Shifting the Conversation on Wildland Fire Smoke Exposures: More Smoke Within and Across Years Requires a New Approach to Inform Public Health Action.

With the increase in acres burned from wildfire over the last few decades, wildfire smoke is an increasing global public health threat. To date, wildfire smoke research, risk communication, and public health action has focused on short-term (or daily) smoke exposures. However, the patterns of wildfire smoke exposure are transitioning to include longer duration and repeated exposures occurring within and across years. Epidemiologic and experimental studies represent important lines of evidence that have informed risk communication and public health actions for short-term smoke exposures; however, they have yet to provide the science needed to refine public health approaches to include other dynamic exposure durations such as repeated, episodic, or cumulative. This commentary provides an overview of methodological approaches used and recent findings from epidemiologic and experimental studies that examined longer duration, repeated smoke exposures. Based on the current science, we recommend that future epidemiologic and experimental studies of wildfire smoke examine multiple exposure metrics to capture the duration, frequency, and intensity of exposures. Such studies would improve the science produced to best support the needs of the public as we strive to further protect public health in a world projected to have more smoke.