Table of Contents About this Report Acknowledgements4Why State of the Air?5Methodology7 Key Findings Key Findings13Ozone Pollution Trends14Short-term Particle Pollution Trends18Year-round Particle Pollution Trends22Populations at Risk25Most Polluted Places to Live28Cleanest Places to Live29 Health Impact of Air Pollution Health Effects of Particle Pollution30Health Effects of Ozone33People at Risk35 Our Health Should Count42EPA Must Return to its Mission and Value the Health of America’s Children42Defend Clean Air Act Progress and Health Protections43State and Local Governments Must Also Act44What Individuals Can Do45 Data Tables Understanding Grades and Tables46Table 1: Populations at Risk by Grade and by Pollutant47Table 2 a-c: Populations at Risk in 25 Most Polluted Cities, by Pollutant48-50Table 3 a-c: Cleanest Cities, by Pollutant51-53Table 4 a-c: Cleanest Counties, by Pollutant54-56State Data Tables58 The American Lung Association “State of the Air” 2026 is the result of the hard work ofmany Acknowledgments We would like to thank: Allen SLefohn, PhD, of ASLand Associates, who compiled thedata; John Balmes, MD, who served as expert volunteer reviewer for the health impactssection Great appreciation goes to the many members of the National Association of Clean AirAgencies who reviewed and commented on their state data to verify their accuracyWealso appreciate the assistance of members of the Association of Air Pollution ControlAgencies, some of whom also reviewed data from their statesWe are grateful forthese agencies as our partners in the fight against air pollutionThis results in this reportshould in no way be construed as a comment on the work any of these agencies do “State of the Air” 2026 would not have been possible without the first twenty formativeyears of the report led by the inspiration and hard work of the late Janice ENolen, orwithout the amazing leadership of Katherine Pruitt, who served as lead author of thereport for the last six years The American Lung Association assumes sole responsibility for the content of “State ofthe Air” 2026 American Lung Association55 WWacker Drive, Suite 1150Chicago, IL 60601 Advocacy Office1331 Pennsylvania Avenue, NW, Suite 1425 NorthWashington, DC 20004(800) 586-4872 Lungorg/sota Copyright ©2026 by the American Lung AssociationAmerican Lung Association and State of the Air are registeredtrademarks of the American Lung Association The Clean Air Act requires the USEnvironmental Protection Agency (EPA) to set health-based limits, called National Ambient Air Quality Standards (NAAQS), for six dangerousoutdoor air pollutants: particulate matter, ozone, nitrogen dioxide, sulfur dioxide,carbon monoxide and lead“State of the Air” looks at two of the most widespread anddangerous pollutants from this group: fine particulate matter and ozone Why “State of the Air”? The NAAQS identify what is considered a safe level of each pollutant to breathe, basedon the most recent health and medical science, including an adequate margin of safetyfor those most at riskThese standards require states and local governments to takesteps to reduce emissions to meet (“attain”) the standardsThe standards also serve toalert families with children, seniors, individuals with lung or heart conditions, and othersabout dangerous air pollution levels through color-coded air quality alertsThis enablespeople to take necessary precautions to minimize their exposureUnder the Clean AirAct, the standards must be based solely on what is needed to protect health and mustbe periodically updated as the science evolves Setting national health-based air quality standards, and requiring states whose airviolates these standards to enact plans to clean up their air pollution problems, havebeen a great benefit to the public health of the nationBetween when the Clean Air Actwas passed in 1970 and 2020, the combined emissions of six key air pollutants fell by78%, according to EPABut as “State of the Air” 2026 shows, millions of people in thiscountry are still breathing unhealthy air—and hard-fought progress is at grave risk Purpose and history of “State of the Air” In the year 2000, the American Lung Association launched its annual “State of the Air”report to provide the public with easy-to-understand information about the quality ofthe air in their communities, based on the credible data and sound science that EPA isrequired to use to set and enforce the air quality standards For the first several years, “State of the Air” focused solely on ozone pollution andincluded data for five populations at increased risk—children, older adults, children withasthma, adults with asthma and people with emphysemaIn 2004, changes to the airquality standards and the deployment of air pollution monitoring enabled the additionof short-term and year-round fine particle pollution (PM25) to the reportOver time,accumulating scientific evidence has shown significant health harms from both ozoneand particle