Investigating Effect of Air Quality on Patients in Tulare County.

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Lin K OMS-II, Andrews M OMS-II, Chang J OMS-II, Dhadwal SOMS-II, Germano N OMS-II, Hoang A OMS-II, Kabacinski T OMS-II, Mangalindan K OMS-II, Melchione M OMS-II, Shahbazi S OMS-II, Lewis J DO, PhD, Navarro I, DMD: Family Health Care Network, Visalia, CA; A.T Still University, Mesa, AZ.

Research Objectives

Nationwide, air quality and pollution levels are important topics that impact millions in a myriad of ways. Poor air quality and excess pollution usually conjures images of major metropolitan areas, not acres of farmland, giant sequoia trees, and Yosemite Falls. Despite the picturesque scenery, the level of air pollution within the San Joaquin Valley (SJV) of Central California ranks among the Los Angeles and Houston areas as most polluted in the nation (Hall et. al., 2007). This study was to determine how low air quality in Tulare County affects residents’ respiratory health and quality of life.

Study Design

In a Cross-Sectional convenience sample, adults 18-65 years old who visited affiliated Family Health Care Network Clinics and who lived in Tulare County for more than 3 months were given surveys to assess general respiratory health. Smokers and those with congenital respiratory defects were excluded. Patient demographics were overwhelmingly of Hispanic nationality, and of lower socio-economic class. Patient information was obtained using a 19-question survey, written in both Spanish and English. Surveys were distributed to patients at clinics and local health fairs. Odds ratio was calculated based on data obtained from the survey and compared to data from various cities.

Principal Findings

Of the 150 surveys distributed, 120 were completed and returned. 40 were excluded due to history of tobacco use and congenital respiratory defects. 66% of subjects were 18-35 years old, 23% were 36-50 years old, 95% were female, 74% were Hispanic, 14% were Caucasian.

* Respiratory Symptoms: 45% of all subjects had 3 or more respiratory symptoms. Lake, CA & Jackson, SD was among the list of top pollution friendly cities with 14% & 8% of the populace having 3 or more respiratory symptoms. Even New York, NY had 15% of their population having 3 or more respiratory symptoms. 46% of subjects who stayed in Tulare County for most of their life (defined as spending less than 3 months outside of the County every year) had 3 or more respiratory symptoms. 76% of subjects who left the County for 3 or more months had 3 or more respiratory symptoms.

* Quality of Life: 58% of all subjects have stayed indoors at least 2 days due to compromised air quality. 81% of all subjects believed that air quality has affected their lives.

Conclusions/Impact on Health Centers

Based on our findings, the compromised air quality of Tulare County and its subsequent adverse respiratory effects places strain on the local healthcare system. Residents with 3 or more respiratory symptoms are more likely to seek and need medical treatment. Due to patient demographics and lower socio-economic class, many will seek treatment in community health centers, straining already limited resources. Policy toward prevention in many levels is necessary to fix this problem. Strict regulations on the industry in the area and multi-level education to all age groups are necessary. If looking to replicate this project in other health centers, we encourage the use of our survey with minor alterations to fit the area’s demographics.


1) United States Environmental Protection Agency. Progress Cleaning the Air and Im proving People's Health . Available at: Accessibility verified December 1, 2013


2) Kristie Ross, James F. Chmiel, and Thomas Ferkol. The Impact of the Clean Air Act. Journal of Pediatrics, The, 2012-11-01; Volume 161, Issue 5, Pages 781-786

3) Huang G, PhD., London J, PhD. Mapping cumulative environmental effects, social vulnerability, and health in the San Joaquin valley, California. Am J Public Health. 2012;102(5):830- 832.

4) American Lung Association. (2014, April). The State of the Air 2013. Retrieved from

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