ALA State of the Air: Nearly Half of American Children Breathe Poor Air

Nearly half of all children in the United States — 33.5 million, or 46% of those under 18 — live in counties that received a failing grade for at least one measure of air pollution in the American Lung Association (ALA)'s 27th annual State of the Air 2026 report, which evaluates 3 years of EPA-verified monitoring data (2022–2024) across ozone, short-term particle pollution, and long-term particle pollution. Overall, 152.3 million Americans — 44% of the population — live in communities earning a failing grade for at least one pollutant.

In an interview with HCPLive, Juanita Mora, MD, an allergist-immunologist at Chicago Allergy Center and attending physician at Advocate Illinois Masonic Medical Center in Chicago, Illinois, and board director of the ALA, described the findings as both a public health indictment and a call to clinical action.

The report grades counties on 3 measures: ground-level ozone (smog), short-term particle pollution spikes, and long-term average particle pollution. Ozone forms when vehicle exhaust, industrial emissions, and chemical compounds react with sunlight; the report found that approximately 4 million more people are now breathing unhealthy ozone levels compared with last year's report — a worsening trend driven in part by warming temperatures that enhance ozone formation.

Nearly 33 million people live in counties earning failing grades across all 3 measures. Bakersfield, California, ranked as the metropolitan area with the worst year-round particle pollution for the 7th consecutive year; Los Angeles retained its position as the most ozone-polluted city in the nation, a ranking it has held in 26 of the report's 27 years.

Mora described the health consequences of both pollutant categories in clinical terms she communicates directly to patients and families. Ozone causes acute airway inflammation triggering wheezing and cough in children and exacerbating asthma and COPD. Long-term exposure to fine particulate matter has systemic reach that extends well beyond the lung: particles enter the bloodstream and have been associated in the epidemiologic literature with increased cardiovascular risk including heart attack and stroke, dementia and Alzheimer's disease with repeated cerebrovascular exposure, and, in pregnant women, elevated risk of preterm delivery.

The ALA report frames wildfire smoke as a growing contributor to both ozone and particle pollution burden, with wildfire events in Canada, California, and the eastern United States increasingly affected air quality across broad geographic regions and populations not historically considered at elevated pollution-related risk.

Racial and socioeconomic disparities in air pollution exposure are a central feature of the 2026 report's findings and a theme Mora returned to throughout her comments. According to the report, a person of color is more than 2.4 times as likely as a white individual to live in a community with failing grades across all 3 pollution measures, and Hispanic individuals are more than 3 times as likely. Communities in Texas, California, and across the South carry disproportionate combined ozone and particle pollution burdens.

Mora called on clinicians to use the report's county-level data — available at lung.org/SOTA — as a tool for contextualizing patient respiratory symptoms and for counseling families about modifiable risk, including indoor air quality, secondhand smoke exposure, and activity timing on high-pollution days. On the policy dimension, Mora expressed concern that current EPA regulatory rollbacks — including changes to economic analyses used to set pollution standards — threaten to undermine the Clean Air Act's multi-decade legacy of reducing air pollution–attributable mortality and morbidity. Children, with developing lungs, are the most biologically vulnerable to the long-term consequences of chronic pollution exposure and continued investment in EPA enforcement and ambient air quality standards are a pediatric health imperative.

“These kids do not have clean air to breathe. Let's do more. We can do more to clean air up,” Mora said. “… Let’s teach our families to keep safe and talk to our legislators about keeping the EPA environmental protection agency funding as is so that way we can continue to make these kids healthy adults.”

Editor’s note: Mora has no relevant disclosures to report.

Reference

American Lung Association. State of the Air 2026. 27th ed. Published April 21, 2026. Accessed May 7, 2026. https://www.lung.org/research/sota