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In the summer of 2012, families throughout the United States, especially in urban areas, were alerted on dozens of days that the air was unsafe for their children to breathe. Some cities experienced record numbers of “code orange” and “code red” smog alert days. With childhood obesity also hitting record levels, how are families to balance the benefits for children of outdoor play with the need to reduce their exposure to harmful air pollution? And should they have to?

As children in our region, metropolitan Atlanta, head back to school in August each year, “bad air” days become a conundrum for PE teachers and coaches, as well as parents. With many school sports and activities taking place outside in the late afternoon when ozone is at its worst, Atlanta’s air pollution problem adds another layer of concern to an already stressful transition for teachers, coaches and parents.

Physicians describe the effects of ozone as “sunburn on the lungs.” Children and youth are vulnerable to the effects of air pollution because their lungs are still developing and they take in air in greater proportion to their body weight than adults. Exercising in “code orange” conditions can make the difference between a great day at school and a trip to the emergency room, particularly for children with chronic conditions such as asthma. Of concern for all children, a California study* found an increased risk of developing asthma for children participating in outdoor athletics in high ozone conditions.

Thanks to the Clean Air Act and its implementation by the Environmental Protection Agency (EPA), ozone and fine particle pollution have been reduced over the past 40 years. At the same time, however, increasingly sophisticated research reveals harm at lower and lower concentrations. A 2010 Emory University study, for example, found that pediatric emergency visits for asthma rise with levels of ozone and traffic pollution well below the thresholds that trigger “code orange.”

The Clean Air Act requires that EPA review clean air standards (limits) every five years so that new scientific evidence can be used to review and revise the standards, if warranted. EPA is expected to announce a new, more stringent fine particle standard on Dec. 13. Tighter standards are critical because they require state agencies to develop and implement plans for reducing pollution.

This process, however, is not immune to political influence. In 2011, EPA attempted to strengthen the ozone standard to a level recommended by independent scientific advisors. Unfortunately, the new standard was delayed, and so the Air Quality Index (AQI), which determines the trigger for ‘code orange,” remains set too high. As a result, ozone concentrations still being described as “yellow” are nonetheless known be high enough to put children at increased risk for respiratory problems. When the AQI does not accurately reflect scientific understanding about the health effects of air pollution, it becomes even harder for parents, teachers and coaches to take appropriate precautions to reduce children’s exposures.

So what’s a parent to do?

Short-term, parents can make sure their child’s school and coaches are monitoring air quality and moving outdoor activity indoors, or reducing the intensity and duration of play/workouts, during peak pollution hours. Coaches should pay particularly close attention because children and youth exercising outdoors are at increased risk of exposure because they are breathing hard and mouth breathing for extended periods of time.

Long-term, we need moms—and dads—rising! We need parents, grandparents, teachers and coaches speaking out and holding EPA, our elected officials in Washington and our state leaders and environmental protection agencies responsible for improving air quality. We should not have to choose between healthy, outdoor play—so essential for children—and protecting their growing bodies from air pollution. We need to get beyond CODE ORANGE for good.

* McConnell, R. et al. 2002. Asthma in exercising children exposed to ozone: a cohort study. Lancet 359: 386-91.

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