 As a parent, there's nothing you can do when your child says that they can't breathe. A glass of water is not gonna, you know, open up their airway. You know, it's nothing that they can cough up, you know. So it's a terrible feeling. The smog is very bad at where we live in the summer. It's very bad. And, you know, you can feel it from just your everyday life. That's, to me, that's scary. It's a terrible, terrible thing to imagine that they're pulling in all that smog into their little bodies. I think for the first time what parents are beginning to understand is that it isn't just somebody out there is being affected by air pollution, but that their child is being affected. Southern California, home to the nation's largest freeway system and to thousands of manufacturing and industrial facilities. Almost 13 million cars and trucks travel these roads every day. They emit enough pollutants to have earned Los Angeles the title of most polluted city in the country. We all know that air pollution is bad for us. We've seen the images before, people rubbing their eyes on days when the smog was really thick. But today the effects of air pollution are not this obvious. So in the early 90s scientists started to wonder if more subtle health damage might be happening to children who grow up breathing air pollution every day. Nobody really knew the answer. That's why the state agency charged with ensuring safe clean air for all Californians stepped in. The California Air Resources Board was determined to find out if children are harmed by prolonged repeated exposure to air pollution. So in 1991 the board began planning the largest ever long-term study on air pollution's health effects on California's children. It became known as the Children's Health Study. The Children's Health Study was set up about 10 years ago to determine whether there are chronic effects of air pollution in Southern California. It had been known for years that there are acute effects, that is it'll make your eyes water, it'll make you cough. But the question is, does prolonged breathing of this kind of air result in permanent irreversible damage to the lung? Dr. John Peters leads the team of scientists who conduct the study at the University of Southern California's Keck School of Medicine. The extensive study involves monitoring air quality, testing pollution samples, examining children's health and then analyzing all the data collected. Dr. Jim Goderman heads up the statistical group that analyzes the data. They're trying to ultimately see whether kids who lived in high air pollution communities had more respiratory symptoms or slower lung capacity growth. This is a question Tony Taylor worries about. She has four children and they all have asthma. When I'm having asthma attack it kind of feels like you're being suffocated. Tiffany and Tessany are twins. They were diagnosed with asthma at age five. Tamika was diagnosed at age two and Max, by the time he was just six months old. Their chest sits up and they're just kind of like that. But theirs is accompanied with a whistling, a wheezing. Nobody knows exactly what causes asthma, but scientists have been studying a host of contributing factors like genetics and diet, as well as environmental causes like indoor allergens and now air pollution. Tony and her kids live in Long Beach five minutes away from the port, less than a block away from a busy freeway with a lot of trucks and surrounded on the north, south and west by refineries. How could it not be possible for them to ingest the things that are burning into the air, you know, and not to affect them? Children are probably most sensitive to air pollution because for one their lungs are developing and so as those lungs develop any assault to that developing tissue may have a large impact compared to an adult. Children typically are outside more exercising, breathing more rapidly than adults are, so in the same environment as an adult may actually be breathing in a lot more air pollution. And if you follow the pollution patterns they typically peak in the hours from say three to six in the afternoon and that correlates very well with when we see kids outside and being active. I and my children live here in Riverside. My oldest child is now 19 and then I have Charisma who's 11 and my son who's just turned nine, Ruben, and the baby. He's 18 months old, Sergio. Irma Mesa's kids are all healthy but she worries about the hidden effects air pollution may be having on them. I grew up in this area and lived just down the street and we have a view of the mountain sides here. Charisma and Ruben in the morning will be getting ready for school and we'll look at our front living room which shows the mountain side just as when I was a teenager if we cannot see the mountain that day we know it's going to be a bad day. Our air pollution problem in Southern California is severe because of a combination of a lot of people in a relatively small place surrounded by mountains with weather conditions that are conducive to the formation of smog. Most of Southern California's air pollution comes from traffic, industry and the ports and diesel trucks are a major culprit. Huge amounts of these pollutants are generated in the central part of Los Angeles County so residents who live there are the first ones exposed to them. So in the LA area we have a predominantly onshore flow of air which means it comes off the Pacific Ocean and heads from west to east. So given that most of the automobile traffic occurs in the downtown LA area and the associated freeways that circulate around that area those pollutants are then kind of lifted up off the ground and they start to head eastward and so as they head eastward these pollutants react with sunlight and form into particles, they form into acid, they form into nitrogen dioxide, they form into ozone along the way and so the most polluted places that we see are approximately 40 to 50 miles east of the LA area and adding to that is the fact that we have mountain ranges that border us on the north and they kind of curve around and border a little bit on the east as well so it provides kind of a stew pot for the air to sit. Robin Koutou lives right in the heart of this stew pot in an area called Pedley. Not only does she get LA's pollution but her community has plenty of its own pollution sources. I'm surrounded by four freeways within maybe a 20 mile radius but I'm very close to one freeway and is a very busy freeway with a lot of trucks. There's a lot of truck stops and there's a lot of truck distribution centers. There's also two major train lines. The train actually goes right maybe about a half a mile from my house and that diesel is bad. So bad the California Air Resources Board has declared the tiny particles and diesel exhaust toxic. Exposure to the particles is linked to both cancer and asthma. If it's a really smoggy day I prefer that my kids just stay in. Robin's daughter Michelle developed asthma at age 11. During the summer sometimes they'll have practice during the dead of the day and I don't want her here because I don't want her to be sick. We have more and more parents talking about their children developing asthma now or how their child had to drop out of his swimming team because he simply couldn't do it anymore. How the coach at the high school talks about their track team and how the kids can barely make it around the field. And I guess that's why the USC study is so important. It shows that we really have a problem here that needs to be addressed. The scientists chose to study 12 communities that are spread out within a 200 mile radius of downtown Los Angeles. The communities east of LA bear the brunt of the region's dirty air. These are the study's most polluted communities. The least polluted are found up in Santa Barbara and San Luis Obispo counties where there are fewer residents, fewer cars and less industry. Also in the study are five communities chosen because certain pollutants are high while others are low. About 500 children were recruited from schools in each community so the total number of kids studied was almost 6,000. In order to gather information about the children, a dedicated team of researchers visits every school in the study. They've been doing this each year since the study began in 1993. Each child fills out a questionnaire about his or her health. This information is used to determine how air pollution affects certain symptoms and conditions such as asthma, bronchitis, wheezing and cough. Now you want to take that mouthpiece and put it between your teeth. Each child undergoes an annual lung function test. Data from each year's results will show how fast their lungs are growing and how big they are getting. The researchers also monitor how many days of school each child misses each year to help figure out what kind of role air pollution plays in absenteeism. When the kids were enrolled in the study, the majority were in fourth grade or about 10 years old. We're picking an age range where the children are developing very rapidly. They're going through puberty and so they're experiencing a growth spurt not only in their body in general, but their lungs are keeping track with that and growing as well. So the idea is that if air pollution is having an effect on growing tissue that that might be a particularly good time to see its effects is when the lung is developing most rapidly. The closest thing that we can probably compare air pollution to with respect to a child's exposure is environmental tobacco smoke or passive smoke or secondhand smoke. This means breathing polluted outdoor air may be like living with a smoker. When the child breathes these pollutants into the lung and they get deep into the lung, we think they may be causing inflammation in the lung and repeated inflammation over days and months and years may cause some restructuring of the lung to try and handle the assault that's happening on a daily basis. And the assault from air pollution is one that many parents find hard to avoid. That's because it happens when kids are engaged in normal everyday activities. Every time exhaust comes out of a car or truck or factory you can assume that somewhere a child is breathing some of it in. When we're at a public forum and discuss the findings of the children's health study the room grows silent. You could hear a pin drop and it's because people are alarmed about the effects that air pollution is having on today's children. The children's health study has found that children who grow up in areas with high pollution levels are at risk for decreased lung function, more frequent respiratory illness, increased school absences and developing asthma. And kids with asthma have a higher risk of getting bronchitis causing them to cough and produce phlegm, which makes them sicker. Scientists agree the most disturbing finding of the children's health study to date is that air pollution affects how children's lungs grow and how well they function. When we breathe our lungs inhale to bring in fresh oxygen and exhale to remove carbon dioxide waste from our bodies. If lungs become damaged by pollutants, lung function is impaired. Think of blowing out candles on a cake. Someone with 100% of their lung function could probably blow out 100 candles in one breath. They can do that because they can completely fill their lungs with air and then blow out all that air with ease. Someone who has difficulty doing this can be said to have reduced lung function. In healthy children, lungs grow as their bodies develop, but the greatest growth rate is during puberty. From ages 10 to 14, healthy children see their lungs grow by about 12% each year. By the late teens or early 20s, lungs have essentially stopped growing and then plateau until about age 30. Then lung function begins to decline at a rate of about 1% per year. Now take a child exposed to high levels of pollution. The children's health study shows that during the crucial puberty years, their lungs will grow 10% less each year. Over a period of four years, that's a significant deficit in lung function compared with kids growing up in low pollution neighborhoods. And the scientists do not yet know how this deficit will affect the rate of future lung growth. What they do know is this deficit can occur in any child, not just in those with asthma. In fact, the children whose lung function is impacted may seem perfectly healthy. I think it's very hard for a parent to pick up on the kinds of things that we're studying. They're not going to be able to observe their child's lung function in any demonstrable way. Their lungs are developing and they're typically out able to play and they probably won't notice anything wrong, even if maybe they are being impacted somewhat by air pollution because they are in this rapid growth phase. But it is well known that reduction in lung function later in life, talking age 50, 60, 70, is a key risk factor for respiratory conditions and ultimately death. I spent a lot of time in the emergency room, a lot, a lot, a lot of time in the emergency room. Tony's kids get sick often and that means keeping them home from school. In a 30-day period, they're missing anywhere from about five to ten days. And they're not the only ones. The Children's Health Study found that more kids stay home from school when the air pollution gets worse. Several days after a significant rise in ozone levels, more kids miss school due to sore throats, coughs, asthma attacks and other similar problems. What we found was that there was a fairly striking relationship between the level of ozone on the two and three days before to the chance of being absent a couple days after that exposure. A typical September month in the Inland Empire, some 40 to 50 miles east of LA, looks like this. The shaded days are the ones that exceed the state ozone standards, meaning the air pollution got worse. The study found that several days after these peaks, the number of kids absent from school would double. And most often, when a child is kept home from school, a parent is kept home from work. That means lost wages and lower productivity. According to an analysis done in conjunction with the Children's Health Study, reducing high levels of ozone could save approximately $67 million every year in Southern California alone in costs related to school absences. When I was about ten, I started playing soccer. I just started running and I started getting really tired and I couldn't breathe. And then I told my mom and we went to my doctor's and he told me that I had asthma and I had to use an inhaler. Actually, me and my mother thought it was the smog because when I would go play somewhere else, it wouldn't happen. And then I'd play in smog and it would happen. So, and I just connected the two. So did the Children's Health Study. We've recently published a paper that is one of the first that shows a potential causative link between air pollution and new asthma, meaning that perhaps air pollution may cause asthma. And this is different from what we have established before and what other people have seen that air pollution causes increased symptoms in the children that already have asthma. We're talking about air pollution actually bringing on the definition of asthma in a child. Well, we've known for a long time that air pollutants aggravate asthma and I don't think that anybody would dispute that anymore. There must be 40 or 50 scientific papers showing that pollutants adversely affect asthmatics. But causing it is something else because now you want to know why this child has developed asthma. In the study, the onset of new asthma cases is primarily linked with the pollutant ozone, a gas that forms as a result of vehicle emissions interacting with sunlight. This is the Lake Arrowhead area. It's a popular vacation spot because it seems far away from urban pollution. But it actually has the highest ozone levels in the country. It also has a lot of athletic kids. What we studied was the children's activity patterns and we categorized children into how many sports they played. And we know children during these ages of school years often will be on a soccer team and a basketball team and a tee ball or baseball or something like this. So we looked at children who played no sports or played a couple sports and then those that played three or more sports. And the three or more sports kids, you can imagine, are the ones that are going to be outdoors the most time and breathing outdoor levels of air pollution at the highest rates and ventilating the highest and so perhaps would be the most exposed children. And it turned out that the kids who played three or more sports and lived in our highest ozone communities had about a three-fold increased risk of developing new asthma. By epidemiological standards, that's a very high risk. I would say half of her high school team had asthma. The coach, he said his pockets were so full because he would hold all their inhalers. And he didn't know whose was whose and they'd all have to write their names on them. It's very hard to watch their struggling knowing how much she wants to be in their plane but she can't breathe. Tony Taylor spent two years in Illinois with her three older kids and to her disbelief, they were virtually asthma-free. It was almost non-existent. It was literally almost non-existent. And in winter, our asthma is so good we can sleep with the winter window open and all the snow and stuff. And we wouldn't have asthma attack there. It's the air much cleaner. It's like, not as thick as out here. It's less pollution. When we got back here, they went back on their steroid plus the inhaler. And once they got the cold, it all just started right back up. It was just like they fell right back into the same cycle of, you know, they get a little cough, a little sniffle of sneeze and there goes their breathing right out the door. So we've been interested in whether the air pollution effects that we see, especially on lung function, are reversible. Meaning that if you leave a high air pollution community, will your lungs revert back to what they would have been had you not been breathing high air pollution? And can you reverse any deficits that may have occurred? The scientists followed children in the study who moved from Southern California to other less polluted communities. What they found is that lung function growth improved in these children. That also means that if the air got better in Southern California, children's health would get better too. The study shows that today's air pollution levels are adversely affecting our children's health. There are relationships to asthma and lung disease and absence from school. It clearly shows we have to do more to clean our environment. The Federal Environmental Protection Agency is charged with regulating the levels of pollutants in the air. California is the only state allowed to set its own air pollution standards, and those set by the California Air Resources Board are the strictest in the nation. In spite of this, the Children's Health Study has found notable health effects in Southern California's young people. We see what's called a kind of a linear dose response relationship, meaning the higher the pollution, the higher the risk of the symptoms. So what it says, I think, to a regulator is the lower they make pollution levels, the better off we'll all be. The Los Angeles area has undergone big improvements in its air quality in the last few decades. This is LA in the 1970s, when there were typically hundreds of smog alerts each year. This is LA today. Now we rarely have any smog alerts. We've made progress. But there are still more than 100 unhealthy air days a year when the state ozone standard is exceeded. Certain pollutants remain high, and it could get worse. Development in Los Angeles is on the rise. The population keeps growing. The ports of LA and Long Beach are expanding. There is talk of adding lanes to busy freeways to accommodate the growing number of trucks. And there's a push toward building an inland port 50 miles east of Los Angeles, the area with the nation's highest particulate pollution. If we stick to the current regulations, we will see levels go up in future years. So if we can reduce what's emitted, reduce the toxicity of what's emitted out of the tailpipe, reduce the diesel exhaust particles that are being emitted by trucks, that will serve to lower almost all the levels of all of these pollutants. The California Air Resources Board has a new plan to dramatically reduce diesel emissions by the year 2010. The board has also just issued a new stricter standard for particulate matter, tiny particles that can get deep into your lungs. New monitoring by the board found very high levels of dangerous particles in an East Los Angeles school that is right next to several freeways. In fact, concern about the health implications of heavy truck and car traffic is leading the Children's Health Study researchers to investigate whether going to school near a busy road or living near a freeway can lead to respiratory problems. The Children's Health Study will continue following these children to see what happens to their health and lung function after they graduate from high school and reach their 20s. The researchers want to determine if the deficits these kids experienced in their childhood will persist, and the researchers don't want to stop there. They hope to follow this group for decades. How will AIB in fact use these results? It's great to fund a study, but how will they be used? I think they will be used right away to assess the research base to look at the health impacts of children to see, in fact, whether our regulations are protective of health, and if not, then how do we strengthen those? We could be pushing hard for more public transportation, more incentives to produce less polluting vehicles, more awareness on the public that some of the vehicles that they're purchasing are polluting vehicles. We need to start putting together a plan that's going to reduce the levels we already have and to prevent development and those types of facilities that will exacerbate the problem even more. The study's results have already led to a temporary ban on the building of new warehouses like these in the Mira Loma area. The children's health study has taken disbelievers that didn't feel that air pollution really affected our children and turned them into believers about the need to move forward with air pollution controls. It is truly a landmark study and provides a sound foundation for our planning and regulatory programs. These type of results can be directly linked to some of the regulatory action here and nationally and internationally to make sure that we're trying to protect public health. I think my fear of what will happen if we don't change what we're doing as someone who has raised two boys with asthma who knows what it is like to go through a nighttime with my husband and I trading times of sleep because we were listening for our children's breathing knowing that at some point we'd have to take them to the doctor that has taught me real well what what pollution does to people and I think if we don't change that there's going to be more and more parents who go through that experience who know what it is like to have to rush their child to the doctor in a life and death situation and I don't think there is a person alive who wants to live their life that way. You can't even begin to imagine not being able to breathe air but what if you breathe air that's damaging. I mean that's just a scary, scary thought and that would be my fear not being able to at least take good deep breaths of air. Clean air.