Recent dramatic and deadly increases in global wildfire activity have increased attention on the causes of wildfires, their consequences, and how risk from wildfire might be mitigated. Here we bring together data on the changing risk and societal burden of wildfire in the United States. We estimate that nearly 50 million homes are currently in the wildland–urban interface in the United States, a number increasing by 1 million houses every 3 y. To illustrate how changes in wildfire activity might affect air pollution and related health outcomes, and how these linkages might guide future science and policy, we develop a statistical model that relates satellite-based fire and smoke data to information from pollution monitoring stations. Using the model, we estimate that wildfires have accounted for up to 25% of PM_2.5 (particulate matter with diameter <2.5 μm) in recent years across the United States, and up to half in some Western regions, with spatial patterns in ambient smoke exposure that do not follow traditional socioeconomic pollution exposure gradients. We combine the model with stylized scenarios to show that fuel management interventions could have large health benefits and that future health impacts from climate-change–induced wildfire smoke could approach projected overall increases in temperature-related mortality from climate change—but that both estimates remain uncertain. We use model results to highlight important areas for future research and to draw lessons for policy.

BACKGROUND

Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership.

METHODS

We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns).

RESULTS

A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition.

CONCLUSIONS

Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.)

Recent dramatic and deadly increases in global wildfire activity have increased attention on the causes of wildfires, their consequences, and how risk from fire might be mitigated. Here we bring together data on the changing risk and societal burden of wildfire in the US. We estimate that nearly 50 million homes are currently in the wildland-urban interface in the US, a number increasing by 1 million houses every 3 years. Using a statistical model that links satellite-based fire and smoke data to pollution monitoring stations, we estimate that wildfires have accounted for up to 25% of PM_2.5 in recent years across the US, and up to half in some Western regions. We then show that ambient exposure to smoke-based PM_2.5 does not follow traditional socioeconomic exposure gradients. Finally, using stylized scenarios, we show that fuels management interventions have large but uncertain impacts on health outcomes, and that future health impacts from climate-change-induced wildfire smoke could approach projected overall increases in temperature-related mortality from climate change. We draw lessons for research and policy.

Estimation of pollution impacts on health is critical for guiding policy to improve health outcomes. Estimation is challenging, however, because economic activity can worsen pollution but also independently improve health outcomes, confounding pollution–health estimates. We leverage variation in exposure to local particulate matter of diameter <2.5 μm (PM_2.5) across Sub-Saharan Africa driven by distant dust export from the Sahara, a source uncorrelated with local economic activity. Combining data on a million births with local-level estimates of aerosol particulate matter, we find that an increase of 10 μg m^–3 in local annual mean PM_2.5 concentrations causes a 24% increase in infant mortality across our sample (95% confidence interval: 10–35%), similar to estimates from wealthier countries. We show that future climate change driven changes in Saharan rainfall—a control on dust export—could generate large child health impacts, and that seemingly exotic proposals to pump and apply groundwater to Saharan locations to reduce dust emission could be cost competitive with leading child health interventions.

Deforestation and landscape fragmentation have been identified as processes enabling direct transmission of zoonotic infections. Certain human behaviors provide opportunities for direct contact between humans and wild nonhuman primates (NHPs), but are often missing from studies linking landscape level factors and observed infectious diseases.