The association said climate change continues to contribute to poor air quality, contributing to spikes in ozone in the 2018 report, while wildfires drove higher particle pollution levels in the 2017 report.
Coming from smokestacks, which also produce particle pollution, ozone "aggressively attacks lung tissue by reacting chemically with it" according to the American Lung Association.
Statewide, 35 million Californians - 90 percent of the population - live in counties affected by unhealthful air during the year, the American Lung Association reported.
Although Rhode Island is still struggling with its ozone pollution, particle pollution levels are much better. The report uses the most current quality-assured nationwide data available for these analyses.
Air pollution is a complex mixture of particles and gases.
"Ozone and particle pollution are especially harmful to children, seniors and those with asthma and other lung diseases". The EPA has stopped the Obama-era Clean Power Plan, which sought to reduce emissions of climate change-causing emissions, despite estimates that the program would cut air pollution and ultimately save 3,600 lives by 2030.
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The greater Philadelphia area (which includes Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester and Salem counties) was listed as the 24th worst city for ozone pollution.
The report also calls for the enforcement of the Clean Air Act, which has driven improvements in air quality for 48 years.
"Once again Suffolk County has some of the worst ozone pollution in New York State", said Seilback, a Suffolk County resident. In this year's report, Wilmington moved up to 12th, with its concentration of particle pollutants decreasing from 6.5 to 5.9.
"Climate change makes it harder to protect human health" the report says. Staten Island has regained the dubious distinction of having the worst ozone levels in New York State.
Los Angeles remains the city with the worst ozone pollution as it has for almost the entire history of the report. And the region had its lowest level of unhealthy ozone days. Unfortunately previous year the EPA administrator proposed to repeal the Clean Power Plan, the only nationwide strategic approach to cutting carbon pollution from the largest industrial scale source of carbon pollution in the United States, power plants.
When 2012 dropped out of the sample period for the 2017 report, Toledo's ozone rating improved dramatically. Los Angeles has maintained its spot at the top of the list for "nearly the entire history of the report", according to the association; however the city is taking steps to save its air quality reputation.
Cities are home to an increasing majority of the world's people, exposing billions to unsafe air, particularly in developing countries, but in rural areas the risk of indoor air pollution is often caused by burning solid fuels.