How do families protect themselves from the health effects of wildfire smoke?

Image

This summer millions of people across the upper Midwest and Northeast United States experienced record-breaking air pollution due to Canadian wildfires. From a public health perspective, it’s critical to understand how people experiencing severe wildfire smoke events are protecting their health and the health of their families. Unfortunately, data on these protective behaviors are sorely lacking.         

The Pilot Grant

In 2024, Christine Loftus and Catherine Karr used a pilot grant from the University of Washington (UW) Interdisciplinary Center for Exposures, Diseases, Genomics & Environment (EDGE) to help address this important research gap. Loftus is a clinical associate professor in the UW Department of Environmental and Occupational Health Sciences (DEOHS) and Karr is a professor in DEOHS and the UW Departments of Pediatrics and Epidemiology. They worked with a team from Heritage University, including local undergraduate students, to survey 200 parents in Washington’s Yakima Valley.  Javier Silva, a doctoral student in the UW Department of Epidemiology who grew up in the Yakima Valley, closely mentored the students in data collection and training in public health research foundations. The surveys collected valuable data on parents’ perceptions of risk from wildfire smoke, the smoke-related health effects they have experienced, their ability to take protective action, and unmet needs for community resources related to wildfire smoke protection.

Wildfire Smoke Protocol for Rapid Response

                  Results from their pilot project supported Loftus in a successful application to the National Institute for Environmental Health Sciences (NIEHS) for a two-year investigator development award in the Environmental Influences in Child Health Outcomes (ECHO) Program. The new study aimed to develop a novel Wildfire Smoke Protocol for Rapid Response (WiSPRR), which could be implemented in existing cohorts like the national ECHO Cohort. ECHO was established to understand the impacts of early environmental influences on child health and development, currently following over 70,000 mother-child pairs across dozens of data collection sites in the United States. Mothers are recruited while pregnant and then participate with their children for up to seven years, during which time they fill out surveys and make visits to clinics.

                  “It’s hard to do rapid response research after extreme events, like wildfire smoke episodes,” said Loftus. “The fact that we had an engaged cohort seemed to be the perfect opportunity to embed a wildfire smoke-specific protocol into ECHO’s existing standard protocol.”

                  Because ECHO Cohort participants are already completing dozens of surveys and several clinical visits, adding an additional survey about wildfire smoke was relatively easy. “All the IRB [institutional review board] agreements and participant relationships exist, and even the data collection systems are in place,” said Loftus. “There’s already a ton of trust with the participants and staff to help make rapid wildfire smoke research possible. The key thing is we were pre-positioned by leveraging the existing cohort infrastructure to be successful in post-event research.” 

                   During the 2025 wildfire season Loftus and Karr piloted the WiSPRR project in three locations—Denver, Sacramento, and Yakima – poised to send out surveys quickly if wildfire smoke events occurred. “We used what we learned in the EDGE pilot to develop surveys that would give unique insight into what happened during and immediately after dangerous smoke episodes,” said Loftus. These included questions about actions parents took to protect themselves and their kids, including staying indoors more than usual, using the Air Quality Index to make choices about activities, and using an indoor air cleaner. Importantly, the survey also asked why the participants weren’t able to do these things.

                  “I focus on the data collection about behaviors and barriers to actions not taken, because this information can directly inform intervention development, but we also collected information on health impacts people experience due to the fires, which could provide rare opportunities to study short-term relationships between smoke and health,” said Loftus.  

Scaling Up

                  Because the WiSPRR pilot was successful, ECHO leadership chose to scale up the protocol across the entire national cohort for the wildfire season of 2026. “We started surveilling for wildfire smoke in June,” said Loftus, “and then in mid-July the smoke events in the Upper Midwest and Northeast hit. Luckily, we were already in position to administer these surveys.” Air pollution levels during the July smoke episode reached historic levels in some locations. In Duluth, Minnesota, where some ECHO Cohort participants live, the AQI topped 900, skyrocketing past the prior record of 159.

Within two weeks of the start of the smoke event, surveys were sent to households representing over 16,000 ECHO Cohort participants. Within the first couple of hours, they had over 600 responses. “This supported our hypothesis that when you have people who are already engaged in research it’s easy for them to respond to surveys,” said Loftus. “Without pre-positioning, investigators interested in studying this smoke event likely would have had to initiate human subjects research from scratch – for example, by recruiting a new cohort of exposed individuals – which would have been extremely resource intensive.”

Developing Interventions

                  Results from the study will inform potential interventions—both at the household and community levels. Because ECHO tracks participants over time, it also provides a valuable opportunity to investigate whether health-protective behaviors related to wildfire smoke actually improve children’s health.

                  The team has already submitted a grant proposal to NIEHS to conduct a randomized clinical trial, testing the effectiveness of a wildfire smoke intervention in Yakima. The proposed intervention has three components. The first is education delivered as an online education module, covering topics like how to use a HEPA air cleaner or fit a N95 mask on a child. The second part is the delivery of supplies, including HEPA air cleaners and N95 masks. These are things that Loftus and Karr have heard from families that they don’t have, might not know where to get or are unable to afford. The third component is text alerts at the time wildfire smoke events to remind people about guidance on taking protective actions, about which EDGE pilot participants expressed high enthusiasm.

                  “The texts are not meant to offer medical advice,” said Loftus, “but they can seamlessly connect people to PEHSU [Pediatric Environmental Health Specialty Unit] specialists to answer questions about wildfire smoke exposure reduction, including how to use air cleaners.”    

                  Given the success of their efforts to date, Loftus and Karr, are hopeful that in the future their rapid response approach could be applied more broadly to other types of disasters like extreme heat.