It's 2:30 a.m., and I'm still awake. I am teetering on the edge of sleep, listening for the telltale cough from the room next door. And there it is. A couple of wheezy breaths followed by a rough rattle. It's the same cough that's plagued my son since last spring. I pad softly into his bedroom in my bare feet, picking out the shadow of my son's shape beneath the blankets, reclined at an oddly upright angle on a wedge pillow to improve his breathing. I urge him to take a drink, my quiet words barely registering over the hum of the air purifier.

We've been fighting lung inflammation for months, like a shadowy opponent that hovers, attacks and then recedes. My son's allergist patiently explains, as she charts the neat rows of 30 angry raised bumps on his back, that the source of the lung inflammation isn't clear. She prescribes another round of steroids and sends us home with a blue plastic contraption called a nebulizer. When I ask her if my son has asthma, she shrugs and says, "Maybe. But you're going to need that at some point this winter."

This revolving door health care is what it's like to raise children in the second most toxic county in the United States. One bout of bronchitis can turn into an entire year spent coughing, repeated chest X-rays and doctor's office visits that produce little relief. And as a parent, I'm hounded by the unrelenting sense of guilt that I might be condemning my child to a shorter life simply by living here.

Welcome to Utah, where the weather forecast could be hazardous not just to our health, but to what many consider our most precious resource: our children.

Smog Lake City
When the rest of the nation thinks pollution, they don't envision the quaint, orderly streets of Salt Lake City. They're imagining Los Angeles, freeways clogged with cars and smog casting a gritty and dense haze across the urban sprawl. But we locals know the dirty little secret hidden behind SLC's squeaky-clean reputation.

It's called inversion. And chances are if you look across the Salt Lake Valley on a winter day, you'll see it clinging to the feet of the mountains and choking the suburbs below.

Unlike good old-fashioned air pollution, which worsens with the higher temperatures of summer, Utah's inversion happens in the winter. And it's a tricky, complicated stew of weather patterns, atmospheric conditions and geography that creates a perfect storm. Our episodes of seasonal inversion force particulate pollution (referred to as PM 2.5 or PM for short) to concentrations that exceed national health standards for days and sometimes weeks at a time.

In normal weather patterns, cool air circulates above, trapping warmer air near the surface. In Utah, however, that pattern can become inverted. Cold air—fed by snowpack and the large, frozen Great Salt Lake—traps warmer air. That pressure system becomes a lid that keeps particulates close to the surface. The bowl-shaped Salt Lake Valley worsens this effect, making inversion linger until a storm blows in and lifts the lid on our pollution pressure cooker.

According to the Environmental Protection Agency, in 2018, Salt Lake County had a whopping 39 days where particulate matter exceeded 51 PM. For reference, red alert days—where all populations are advised to stay inside because the air is too dangerous to breathe—are triggered by a rating of 55.5 PM. Air is considered unhealthy for sensitive groups like children and the elderly at a much lower threshold of 35.5 PM.

Poor air quality along the Wasatch Front earned Utah's capital city a spot on the not-so-coveted American Lung Association's 2019 list of the most polluted cities in America. Salt Lake City, Provo and Orem ranked No. 8 nationally for high levels of short-term particle pollution. In fact, Salt Lake City is one of several cities highlighted as having an "ozone problem" in Climate Central's 2019 research on air quality. Last year, research showed Salt Lake City tipped the scales with 31 unhealthy ozone days, compared to an average of 22 per year from 2000-14. Utah is now also one of eight states where the EPA monitors ozone year-round.

Salt Lake City also earned a big fat "F" on the latest air quality report card from the American Lung Association. The reason? Last year, 63 days registered air quality considered unhealthy for sensitive populations. That means that, on average, in Salt Lake City, it's unsafe to go outside for children, the elderly and anyone with respiratory problems at least once every six days.

The Clean Air Act of 1970 has improved pollution in many major metropolitan areas across the United States by regulating automobiles and improving standards for energy efficiency and emissions across industries. Overall, Americans enjoy air that is 30% cleaner than a few decades ago, despite an increasing population and expanding urban sprawl.

But our city's rate of improvement has been slower than others, largely because Utah hasn't been held accountable for failing to meet air quality standards. In early 2019, The Center for Biological Diversity, Utah Physicians for a Healthy Environment (UPHE), Westside Coalition and SLC Air Protectors filed a lawsuit against the state for negligence in addressing pollution. The suit contended failure to comply with EPA air quality standards since 2006, meaning the state had exposed millions of Utahns to polluted air and the health risks associated with it. That lawsuit prompted Utah's Department of Air Quality to submit a comprehensive plan to federal officials outlining how they'll lower pollution levels in the coming years. It might have also been part of the motivation behind Utah's unprecedented $29 million appropriations for air quality initiatives during the 2019 legislative session.

Rep. Patrice Arent, D-Millcreek, founder and co-chair of the bipartisan Clean Air Caucus, says even though the Utah Legislature did not allocate the $100 million Gov. Gary Herbert initially asked for, advocates were pleased with the progress made in the past Legislative session.

"That money went toward important efforts," Arent tells City Weekly. In fact, she shared that the Legislature got busy in 2019 funding an array of solutions aimed at improving air quality, including the following:

• Funding teleworking expenses for state employees.

• Installing electric vehicle charging stations at state facilities.

• Incentivizing businesses to install electric vehicle charging equipment.

• Assisting homeowners with weatherization that reduces energy consumption, including updating home appliances like water heaters.

• Funding air quality public messaging campaigns.

• Replacing more than 238 pre-2007 era state vehicles.

• Providing air quality monitors on Trax lines.

Perhaps most importantly, the Legislature earmarked funding for a research study that will produce an air quality and climate change roadmap for lawmakers to consider during the 2020 legislative session. Arent also points toward vital legislation passed in the 2019 session that'll enable Utah to better address pollution, including bills that removed restrictions on municipal ordinances to curb idling and resolutions that encourage refineries to step up the manufacturing of low-sulfur, Tier 3 gasoline. Bills passed during the past session also enforce stricter penalties for visible emissions, otherwise known as "rolling coal" that you sometimes see rising in big black puffs from large trucks with aftermarket mufflers.

As a result of all this legislative progress, the lawsuit filed against the state for failing to meet EPA standards was dropped in the spring. However, air quality advocates say they expect to revive it in the coming years as Utah faces new challenges. They claim the Department of Environmental Quality's plan to clean up the air hasn't adequately accounted for future population growth and complications from projects like the inland port.

In fact, UPHE, a group of health professionals established in 2007, is deeply concerned about the potential for rising levels of pollution from the proposed inland port. The group's board president, Brian Moench, speculates traffic and toxins from the port could mean a 5% rise in levels of pollution, contributing to the premature deaths of thousands of Utahns every year.

And as environmental activists struggle for every air quality dollar squeezed from the tight fist of the Legislature, Utahns and their children will continue the fight to breathe through another winter.

The Kids Are Not Alright
Nearly 80% of Utah's population crowds along the Wasatch Front, where the valley floor, once an ancient lakebed, rises to meet the mountains. Pollution pools across the valley and reaches levels that doctors have long believed contribute to community mortality. A recent Harvard study confirms this, indicating a 16% rise in heart attack or chest pain corresponds to even short-term exposure to unhealthy levels of particulate matter.

Other studies of health care providers and hospitals in the Salt Lake region show that emergency room visits increase 40% on days when the pollution ranks as unhealthy. For those with chronic pulmonary disease, visits to the emergency room rise 90% during an inversion.

UPHE estimates that between 1,000 to 2,000 people die in Utah yearly as a result of complications stemming from poor air quality. These premature deaths include not only those with respiratory illnesses like asthma but also those with coronary heart disease for which poor air quality is a contributing factor.

An alarming 2017 study published in the International Journal of Environmental Research and Public Health points at pollution effects far more insidious than respiratory illness. Their research indicates a strong link between exposure to pollution and infant mortality. Ozone exposure in the week before delivery was associated with a 13%–22% increased stillbirth risk, while chronic exposure throughout pregnancy increased infant mortality by nearly 40%.

Even if recent initiatives improve air quality slowly in the coming years, Moench remains gravely concerned about the health risks inversions along the Wasatch Front pose for pregnant mothers.

"Even short-term exposure to pollution during pregnancy can have significant impacts," he says. "There is evidence that during vital windows of fetal and infant development, pollution can affect not only fetal viability, but alter chromosomes and brain development, leading to a greater likelihood of developing heart disease, cancer, brain disorders and even autism."

For a state that prides itself on a family-oriented culture, it's startling to witness the extent to which air quality is allowed to undermine the health of its born and unborn children. In addition to higher rates of asthma and respiratory illness, research shows children suffer long-term effects in physical and mental health as a result of exposure to pollution.

For Utah's children, those red air days mean long stretches of school time without outdoor recess, less opportunity for exercise, and, ultimately, more time in front of the TV. Past studies have even suggested red air days trap students at home, forcing absences and impacting academic performance.

These disruptions affect not just learning and child development but produce a myriad of undesirable outcomes that can cascade into serious health problems. Elisabeth Luntz, an administrator for the Facebook community of Utah Moms for Clean Air, says the health impact of air quality on children cannot be overstated.

"Air quality has a tremendous impact on all children in our state both long and short term. The scientific research on the relationship between poor air quality and negative health outcomes is indisputable," Luntz says. "Adverse effects of dangerous air quality on our children are both physical and mental, from respiratory disease to increased psychiatric symptoms. Poor air quality is associated with low birth weight, increased post-neonatal death rate and miscarriage." She stresses these negative impacts are disproportionately prevalent in communities of color and the poor, "the people who are the most unlikely to be represented in our Legislature."

When it comes to Utah's dirty air, one thing is clear—it's hazardous for your health and your kids. And even when folks on both sides of the aisle share the same priorities, getting to the bottom of all this smog is easier said than done.

No Silver Bullets
Improving air quality in Utah isn't just about reducing emissions from the usual suspects. It's a much more complicated equation that needs to factor in the science behind what's driving pollution along the Wasatch Front. Arent cautions against looking for a one-size-fits-all solution.

"There isn't a silver bullet. I know we're all looking for one, but it simply isn't there," Arent explains. "Certainly, we need to look at reducing emissions from our No. 1 supplier of pollution, which is mobile sources. But our No. 2 supplier of pollution is stationary sources like buildings and homes and industry sources of pollution."

An overwhelming 48% of Salt Lake City's pollution comes from mobile sources such as cars, trucks and buses. Various studies over the years all point toward motor vehicles as the largest single source of particulates. Earlier this month, Hebert signed the 11th Annual Alternative Fuels Declaration, aimed at tackling mobile sources of pollution by renewing Utah's commitment to alternative fuels and funding low and zero-emissions transportation options across the state.

While motor vehicles are the major contributor to pollution along the Wasatch Front, investing in public transit and alternative fuels only scratch the surface. Sulfur in gasoline turns out to be a sneaky culprit because it impedes the ability of a car's emission system to work properly. EPA regulations passed in 2014 require refineries to reduce sulfur in gasoline, but small refineries were allowed a more generous time frame to bring their equipment up to snuff.

Much of Utah's gasoline is supplied by five local, small refineries that are not yet required to meet the new EPA standards on reduced sulfur emissions. The governor's office received commitments from the majority of these refineries that they would voluntarily lower sulfur and produce cleaner fuel by January 2020. This commitment could all come to naught, however, if the Trump administration has its way. Their plans to roll back penalties for automakers who fail to meet emission standards could be a significant setback in the quest for cleaner emissions.

Echoing Arent's words, Ashley Miller, the vice chair of Breathe Utah, says many Utahns have a fundamental misconception of the sources of pollution in the Salt Lake Valley.

"Many people think it's the refineries here. And that makes sense to the average person because you have these factory looking things that people think are smokestacks, but they're actually steam," Miller points out. "And when you look at the breakdown, all five refineries combined only equal about 3%-4% of the whole problem. So you have to look at what are the actual sources. And start looking at all the people living here. Our cars make up about half of the pollution and our homes can be also big sources."

And finally, we come to the inconvenient truth about pollution. We not only love but rely upon the independence of driving. Our addiction to fossil fuels isn't just killing us, it's killing our children. While Salt Lake City is very much an urban area, it still functions as part of a rural state where distances are vast and public transit can be non-existent. We do have a mass transit system that includes alternative fuel buses and, more recently, Trax, which runs trains along a few key commuter routes and to downtown hubs. But service is sporadic, and depending on where you live, not feasible as a primary means of transportation.

As an example, let's say I wanted to take my daughter to her brilliant progressive charter school using mass transit. When I drive our car from where I live to her school in the Avenues, it's an 18-mile drive from our home in the suburbs. It takes me 30 minutes and costs $2.57 in gas.

In contrast, opting to use the maze of public transportation for the same commute is confusing, time-consuming and costly. The closest Trax station to us is five miles away and not served by a direct bus route. Ride UTA suggests that I walk 1.2 miles, ride a bus for 50 minutes, walk another half a mile, transfer to a different bus for 10 minutes and then finish off another half mile on foot to get to my daughter's school. Using public transit exclusively would require my 6-year-old daughter to walk 1.5 miles, spend 64 minutes commuting and cost $2.50 each way.

You're probably beginning to see why only 25% of commuters to Salt Lake City use mass transit. Large suburban sprawls are the norm in Utah, and all that space increases commute time. Even carpooling can be problematic. Studies show that in the Beehive State, at least 1 in 5 people in carpool lanes are single-occupancy vehicles in violation of the law.

Luntz sums it up nicely: "We need to stop investing tax dollars propping up the fossil fuel industries," she says. "We need our educational institutions to divest from fossil fuels. We need to prioritize clean energy in our state energy portfolio. ... We need a comprehensive transportation infrastructure that works for everyone."

We also need a state Legislature that can prioritize those things before the air gets so chewy you need a knife and fork to cut through it.

A Better Way to A Brighter Forecast
While the sources of Utah's pollution are hotly debated, there are a few solutions we can all agree on. The problem thus far has been getting officials at any level to take decisive action. The recent steps toward providing funding for air quality initiatives are a positive sign, but it'll take decades of work to clean up the mess we've made.

Most experts agree a universal first step to reducing air pollution is to focus on public policy that decreases fossil fuel dependency. That means not only discouraging the consumption of traditional fuels but investing in mass transit and alternatives like solar and electric. Recent efforts to subsidize more charging stations for electric cars and offer fare-free days are a step in the right direction, but we should also be aggressively pursuing idle-free public education programs and going all-in replacing "dirty" school buses with fleets of CNG vehicles.

Another step in reducing air pollution is better small-industry standards, stricter zoning laws and improving urban planning. Since wood smoke is believed to contribute to as much as 15% of pollution along the Wasatch Front, state-subsidized programs to assist those who use wood-burning devices as a primary heating method could help. We also need to continue to fund efforts to replace gas-powered snowblowers and lawnmowers that contribute to small-scale pollution.

Finally, Salt Lake City would do well to borrow a chapter from Park City's manual on addressing climate change. The resort town now faces a forbidding forecast of zero snowpack and a temperature rise of 9 degrees by 2075. This warming would transform Park City into a climate that mirrors SLC, nearly 3,000 feet lower in elevation. It's estimated that from 2000–10, lower levels of snowpack cost the ski industry more than $1 billion, so imagine the kind of economic impact climate change could have on Utah's ski and snowboarding industry.

In response to the dismal forecast, Park City has committed to a zero-carbon footprint by 2032. It's an investment that will not only improve quality of life, but ultimately save the city money. They've developed a plan to rely on solar and wind farms, renewable energy grids, electric city buses and large swathes of undeveloped land. Let's hope that by 2032, Smog Lake City's pollution hasn't crept into the canyons and stolen Park City's forecast for a brighter future.

If the coughing of our children doesn't kick Utah's legislative leadership in the feels, perhaps a jolt to their wallets will do the trick. In addition to human costs, there are certainly economic consequences of ignoring air quality. An Envision Utah survey cites air quality as one of the top reasons employees at Utah tech companies say they would consider leaving the state. And it was certainly the straw that broke the camel's back when the Outdoor Retailers Association picked up and left our smoggy convention center last year after nearly 20 years of pumping millions into the local economy.

Arent says getting the Legislature to do more on air quality comes down to communicating priorities. "The public needs to contact their representatives and tell them air quality is important," she says. "It makes a difference. There are a lot of competing needs in government and your representative needs to hear about what matters most to you."

Breathe Utah's Miller says their organization takes a two-prong approach to educating Utahns about air quality. First, they fund and develop curriculum kits and conduct professional development workshops for teachers so they can educate students all along the Wasatch Front about the science behind pollution. Secondly, she and her team work directly with legislators to help educate them on the sources and science behind pollution and help write bills aimed at improving Utah's air quality.

"It's a big misconception that the state doesn't do anything," Miller says. "That really couldn't be further from the truth. We have a really great division of air quality and bipartisan support with legislators on both sides of the aisle."

Miller stresses that while there are some things the state could do to enforce the Clean Air Act, there are also simple steps every Utahn can take to breathe a little easier through winter and beyond. It begins with becoming better informed about pollution and signing up to receive air quality alerts from Utah's Department of Environmental Quality.

"It's really easy to point the finger at someone or something else when it comes to air quality," Miller says. "But we all need to look at ourselves and how we can improve on an individual level."

On red or orange action days, for example, have a plan in place to minimize your emissions either through public transit, carpooling or telecommuting. And if you do drive, drive smarter. Don't idle your vehicle. Reduce cold starts by trip chaining errands to be more efficient. And try to avoid drive-thru windows. Most of all, don't burn wood. Ever. Even small actions, when executed on a large scale can have a big impact.

And, of course, vote your priorities.

As Luntz points out, "If we refuse to participate in even the basic levels of politics, like voting, we can expect greedy self-interests to determine our fate. We need to vote for our children, because they can't."