15 Cities With the Most Unhealthy Air in America

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Smog over Bakersfield, California
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There’s something in the air — and it’s not love.

The American Lung Association has released its latest annual State of the Air report, which grades the levels of pollution — from soot to smog — that Americans were exposed to over the three-year period from 2018 to 2020. It also grades the worst short-term spikes in pollution, for example from wildfires.

The 2022 report “finds that 2.1 million more Americans live in counties with unhealthy air compared to [the 2021] report, and exposure to deadly particle pollution has gotten worse,” the ALA says. Particle pollution consists of microscopic particles that come from sources such as coal-fired power plants, diesel engines and wood-burning stoves and can trigger asthma attacks, strokes and other health problems.

Following are the cities with the worst year-round particle pollution according to the ALA.

15. Bend-Prineville, OR

Smoke in a forested area near Bend, Oregon
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Bend, Oregon, is one of several cities on this list living under the threat of wildfires. “Wildfires in the western U.S. were responsible for a sharp rise in particle pollution spikes in several states,” the ALA says.

Although Bend’s wildfire forecast is better than those of the past two years, it is still above normal, according to The Statesman Journal.

The Bend area also ranked 41st (out of 221 metros) for single-day pollution levels.

14. Pittsburgh-New Castle-Weirton, PA-OH-WV

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Pittsburgh has a long history of industrial air pollution, and despite environmental strides, it remains near the top of the list. The metro area also ranked 22nd for single-day pollution.

While air pollution is a problem, Pittsburgh scores high in other measures of cleanliness and was recently named one of “The 15 Cleanest Big Cities in America.”

13. Indianapolis-Carmel-Muncie, IN

Indiana Power Plant
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Much of Indianapolis’ air pollution comes from cars, according to the Indianapolis Star. Its residents drive more miles per capita than any other large urban area in the U.S. Power plants are also a major source.

Beyond making the top 15 for year-round particle pollution, Indianapolis is No. 40 for single-day pollution, according to the ALA.

12. Cincinnati-Wilmington-Maysville, OH-KY-IN

Cincinnati Ohio
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The Cincy area also ranks 81st for single-day pollution. If you can deal with the air, however, it’s relatively affordable. In 2021, it was at the top of “10 Cities Where Renters Can Afford to Live Alone.”

11. Sacramento-Roseville, CA

California Capitol building in Sacramento
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For nearly 30 years, Sacramento has scheduled Spare the Air days to help reduce pollution. On these days, residents are encouraged to drive less and avoid using gas-powered devices or aerosols.

Sacramento is No. 7 for single-day pollution in the ALA’s ranking.

10. El Centro, CA

El Centro, California
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El Centro is one of several California cities in the top 10. It also ranks 27th for single-day pollution.

While wildfires and climate issues are beyond the area’s ability to fix, it’s doing what it can. Imperial County, where El Centro is located, holds an annual event where residents can exchange their used gas-powered lawn equipment for a brand-new battery-powered mower, trimmer, blower or chainsaw.

9. Chico, CA

Chico, California
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Chico also ranks No. 6 for single-day pollution. It has around 39 days a year with unhealthy or hazardous air, according to Environmental Protection Agency data.

8. Phoenix-Mesa, AZ

Phoenix, Arizona
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The Phoenix metro is 11th for single-day pollution. Even during the early days of the coronavirus pandemic, when traffic across the country virtually ground to a halt, “ozone stubbornly persisted” in the area, according to The Arizona Republic.

7. Fairbanks, AK

Fairbanks Alaska
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Wood-burning stoves are a large source of pollution in this colder latitude where wood is readily available, according to the Anchorage Daily News. Power plants, cars and heating oil also contribute.

Fairbanks ranked No. 3 for single-day pollution, the ALA says.

6. Medford-Grants Pass, OR

Medford, Oregon
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The Medford area is ranked 21st for single-day pollution, the ALA says.

The record-breaking levels of wildfire smoke behind that ranking have some people leaving the area, according to Oregon Public Radio — even after living there for decades.

5. Los Angeles-Long Beach, CA

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Like Pittsburgh, Los Angeles has a long history of smog problems and a long history of fighting it, including creating the nation’s first air pollution control program. Still, the metro area ranks No. 8 for single-day pollution in the ALA report. It’s also near the top of the list of “The 15 Dirtiest Cities in America.”

4. San Jose-San Francisco-Oakland, CA

The skyline of San Jose, which has a lower median rent than median mortgage payment
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It might seem surprising that a city in the high-tech Bay Area has worse pollution than some major manufacturing cities. Part of the reason is weather-related but has nothing to do with wildfires.

Wintertime “inversion layers” of cold, still air can trap pollution created by fireplaces and other heat sources at ground level. The San Jose metro is also No. 4 in the ranking of single-day pollution.

2. Visalia, CA (tie)

Visalia, California
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Visalia ranks No. 9 for single-day pollution. This city and nearby Fresno — with which it tied — are among five Central Valley cities that suffered the biggest declines in air quality from 2019 to 2020.

2. Fresno-Madera-Hanford, CA (tie)

Fresno California
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The Fresno metro also ranked No. 1 for single-day pollution, the ALA says.

1. Bakersfield, CA

Bakersfield, California
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The top three metros on this list are a tight cluster, with Visalia sandwiched between Bakersfield and Fresno.

It’s no surprise, then, that Bakersfield ranked No. 2 for single-day pollution — or that the city also sits on the same list of hottest real estate markets as Fresno.