Health Effects of Wildfire Smoke in Children and Public Health Tools: A Narrative Review
Open accessAbstract
Wildfire smoke is an increasing environmental health threat to which children are particularly vulnerable, for both physiologic and behavioral reasons. To address the need for improved public health messaging this review summarizes current knowledge and knowledge gaps in the health effects of wildfire smoke in children, as well as tools for public health response aimed at children, including consideration of low-cost sensor data, respirators, and exposures in school environments. There is an established literature of health effects in children from components of ambient air pollution, which are also present in wildfire smoke, and an emerging literature on the effects of wildfire smoke, particularly for respiratory outcomes. Low-cost particulate sensors demonstrate the spatial variability of pollution, including wildfire smoke, where children live and play. Surgical masks and respirators can provide limited protection for children during wildfire events, with expected decreases of roughly 20% and 80% for surgical masks and N95 respirators, respectively. Schools should improve filtration to reduce exposure of our nation's children to smoke during wildfire events. The evidence base described may help clinical and public health authorities provide accurate information to families to improve their decision making.
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Holm et al.'s summary of real-world studies reports mask efficiency ranges of 0-50% for cloth, 20-70% for surgical, and 70-97% for respirator masks.
“Holm et al.’s summary of real-world studies of cloth, surgical, and respirator mask efficiencies (with ranges 0–50%, 20–70%, and 70–97%, respectively) [53]”
From Comparative Mask Protection against Inhaling Wildfire Smoke, Allergenic Bioaerosols, and Infectious Particles (2022) · cites this paper as [53]
The 'Respirator Use by Children During Wildfire Events' section summarizes studies of all three mask types and supports their differing levels of protection. It does not report the claimed ranges as real-world efficiency ranges: it describes an 85% exposure reduction for one fitted cloth mask, 15–40% average reductions for surgical masks in NIOSH testing, and a 66–70% reduction for nearly everyone wearing the tested respirators. The specific ranges attributed to Holm et al. are therefore not supported as stated. (LLM, conf=0.87)
Experimental — accuracy not yet measuredRespirator mask intervention studies have demonstrated reduced but still potentially useful protection (>70%) for children and other cases of sub-optimal fit.
“Respirator mask intervention studies have demonstrated reduced but still potentially useful protection (>70%) for children and other cases of sub-optimal fit [53].”
From Comparative Mask Protection against Inhaling Wildfire Smoke, Allergenic Bioaerosols, and Infectious Particles (2022) · cites this paper as [53]
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- Authors
- Holm, S. M., Miller, M. D., & Balmes, J. R.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Holm, Stephanie M.
- Venue
- Journal of Exposure Science & Environmental Epidemiology
- Published
- 2020-09-20
- Volume
- 31
- Issue
- 1
- Pages
- 1-20
- ISSN
- 1559-0631 (ISSN-L)
- 1559-064X
- PMC
- PMC7502220
- OpenAlex
- W3087506932
- Cited by
- 246
- References
- 125
- Citations by year
- 2026: 26 · 2025: 60 · 2024: 57 · 2023: 51 · 2022: 33 · 2021: 19
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Exposure Science & Environmental Epidemiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- U.S. Environmental Protection Agency (DW-75-95,877,701)
- California Air Resources Board
- California Environmental Protection Agency
- Centers for Disease Control and Prevention (R01TS000296, NU61TS000296)
- University of California, San Francisco
- National Institute for Occupational Safety and Health
- Agency for Toxic Substances and Disease Registry (1 NU61TS000296-01-00, 95877701)
- Lawrence Berkeley National Laboratory
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Social Sciences › Sociology and Political Science › Environmental Justice and Health Disparities
- Keywords
- wildfire smoke, children, respiratory effects, air pollution exposure, low-cost particulate matter sensors, N95 respirators, surgical masks, public health communication, spatial variability of pollution
- MeSH terms
- Wildfires, Air Pollution, Child, Environmental Exposure, Humans, Public Health, Smoke
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