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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Copyright ©2023 by the American Lung Association
American Lung Association and State of the Air are registered trademarks of the American Lung Association.


Did You Know?

  1. More than 4 out of 10 people live where the air they breathe earned an F in State of the Air 2021.
  2. 150 million people live in counties that received an F for either ozone or particle pollution in State of the Air 2020.
  3. More than 20.8 million people live in counties that got an F for all three air pollution measures in State of the Air 2020.
  4. Breathing ozone irritates the lungs, resulting in something like a bad sunburn within the lungs.
  5. Breathing in particle pollution can increase the risk of lung cancer, according to the World Health Organization.
  6. Particle pollution can also cause early death and heart attacks, strokes and emergency room visits for people with asthma and cardiovascular disease.
  7. Particles are smaller than 1/30th the diameter of a human hair. When you inhale them, they are small enough to get past the body's natural defenses.
  8. Ozone and particle pollution are both linked to increased risk of lower birth weight in newborns.
  9. Do you live near, or work on or near a busy highway? Pollution from the traffic may put you at greater risk of harm.
  10. People who work or exercise outside face increased risk from the effects of air pollution.
  11. Millions of people are especially vulnerable to the effects of air pollution, including infants, older adults and people with lung diseases like asthma.
  12. People of color and those earning lower incomes are often disproportionately affected by air pollution that put them at higher risk for illnesses.
  13. Air pollution is a serious health threat. It can trigger asthma attacks, harm lung development in children, and can even be deadly.
  14. You can protect your family by checking the air quality forecasts in your community and avoiding exercising or working outdoors when the unhealthy air is expected.
  15. Climate change enhances conditions for ozone to form and makes it harder to keep ozone from forming.
  16. Climate change increases the risk of wildfires that spread particle pollution and ozone in the smoke.
  17. This Administration is trying to roll back or create loopholes in core healthy air protections under the Clean Air Act. The Lung Association opposes these actions that will add pollution to the air we breathe.
  18. Cutting air pollution through the Clean Air Act will prevent at least 230,000 deaths and save $2 trillion annually by 2020.
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Page last updated: April 10, 2023