for wildfire concerns, but has information about air filters in references.

4- Find out what air “cleaners” are being used in your school, church and home. If they are using ionizing technology and hydroxyl radical generators, ask whether the device has been studied in occupied spaces. You can also reach out to me, and I can try to put you in touch with scientists who are interested in studying the effectiveness of this technology in the real world.

5- Learn more about school and home air safety with COVID19 by listening to the episode “The Air Kids Share” with Dr. Olsiewski of Johns Hopkins Center for Health Security.

6- Consider a donation to IBEC to help them in their work to make the air in our schools, churches and workplaces safer.

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Ritney Castine joins me today to talk kids, tobacco, and flavors, and also about the time he had to lobby a smoking Senator and future President! He is the former Managing Director of Community and Youth Engagement at Truth Initiative, a Washington, DC-based public health organization and also the former Director of Youth Advocacy at the Campaign for Tobacco-Free Kids. He currently works with Center for Black Health and Equity, and is a fellow podcaster as a cohost of the Black Body Health podcast. He is the youth pastor at Trinity Church in Gonzales, LA, and we dive into what we can do as parents, communities, and churches to help break free of tobacco.

To Do:

1- Advocate for flavor bans and menthol bans in your community. Often these can be done at the county level. I have advocated for this in my own county, and a neighboring county recently passed a flavor ban. Remember, Big Tobacco may show up in insidious ways to fight back, but don’t be intimidated.

2- Contact your members of Congress to continue to pressure the FDA to move forward with regulating mentholated tobacco and vape products. Learn more at Centerforblackhealth.org for more on the importance of a menthol ban and important history, or check out the Black Body Health podcast- episodes 4, 10 and 17 to learn more.

3- Talk to your kids about how flavored tobacco and vape products are designed to hook them. Learn more about how to have these conversations at Flavorshookkids.org. Maybe your kid would like to be a youth ambassador against tobacco in their peers.

4- Consider a donation to Campaign for Tobacco Free Kids or the Center for Black Health and Equity, who have been working to help keep kids and communities free of addiction.

5- If you are part of a faith community, consider engaging in a No Menthol Sunday next May to educate about tobacco’s toll on the sanctity of life and how Big Tobacco preys on many of the most vulnerable.

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Today I am joined by Dr. Fernando Holguin, the Director of the Clinical and Research Asthma Program and the Executive Director of the Colorado School of Public Health’s Latino Research and Policy Center. We discuss the interaction of asthma, obesity and air pollution today, with a particular focus on how it impacts Latino communities in the United States. Patients with asthma who are obese often struggle to get a diagnosis since their trouble breathing is attributed to their weight. Once people are obese, asthma in some can be more challenging to control, and their body may also be more affected by air pollution. Obesity is extremely complex with many inputs, and there is much more we need to learn. Dr. Holguin is working hard on this research, and shares what he has learned with us today.

We also discuss what can be done at the individual and community level to improve our health, with a focus on taking manageable steps. 

To Do

1- Decrease processed foods in the diet, add more vegetables, fruit and whole grains to the diet. 

2- Work for clean air in your home and community.

3-  If you or someone in your family is coughing regularly or has shortness of breath, talk to your doctor about it. A diagnosis is very important!

4- Learn more about asthma risk factors and triggers- see the Twitchy Airways Club section of the website.

5- As always, stop smoking! Click here if you need help to quit.

6- Calculate your BMI here, if it is over 25, you may be overweight. If it is over 30, you may have obesity and be at risk for a more severe impact from air pollution. Talk to your doctor about what steps may be most important for your health.

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Hoy me acompaña el Dr. Fernando Holguin.  Discutimos la interacción del asma, la obesidad y la contaminación del aire en la actualidad, con un enfoque particular en cómo impacta a las comunidades latinas en los Estados Unidos.  ¡También discutimos lo que se puede hacer a nivel individual y comunitario para mejorar nuestra salud!

Que hacer

1- Disminuir los alimentos procesados en la dieta, agregar más verduras, frutas y granos integrales a la dieta.

2- Si usted o alguien de su familia tose regularmente o tiene dificultad para respirar, hable con su médico al respecto.  ¡Un diagnóstico es muy importante!

3- Aprenda más sobre los factores de riesgo y desencadenantes del asma, escuche el Episodio 28 con el Profesor Celedon para obtener más información, ¡especialmente para los padres!

4- ¡Como siempre, deja de fumar!  Haga clic aquí si necesita ayuda para dejar de fumar.

5- Calcula aquí tu IMC, si es superior a 25, es posible que tengas sobrepeso.  Si tiene más de 30, es posible que tenga obesidad y esté en riesgo de sufrir un impacto más severo por la contaminación del aire.  Hable con su médico sobre los pasos que pueden ser más importantes para su salud.

6- Vacúnese contra COVID19 cuando pueda para ayudar a retrasar la propagación y evitar variantes peligrosas y seguir las precauciones de salud.  ¡Disminuir el aislamiento también ayudará con la salud mental!

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You may remember Destiny Aman from the recent episode on the science of vaccines. She’s back to talk about having these conversations from the behavioral science side of things. Destiny Aman runs JPoint Collaborative and has a background in behavioral science working as a risk communication expert and has over 20 years of helping translate science into practical solutions adapting to environmental risks, including in work that has supported FEMA and the CDC. She’s here today to share more about how people think about risk, mistrust of science, and how to reach out about vaccines while maintaining relationships with people we love.

4 Steps Toward More Effective Vaccination Conversations Reflect on and invest in the relationship. Identify common ground, and (importantly) validate that shared common ground. Address barriers, using your own personal story. Make a gracious and respectful exit.

To Do:

1- Get your COVID 19 vaccine if you haven’t done so yet. Learn more about the COVID19 vaccines at the American Lung Association, and find where you can get your vaccine here.

2- Reach out to your loved ones about the importance of vaccination- feel free to share the last podcast regarding vaccine science or share what you’ve learned as an equal, especially in how to communicate more effectively.

3- Make a plan for the holidays and be sure you are giving friends and loved ones over a month’s awareness of where your COVID safety lines will be for the holidays and what accommodations for unvaccinated family and friends you may be able to make.

4- Consider a donation to the American Lung Association here, who is trying to help share accurate information about COVID19 vaccination and fund research and advocacy.

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Today I am releasing the first of two podcasts about COVID19 vaccination on the day before World Lung Day 2021.  I talk to two experts in their fields, Dr. Gigi Gronvall PhD and Destiny Aman. Dr. Gronvall studies the immune system and is a Senior Scholar at the Johns Hopkins Center for Health Security and on the editorial board of the journal Health Security.  She is a biosecurity and bioterrorism expert and has served as a member of the Threat Reduction Advisory Committee providing the Secretary of Defense with independent advice and recommendations on reducing risk to the United States, its military forces and allies.

Destiny Aman is a behavioral science and risk communications expert running JPoint Collaborative with over 20 years of experience translating science into practical solutions to improve resilience at individual, community, and national levels. Her research has centered on developing and promoting creative adaptations to environmental risks, including natural hazards like wildfires and flooding, and now the ongoing COVID-19 pandemic. She provides essential help with how best to understand the concerns people have around vaccines and how to best communicate. I found this conversation so helpful, and hope you do too!

To Do:

1- Get your COVID 19 vaccine if you haven’t done so yet. Learn more about the COVID19 vaccines at the American Lung Association, and find where you can get your vaccine here.

2- Reach out to your loved ones about the importance of vaccination- feel free to share this podcast or share what you’ve learned, especially in how to communicate more effectively.

3- Learn more about why there may be very legitimate hesitancy about the medical community, vaccines and scientific research by learning about the history of the Tuskegee experiment, Henrietta Lacks, and more. Medical Apartheid is a vital read for all in healthcare.

4- Consider a donation to the American Lung Association here, who is trying to help share accurate information about COVID19 vaccination and fund research and advocacy.

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Today, I’m providing a summary of the health effects of wildfire smoke. I recorded a webinar in June 2021 on the health effects of wildfire smoke that is available in English and Spanish. I’m providing an expanded podcast version of that summary here today. Topics covered include: What we know and don’t know, vulnerable/sensitive groups, short and long term effects of wildfire smoke and individual characteristics that affect this risk, respirator use, what to do before, during, and after smoke events.

In this episode, I reference the ATS standard of 11ug/m3 for PM2.5 exposure. ATS has submitted testimony to the EPA asking the EPA to consider a standard of 8ug/m3 because of adverse health effects even below the 11ug/m3 standard.

More information:

For more on the cardiac death study, listen to the Season 1 Episode 11 Apocalypse Now For information on clean indoor air, listen to S1 E13 with Prof Elliot Gall. You can also see his post here on how to make a clean air room. For more information on the long-term effects of wildfire smoke, listen to S1 E18 with Prof Chris Migliaccio For more information about outdoor work, listen to S1 E 14 with Prof Alya Khan. Each of those episodes also have links to references and things you can do.

To Do:

1- Identify whether you or a loved one are in a sensitive group for particulate matter.

2- Make a plan before wildfire season about the health of you and your family members. If you are going to get a respirator, make sure it is NIOSH certified here or here.

3- Make sure you have a plan for clean air in case of smoke events

4- Donate to Neighbors for Clean Air, or Oregon Physicians for Social Responsibility, who hosted the webinar Our Health in Wildfire Season

5- Donate to PCUN- working to keep outdoor workers safe

6- Get your COVID19 vaccine if you have not done so, and your booster if you are a member of a recommended group. We are all in this together. Find out more from the American Lung Association here.

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Back to school with Season Two of Air Health Our Health! I am joined by Dr Paula Olsiewski of the Johns Hopkins Center for Health Security, where she is a pioneering leader in policy and scientific research programs in the microbiology and chemistry of indoor environments. She spent two decades at the Alfred P Sloane foundation leading innovative and multidisciplinary programs partnering with academic, governmental and for-profit stakeholders understanding the chemistry of indoor environments and the microbiology of the built environment. She is recognized as a leading expert in biosecurity and is a member of the Council on Foreign Relations. She is chair of the US Environmental Protection Agency (EPA) Homeland Security Research Subcommittee and is a member of the EPA Board of Scientific Counselors Executive Committee, in addition to serving as a member of the NTI|bio Working Group for Biosecurity Innovation and Risk Reduction Initiative and a Fellow of the American Association for the Advancement of Science in chemistry.

She is also the grandmother of 4 young children, and she joins me today to talk details and specifics about how to reduce COVID 19 risk in the classroom. There are actually simple, concrete steps we can all take right now, even in districts with old buildings with poor ventilation. More importantly, the CARES Act has provided funding to ensure that no school is left behind. 

To Do:

1- Reach out to your school- Find out about the number of air changes per hour in the room. Ideally it should be 6 or more. Review the full Johns Hopkins report here.

2- Find out if your school has an HVAC system with MERV13 air filters or higher. If not, ask or demand that your school work on obtaining them or put in HEPA filters and make a plan for proper filter maintenance throughout the year.

3- Review filters on CARB here to ensure they are safe. You want mechanical filters to remove particles. Learn more about air filters and HVAC here, and how to size and place portable filters. 

4- Be a parental voice for school safety- advocate masking, vaccination, distancing, and testing. Also, remember that investing in clean indoor air in schools and robust air filtration will pay off in wildfire season, for air pollution, and more! Kids learn better in clean air. 

5- Get your COVID19 vaccine if you have not done so. Lovingly encourage those around you to do the same. This is the most important step.

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What a year! Thanks to all of you who have been listening to the Air Health Our Health podcast. In this episode, I share my thoughts on what it has been like to live and work as an ICU and lung doctor this year during COVID19, worry about three young children, and ask your input on thinking ahead to Season Two!

To Do

1- Catch up on episodes you missed and please like the podcast, leave a review and share with family and friends to spread the word about the importance of clean air. Consider buying a T-shirt to spread the word "Don't Light Things on Fire..." Proceeds go to American Lung Association.

2- Enjoy your summer, and take a moment of mindfulness and gratitude whenever you are breathing healthy air. We too often take it for granted.

3- If you or someone you love in your life smokes, make this summer the summer you quit or help them break free of Big Tobacco.

4- Send me a message through the site, record your thoughts or a question on the Anchor app, or follow on Instagram or Facebook.

5- Come back for Season Two in the Fall! It will be in this feed, so stay subscribed!

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Today I am joined by Ashia Allen, whom I first met when she was critically-ill at Emanuel Hospital with severe asthma. She shares her story growing up in Albina near freeways and construction and what it was like to live with asthma. Ben Duncan joins me as well to discuss the history of working on air pollution concerns in Albina, a formerly red-lined district and the historic heart of the black community. Their stories are powerful reminders of why working to clean up air pollution is so important, and why the cost of inaction is high.

Things you can do- 

- Listen to other podcast episodes to learn more about the impact of air pollution and redlining on health, and share with your friends and family.

- Find out what you can do in your community to decrease air pollution. Reach out to your local county commissioner, city council, and state and national legislators to tell them that cleaning up the air not only saves lives it saves money. For more on that, learn about the ROI on the Clean Air Act here.

- Consider a donation to organizations like Neighbors for Clean Air or OPAL Environmental Justice or a group in your community working to clean up the air. Consider it an investment with high returns in terms of lower future healthcare expenditures and higher productivity!

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Hoy hablo con el Dr. Juan Celedón, profesor de pediatría, medicina, epidemiología y genética humana y Jefe de División de Medicina Pulmonar Pediátrica en Universidad de Pittsburgh y el primer presidente latino de la American Thoracic Society, sobre el asma en la comunidad hispana de EE. UU. Exploramos cómo el aire que respiramos puede afectar nuestro riesgo y el riesgo de nuestros hijos. Escuche para aprender sobre la importancia del aire saludable en el exterior y cómo la exposición al aire en interiores puede afectar a las personas con asma y aumentar el riesgo de asma y más.  También hablamos sobre el impacto de la inmigración, la violencia y la dieta sobre el asma en los niños latinos.

Busque podcasts con títulos en español y el logotipo de “Nuestro Aire Nuestra Salud” para ver más episodios en español.

Que hacer

1- No fume y deje de fumar si ya ha comenzado; si no es por usted, ¡hágalo por sus hijos! Aprende más aquí. No permita que sus hijos empiecen a fumar cigarrillos electrónicos o vapear.

2- Verifique si hay infestaciones de cucarachas o moho en su hogar y elimínelas. Asegúrese de que no haya cucarachas. Revisa esta lista. (Segundo Dr. Celadón, una mascota puede ser útil si los padres no son alérgicos).

3- Evite vivir cerca una autopista muy transitada o en áreas de alta contaminación del aire si puede.

4- Trabaje por leyes que disminuyan la contaminación del aire y aumenten las áreas en su vecindario con aire limpio para que los niños jueguen al aire libre.

5- La salud mental y el control del estrés es muy importante en general y para el asma en particular.  Trabajar para reducir la exposición de los niños a la violencia.  Considere unirse a organizaciones como Everytown for Gun Safety (sitio web en inglés)

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Dr. Vivek Shandas is a Professor of Climate Adaptation and Founder and Director of the Sustaining Urban Places Research Lab at Portland State University and serves as Chair of the City of Portland’s Urban Forestry Commission in addition to other local and national advisory boards. He joins me on the podcast today to discuss his research on everything from trees in human communities, nitrogen dioxide exposure, economic benefit of green spaces and environmental services, as well as the impact of redlining in real estate and development and its impact on health now.

Which trees are best at reducing air pollution? How much can they help? How much money and health can we save by planting more trees? How has redlining impacted the trees in our communities, and what can we do to make things better? Listen and learn! 

To Do

1- Plant a tree! In the Pacific Northwest, consider volunteering or donating to Friends of Trees!

2- Plant a tree when you search! Use Ecosia when you search on-line!

3- Air quality is local- advocate for cleaner construction standards. Donate to Neighbors for Clean Air.

4- Learn about the history of red-lining and how it impacts health now- see the Mapping Inequality project for more. Good books include the Color of Law and A Terrible Thing to Waste.

5- Listen to podcast episode “Tubman’s Air Troubles” to learn more from an atmospheric chemist about air pollution.

Twitchy Airways Club Members

1- Commute on lower pollution routes if you can, avoid busy roads, peak traffic times, etc

2- Advocate for cleaner air for you and your community!

3- Look for green spaces, and encourage more trees in your community. Check out Imperial College London Air App- helps a Londoner find the safest commute for air pollution. Let me know if your city has one, too!

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Bienvenido/a al primer podcast de "Air Health Our Health" en español. 

El Dr. Alejandro Díaz es profesor asistente de medicina en la Escuela de Medicina de Harvard, donde enseña español médico, y médico científico que estudia imágenes pulmonares en el Brigham and Women’s Hospital.  También estudia la salud respiratoria de la comunidad hispana / latina y le apasiona comprender mejor los desafíos de salud que enfrentan sus miembros. 

Que puede hacer Usted?

- Ten cuidado al usar agentes limpiadores.  Asegúrese de que la habitación esté bien ventilada y tal vez use su agente de limpieza como último elemento antes de salir de la habitación.  

- Preste atención si los agentes son particularmente irritantes para usted y evítelos.  

- Si habla inglés y cree que tiene asma o bronquitis crónica, obtenga más información en la parte del sitio web llamada "Twitch Airways Club" o sobre el asma aqui en español.

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In a first on the podcast, we are joined by an analyst from Wallet Hub, a financial literacy website. Jill Gonzalez normally appears on venues such as Fox Business Network, the Wall Street Journal Live, C-Span, and Fortune. Today she joins me to talk about WalletHub's analysis - The True Cost of Smoking. Listen and learn to find out how much smoking costs the individual over a lifetime, and all the different ways it can impact one's finances. 

To Do:

1- Find out what grade your state gets for tobacco control with this tool from the American Lung Association.

2- Calculate the lifetime cost of smoking in your state using the Wallet Hub tool and share that information with anyone who needs to know.

3- If you or someone you love needs to quit smoking, check out Smokefree.gov or the ALA for more information.

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Dr. Alejandro Diaz of Harvard Medical School and Brigham and Women’s Hospital joins me today to talk about chronic bronchitis and challenges facing the US Hispanic Community, as well as the health effects of cleaning agent exposure.

To Do:

1- Support more research on health in Hispanic community- one such study is going on in COVID19 in Yakima WA now, funded by the ALA. There is still time to donate to our ALA fundraiser here (before Mar 14, 2021) or here (after March 14, 2021).

2- Donate to the Immigrant Worker Safety Net Fund- help those who generally can’t afford a sick day stay home to care for themselves or relatives

3- Twitch Airways Club Members- be careful when using cleaning agents. Ensure the room is well-ventilated, and perhaps use your cleaning agent as the last item prior to leaving the room. Pay attention if agents any are particularly irritating to you, and avoid them.

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Today on the podcast, I am joined by Gabriella Shirtcliff, who is a junior in high school and shares her experience about e-cigarettes and vaping among her peers. Karen Ard works in public health in the Deschutes County and works with Gabriella to address teen tobacco use. This episode is vital for all of us, but especially parents and educators concerned about Big Tobacco’s grip on a new generation. It also, as a bonus, gives me hope if there are as many great teens as Gabriella out there fighting for their futures.

Action Items:

1- Talk to your kids or youth in your life about vaping and e-cigarettes-  You can find resources from the Campaign for Tobacco Free Kids here. If you or your kids use social media, share about your concerns.

2- Find out whether your state or town has Tobacco Retail Licensing. If it doesn’t, push for it at the local and state level. Use ALA’s State of Tobacco Control Report.

3- Find out whether your state, county or town has a flavor ban, and make sure it includes menthol. If it doesn’t, write your elected representatives at all levels to share why it is important. Push for the national flavor ban to include all tobacco products, including e-cigarettes and vaping.

4- Donate to the Campaign for Tobacco Free Kids.

5- Join the Air Health Our Health Fight for Air Climb! Climb on your own terms, your own way, and raise money for the ALA! Or just donate to support our efforts if you don’t want to climb! Due date is 2/14/2021, so okay to just go to regular AHOH ALA fundraiser if you’re listening after that date. Maybe you can join next year’s team!

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Today I am joined by Will Graff. Will is a home inspector who is passionate about healthy, energy efficient, and sustainable homes. He is also a strong advocate for radon-testing, which is what he is here to talk about today. Radon is personal for him, and has affected his family in a devastating way. Today, he shares his radon story, and why he urges testing. See more about Will’s story here. This podcast is originally posted in January during National Radon Action Month. Make sure you take action!

Things You Can Do

Ensure your home is tested for radon- test every 2 years if you have not mitigated radon and after home upgrades. More information here
-If you need help with mitigation costs, call 1-800-SOS-RADON or go here Find out what your local radon laws are- consider advocating for protective standards The EPA estimates around 1 in 5 schools may have elevated radon levels in at least one  frequently-occupied room. Find out if your child’s school has been tested for radon and whether it has been mitigated, particularly if close to or over the EPA action level of 4.0 pCi/L Join the Air Health Our Health Fight for Air Climb! Climb on your own terms, your own way, and raise money for the ALA! Or just donate to support our efforts if you don’t want to climb.

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What do we know and how do we know it? To answer questions such as “What causes cancer?” we need the science of epidemiology. There is a lot of pseudoscience out there as well as well-meaning but poorly-designed studies that throw confusion on an issue. To get to the bottom of radon science, I talk today to Professor Bill Field, who is an epidemiologist and radon expert. We talk about the history of radon discoveries, how good studies are designed, as well as his own history with radiation exposure. 

Things You Can Do

Ensure your home is tested for radon- test every 2 years if you have not mitigated radon and after home upgrades. More information here
Find out what your local radon laws are- consider advocating for protective standards
The EPA estimates around 1 in 5 schools may have elevated radon levels in at least one  frequently-occupied room. Find out if your child’s school has been tested for radon and whether it has been mitigated, particularly if close to or over the EPA action level of 4.0 pCi/L
Join the Air Health Our Health Fight for Air Climb! Climb on your own terms, your own way, and raise money for the ALA! Or just donate to support our efforts if you don’t want to climb.
If you are a health professional, learn more about patient outreach with this guide to radon.

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Today's brief podcast is a reflection on the gifts of hope in the current darkness. I share my perspective as an ICU doctor seeing the toll of COVID19, and how I find joy in the midst of sorrow. We touch on what the science has shown us about indoor spread, and I share a couple strategies I have used to maintain contact with family and loved ones safely.  

This is the last podcast of 2020. Thank you to those who have begun listening this year. Will see you after the holidays in 2021.  

Things you can do: 

1- Follow health authority guidelines for pandemic safety- CDC guidelines here 

2- Get outdoors if you can 

3- Donate to your local foodbank 

4- Get your flu shot 

5- Join or donate to the Fight For Air Climb to benefit the American Lung Association and their lifesaving COVID19 research and more. Would be great to have you on the Air Health Our Health team!

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I am a lung doctor who cares for patients in the clinic and ICU when they are sickened from diseases caused or worsened by air pollution. However, air pollution is actually even more damaging to the heart and blood vessels of the body, as my podcast guest Dr. Thomas Muenzel today knows too well. He is a heart doctor who can help intervene to open up arteries on patients who are suffering from blockages that cause heart attacks and other damage. For both of us, having a patient come to need our intervention already indicates that person is very sick, and we would both like to prevent them getting that ill in the first place. Dr. Muenzel has studied how air pollution actually damages the blood vessels in our body and around our heart.  COVID19 has been consuming communities around the world, and is currently raging out of control in the United States at the time of this post. Dr. Muenzel and his group have worked to define how many of the deaths from COVID19 may be related to its interaction with air pollution. On the podcast today, we talk about the impact of air pollution on the heart and blood vessels as well as its interaction with COVID19.

What to Do:

1- Follow public health guidance on decreasing COVID19 pandemic so we can get through this sooner.

2- Pay attention to the absolute PM2.5 level where you live and AQI to help determine when it is safe to exercise.

3- Do your part to decrease air pollution in your own life and encourage your community and country to do the same.

4- Consider a donation to the American Lung Association or spreading the word about the importance of healthy air by wearing an Air Health Our Health T-shirt or using a mug or tote (proceeds also go to supporting healthy air).

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I am joined today by Professor Christopher Migliaccio, who is a researcher and professor at the University of Montana Center for Environmental Health Sciences. He studies the way the immune system of the lung interacts with environmental exposures. He has studied the impact of wildfire smoke on our health and published a study that is useful to understanding the potential impact of short term, high levels of exposure. We discuss the impact of the heavy smoke that affected Seeley Lakes, Montana in 2017 and what the long-term effect on that community was. We discuss influenza rates in the year following as well as impact on lung function. 

What can you do?

1- Make sure you have a plan for indoor air quality- remember fire and smoke season will come again; make sure you have a place in your home at least where you can breathe healthy air. See earlier post on indoor air quality prior and listen to the episode with Professor Gall for more information.

2- Get your flu shot- this is always a good idea, but increased flu burden was seen in the year following the severe smoke exposure in Seeley Lake.

3- Donate to your local food bank!

4- Donate to those working for healthier air and helping those with lung disease. Consider a donation to the Air Health Our Health fundraiser for the ALA- link here!

5- Spread the word about health air by being a billboard! Check out the Air Health Our Health shop for options.

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Dr. Beate Ritz, MD, PhD became interested in air pollution and its effects on pregnancy when she was pregnant herself. She has a wide-ranging career, but over the last several decades has helped us understand more about the impacts of every day transportation-related air pollution on pregnant women and their children. Listen and learn! As always, for links to the studies, please be sure to visit the website. Professor Ritz also contributed to this video for a summary of pollution effects on newborns.

What can you do?

1- Be considerate about flying. Save money and air quality! Can you schedule that business meeting over video conferencing? Can you take a local vacation? Save up your flights for the truly important trips, like those to visit family or particularly extraordinary or important experiences.

2- Ask your community and local airport to be thoughtful about the total burden of air pollution being brought in. Consider actions like zero or low emissions airport shuttles and transportation, increased public transportation service to the airport, etc, to offset the burden of jet fuel in the area while we hope for future, cleaner air travel.

3- Donate to those working for healthier air and to keep a public health lens on the transportation sector. Consider a donation to the Air Health Our Health fundraiser for the ALA- link here!

4- Spread the word about health air by being a billboard! Check out the Air Health Our Health shop for options.

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What would happen in terms of our health and wealth if we started only purcashing electric vehicles by the year 2030? Today on the podcast I talk to Will Barrett of the American Lung Association about the new analysis the ALA has commissioned called the Road to Clean Air. We recorded this with sky high levels of PM2.5 outside due to wildfires worsened by climate change, and it was an analysis that gave me some hope on the dual benefits of addressing climate change and decreasing particulate matter. Furthermore, Will is hopeful that we can actually achieve these goals. Listen to the podcast today for a dose of hope, then take action for healthy air in your own life.

What Can You Do?

1- Speak up about the health of clean air- you can sign the ALA’s petition to your local Governor to focus on healthy air here. Write a letter to the editor of your local paper. Post about the importance of clean air with the #Standupforcleanair.

2- Ask your representatives at all levels of government, including your state legislature to incentivize electric vehicles. Ask your state, town or county to only purchase electric vehicles- frequently a municipality has bulk purchasing power and can invest in infrastructure that makes electrification more possible for individuals and businesses.

3- Donate to the ALA here- show support from the Air Health Our Health community!

4- Are you considering purchasing a new car soon? Choose electric! Or a plug-in hybrid with a decent range if you’re not ready to go full electric. Consumer Reports estimates a typical EV owner can save $800-$1000 on fuel costs especially if they charge at home, and lifetime savings of $4,600 on vehicle maintenance, oil changes, etc.

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Join for a conversation with Dr. Farzad Moazed, MD, who has studied the impacts of tobacco on the Acute Respiratory Distress Syndrome (ARDS), which is the dreaded fulminant respiratory failure that can be seen from severe viral illnesses like influenza and COVID19. Listen and learn!

What Can you Do?

1- Support people to quit smoking and vaping- do this in every way you can. If you smoke, go to the Tobacco and Veterans post to learn more about how to quit. If you don’t, donate to the ALA or the Campaign for Tobacco Free kids (on Invest part of site). Wear a T-shirt telling people not to light things on fire and breathe them into their lungs.

2- Support tobacco taxes- honestly, I generally vote for tobacco taxes, even if I don’t like the design, because I will take anything that helps get this scourge out of people's lives. The best ones go only to funding cessation programs and healthcare, and I think Measure 108 in Oregon fits that bill. Learn more about its design in my conversation with Cyreena Boston Ashby, and by going here. If nobody is working on one in your state or community, or if there is a carve-out for vaping, be the person in your community who works on it. We can stop when it is $16/pack or higher, or everyone just quits smoking.

Twitchy Airways Club Members-

1- if you smoke, please get help to quit. You can find resources here, and support and motivation from my conversation with veteran Brandy Carpenter. Also feel free to get in touch with me via the website or Instagram if you need more resources or have questions.

2- use your voice as someone with lung disease to talk about the importance of healthy air! You can learn more at the Tobacco & Vaping section.

3- Speak up for your own health- if someone is smoking or vaping around you, you can ask them to make choices that preserve healthy air for you. If you are willing to share that you have lung disease, you can, or you can just remind them that healthy air is good for everyone

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Like many in the West and other parts of the world increasingly affected by fire, I think often of the hard work and heroism of our wildland firefighters. “Los bomberos” have been regularly mentioned in our family prayers before meals and bedtimes, and my children have participated enthusiastically in making thank you cards. As a lung doctor, I worry frequently about the health of frontline workers. One person who is an expert in evaluating and protecting high risk occupations is my podcast guest today. Dr. Alya Khan is an occupational medicine physician at the University of California Irvine, and directs the Occupational Medicine Residency program there.  In addition to a Master’s degree in Environmental Toxicology, she holds dual board certifications in internal Medicine and Preventive Medicine.  She works at the Center for Occupational and Environmental Health which provides clinical and preventive services to local and regional employers, conducts worksite surveillance programs, as well as providing toxicology consultations. Earlier this year, she chaired a symposium on wildfires and health risks with a variety of professions, from public health researchers to wildland firefighters and forest management experts.

Listen and learn! 

Ways to Take Action

Thank your firefighters- and make sure you advocate for them to have lifelong high quality health coverage since they are risking their lives and health to keep us all safe. Episode photo of Steelhead Enterprises Firefighters who fought our fires here in Oregon.
Donate to the National Fallen Firefighters Foundation- Charity Navigator Score of 93.91, and participate in the Tribute to Fallen Firefighters on October 4th
Ensure protection for outdoor workers- ensure your state has workplace safety considerations in place for outdoor workers. These can be complex issues, but just because issues are complex, does not mean we should not work on them. One example is here.
Check with your local fire department on how to make your home and community more resilient to wildfire
Contact your legislators to support increased wildland fire prevention - for example with a pro-active forest management approach with year-round staffing. We need to let the science lead to help us understand which areas are at risk and spend the money to pay people to safely address it. This will also bring good, high quality jobs as well.

Want to hear more from Dr. Khan? Check out woema.org/podcasts.

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This podcast is airing while catastrophic wildfires are raging over the entire West Coast, and many of us have been living in air quality that is beyond the air toxics index. I have never thought so much about my HVAC system and the trade-offs of protecting my home from external particulate matter and needing to ventilate my home. As a lung doctor, it is hard not to think about how much our buildings need to breathe just like we do. One person who makes it his job to study these things is Dr. Elliott Gall, a scientist in the department of mechanical and materials engineering at Portland State University. He obtained his PhD in Civil Engineering from the University of Texas at Austin. He studies indoor air quality, including HVAC systems and understanding how air pollution enters and leaves our homes and other buildings where we live our lives.

Listen to our conversation today- we cover so many questions, including how to pick and size air filters, pitfalls to avoid, what we can and cannot protect ourselves from with technology, the differences among air quality monitors, etc. 

We also address some memes and pseudoscience flying around the Internet and social media, from dangerous ozone-generating air "purifiers" to the rumor that boiling water will clean the air. He actually did some experiments on this today before this podcast to answer the question!

Overall, it is hard to not think about the magnitude of the cost of these fires, not only in the toll on human life and property that has already occurred, particularly for those who have lost loved ones and all their possessions directly due to fire, but also in the healthcare expenditures, decreased human potential, lifelong illnesses and economic devastation from those affected by the smoke itself as well as the costs that all of us will have to lay out to prepare our own homes for decreasing air pollution exposure. It has never been so clear to me that healthy air leads to healthy people and a healthy economy.

Resources-

Follow Dr. Gall on Twitter at @etgall.

He sent me so many great references, they actually don't fit in the show-notes! Go to the airhealthourhealth.org post for this episode to see them. I'll keep updating it as I get more. 

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September is usually a time when kids board school buses to start a new school year. In 2020,  we are instead logging into Zoom calls, and  hunkered down in our homes avoiding a pandemic virus and wildfires. Sometimes it is hard to find hope, but there is hope in this episode today! I focus on a very hopeful topic- the massive benefit of cleaning up diesel. While trying to convey the importance of decreasing diesel exhaust, I frequently cite a particular study by my guest Professor Sara Adar. We talk about what happened when Washington State decided to invest money and policy into cleaning up the engines and fuel of school buses for young children.  I love this study, because it gives me hope. Dr. Adar and I also discussed studies in Georgia, where changes to cleaner buses led to better educational achievement in students. We also discussed the many studies that have shown additional healthy life expectancy from intelligent air pollution policy and investing in healthy air. It’s a win-win. Let’s clean up the air. 

Take Action- 

1- Find out the age of the school buses or other public diesel engines in your area. If they have not been retrofitted or do not have engines from after 2007, find out what your school district or municipality is planning to do and whether they have applied for DERA funding to help improve health and decrease absenteeism. Find out if your local area can obtain funding from the Volkswagen Settlement for cleaning up the fleet. 

2- Call or write your Members of Congress and tell them you support a Clean School Bus Act in the next Congress- it’s an investment in the futures of our kids and a future strong economy. 

3- Make sure your bus drivers have good health insurance and working conditions. 

4- Talk to your local town or city council, your state legislature, and your federal elected representatives about your concerns about air pollution and diesel, and share your thoughts about the economic benefits of healthy air.

TLDL (To Long Didn't Listen)- Diesel exhaust makes kids sick, and cleaning up diesel school buses decreases sick days and helps kids do better in school. Let's invest in our kids!

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Today's episode is a brief one outside the regular two week schedue. It is recorded in the setting of the wildfires engulfing the West Coast. I focus on the health effects of breathing wildfire smoke. I also provide some steps that we can take in response. 

TLDL (To Long Didn't Listen)- Climate change is driving wildfires which will lead to astronomical costs in human and economic health. We need to do something. 

Things you can do: 

Donate Money- 

Donate to World Central Kitchen- working to feed firefighters and those on the frontline 

Donate to Pacific NW Red Cross- fund organized by KGW news 

Donate to California Fire Foundation- supporting families of fallen firefighters, firefighters, and their communities 

Donate to the NorCal Wildfire Relief Fund- helps Latino-lead organizations get critical financial assistance, rehousing support, and emergency translation for Latino and immigrant families affected by the fires 

Take Action- 

Demand your elected representatives take climate change seriously and fund programs to decrease carbon emissions and mitigate climate change effects, including catastrophic fires. 

Thank your firefighters. Donate to organizations above to support them. Ensure they have adequate PPE, health care coverage and support for their families. 

Recognize that many of those who need to flee fire are climate refugees. Expand your compassion to those around the world who also need to flee drought and heat to find better lives. We are all in this together. 

Twitchy Airways Club- If you are a member of the Twitchy Airways Club and suffer from asthma or COPD, make sure to follow the air quality reports from airnow.gov or other local public health websites and pay attention to recommendations for sensitive or vulnerable groups. 

- Make sure to carry a rescue inhaler with plenty of doses, and if you have worsening symptoms, talk to your doctor about whether you need increased maintenance medication as well, and what your emergency control plan is. 

- Consider using an N95 mask outside to decrease your particulate matter burden. 

- If considering an air filter, avoid one that generates ozone. More information on this post. 

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For more information, go to airhealthourhealth.org. 

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Dr. Lewis Ziska, PhD is an extraordinary plant physiologist who joins me today to discuss pollen and allergens in our air. He had a 24 year career at the USDA’s Agricultural Research Service and is currently at the School of Public Health at Columbia University. He has contributed to International Panel on Climate Change reports with respect to food security as well as to National Climate Assessments regarding public health and air quality. His most recent book is: Agriculture, Climate Change and Food Security in the 21 st Century: Our Daily Bread. Listen to our discussion today about how climate change affects pollen. 

We also cover more recent science suggesting that climate change is changing the nutritional content of our food, and may be affecting food allergies as well. He also shared more about the political interference with science that forced him to decide to leave the USDA, a place where he has served under Republican and Democratic administrations. As someone who works as an ICU doctor on the COVID19 frontline, it was sadly familiar to hear the current Administration ignoring life-saving science to feed a simple political narrative.  As a climate scientist, he also discusses the zoonotic origins of COVID19 and what we can expect regarding future pandemics and how we can prepare as a society and scientific community. 

TLDL (To Long Didn't Listen)- Climate change is leading to more allergenic pollen, in greater amounts, for longer pollen seasons! Science saves lives! 

Want to Take Action? 

1- Twitchy Airways Club Members- see the post for this episode for ideas on adding up the costs of your allergies or asthma and how to use those to communicate the tangible costs of climate change. 

2- Share your knowledge gained from this episode with your family, aquaintances, and on social media.   

3- Consider donating to the National Resources Defense Council to work to mitigate damage from climate change and preserve clean air. 

4- Write a comment in the iTunes store or wherever you listen to encourage others to discover the podcast and learn more about healthy air. 

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Under our homes and schools a silent killer often rises from the earth. . . radon. Join me in a lively discussion today with Curtis Cude of the Oregon Health Authority to discuss radon and you. He and I have both had to take action to decrease radon in our own homes, and we discuss the landscape of radon testing, homes, schools, mitigation, and barriers to reducing radon levels. Think you're protected because your neighbor has low radon or you're in new construction? What does it mean to have radon resistant construction? Does that mean you don't need to test your home?

Listen to this episode to find out about how you can protect yourself, your home, and your community.

Want to take action?

1- At home- make sure your home has been tested for radon. Test yourself if you aren’t sure. Order a kit from and test in winter with doors and windows closed

2- At school- find out whether your school has been tested for radon and whether the level is above 2 pCi/L (consider action) or above 4 pCi/L (action definitely advised)

3- Your community- Consider contacting your elected representative to express your concern about the high health costs of radon. Diagnosing and treating lung cancer is expensive, not to mention the devastation it can cause an individual or their family. It is likely worth supporting programs to help people test and mitigate their homes. It certainly seems a wise idea to ensure that our children are not breathing radon at school.

4- Consider donating to the American Lung Association, who provides outstanding radon education and outrearch resources.

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Today I am joined by Dr. Jeffrey Gotts, MD, PhD. Like me, he is a lung and ICU doctor trying to navigate all the valid questions his patients and community have about e-cigarettes, vaping, etc. He is also an expert on the science regarding vaping. We discuss what that science tells us about e-cigarettes, as well as exploring the hope that many have felt that these devices may represent a path towards freedom from conventional cigarettes. As always, the tobacco industry is pressing their agenda of killing people for profit (or not caring that people die for their profits), as well as addicting children for financial gain. Despite that downer of a fact, this is an engaging episode to help understand the science behind e-cigarettes/vaping, and how it affects our immune responses in our lungs. Since both Dr. Gotts and I are working on the frontline in the COVID 19 pandemic, that can’t help but enter our conversation as well. And, as always, Big Tobacco is out spreading doubt and uncertainty and risking lives in the process. It’s like they are racketeers or something…. Wait. I think we already decided that.

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Today I am joined by Dr. Linda George, PhD of Portland State University. When I started medical school, I never really thought that I'd be interviewing an atmospheric chemist. However, my experience as a physician treating patients who have been heavily exposed to diesel or have grown up breathing polluted air has led me to look at the world in a different way. We dive into that extensively on the podcast today, talking about how inequities have led to the delayed evaluation of the air toxics at Harriet Tubman Middle School (a public school located only 50 feet from a freeway), to how bicycle lane design can decrease cyclist exposure to ultrafine particulate matter, and whether you should drive with or without the recirculated air in your car.

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Big Tobacco has a history of targeting the military, from including tobacco in rations to leaked documents showing how they targeted recruits and veterans as ripe for tobacco addiction. Brandy Carpenter was serving in Afghanistan when she received word via the Red Cross that she was about to be made an orphan by Big Tobacco. Join us in a discussion about how this changed her life. Brandy works as a nurse practitioner and a tobacco treatment specialist in a lung cancer screening program. She shares her own story and her wisdom about how to break individuals and our society free of tobacco.

Update- lung cancer screening criteria have changed since this episode was published! 

The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be stopped once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

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Mary Peveto of Neighbors for Clean Air joins me on the podcast today. We dive into this gap between safety and legality and the many air toxics that are not regulated under the Clean Air Act. Like many Oregonians, I always thought our state had a green reputation and healthy air. I have learned as a lung doctor that is not the case. There is a large gap between what people think is happening with air quality regulation and the reality of our permitting processes that does not protect human health.

We also talk about the history of racial injustice in poor air quality, and the difference in action when levels of arsenic were known to be elevated in the historically black community of North Portland vs when cancer causing air toxics were found in whiter neighborhoods.

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We also talk about what gives her hope, and future needs for diesel mitigation.

Learn more about Neighbors for Clean Air and their important work here: http://www.whatsinourair.org/ . Consider donating to their important work!

Learn more about Cleaner Air Oregon here.

If you live in Oregon, look up your State Senator and Representative here, and tell them how important it is to breathe clean air and that you support a robust permitting standard, benchmarked to human health. 

As a lung and ICU doctor, I have been perplexed by the descriptions of teargas as "non-lethal." In this podcast, I explore the science surrounding the idea of safety and try to assess what the true risks to health and healthcare costs might be. 

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