Narrative review of wildfire smoke interventions: considering the unique vulnerabilities of children and pregnant individuals

Abstract

Exposure to wildfire smoke is becoming more common due to climate change. The effects of wildfire smoke can be more pronounced in high-risk populations, including children and pregnant individuals. This review summarizes literature on interventions that can help minimize wildfire smoke exposure, with a focus on children and pregnant individuals. We reviewed English-language papers published before September 2024 by searching PubMed, Google Scholar, and Scopus databases. We limited the review to studies focused on wildfire smoke, but did not limit it to studies focused on children, birth outcomes, or pregnancy. We reviewed 26 studies related to wildfire smoke interventions. Our review of 17 studies on staying indoors and air filtration indicated that staying indoors with added filtration has the potential to offer the best protection from wildfire smoke if certain conditions are met. To protect children and pregnant individuals, air purifiers should be located where they spend most of their time, such as bedrooms, classrooms, doctors’ offices, or workplaces. Outdoor physical activity should be limited during wildfire smoke events, based on four studies on physical exertion. AQI-based activity guidelines can help school districts and healthcare providers make decisions to protect children’s and pregnant people’s health. Based on reviewing eight studies on masking, if people must be outdoors, wearing a well-fitted N95 mask can offer the best protection; protection offered by other mask types can still be better than none. This paper summarizes recent literature on interventions that can help minimize wildfire smoke exposure, with a focus on children and pregnant individuals. In considering public health recommendations for wildfire smoke protection, it is important to provide focused advice for more vulnerable populations while considering the latest relevant research. This is especially important in the face of climate change, with worsening fire seasons that can expose large swaths of the population to hazardous levels of wildfire smoke for days to weeks at a time.