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Rural Health Information Hub

Feb 08, 2023

Facing Unique Challenges, Rural Communities Find Unique Solutions to Protect Against Wildfire Smoke Exposure

by Gretel Kauffman

Branch Manager Doreen Schmidt waves a green flag — indicating “good” healthy air quality — outside of the Peck Community Library in Peck, Idaho.

As a librarian in Peck, Idaho — a self-described “one-woman show” in a community of just under 200 people — Doreen Schmidt's workdays begin with an unusual routine.

First, Schmidt checks the air quality monitor installed on the side of the library building. Next, she chooses a flag that best matches the results: green for healthy, red for unhealthy, or yellow for in-between.

And at 10 a.m. every Tuesday and Thursday, when the Peck Community Library opens its doors, Schmidt hangs the flag outside, announcing the air quality of the day to students in the one-room schoolhouse across the street, post office-goers, and other community members passing by.

This routine is one of several initiatives that the Peck library and eight others in rural northern Idaho have adopted in partnership with the Nez Perce Tribe's Air Quality Program in an effort to raise awareness of the health risks posed by wildfire smoke and steps that local residents can take to protect themselves against it.

“We librarians became informed [about air quality] so that we can inform our communities,” said Schmidt, who serves as branch manager of the Peck Community Library. “The partnerships and the connections we make through the libraries are really important, because the library is the hub of our community.”

Across the western U.S., wildfire smoke is increasingly recognized as an urgent public health issue for urban and rural dwellers alike. But rural communities face some unique challenges when it comes to collecting and spreading information about wildfire smoke and its health impacts — and, in response, uniquely rural solutions are emerging.

We need to be thinking about smoke just as much as we're thinking about fire.

“Smoke has become more and more prevalent as a topic of concern in rural communities, but there's still a lag” when it comes to making sure rural residents know how best to protect themselves against smoke exposure, said Savannah D'Evelyn, PhD, a postdoctoral fellow in the University of Washington's Department of Environmental and Occupational Health Sciences. “We need to be thinking about smoke just as much as we're thinking about fire.”

Rural risks

Unhealthy air quality can affect any person who is exposed: immediate impacts of breathing in smoke may include coughing, difficulty breathing, headaches, irritated sinuses, and a fast heartbeat, according to the Centers for Disease Control and Prevention. But some populations are especially at risk, including the elderly, children, pregnant women, and people with conditions including asthma, heart disease, and Chronic Obstructive Pulmonary Disease (COPD), a rising cause of death in rural America. Wildfire smoke can also negatively impact mental health in rural communities, a study from University of Washington researchers found, with rural study participants reporting increased anxiety, depression, isolation, and a lack of motivation during smoke episodes.

As public health researchers learn more about the physical and mental health impacts of wildfire smoke, including in rural communities, a clearer picture of who is most at risk has started to develop, according to Elizabeth Walker, PhD, an Affiliate Assistant Professor in the University of Washington's Department of Environmental and Occupational Health Sciences and one of the authors of the mental health study. People who tend to be particularly vulnerable during smoke episodes include lower-income residents, those with outdoor occupations, and people experiencing housing insecurity or homelessness, said Walker, who is also the founder of Clean Air Methow, a nonprofit program that provides information and resources to help residents of Washington's rural Okanogan County protect themselves against unhealthy air quality.

Wildfire smoke visible in the air near Mackay, Idaho.

For these particularly at-risk groups, avoiding smoke exposure altogether is often not an option. Rural-based industries such as agriculture, forestry, and outdoor recreation often revolve around outdoor work, exposing employees to unhealthy air throughout the workday. And in small communities that lack indoor public gathering spaces with clean air, residents without housing — or who don't have sufficient air filtration systems in their homes — may have nowhere to go to escape the smoke; in places that do have community spaces with clean air, it may not be practical or affordable for some residents to travel long distances from their homes to use them.

In some rural communities where wood-burning stoves are commonly used during colder months, smoke is inescapable even in winter: residents may experience exposure year-round, compounding the health impacts without seasonal relief.

“If people are getting a much higher exposure, either due to outdoor work or to their housing conditions, those folks really need to be targeted for providing whatever interventions we can,” Walker said.

Monitoring the problem

For many rural communities, protecting against wildfire smoke exposure is made significantly more difficult by the fact that there is no way of knowing exactly how much smoke is in the air on any given day.

Information about air quality is often limited in rural areas, with air quality monitors more densely concentrated around larger population centers. The result is what D'Evelyn refers to as “monitoring deserts”: places where smoke is palpable in the air but where a lack or shortage of monitors leaves exact air quality levels unknown, making it more difficult for communities to gauge what sort of health protection measures are needed.

…when you have wildfires and smoke, you go from a decent air quality to a very bad air quality in the range of a few days.

“We [air quality researchers] tend to focus on areas that are densely populated, because you already have air quality issues there from things like traffic and industry,” said Danilo Dragoni, PhD, Bureau Chief of the Nevada Division of Environmental Protection's (NDEP) Air Quality Planning Bureau. “In rural communities where only indirect methods of measuring air quality are available, the understanding is that air quality is relatively good. But when you have wildfires and smoke, you go from a decent air quality to a very bad air quality in the range of a few days.”

In Nevada, smoke from a series of wildfires near the California-Nevada border in recent years served as a wake-up call of sorts for state officials, Dragoni said. During these episodes, the bureau received phone calls from emergency managers and school district officials in rural northern Nevada requesting air quality information, as information found online “didn't really match what they were experiencing on the ground.”

“We realized that the coverage in terms of air quality monitoring was not enough,” Dragoni said. “Wildfire smoke is very unpredictable and can change very rapidly. So they started calling us to say, 'Hey, can you give us more information?' And we realized that we couldn't really do it.”

Greg McCurdy of the Desert Research Institute (left) and Yeongkwon Son (right) install an air quality monitoring station in rural Nevada.

To start to fill these gaps, NDEP purchased dozens of PurpleAir sensors — air quality sensors that are relatively inexpensive and easily installed, but less accurate than regulatory-grade monitors — to loan to rural communities across the state at no cost. The department has also partnered with the Desert Research Institute (DRI) — the nonprofit research arm of Nevada's state higher education system — on a grant-funded project to improve and expand wildfire smoke air quality monitoring infrastructure and public information resources for rural communities statewide. The program, which began in 2021 and is ongoing, included the installation of roughly 60 smart technology air quality sensors as well as additional communication resources to identify gaps in public knowledge around the health risks of wildfire smoke in rural communities and develop new educational materials.

“Risk communication messaging around wildfire smoke is directly informed by air quality data,” said Kristin VanderMolen, PhD, an assistant research professor of atmospheric sciences at DRI. “And so for these counties where there isn't quality data, messaging becomes difficult because, you know, what do you say?”

In Pershing County, Nevada — a county of roughly 6,500 people spanning more than 6,000 square miles — a lack of reliable air quality monitoring made measuring air quality difficult during wildfire season.

“Other than looking outside and seeing that your visibility was reduced, there was no quantitative method for determining how bad the smoke was,” said Sean Burke, Director of Emergency Management for Pershing County.

But the health impacts were evident, especially during the smokiest part of the season, Burke said: As an EMS worker, he saw a noticeable increase in asthma and COPD exacerbations when the smoke was thick.

Participating in the DRI-NDEP project has provided Pershing County with new tools to measure smoke particles in the air. Making sure that local residents understand the extent of the health risks involved — and how they can best protect themselves — can still be challenging, though, Burke said.

“I talked to one old fellow who said, 'If I want to know how the smoke is, I'll look out my window,'” Burke recalled. “I think, generally speaking, people get it: There's smoke, and it's not great. But I don't think they understand necessarily just exactly how bad it can be, particularly if you're in one of those sensitive health categories.”

'Harnessing toughness'

Smoke exposure levels tend to be higher in rural communities, according to D'Evelyn, in part because fires are often closer to home. The nearer and bigger the fire, the worse the smoke episode likely will be — but the more likely it is that air quality will be overshadowed by concerns about the fire itself.

“Fire is always the top concern because in rural communities, a fire can come right through and burn down your home,” D'Evelyn said. “And so this concept of being concerned about smoke exposure has been secondary on people's minds — they're much more worried about fire, which makes sense.”

Wildfire smoke in the air in Idaho's Wood River Valley.

A “long-term historical familiarity and cultural tolerance for smoke” in many rural communities in the West may also contribute to the perception that smoke isn't an urgent public health issue, Walker said.

When something is familiar to you, you tend to underestimate the risk that it poses.

“When something is familiar to you, you tend to underestimate the risk that it poses,” she said. “The classic example is that people routinely think that being in a car is safer than being in an airplane. Smoke is woven into our experiences here, so it's often not seen as something that can cause severe health risks.”

A public outreach campaign by Clean Air Methow over the past year has focused on changing these perceptions, using messaging that leans into what were identified through community focus groups and surveys as the “top three values” of the region: determination, grit, and family.

“Toughness is a strength to harness in rural communities, and we've tried to design the campaign around the idea that toughness means protecting and caring for other people and promoting awareness of who the most vulnerable groups are,” Walker said. “Maybe someone in your family or your neighbor falls into one of those vulnerable categories, even if you don't, and they might need some help taking steps to protect their well-being and health.”

A sign to raise awareness of wildfire smoke, printed in the Nez Perce language and developed by the Nez Perce Tribe's Air Quality Program.

Within the Nevada communities participating in the DRI-NDEP project, “people are generally familiar with wildfire smoke risk exposure, and they're generally familiar with who tends to be more vulnerable or at risk,” VanderMolen said. “But when it comes to mitigation strategies, there is a little bit of fine-tuning to be done.”

In rural northern Idaho, finding — and communicating — the most effective mitigation strategies has meant taking into consideration the unique needs of the region.

“Five or ten years ago, the messaging was just, 'Stay indoors,'” said Mary Fauci, an Environmental Specialist with the Nez Perce Air Quality Program. “But many people up here don't have air conditioning and have to keep the windows open to cool their house down at night, which brings in wildfire smoke. So the general acknowledgement was that we need to either change the messaging or provide means of help to get people to change so that they can be ready and resilient.”

Trusted sources

In rural environments, information about smoke and its health impacts may be most effectively disseminated by sources close to home, research has found.

In a series of interviews and focus group discussions with residents of rural and tribal communities in north central Washington, D'Evelyn and other University of Washington researchers found that participants generally trusted local sources of information — such as tribal or local governments, or informal community communication networks — more than non-local sources, such as the state or federal government agencies. The research was conducted and published in collaboration with the Confederated Tribes of the Colville Reservation and the Okanogan River Airshed Partnership.

Interviewees also “overwhelmingly” described local and community channels — such as community information boards, local news, friends and family, and social media — as their main sources of information on air quality and smoke risk, according to the report.

A hanging wall dial designed by the Nevada Division of Environmental Protection and the Desert Research Institute to indicate Air Quality Index, intended for display in public community spaces.

Within any given community, “networks of communication are super varied,” D'Evelyn said. “There will be Facebook groups that 30% of the community is incredibly active in, and then there's another percentage of the community that doesn't even have internet access at their home and doesn't want to. Making sure that you're tapping all of the different communication networks that are necessary is really important.”

In Pershing County, a lack of real-time media coverage has made it difficult to keep community members informed about air quality and health risks in a timely way, Burke said. With the nearest television station in Reno, roughly 100 miles away, the local newspaper — which publishes once a week — is the primary source of local news.

“If you're in a larger metropolitan area, you would expect to see something on the local news about hazardous levels of smoke, but we kind of fall outside of the major reporting area,” Burke said. “Our single largest challenge is getting the word out effectively.”

An infographic for social media designed by the Nevada Division of Environmental Protection and the Desert Research Institute.

To do this, Pershing County and other rural communities have had to find alternative methods for communicating risk to the public. In Pershing County, those methods include posting information in public places — such as senior centers, community centers, and hospitals — and on social media, though spotty or nonexistent internet access in some rural areas can make the latter more difficult. In another Nevada county participating in the DRI-NDEP project, traveling U.S. Forest Service field technicians plan to deliver pamphlets with smoke information to particularly remote communities without reliable cell phone service or internet access.

To reach a diverse range of Okanogan County residents, Clean Air Methow has taken a diverse approach to its public messaging that includes billboards, print materials, radio spots, bar coasters, and social media posts. As part of a recent outreach campaign funded by the Washington State Department of Ecology, the organization and regional partners distributed more than 3,000 copies of a Smoke Ready Checklist, which lists instructions and best practices for minimizing smoke exposure — including setting up a do-it-yourself air cleaning system at home, making a plan for vulnerable household members, gathering N95 masks, and ideas for staying “mentally strong and engaged” throughout wildfire season — in both English and Spanish.

With funding from an Environmental Protection Agency grant, Clean Air Methow also made box fan air filters available for free to community members, with more than a dozen pop-up displays with information about how to get one set up at health clinics and social service organizations throughout the county.

Partnerships with “trusted partners” in the community, such as healthcare and social service providers and fire safety entities, have been key to Clean Air Methow's success in distributing information about smoke exposure and protection strategies, according to Walker.

“Everything we have ever accomplished has only been on the basis of those strong partner networks and relationships,” she said.

An informational air quality display amid wildfire smoke in Okanogan County, Washington.

A community effort

In northern Idaho, the Nez Perce Air Quality Program has found a different kind of trusted partner in the region's community libraries.

The program began by approaching a handful of libraries in 2012, to ask whether one of the program's interns could host presentations on air quality safety as part of the libraries' summer reading programs. From there, the relationships grew, with more libraries signing on to host summer reading presentations on air quality and STEM (science, technology, engineering, and mathematics) subjects.

“Libraries have a lot more than books, and I think communities and the public are starting to realize that there's other things they can do,” said Johna Boulafentis, an Environmental Specialist with the Nez Perce ERWM Air Quality Program. “Following through, showing up, and having our intern be there started to really build that trust.”

The Nez Perce Tribe has had a robust air monitoring system in place on its reservation since the early 2000s. But some of the area's smallest communities, including Peck, were without their own air monitors — leaving mini monitoring deserts in a landscape where air quality can change abruptly from town to town.

When the Air Quality Program approached Schmidt in 2021 to ask whether the Peck Community Library would be interested in installing a PurpleAir Monitor and putting out a flag each day to help inform community members about air quality, Schmidt says she was “thrilled.”

Students at Peck Elementary School across the street — a one-room schoolhouse with 34 students ranging from kindergarten through sixth grade — have also embraced the program enthusiastically, using the flag to determine whether it's safe to play outside for recess during fire season. At noon, when the students come over to the library for programming, they check on the PurpleAir sensor and help Schmidt to update the flag if needed. And “at the end of the day, after school, they'll run across the street to see if they can check on it again,” Schmidt said with a laugh.

The Nez Perce Air Quality Program hosts a class to teach people how to make their own air cleaners out of box fans.

The Nez Perce Air Quality Program has expanded its partnership with participating libraries to include other community outreach efforts in addition to the flag program, such as hosting “Build Your Own Sensor” workshops for local junior high school students and demonstrations for the public on how to build an air filter out of a box fan. Box fan air filters are displayed inside the library entrances as well, with librarians available to answer questions about air quality.

Libraries aren't the only community partners that the Nez Perce Air Quality Program relies on to help spread public awareness. The program has worked with health agencies, school districts, tribal housing entities, and others to share air quality information and teach strategies for minimizing smoke exposure and has distributed educational materials throughout the community in both English and the Nez Perce language.

But the multigenerational scope of community libraries gives them a unique ability to reach people of all ages and walks of life, Schmidt said.

If you ever want adults to pay attention, you teach the kids.

“If you ever want adults to pay attention, you teach the kids,” Schmidt said. “They bring it home and they really want to make sure that their parents or grandparents, or whoever their caregiver is, are understanding what they're learning.”

While the impact of the program is difficult to measure in numbers one year in, there is anecdotal evidence that adults are paying attention as well. Several older men living in Peck have asked Schmidt to help them install air quality apps on their cell phones after seeing the colorful flags out front, and at least one library visitor reported back that he had made his own box fan air filter after seeing the display.

A homemade flag to indicate the Air Quality Index stands outside a home on Main Street in Peck, Idaho.

Perhaps the most notable indicator of the program's impact, however, showed up on Peck's Main Street after the flag program began: One man, noticing that the flags were only updated the two days a week that the library was open, made his own flags to display in his front yard on the days the library was closed.

“To see that person using his own saw and equipment and taking all those steps to display a flag in his yard, and then going into a library and seeing that they have their fan filter going, has been really inspiring,” Boulafentis said. “It makes you want to say, 'Hey, what should we try together next?'”

“For the community to get excited about it and then see other people participating,” Schmidt added, “brings out the good in us all.”

Gretel Kauffman
About Gretel Kauffman

Gretel Kauffman has been a web writer for the Rural Health Information Hub since 2022. She writes on a variety of rural-specific issues in the Rural Monitor and Models and Innovations. Gretel has a bachelor of arts degree in American Studies from the University of Notre Dame. Full Biography

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