Chang HH, Zhou J, Fuentes M. 2010. Impact of climate change Mudway IS, Kelly FJ. 2000. Ozone and the lung: a sensitive Berman et al. estimates, and the annual population estimates from 2000 census data. Instead, our confi- dence intervals were based solely on variance from the health studies, which may have led us to underestimate overall uncertainty and led to potentially spurious conclusions. As sug- gested by Davidson et al. (2007), health effects estimates should be interpreted not necessarily as actual benefits, but as representations of the anticipated magnitude. One approach to addressing these limitations would be to utilize more sophisticated methods such as probabi- listic-based spatial interpolation, localized risk estimates, or Bayesian models. This will be investigated in future research. Conclusions Using national air monitor data and published C-R functions, we estimated health bene- fits from compliance with the current ozone NAAQS and potential benefits from adopting stricter ozone standards. A minimum ozone threshold associated with no increased risk of premature mortality has not been identified (Bell et al. 2006; Gryparis et al. 2004; Ito et al. 2005; Levy et al. 2005) and we contend that a more stringent standard would prevent substantial numbers of adverse health out- comes. Our findings suggest that attainment of the 75-ppb ozone NAAQS would prevent > 1,000 annual premature mortalities nation- ally, with substantial additional health bene- fits afforded from stricter air quality standards of 70 and 60 ppb. The potential impact of estimated health benefits varied by region and time over several years of data, but our analy- sis indicates that reducing ozone concentra- tions to levels proposed by the CASAC would result in dramatic public health benefits. Ref Rencs Bell ML, Dominici F, Samet JM. 2005. A meta-analysis of time- series studies of ozone and mortality with comparison to the National Morbidity, Mortality, and Air Pollution Study. Epidemiology 16:436–445. Bell ML, McDermott A, Zeger SL, Samet JM, Dominici F. 2004. Ozone and short-term mortality in 95 US urban communities, 1987–2000. JAMA 292:2372–2378. Bell ML, Peng RD, Dominici F. 2006. The exposure–response curve for ozone and risk of mortality and the adequacy of current ozone regulations. Environ Health Perspect 114:532–536. Boldo E, Linares C, Lumbreras J, Borge R, Narros A, García- Pérez J, et al. 2011. Health impact assessment of a reduc- tion in ambient PM2.5 levels in Spain. Environ Int 37:342–348. Briggs DJ, Sabel CE, Lee K. 2009. Uncertainty in epidemiology and health risk and impact assessment. Environ Geochem Health 31:189–203. Burnett RT, Smith-Doiron M, Stieb D, Raizenne ME, Brook JR, Dales RE, et al. 2001. Association between ozone and hos- pitalization for acute respiratory diseases in children less than 2 years of age. Am J Epidemiol 153:444–452. CAA (Clean Air Act). 1970. 42 USC 7401. 1410 ovlume 120 | number 10 | October 2012 • Environmental Health Perspectives on ambient ozone level and mortality in southeastern United States. Int J Environ Res Public Health 7:2866–2880. Chen J. 2004. Voronoi-based k-order neighbour relations for spatial analysis. J Photogramm Remote Sens 59:60. Chen L, Jennison B, Yang W, Omaye S. 2000. Elementary school absenteeism and air pollution. Inhal Toxicol 12:997–1016. Choi M, Curriero FC, Johantgen M, Mills MEC, Sattler B, Lipscomb J. 2011. Association between ozone and emer- gency department visits: an ecological study. Int J Environ Health Res 21:201–221. Connecticut Department of Environmental Protection. 2009. Connecticut Regional Haze SIP Revision. Draft, July 15, 2009. Mid-Atlantic/Northeast Visibility Union (MANE-VU). Available: http://www.ct.gov/dep/lib/dep/air/regulations/sip/ regionalhaze/publichearing/july152009rhsip.pdf [accessed 13 August 2012]. Davidson K, Hallberg A, McCubbin D, Hubbell B. 2007. Analysis of PM2.5 using the Environmental Benefits Mapping and Analysis Program (BenMAP). J Toxicol Environ Health Part A 70:332–346. Dockery DW, Pope CA III. 1994. Acute respiratory effects of par- ticulate air pollution. Annu Rev Public Health 15:107–132. Hubbell BJ. 2011. Estimating the national public health burden associated with exposure to ambient PM2.5 and ozone. Risk Anal 32(1):81–95. Fiore AM, Horowitz LW, Purves DW, Levy H II, Evans MJ, Wang Y, et al. 2005. Evaluating the contribution of changes in isoprene emissions to surface ozone trends over the eastern United States. J Geophys Res 110:D12303; doi:10.1029/2004JD005485 [Online 30 June 2005]. Foster WM, Brown RH, Macri K, Mitchell CS. 2000. Bronchial ozone. J Appl Physiol 89:1804–1810. Gilliland FD, Berhane K, Rappaport EB, Thomas DC, Avol E, Gauderman WJ, et al. 2001. The effects of ambient air pol- lution on school absenteeism due to respiratory illnesses. Epidemiology 12:43–54. Gong H Jr, Bradley PW, Simmons MS, Tashkin DP. 1986. Impaired exercise performance and pulmonary function in elite cyclists during low-level ozone exposure in a hot environment. Am Rev Respir Dis 134:726–733. Gryparis A, Forsberg B, Katsouyanni K, Analitis A, Touloumi G, Schwartz J, et al. 2004. Acute effects of ozone on mortality from the “Air Pollution and Health: A European Approach” project. Am J Respir Crit Care Med 170:1080–1087. Huang Y, Dominici F, Bell ML. 2005. Bayesian hierarchical cardio-respiratory mortality. Environmetrics 16:547–562. Hubbell B, Fann N, Levy J. 2009. Methodological considerations in developing local-scale health impact assessments: balancing national, regional, and local data. Air Qual Atmos Health 2:99–110. Hubbell BJ, Hallberg A, McCubbin DR, Post E. 2005. Health- related benefits of attaining the 8-hr ozone standard. Environ Health Perspect 113:73–82. Ito K, De Leon SF, Lippmann M. 2005. Associations between ozone and daily mortality: analysis and meta-analysis. Epidemiology 16:446–457. Jaffe DH, Singer ME, Rimm AA. 2003. Air pollution and emer- gency department visits for asthma among Ohio Medicaid recipients, 1991–1996. Environ Res 91:21–28. Jerrett M, Burnett RT, Pope CA III, Ito K, Thurston G, Krewski D, issue. Mol Aspects Med 21:1–48. Office of the Press Secretary, the White House. 2011. Statement by the President on the Ozone National Ambient Air Quality Standards. Available: http://www.whitehouse. gov/the-press-office/2011/09/02/statement-president- ozone-national-ambient-air-quality-standards [accessed 21 November 2011]. Environ Res 50:238–247. Ostro BD, Rothschild S. 1989. Air pollution and acute respiratory morbidity: An observational study of multiple pollutants. Peel JL, Tolbert PE, Klein M, Metzger KB, Flanders WD, Todd K, et al. 2005. Ambient air pollution and respiratory emergency department visits. Epidemiology 16:164–174. Rizzo M. 2005. A Comparison between Different Rollback Methodologies Applied to Ambient Ozone Concentrations. Memorandum to Ozone NAAQS Review Docket (OAR- 2005-0172), November 7, 2005. Available: http://www.epa. gov/ttn/naaqs/standards/ozone/data/rizzo-memo-11-05.pdf [accessed 13 August 2012]. Schwartz J. 1994. Air pollution and hospital admissions for the elderly in Detroit, Michigan. Am J Respir Crit Care Med 150:648–655. hospital admissions of the elderly for respiratory disease. Thorax 50:531–538. Schwartz J. 2005. How sensitive is the association between ozone and daily deaths to control for temperature? Am J Respir Crit Care Med 171:627–631. Tagaris E, Liao KJ, DeLucia AJ, Deck L, Amar P, Russell AG. 2010. Sensitivity of air pollution-induced premature mortal- ity to precursor emissions under the influence of climate change. Int J Environ Res Public Health 7:2222–2237. 14 January 2011]. ozone exposures and mortality. J Expo Anal Environ Epidemiol 11:286–294. U.S. EPA (U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards). 2008a. AQS Data Coding Manual. Available: http://www.epa.gov/ttn/airs/ airsaqs/manuals/AQS Data Coding Manual.pdf [accessed U.S. EPA (U.S. Environmental Protection Agency). 2008b. Final Ozone NAAQS Regulatory Impact Analysis. EPA-452/R- 08-003. Research Triangle Park, NC:U.S. EPA, Office of Air Quality Planning and Standards. rule. Fed Reg 73:16436–16514. U.S. EPA (U.S. Environmental Protection Agency). 2008c. National Ambient Air Quality Standards for Ozone; final Quality Planning and Standards). 2010a. BenMAP User’s ManualAppendices.Available:http://www.epa.gov/oaqps001/ benmap/models/BenMAPAppendicesSeptember2011.pdf [accessed 14 August 2012]. U.S. EPA (U.S. Environmental Protection Agency). 2010b. National Ambient Air Quality Standards for Ozone; proposed rule. Fed Reg 75:2938–3052. U.S. EPA (U.S. Environmental Protection Agency). 2012a. Environmental Benefits Mapping and Analysis Program (BenMAP). Available: http://www.epa.gov/oaqps001/ benmap/index.html [accessed 14 August 2012]. U.S. EPA (U.S. Environmental Protection Agency). 2012b. Technology Transfer Network (TTN), Air Quality System (AQS). Available: http://www.epa.gov/ttn/airs/airsaqs/ [accessed 22 August 2012]. Fann N, Lamson AD, Anenberg SC, Wesson K, Risley D, Schwartz J. 1995. Short term fluctuations in air pollution and reactivity of healthy subjects: 18–20 h postexposure to Thurston GD, Ito K. 2001. Epidemiological studies of acute distributed lag models for summer ozone exposure and U.S. EPA (U.S. Environmental Protection Agency, Office of Air et al. 2009. Long-term ozone exposure and mortality. N Engl Voorhees AS, Fann N, Fulcher C, Dolwick P, Hubbell B, Bierwagen B, J Med 360:1085–1095. Larsen S, Matsubara S, McConville G, Poulsen S, Gelfand E. 2010. Ozone increases airway hyperreactivity and mucus hyperproduction in mice previously exposed to allergen. J Toxicol Environ Health Part A 73:738–747. Levy J, Carrothers T, Tuomisto J, Hammitt J, Evans J. 2001. Assessing the public health benefits of reduced ozone concentrations. Environ Health Perspect 109:1215–1226. Levy J, Chemerynski S, Sarnat J. 2005. Ozone exposure and mortality: an empiric Bayes metaregression analysis. Epidemiology 16:458–468. 43:1310–1319. et al. 2011. Climate change-related temperature impacts on warm season heat mortality: a proof-of-concept methodology using BenMAP. Environ Sci Technol 45:1450–1457. Wang H, Jacob DJ, Le Sager P, Streets DG, Park RJ, Gilliland AB, et al. 2009. Surface ozone background in the United States: Canadian and Mexican pollution influences. Atmos Environ Wilson AM, Wake CP, Kelly T, Salloway JC. 2005. Air pollution, weather, and respiratory emergency room visits in two northern New England cities: an ecological time-series study. Environ Res 97:312–321.