Martha Cota awakened one morning to find her infant son, Jose Miguel, gasping for air, his lips and the skin under his fingernails blue from lack of oxygen. Terrified, she rushed him to her local hospital in Long Beach, Calif., where doctors stabilized the toddler and sent him home with medications to control his fever and an inhaler to help him catch his breath. The cycle went on for more than five years — Jose turning blue and barely able to breathe, Cota frantically strapping him into his car seat and racing through traffic, spending countless days and nights sitting in hospital emergency rooms.
Like so many other kids in their working-class neighborhood not far from Long Beach’s massive port, Jose had severe asthma, and it took doctors years to hit on a regimen that controlled his symptoms. “He could have died at any time,” Cota told me, her eyes brimming with tears, when we conversed one April morning through an interpreter at a coffee shop near her office in Long Beach. “At least once a month, I’d get a call from his school threatening to send me to jail because he was absent so much.”
Tall and attired in an elegant black suit, Cota, who is now in her late 40s, has a long mane of dark hair shot through with auburn highlights and large, expressive eyes. She was a social worker in her native Mexico and now works as a community educator for the Long Beach Alliance for Children with Asthma. When she first discovered that many other women and children in her community were having trouble with respiratory illnesses, she was determined to find out why living downwind of the nation’s largest port complex was making so many people sick.
Even at noon on this otherwise sunny day, the sky was blanketed in hazy toxic smog from the ports of Los Angeles and Long Beach, the entry points for more than half of the goods shipped into the United States and the largest source of air pollution in California.
Every day, idling cargo ships carrying 30,000 containers from Asia and the Pacific basin are unloaded by construction cranes towering more than 200 feet high on the docks. Then the containers are dispatched from the rail yards alongside the harbor onto 1,200 diesel-powered freight trains that ferry goods up and down the coast, and 35,000 semi tractor-trailers that speed along heavily congested highways to the rest of the country. Since the 1970s, the massive port complex has exploded to five times its original size, transforming the surrounding area into what one local physician called “an environmental nightmare.”
California may have a reputation as a sun-kissed paradise with some of the world’s most photographed real estate — Southern California’s sparkling white beaches, the celebrated rocky coastline along Big Sur and the epic grandeur of Yosemite and the Sierras. But the reality is that the nation’s most populous state is an industrial colossus — the world’s ninth-largest economy — with the worst air quality in the nation, according to annual report cards issued by the American Lung Association.
The Los Angeles metropolitan area, with nearly two cars per household, has the dubious distinction of having the highest vehicles-per-capita ratio in the world; more than 12 million cars travel on the extensive freeway system every day. But all this commercial activity exacts a heavy toll on residents’ health. The exhaust-filled industrial corridor that stretches from the ports of Los Angeles and Long Beach to Riverside — a city of 300,000 residents and a distribution hub that sprouted up next to the freeways where trucks and trains transporting goods belch dark clouds of diesel dust — is what environmentalists call the “diesel death zone.”
Cota’s first encounter with the environmental cause that would come to consume her life was at a parents’ workshop held at her son’s school, situated about a mile northeast of the waterfront. There, she met a team of physicians connected with the Children’s Environmental Health Center at the University of Southern California who were conducting a long-term study on the link between chronic exposure to air pollution from freeway traffic and respiratory illnesses.
Called the Children’s Health Study, the research project began in 1993 and eventually involved about 5,500 children in 12 communities in Southern California. Two-thirds of them were enrolled as fourth-graders, and all were followed until they graduated from high school. Cota immediately signed up for the study and learned how to use a particle counter, which measures particulates and toxins in the air, to take samples of ambient air quality surrounding her home. “Every time a truck would go by,” she recalled as we sat sipping coffee, “the meter would spike off the charts.” Sometimes it measured 7,000 micrograms of particulate matter per cubic meter, which is more than 400 times the maximum level that federal standards consider healthy.
What the USC researchers ultimately uncovered after a decade of meticulous monitoring was eye-opening. The lung development of children who lived near highly trafficked corridors was stunted — about 20 percent smaller than average — which greatly impaired their functioning. These youngsters also suffered from asthma at significantly higher rates — those living within a quarter of a mile from a freeway had an 89 percent higher risk of asthma than kids more than a mile away.
Their asthma symptoms also were worse, and even among those with health insurance, their odds of ending up in the hospital emergency room choking from the bad air was triple that of youngsters in more affluent areas. Worse yet, pregnant women living in these high-traffic areas were more likely to give birth to premature or low-birth-weight infants, setting up the next generation for a lifetime of disabilities and developmental deficits.
Cota hardly needed a study to tell her this. She and two of her other children later developed severe allergies and now use inhalers and an arsenal of medications just to get through the day. “No one in my family had asthma or allergies,” Cota told me. She started working for the Long Beach Alliance for Children with Asthma, she said, “so no other mother has to put up with what I had to.”
The Other California
The situation is even worse in California’s Central Valley, where a combination of farming, industry, traffic and topography has made the air quality so bad that four regional metropolitan areas rank among the nation’s top 10 dirtiest cities, according to the American Lung Association. Bakersfield, the birthplace of the renegade rockabilly honky-tonk of Merle Haggard and Buck Owens, consistently tops the list.
A long, crescent-shaped lick of fertile flatlands that stretches more than 450 miles and covers 22,000 square miles (slightly smaller than West Virginia), the Central Valley is nestled between the coastal mountains on the west and the Sierra Nevada to the east. They call it “the other California,” with patches of farmland extending as far as the eye can see and hardscrabble towns originally settled by Dust Bowl refugees now covered with strip malls and fast-food outlets. But this high desert region is also home to 6.5 million people — more than the population of two-thirds of the states in the U.S.
The spreading urban sprawl, coupled with industrial growth, has yielded increasingly tainted air. Dairy farm waste, soil blown from farmlands, pesticides, industrial emissions, vehicle exhaust and dust particles kicked up by cars and the big rigs ferrying produce down Interstate 5 and Highway 99 — the valley’s two main arteries — have made this one of the smoggiest places in the nation. The surrounding mountains trap these pollutants, and the stagnant air envelops the region in a perpetual cloud of haze.
On hot days, locals told me, the toxic smog fills hospital emergency rooms and doctors’ offices with children who can’t breathe, and schools in Fresno fly color-coded flags to alert students to the air quality: Green means it’s OK to be outside, while red is a warning to stay indoors. On average, nearly four Central Valley residents die prematurely every day because of the pollution, and experts predict that within the next few years, as temperatures continue to rise and population growth raises smog levels, one of every four children will have asthma.
“In the past 10 years, I’ve had to put more kids on steroids than ever before, which terrifies me,” said Kevin Hamilton, a respiratory therapist and administrator for Clinica Sierra Vista, a string of medical centers throughout the Central Valley that cares for about 50,000 low-income youngsters every year. “It can be overwhelming with patients in every room on inhalers and nebulizers” — the heavy artillery of an asthmatic’s medicinal arsenal. “These kids never get well, and now we have a generation who are permanently damaged by their constant exposure to pollution,” Hamilton, a burly, bearded man in his late 50s, sighed in frustration when we met in his cramped office at the clinic. “The effects are not transient. If they get pneumonia, they’re more prone to end up in the hospital. They can’t participate in athletics, and when they get older, they’re more likely to have heart disease because their bodies can’t generate enough oxygen. They get sicker faster, and die younger.”
A CLOSER LOOK: AIR POLLUTION
Take a deep breath — more bad news on air pollution
The consequences of breathing bad air is linked to appendicitis and ear infections, new studies indicate.
It’s easy to see how air pollution would affect respiratory disease: You breathe in smog-filled miasma all day and the ozone, other noxious gases and small particulate matter therein can make you wheeze and cough. Pollutants can trigger asthma attacks and bronchitis in susceptible individuals.
But it’s harder at first blush to understand links to other conditions. In two studies reported last week, bad air was associated with higher rates of appendicitis and ear infections.
The new reports have been met with surprise because neither health problem seems obviously linked with the airway or bloodstream. At the same time, they represent a trend toward broadening the research scope of air pollution and health.
“People are looking at everything and air pollution these days,” says Francine Laden, an epidemiologist at Harvard School of Public Health in Boston.
Research on air pollution has been conducted worldwide for decades and is part of the basis for government regulation of air quality. Study after study has found more hospitalizations and higher death rates when certain pollutants are high. In addition to respiratory effects, research has established that air pollution increases the risk of cardiovascular events such as arrhythmia, heart attack and stroke, and the incidence of certain cancers.
In the appendicitis study, published Oct. 5 in the Canadian Medical Assn. Journal, researchers examined records for 5,191 adults admitted to Calgary hospitals for appendicitis from 1999 to 2006. The dates of the patients’ admissions were compared to air pollution levels in the preceding week, using data from three air quality surveillance sites in the city.
The scientists found a significant effect of pollutants on appendicitis rates in the summer months among men, but not women.
The risk of going to the hospital with appendicitis more than doubled when summer pollution was at its highest, says study lead author Dr. Gilaad Kaplan, a physician-researcher at the University of Calgary.
The strongest effects were found when high pollution days preceded hospital admission by at least five days rather than a shorter period. This suggests there is a certain lag time between pollutant exposure and the development of appendicitis.
The study did not examine how pollution might cause appendicitis, but Kaplan speculates that inflammatory processes are involved. Substances the body produces to ramp up inflammation are implicated in appendicitis. Other research has found these substances in healthy volunteers after they breathed diesel exhaust.
A similar argument is used to explain cardiovascular risk factors associated with air pollution: that substances involved in blood clotting are produced after exposure to bad air.
In the ear infection study, presented at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery in San Diego, researchers compared prevalence of the disease in 126,060 children with trends in air pollution from 1997 to 2006. Health information came from the National Health Interview Survey, administered by the U.S. Census Bureau, and air quality data came from U.S. Environmental Protection Agency records.
Four pollutants — carbon monoxide, nitrous dioxide, sulfur dioxide and particulate matter — decreased nationwide over the 10-year period. The number of children reported as having more than three ear infections in a year also declined.
Again, the study cannot say air pollution causes ear infections, only that the two are associated. And it did not investigate how pollutants affect the ear canal.
But it’s not a stretch to go from respiratory illness to ear infection, says lead author Dr. Nina Shapiro, a pediatric otolaryngologist at UCLA School of Medicine. Pollutants have been shown to damage cilia — tiny little hairs that line many of the body’s passageways.