Oregon State University receives $3.2M Environmental Health grant from the National Institutes of Health

Clean air and heat relief: evaluating cardiovascular and respiratory health outcomes among recipients of Oregon's free ac and air filter program - abstract wildfire smoke and extreme heat are growing health threats associated with significant morbidity, mortality, and healthcare costs. Each year in the united states, these hazards result in over $16 billion in direct healthcare costs. Individuals with pre-existing respiratory and cardiovascular conditions face increased risks, especially when lacking access to air conditioning (ac) and air filtration (af) devices. In response, Oregon implemented large-scale programs through the Oregon health authority, a medicaid 1115 demonstration waiver, and coordinated care organizations to provide free portable ac and af units to medically vulnerable individuals, including older adults and children with chronic health conditions that increase their vulnerability to heat and smoke exposure. From 2022 to 2024, approximately 17,000 ac and 16,000 af units were distributed and an additional 10,000 devices per year will be distributed until 2028. These programs demonstrated widespread deployment feasibility, which could be scaled up to a national model if they prove to be effective at reducing exposures and improving individual health outcomes. We propose implementing a mixed-methods effectiveness–implementation hybrid (type 1) study design comprised of three complementary evaluations. Aim 1 will evaluate program implementation and effectiveness using the reach, adoption, effectiveness, implementation, and maintenance (re-aim) framework. Evaluations will include analyses of administrative data on device recipients, repeat surveys of 500 recipients from different program cohorts, and interviews with diverse stakeholder, including public health officials, clinicians, community-based organizations, and program administrators, to comprehensively assess program reach, adoption, implementation quality, recipient experiences, and long-term sustainability. Aim 2 will assess the immediate and sustained effectiveness of ac and af device deployments in reducing household exposures by continuously monitoring indoor fine particulate matter air pollution and temperature in 120 homes, comparing device recipients to matched control households and outdoor concentrations. Aim 3 will assess health outcomes by linking 30,000-50,000 device recipients to medicaid claims data. Using difference-in-differences analysis, we will estimate overall device effectiveness, defined as changes in health outcomes across the full follow-up period, capturing both acute (short-term) impacts during extreme heat and wildfire smoke events and chronic (longer-term) improvements in health. Outcomes will include cardiovascular and respiratory health conditions, healthcare utilization, and associated healthcare costs. This research will generate the first real-world evidence on the effectiveness of statewide ac and af distribution programs. Findings will inform targeted interventions and guide resource allocation to protect individuals from the growing health threats posed by wildfire smoke and extreme heat.