January 2026 State of Our Children 360 Newsletter

Small Lungs, Big Risks: What Every Community Must Know about How Air Pollution Harms Our Children

by Tania Pacheco-Werner, PhD, San Joaquin Valley Air Pollution District and California Air Resources Board Member

We often hear that the San Joaquin Valley faces the worst air pollution in the nation, but most of us don’t know that children are among the most vulnerable communities to its health impacts. Why are children more at risk? According to the Environmental Protection Agency, children breathe approximately 50% more air per pound of body weight than adults, with the ratio being even higher for infants and toddlers. Added exposure leads to real health risks. Fortunately, many of these risks can be mitigated through education, prevention and treatment. While policymakers, agencies and private industries are hard at work successfully cleaning up the air, there are things that every parent and community member can do to help our children breathe easier and safer.

First and foremost, we must understand how children’s lungs are at risk. While most of us might see the occasional dust devil, the pollution we can’t see is what is most harmful. First, there is a type of pollution that is about thirty times smaller than the average human hair, known as particulate matter 2.5 (PM 2.5 for short). This pollutant has been known to impact on how children breathe, their heart health and immune systems. The more the child is exposed to high concentrations of PM 2.5, the more likely they are to have those negative health effects. The other pollutant we can’t see is ground-level ozone, which is a chemical reaction of oxides of nitrogen and volatile organic compounds in the air with heat and sunlight that cause harmful gas. This gas is immediately damaging to children’s lungs, especially those who are already at risk with asthma or other respiratory conditions. As a result of the ozone layer’s reaction to sunlight and heat, afternoon hours of the summer season can be the worst.
 

First and foremost, we must understand how children’s lungs are at risk. While most of us might see the occasional dust whirl, the pollution we can’t see is what is most harmful. 

Cleaning up the air is an uphill task, and two environmental events are making it harder: extreme heat and wildfires. Extreme heat events mean higher than average temperatures, even for a place like the valley that gets hot summers. The heat lingers over a long period of time and does not provide much relief in the evening. This extreme heat and sunlight supercharge the formation of ground-level ozone. Large wildfires can create as much PM 2.5 pollution in a day than a year’s worth of car pollution. Smoke can also travel long distances and come down on communities that are many miles away from where those fires are burning. Unfortunately, due to changing climate conditions, we expect to see more extreme heat and wildfire events in the future.

Okay, all bad news. Let’s take a deep breath together. Now, how do we roll up our sleeves and help our children not only survive, but thrive in our communities? First, knowledge is power. Using phone tools like Valley Air District or EPA air quality applications can help us know PM 2.5 and Ozone levels in real-time. When you see an advisory that “sensitive groups” might be at risk, know that is referring to kids too. Schools and sports teams can adopt air quality policies, such as indoor recess or moving activities to a later date. That pollution affects all kids, not just those with asthma or breathing problems. Coughing, wheezing and chest pain can mean a child should be evaluated by their pediatrician. Adopting clean air filtration, cooling centers and masks can provide immediate relief from extreme heat and wildfire related pollution. Long-term strategies like more trees in neighborhoods, clean energy vehicles and car idling prevention programs at schools can provide big payoffs for our air. Continued policy changes and cleaner practices by industry like the use of clean trucks and tractors play a significant role in reducing air pollution for all. Community-level changes can help small lungs in a big way.
 

Sources and Resources

• U.S. Environmental Protection Agency. (2011). Exposure factors handbook: 2011 edition (Chapter 6—Inhalation rates). National Center for Environmental Assessment. https://www.epa.gov/sites/default/files/2015-09/documents/efh-chapter06.pdf
• Prunicki, M., Cauwenberghs, N., Lee, J., Zhou, X., Zhang, H., Zhu, A., Haddad, F., Rosenberg-Hasson, Y., Maecker, H., Wu, J., Snyder, M., & Nadeau, K. (2021). Air pollution exposure is linked with methylation of immunoregulatory genes, altered immune cell profiles, and increased blood pressure in children. Scientific Reports, 11, Article 4067. https://doi.org/10.1038/s41598-021-83577-3 
   

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Asthma: The Most Common Reason for School Absences

by Marisela Sanchez, MSN, RN

As a school nurse leader in Bakersfield, I have seen firsthand how asthma continues to be one of the most common and preventable reasons students miss school, largely due to misconceptions. As school nurses, we want our families to know that each absence represents more than just a missed lesson; it's a lost opportunity for growth, connection and building our students’ self-confidence. By working proactively with community providers, we aim to prevent asthma-related absences for our families.  

A critical tip we'd like to share with families for strong control of their asthma is the use of spacers or aerochambers, no matter what age. Our goal in sharing with families is that without them, inhalers don't deliver the necessary dose deep into the lungs where it is needed the most. When medication isn't reaching the lungs effectively, our students appear "uncontrolled" and end up sitting out or going home. The solution may involve the consistent use of a spacer, with maintenance medication provided at home and rescue medication available at school.   Our school nurses invest critical time in teaching students correct  inhaler techniques and proper spacer use as we believe it can be the difference between missing class and mastering their control.

Another hidden complexity in absences is the absence of physical activity. Too often, students with asthma believe they "can't" participate in physical education or exercise. But avoiding it all together isn't the answer. Physical activity and exercise are essential parts of asthma management when symptoms are well controlled. We want our families to know that while physical activity strengthens lung capacity, it reduces stress; it's also connected to better academic achievement and stronger emotional regulation skills. This directly impacts a student's overall classroom success. Helping our students with access proper asthma care and participating safely in physical activity is more than fitness; it's about nurturing the whole child. The goal isn't to sit out at home until they are better - it's to stay in school, stay active and stay healthy with proper collaboration between the families, providers and school nursing staff.

School nurses work hard not just managing asthma during the school day - but also by teaching students how to manage it themselves. This confidence carries beyond the classroom, and while spacers can seem like an extra step, they are an important tool that help keep students in class, participating fully. 
 

How Local Action Is Making a Difference for Families with Asthma

by Tim Tyner, Executive Director, Central California Asthma Collaborative

Asthma is a major public health concern in Central California, with most counties registering higher asthma prevalence rates than the statewide average. Families face multiple challenges to manage this chronic disease, including exposure to indoor and outdoor air pollution. It is especially challenging, and scary, for the parents of young children. Breathing polluted air both inside and outside the home makes it difficult to effectively manage asthma and often leads to urgent care and emergency room (ER) visits, especially among children. The Central California Asthma Collaborative (CCAC) has played a critical role in addressing these challenges by providing an in-home asthma education and trigger remediation program, as well as a community-based outdoor air pollution monitoring and alert network, to reduce exposures and ER visits.

Founded in 2011, CCAC works toward a vision of creating healthy, resilient communities where all people can breathe clean air and thrive. Our mission is to advance health equity and environmental justice by empowering Central California communities through services, research, advocacy and data-driven solutions to reduce the burden of asthma. 

With the introduction of the California Advancing and Innovating Medi-Cal (CalAIM) asthma remediation community support service in 2022, CCAC launched the Comprehensive Asthma Remediation and Education Service (CARES) program, based on a decade of CCAC’s asthma home-visit experiences. We developed a team of highly trained community health workers (CHWs) who conduct hundreds of home visits every month to help families identify asthma triggers and determine which asthma remediation tools we will provide free to the family to help reduce those triggers.  

Our CARES CHWs focus on increasing awareness, improving asthma self-management, and providing patients with the knowledge and resources they need to lead healthier, more fulfilling lives. 
 

“I learned so much from this program, I learned how to use my inhalers properly and how to best prep my home to manage my flare-ups. I am grateful for the resources this program has provided for me. It has significantly helped my breathing issues I faced constantly as a pet owner with chronic asthma.” - CARES participant

We are proud to have served more than 7,400 patients with asthma since our launch of CARES in 2022, with our amazing team of CHWs currently serving all eight counties of the San Joaquin Valley, as well as five counties in the Sacramento region. CCAC is contracted with seven Medi-Cal managed care plans to provide CalAIM asthma remediation services, including Anthem Blue Cross, CalViva Health, Health Net Community Solutions, Health Plan of San Joaquin, Molina Healthcare, Kern Family Health Care and Kaiser Permanente. In 2021, CCAC received the U.S. Environmental Protection Agency (EPA) National Environmental Leadership Award in Asthma Management. 

As a supplement to our CARES program, CCAC also operates a community-based air monitoring network San Joaquin Valley Air (SJVAir). Unlike the limited network of regulatory air monitors operated by the Valley Air District, CCAC has partnered with community groups and schools across the Valley to install hundreds of air monitors, prioritizing communities that lack a regulatory air monitor and providing schools and residents access to local, real-time air quality information. SJVAir provides unhealthy air quality alerts through a free SJVAir smartphone app (Apple or Android), as well as text message notifications (you can sign up for text alerts on the SJVAir.com website). 

CCAC also has an environmental health research program that partners with academic centers across California to study the impacts of air quality on children with asthma. CCAC has also partnered with institutions like University of California (UC), Berkeley and UC San Francisco to study the broader effects of air pollution on children, including potential associations with metabolic dysfunction and cognitive development. CCAC is currently partnering with Lawrence Berkeley National Lab to study the impacts of cooking electrification on children with asthma. This study includes the replacement of gas stoves with electric induction ranges in homes of CARES patients and the measurement of indoor air pollutants (e.g. NO2), lung function (spirometry and FeNO) and asthma symptoms before and after the cooking electrification intervention. This is the first randomized control trial to assess the health impacts of replacing gas stoves with electric induction.

We welcome referrals of asthma patients from all managed care providers throughout our service area. For more information about CARES and our other programs, please visit www.centralcalasthma.org. 

 

Additional Resources